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EXPLORING COLLEGIATE STUDENT-ATHLETES’
SATISFACTION WITH ATHLETIC TRAINERS

presented by

Jason Joseph Pilgrim

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EXPLORING COLLEGIATE STUDENT-ATHLETES’ SATISFACTION WITH
ATHLETIC TRAINERS

By

Jason Joseph Pilgrim

A THESIS
Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of
MASTER OF SCIENCE

Kinesiology

2010

ABSTRACT

EXPLORING COLLEGIATE STUDENT-ATHLETES' SATISFACTION WITH
ATHLETIC TRAINERS

By
Jason Joseph Pilgrim
In recent times, feedback on the quality of patient care and patient
satisfaction has become very important in efforts to measure and improve the
quality of healthcare. This finding may also allow us to achieve the purpose of
this study of investigating the differences in level of satisfaction with athletic
training services by student athletes according to their nationality, sex and
athletic division. Student- athletes from Trinidad & Tobago attending college in
the United States of America and their teammates were invited to participate in
the study. A second study was conducted to determine the effect of sex or
experience of the athletic trainer on the student-athletes’ satisfaction with the
athletic training services. Field hockey players competing in the United States of
America NCAAI division were invited to participate in the study. The instrument
used in both studies was a questionnaire consisting of 50 questions developed
by Scott Unruh. Overall, the student-athletes were satisfied with the quality of the
athletic training services received from their athletic trainers. However, no
significant differences were observed in the level of satisfaction perceived by the
student-athletes for any of the independent variables of both Study 1 (nationality,
sex and athletic division) and Study 2 (athletic trainer’s sex and athletic trainer’s
fifle)

Key Words: Athletic Training, satisfaction, student-athlete

DEDICATION
This work serves as a culmination of a mothers dream for her son to be all he
can be. My mother’s faith in my potential has never wavered even for one
second. She has always seen greatness in me even when I did not see it in
myself. I am truly blessed to know a mother’s love.
I would like to dedicate this thesis to my mother, Joan Pilgrim.

Also, glory to God, for without him, this will not be possible.

ACKNOWLEDGEMENTS

Many persons contributed to the completion of my thesis. First and
foremost I offer my sincerest gratitude to my thesis supervisor, Dr. Tracey
Covassin. Dr. Covassin spent countless hours reviewing my work, providing
guidance and support throughout this entire process. I would also like to thank
the other members of my thesis committee, Dr. Sally Nogle and Dr. Joey
Eisenmann whose time, knowledge and insightful criticisms aided in the
completion of this project in an innumerable amount of ways.

This study also richly benefited from the previous work of Dr. Scott Unruh.
I would like to thank Dr. Unruh for providing me with the instrument of his study
and granting me permission to use it. To the athletes and coaches of Michigan
State University Field Hockey and Track & Field/ Cross Country teams, I wish to
express my sincere appreciation for allowing me to “pick your brains” on your
experiences with athletic trainers. To all of the subjects of this study, I thank you.
I would also like to thank Dr. Oba Gulston and Mrs. Helen Knull for their
assistance in the location of subjects and the distribution of questionnaires. My
appreciation also goes to Ms. Naghme Naseri for proof reading this document.

In closing, I will like to thank the Government of Trinidad & Tobago for
giving me the opportunity to pursue undergraduate education, and Michigan
State University for funding my graduate studies. Finally, I thank my family,
friends and the “Suga” crew for supporting and keeping me grounded and sane
throughout my college career. I would also like to issue a special thank you to,

Ruby, Esther, Kathleen, Markus, Nathaniel, the Pontiflets and Mr. Mark Gibson.

iv

Table of Contents

LIST OF TABLES ................................................................................................ vii
CHAPTER 1 .......................................................................................................... 1
INTRODUCTION ............................................................................................... 1
Overview of the Problem ................................................................................ 1
Significance of Problem .................................................................................. 3
Purpose Statement ......................................................................................... 6
Hypotheses .................................................................................................... 6
Definition of Terms ......................................................................................... 7
CHAPTER 2 ........................................................................................................ 10
REVIEW OF LITERATURE ............................................................................. 10
Introduction .................................................................................................. 10
History of Athletic Training ........................................................................... 1O
Athletic Training Profession .......................................................................... 13
Satisfaction of Athletic Training Services ..................................................... 21
Globalization and Athletic Training Services ................................................ 26
Trinidad and Tobago Athletes and Athletic Training Services ...................... 28
Summary ...................................................................................................... 31
CHAPTER 3 ........................................................................................................ 32
METHODS ....................................................................................................... 32
Introduction .................................................................................................. 32
Study 1 ............................................................................................................ 32
Research Design .......................................................................................... 32
Subjects ....................................................................................................... 32
Instrumentation ............................................................................................ 33
Data Collection Procedures .......................................................................... 34
Data Analysis ............................................................................................... 36
Study 2 ............................................................................................................ 37
Research Design .......................................................................................... 37
Subjects ....................................................................................................... 37
Instrumentation ............................................................................................ 38
Data Collection Procedures .......................................................................... 38
Data Analysis ............................................................................................... 38
CHAPTER 4 ........................................................................................................ 39
RESULTS ........................................................................................................ 39
Introduction .................................................................................................. 39
STUDY 1 ......................................................................................................... 39
Demographic Data ....................................................................................... 39
Athletic Training Patient Satisfaction Questionnaire ..................................... 44
Study 2 ............................................................................................................ 45

V

Demographic Data ....................................................................................... 45

Athletic Training Patient Satisfaction Questionnaire ..................................... 47
CHAPTER 5 ........................................................................................................ 49
DISCUSSION .................................................................................................. 49
Introduction .................................................................................................. 49
Study 1 ......................................................................................................... 49
Study 2 ......................................................................................................... 52
Clinical Implications for Athletic Trainers and Athletes ................................. 52
Limitations of Study ...................................................................................... 53
Future Research .......................................................................................... 54
Conclusions .................................................................................................. 55
APPENDICES ..................................................................................................... 56
Appendix A: The Member Organizations of World Federation of Athletic
Training and Therapy ...................................................................................... 56
Appendix 8: Trinidad & Tobago Olympic Committee’s Affiliation with 37
Organizations .................................................................................................. 58
Appendix C: Athletic Training Patient Satisfaction Questionnaire .................. 60
Appendix D: Recruitment Letter ..................................................................... 67
Appendix E: The means for the Athletic Training Patient Satisfaction
Questionnaire broken down by question and country ..................................... 68
REFERENCES ................................................................................................... 76

vi

LIST OF TABLES

Table 1:

Table 2:

Table 3:

Table 4:

Table 5:

Table 6:

Table 7:

Table 8:

Table 9:

Table 10:

Table 11:

Table 12:

Table 13:

Table 14:

Percentage of Trinidad and Tobago and American
Student-Athletes in the Sample Population
Representing NCAA Divisions ..................................... 40

Distribution of Student-Athletes according to Sex
, Athletic Division and Country of Origin ........................... 40

Distribution of Athletes according to Sports Team,
Sex and Country of Origin ............................................. 41

Distribution of Athletes according to Year in
School, Sex and Country of Origin ................................... 41

Distribution of Athletes according to Frequency
of visits to their Athletic Trainer, Sex and
Country of Origin ............................................................ 42

Distribution of Athletes according to Athletic
Trainers’ Sex, Athlete Sex and Country of Origin ................ 42

Distribution of Athletes according to Athletic
Training Rank/ Title, Sex and Country of Origin .................. 43

Distribution of Athletes according to Athletic
Training Travel, Sex and Country of Origin ......................... 43

Cumulative Mean Scores for the independent
Variable groups of Study 1 ............................................... 45

Distribution of Athletes according to Year
in School ...................................................................... 46

Distribution of Athletes According to Country
of origin ....................................................................... 46

Distribution of Athletes according to Number
of Visits to ATC ............................................................. 46

Distribution of Athletes according to Sex of
Athletic Trainer ............................................................ 47

Distribution of Athletes according to Athletic
Trainer Traveling to Competitions 47

vii

Table 15:

Table 16:

Table 17:

Table 18:

Table 19:

Distribution of Athletes according to Athletic
Trainer Rank! Title ...................................................... 47

Cumulative Mean Scores for the independent
Variable groups of Study 2 ............................................... 49

The Member Organizations of World
Federation of Athletic Training and Therapy ....................... 56

Trinidad & Tobago Olympic Committee’s
Affiliation with 37 Organizations ..................................... 58

The means for the Athletic Training Patient

Satisfaction Questionnaire broken down by
Question and Country ..................................................... 68

viii

CHAPTER 1
INTRODUCTION

Overview of the Problem

In recent times, the quality of patient care and patient satisfaction has
become very important in efforts to measure and improve the quality of health
care (Haskell & Brown, 1998; Cleary, 1999). One example of institutions
measuring the quality of health care is the US. Agency for Healthcare Research
and Quality (AHRQ). The AHRQ funds and administers the Consumer
Assessment of Healthcare Providers and Systems (CAHPS) program. The
CAHPS program uses surveys to conduct assessments of patients’ experiences
with healthcare in the United States. CAHPS survey data is accessed by
“patients and consumers, quality monitors and regulators, purchasers, provider
organizations, and health plans either seeking to contract quality healthcare
services or improve their quality of care” (CAH PS, 2008).

The quality of patient care has been broken into two parts: technical care
and interpersonal relationships (Donabedian, 1988). Technical care depends on
the knowledge base and skill set of the practitioner. A practitioner with a great
knowledge base may be better prepared to develop and implement strategies as
needed (Donabedian, 1988). However, Donabedian (1988) also recognizes the
importance of the interpersonal relationship between the practitioner and the
patient. The author states, “the interpersonal process is the vehicle by which
technical care is implemented and on which its success depends” (Donabedian,

1988). While patients lack the knowledge and experience to accurately judge the

1

technical care of a practitioner, they can judge and offer feedback on the
delivery, success, and satisfaction with the technical care.

Recently, there has been an increased interest in patient satisfaction with
healthcare services (Aharony & Strasser, 1988). Several studies have
documented the benefits that patient satisfaction studies can have on the service
provided by medical professionals (Aharony & Strasser, 1988). These benefits
include but are not limited to recognitions of concerns, limitations, and needs for
improvements in the provision of the service (Aharony & Strasser, 1988). In
contrast, there have been no such increases in the research of patient
satisfaction in the allied healthcare field of athletic training. Given healthcare’s
new appreciation of patients’ preception of care, there is a need for the field of
athletic training to pursue more research in this area.

In 1998, the National Athletic Trainers” Association (NATA) mandated
research into a possible role for athletic training on the world stage (Ferrara,
2006). As NATA seeks to globalize the profession of athletic training, it would be
beneficial to establish the level of satisfaction with athletic training experience by
patients/athletes of different nationalities. Research on the perception of athletic
training services by different cultures may also help the NATA tailor athletic
training services to be more appealing to countries other than the United States
of America. One such country is Trinidad and Tobago. Moreover, research
should be completed to investigate if United States athletes differ on their level of
satisfaction with athletic training services compared to Trinidad and Tobago

athletes competing on the United States of America collegiate circuit.

2

After survey administration of the first study, it was determined that there
were several other factors that could affect the outcome of the study: sex and
experience of athletic trainer. A second study was conducted using NCAA
Division I Field Hockey athletes. This study allowed us to focus on athletes of the
same sex, athletic division and sport, allowing us to examine whether the sex or
the rank/ title of the athletic trainer influenced the athlete’s perception of
satisfaction with the athletic training service.

Significance of Problem

Ato Boldon was a winner of four Olympic medals (1 silver, 3 bronze) and
is considered one of the most successful track and field athletes in Trinidad and
Tobago (IAAF, 2009). In the mid 1990’s, he attended the University of California,
Los Angeles and was a member of its track and field team (Boldon, Ato). In 2005,
Ato Boldon ranked his athletic trainer as the third, or, potentially even the second
most important person in his collegiate career (Boldon, 2005). However, is
Boldon’s perception of satisfaction with his collegiate athletic training experience
shared by other Trinidad and Tobago athletes competing at universities/colleges
in the United States of America? How does the student-athlete’s satisfaction with
the athletic training services vary according to nationality, for example, Trinidad &
Tobago versus the USA?

In the intercollegiate setting of the United States of America, athletic
trainers serve as the central figure in the delivery of healthcare services to the
student-athletes. Because of the convenience of this healthcare delivery system,

athletic trainers are often the first person who interacts with the injured athlete.

3

The athletic trainer works under the guidance of a physician and is responsible
for the prevention, evaluation, immediate care, rehabilitation and management of
injuries. In order for anyone to achieve certification as an athletic trainer, they
must complete a standardized educational process from an accredited program
and pass a board certification exam. The profession of athletic training has grown
from a few individuals traveling with the Olympic teams of the United States in
the 19303 (Ebel, 1999) to over 30,000 certified athletic trainers (ATC) nationwide
(NATA, 2010). Athletic trainers are represented by the professional organization,
National Athletic Training Association (NATA) which was founded in 1950 and
continues to manage the growth of the profession (Ebel, 1999).

It is expected that all athletic training programs should produce skilled
athletic trainers with a great knowledge base as the programs all complete a
standardized course of study. This knowledge base helps the athletic training
student to pass the certification exam. Certified athletic trainers are employed by
many different institutions to provide care to individuals. Therefore, to effectively
quantify the quality of health care provided by an athletic trainer, we must gain
feedback from the individuals served by athletic trainers. Previous research
found that student-athletes expressed satisfaction with athletic training services.
However, the level of satisfaction differed across the board according to sex,
sports profile and level of competition (Unruh,1998; Unruh, Marta, & Seshadri
2005) . In, an undergraduate research study at the University of Wisconsin - Eau
Claire, Maresh & Peterson (2007) found that the university’s student-athletes

expressed a pattern of satisfaction with their athletic training services. However,

4

to-date, no research has investigated the relationship between the levels of
satisfaction with athletic training services of the student-athletes born in United
States versus the Trinidad and Tobago student-athletes competing at American
Universities.

There are several other factors which may affect the student-athlete’s
level of satisfaction with his/ her athletics trainer. Drummond et al (2007) showed
that some athletes may display discomfort with the care given by their athletic
trainer because of the sex of the athletic trainer. According to the self-reported
comfort of collegiate athletes with injury and condition can be same-sex and
opposite —sex athletic trainers, the authors found significant differences in
comfort levels between the sexes of athletic trainers for gender specific injuries
and conditions (Drummond, Hostetter, & Laguna, 2007). It is assumed that if an
athlete experiences discomfort with a gender specific issue while interacting with
an athletic trainer, then their perception of the care received would diminish. It
was also assumed that athletes would have a greater perception of care if the
care was received from an experienced athletic trainer. In most cases, the title of
undergraduate athletic training student, graduate assistant athletic trainer, intern
and staff athletic trainer, usually correlates with the experience of the athletic
trainer in ascending order. Maresh and Peterson (2007) found that certified
athletic trainers received a rating of slightly higher satisfaction scores on athletic

training services compared to athletic training students.

Purpose Statement

The purpose of this study is to explore factors which may affect the
student-athlete’s satisfaction with the athletic training service provided by the
athletic trainer.

Hypotheses
This study examined the following hypothesis:

1. There will be no difference in level of satisfaction in athletic training
services between US based student-athletes originating from Trinidad
and Tobago and US student-athletes.

Exploratory Questions for study 1

2. Are there differences in the level of satisfaction in athletic training
services between NCAA divisions?

3. Are there differences in the level of satisfaction in athletic training
services between sexes (student-athletes)?

Exploratory Questions for Study 2

4. Are there significant differences in the level of satisfaction of the field
hockey athletes with the athletic training services provided according
to the sex of the athletic trainer?

5. Are there differences in the level of satisfaction of the field hockey
athletes with the athletic training services provided according to the

rank/title of athletic trainer?

Definition of Terms

Agency for Healthcare Research ancmualitv (AHRQ); Federal agency
with the responsibility of improving the quality, safety, efficiency, and
effectiveness of health care for all Americans.

_B_oard of Certification (BOC): national certifying body for athletic trainers
in the United States; administers ATC® credential to those meeting qualifications
to become a certified athletic trainer.

Certified Athletic Tra_iner (ATC): a unique health care provider who
specializes in the prevention, assessment, treatment, and rehabilitation of injuries
andiflnesses.

Canadian Athletic Therapists’ Association (CATA): the professional
membership association for certified athletic therapist in Canada.

Commission on Accreditation of A_thletic Trajninq (CAAE); the
accreditation body for entry level athletic training programs.

Consu_mer Assessment of Healthca_re Providers mistemsfiAfl: a
public/ private program to develop standardized surveys of patients experiences
with healthcare providers and facilities.

Facebook: a popular online social network"

Federation lntemationale de Football Association (FIFAQ: the international
governing body for football (soccer).

International Association of Athletics Federation (IAAF): the international

governing body for athletics.

 

Institutional (lntemal) Review Board I IRB): the committee responsible for
protecting the rights and welfare of research subjects through the processing of
monitoring, reviewing and approving research projects.

National Association of Intercollegiate Athletics (NA_IA_): an athletic
association for smaller colleges and universities in the United States

National Collegiate Athletic Association (NCAA): the major athletic
association for colleges and universities in the United States. This association is
divided into three divisions: Division I, Division II and Division III. Divisions l & II
are the only divisions allowed the offering of scholarships to their athletes.

NationgLAthletic Trainers’ Association (NE A): the professional
membership association for certified athletic trainers and others who support the
athletic training profession.

National Rfiearch Corporation (NRC): a company dedicated to the
measurement of patients’ experience with healthcare services and performance.
Olympic (summer) Games: a major international multi-sport games
involving thousands of elite athletes representing their countries. This

competition is held every four years.

Mmerican Games: a multisport games held every four years for
athletes from the Americas.

The Picker Institute: a company dedicated to the measurement of patients

experience with healthcare services and performance.

Trinidad and Tobago Ohmeic Companv (TTOC): the umbrella
organization that represents the sporting bodies of each Olympic sport in
Trinidad & Tobago.

Mad and Tobago Intercoll_eg_iate Athlete: any athlete born and
completed high school in Trinidad & Tobago.

United States lntercoflfifiate Athlete: any athlete born and completed high
school in the United States of America.

(FIFA) World Cup Championship: a major international football (soccer)
tournament among 32 teams of countries around the world. This tournament is
held every four years.

(IA/1F) World Track and Field Championships: A major international track

and field competition.

CHAPTER 2
REVIEW OF LITERATURE

Introduction

Athletic trainers find employment in many different places including
schools, clinics, professional and industrial settings (NATA, 2010a). In clinics,
schools and professional teams, athletic trainers provide care for clinical patients,
student- athletes and professional athletes respectively (NATA, 2010a). The
NATA considers athletic trainers to be a valuable allied healthcare provider.
However, how does the athletic training customer perceive the services of the
athletic trainer? What is the perception of the patient/athlete towards the athletic
training services rendered? Do all patients/ athletes have the same or similar
perceptions of athletic trainers and the services provided by athletic trainers?
Does cultural origin affect the perception of athletic training services? In an
attempt to answer these questions, the review of literature will explore the history
of athletic training, athletic training profession, satisfaction with athletic training
services, globalization of athletic training and the relationship between the
Trinidad and Tobago athlete and the athletic trainer.

History of Athletic Training

Athletics can be dated back to ancient Grecian times. We can assume
that where there are athletics, there are also athletic trainers or paidotribes as
they were referred to then. After the fall of Rome, athletic competition vanished.
It was not until the 19th Century that interest in athletics began to rise once again.

During this time, gymnastics and a recreational form of football (soccer)

10

developed in Europe and the United States. Back then, coaches and physicians
managed athletic injuries. Very few schools actually employed a “trainer" until
the 1920’s. In this era, the profession saw opportunities arise at major
universities for medical personnel to work with active populations. Through the
1930’s, athletic trainers began traveling with the United States Olympic teams
and shared ideas and techniques they learned via workshops and publications
(Ebel, 1999). As people began to hear about the birth of this new profession,
many men were drawn to institutions where athletic training was practiced (Ebel,
1999)

In 1938, the first National Athletic Trainers’ Association (NATA) was born
during the Drake Relays at the University of Iowa (Prentice, 20,10).The
association had two annual meetings, one at the Drake Relays (Western
Division), and the other at the Penn Relays (Eastern Division). Despite the hope
of organization of the profession of athletic training, the United States became
involved in Worid War II soon after the birth of the first NATA. During this time,
athletic trainers were drafted and deployed as soldiers (Prentice, 2010). Some
athletic trainers utilized their skills by preparing men physically for battle and
assisting with the rehabilitation of injured soldiers (Prentice, 2010).Even though
some athletic trainers remained active during the war, the NATA went bankrupt
and in 1944, the first NATA no longer existed (Ebel, 1999).

Although the first NATA disbanded during World War II, after the war,
groups of athletic trainers began to form regional associations around the nation.

However, these organizations needed a unifying unit, which lead to the birth of

11

the new NATA in 1950 (Prentice, 2010).The organization slowly grew, hosting
annual meetings, collecting dues, establishing district and executive
representatives, and recruiting membership. In 1956, the first athletic training
scholarly journal was established and a Code of Ethics was adopted in 1957 in
accordance with the NCAA (Delforge & Behnke, 1999).

After 20 years of growth, the NATA decided it was time for change and
restructuring. An organizational chart was developed, and the executive council
was restructured and the position of NATA president was established (Kutz,
2010). Also during this decade, the Board of Certification (BOC) Examination
was implemented, the inclusion of women in the profession began, and state
Iicensure was emerging. During the 1980’s, the NATA gained corporate
sponsorship in Quaker Oats/Gatorade and became incorporated as the NATA
Inc (Kutz, 2010). The membership totaled over 10,000 and the budget of the
corporation was rapidly growing (Kutz, 2010). A headquarters was established in
Dallas, Texas and a full-time professional staff was hired to run the operations of
the NATA.

Throughout the 1990’s, the NATA underwent major changes to
operational procedures, rules, and bylaws. A new Policies and Procedures
Manual was developed. The NATA also hired a company to assist in the
assimilation of a strategic plan for the organization and profession. By 1999, the
NATA enlisted over 25,000 members in good standing; a drastic change from

101 members 50 years prior (Ebel, 1999).

12

As of December 2009, the NATA membership totals 36,387 (NATA,
2010b). Of these members, 26,419 are certified athletic trainers (ATCs), which
accounts for 72.6% of the certified population (NATA, 2010b). These unique
health care professionals now work in diverse settings, ranging from the
traditional intercollegiate setting to emerging settings, such as performing arts or
rodeo, specializing in the prevention, assessment, treatment and rehabilitation of
injuries and illnesses.

Athletic Training Profession

Athletic trainers are the coordinators of the healthcare system in
Intercollegiate Athletics in the United States of America. In this setting, the
athletic trainer provides on-site supervision of intercollegiate athletes’ sport-
related activities and is responsible for the prevention, recognition, initial
evaluation, treatment, referral and rehabilitation of the injuries of college athletes
(Starkey & Ryan, 2002; Andersen, Hall, & Martin, 2004; Prentice, 2010). The
definition of athletic training that was approved by NATA Board of Directors in
October, 2007 defines athletic training as “. . .practiced by athletic trainers, health
care professionals who collaborate with physicians to optimize activity and
participation of patients and clients. Athletic training encompasses the
prevention, diagnosis, and intervention of emergency, acute, and chronic medical
conditions involving impairment, functional limitations, and disabilities” (NATA
2008)

The educational content for all entry-level athletic training programs are

standardized across the board. Athletic training students complete the same

13

NATA competencies and clinical proficiencies as mandated by The Commission
on Accreditation of Athletic Training Education (CAATE). CAATE maintains the
required standard of athletic training education programs through its
comprehensive accreditation review processes. Each program must adhere to
the standard for athletic training education programs as mandated by CAATE in
order to remain a CAATE accredited athletic training education program. In
September 2009 there were 346 CAATE accredited undergraduate athletic
training education programs and 20 entry-level graduate programs (CAATE,
2009)

The CAATE standards are inclusive of the National Athletic Trainers’
Association’s Education Council’s Educational Competencies and Clinical
Proficiencies. Currently in its fourth edition, the NATA competencies are
designed to define the skills required of an entry-level ATC to provide athletic
training services to patients/athletes of differing age, sex, work, lifestyle and
need.

The competencies are divided into Foundational Behaviors of Professional
Practice, and 12 content areas comprising the knowledge and skill set of the
entry-level ATC. The 12 areas are Risk Management and Injury Prevention,
Pathology of Injuries and Illnesses, Orthopedic Clinical Exam and Diagnosis,
Medical Conditions and Disabilities, Acute Care of Injuries and Illnesses,
Therapeutic Modalities, Conditioning and Rehabilitative Exercise, Pharmacology,
Psychosocial Intervention and Referral, Nutritional Aspects of Injuries and

Illnesses, Health Care Administration, and Professional Development and

14

Responsibility (Prentice, 2010). Each content area is subdivided into behavioral
classifications of cognitive domain (i.e., knowledge and intellectual skills),
psychomotor domain (i.e., manipulative and motor skills), and clinical
proficiencies (i.e. decision-making and skill application). The “Foundational
Behaviors” are basic behaviors that should permeate every aspect of
professional practice and should be incorporated into every educational aspect of
athletic training education. Cultural competence is included in the behaviors,
stating the “ATC should understand the cultural differences of patients’ attitudes
and behaviors toward health care, demonstrate knowledge, attitudes, behaviors,
and skills necessary to achieve optimal health outcomes for diverse patient
populations, and demonstrate knowledge, attitudes, behaviors, and skills
necessary to work respectfully and effectively with diverse populations and in a
diverse work environment” (NATA, 2009b).

In order to become a certified athletic trainer, an individual must obtain a
degree from an athletic training education program accredited by CAATE and
pass the BOC examination (NATA, 2009b). The BOC certification exam tests the
knowledge of the athletic training student in the following six domains: 1)
injury/illness prevention, 2) clinical evaluation and diagnosis of injuries/illness, 3)
immediate care of injuries/illnesses, 4) treatment, rehabilitation, and
reconditioning of injuries/illnesses, 5) organization and administration, and 6)
professional responsibility (BOC, 2006). These six domains were identified by a
Role Delineation study conducted by the NATA as the essential knowledge base

and skills set of a certified athletic trainer (800, 2006).

15

The practice of athletic training is also standardized as all certified athletic
trainers are required to comply with the BOC Standards of Professional Practice.
The BOC Standards of Professional Practice are made up of two sections:
Practice Standards and Code of Professional Responsibility. The Practice
Standards describe what services one can expect from a certified athletic trainer,
and allows the certified athletic trainer to understand his or her duty and
obligation as a holder of the ATC® credential. The Practice Standards can also
be used to evaluate the services rendered by a certified athletic trainer (BOC,
2006). The Practice Standards are broken down into seven sections and are
listed below as found on the BOC website.
§t_a_ndard 1: Direction: The athletic trainer renders service or treatment under the
direction of a physician.

Standard 2: Prevention: The athletic trainer understands and uses preventive
measures to ensure the highest quality of care for every patient.

Standard 3: Immediate Care: The athletic trainer provides standard immediate
care procedures used in emergency situations, independent of setting.

galrdard 4: Clinical mlpation and Diagnosis: Prior to treatment, the athletic
trainer assesses the patient’s level of function. The patient’s input is considered
an integral part of the initial assessment. The athletic trainer follows standardized
clinical practice in the area of diagnostic reasoning and medical decision-making.

Standard 5: Treatment Rehabilitation and Reconditioning: In development of a

 

treatment program, the athletic trainer determines appropriate treatment,

rehabilitation and/or reconditioning strategies. Treatment program objectives

16

include long and short term goals and an appraisal of those which the patient can
realistically be expected to achieve from the program. Assessment measures to
determine effectiveness of the program are incorporated into the program.
Standa_rd 6: Program Discontinuation: The athletic trainer, with collaboration of
the physician, recommends discontinuation of the athletic training service when
the patient has received optimal benefit of the program. The athletic trainer, at
the time of discontinuation, notes the final assessment of the patient’s status.
mm 7: Organi_zation a_nd Administration: All services are documented in
writing by the athletic trainer and are part of the patient’s permanent records. The
athletic trainer accepts responsibility for recording details of the patient’s health
status.

These above mentioned standards provide the practice expectations for
all athletic trainers. Athletic trainers are also required to follow a Code of
Professional Responsibility. This Code of Professional Responsibility asks that all
certified athletic trainers and applicants conduct themselves in a “professionally
responsible manner in all athletic training services and activities” (BOC, 2006).
The Code of Professional Responsibility consists of six parts and is listed below
according to the BOC.

Code 1: Patient Responsibility

The athletic trainer or applicant:

1.1 Renders quality patient care regardless of the patient’s race, religion, age,
sex, nationality, disability, social/economic status or any other characteristic

protected bylaw.

17

1.2 Protects the patient from harm, acts always in the patient’s best interests and
is an advocate for the patient’s welfare.

1.3 Takes appropriate action to protect patients from athletic trainers, other
healthcare providers or athletic training students who are incompetent, impaired
or engaged in illegal or unethical practice.

1.4 Maintains the confidentiality of patient information in accordance with
applicable law.

1.5 Communicates clearly and truthfully with patients and other persons involved
in the patient’s program, including, but not limited to, appropriate discussion of
assessment results, program plans and progress.

1.6 Respects and safeguards his or her relationship of trust and confidence with
the patient and does not exploit his or her relationship with the patient for
personal or financial gain.

1.7 Exercises reasonable care, skill and judgment in all professional work.
Code 2: Comgtency

The athletic trainer or applicant:

2.1 Engages in lifelong, professional and continuing educational activities.

2.2 Participates in continuous quality improvement activities.

2.3 Complies with the most current BOC recertification policies and
requirements.

Code 3: Professional Resmnsibility

The athletic trainer or applicant:

3.1 Practices in accordance with the most current BOC Practice Standards.

18

3.2 Knows and complies with applicable local, state and/or federal rules,
requirements, regulations and/or laws related to the practice of athletic training.
3.3 Collaborates and cooperates with other healthcare providers involved in a
patient’s care.

3.4 Respects the expertise and responsibility of all healthcare providers involved
in a patient’s care.

3.5 Reports any suspected or known violation of a rule, requirement, regulation
or law by him/herself and/or by another athletic trainer that is related to the
practice of athletic training, public health, patient care or education.

3.6 Reports any criminal convictions (with the exception of misdemeanor traffic
offenses or traffic ordinance violations that do not involve the use of alcohol or
drugs) and/or professional suspension, discipline or sanction received by
him/herself or by another athletic trainer that is related to athletic training, public
health, patient care or education.

3.7 Complies with all BOC exam eligibility requirements and ensures that any
information provided to the BOC in connection with any certification application is
accurate and ththfuI.

3.8 Does not, without proper authority, possess, use, copy, access, distribute or
discuss certification exams, score reports, answer sheets, certificates, applicant
files, documents or other materials.

3.9 Is candid, responsible and truthful in making any statement to the BOC, and
in making any statement in connection with athletic training to the public.

3.10 Complies with all confidentiality and disclosure requirements of the BOC.

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3.11 Does not take any action that leads, or may lead, to the conviction, plea of
guilty or plea of nolo contendere (no contest) to any felony or to a misdemeanor
related to public health, patient care, athletics or education; this includes, but is
not limited to: rape; sexual abuse of a child or patient; actual or threatened use of
a weapon of violence; the prohibited sale or distribution of controlled substance,
or its possession with the intent to distribute; or the use of the position of an
athletic trainer to improperly influence the outcome or score of an athletic contest
or event or in connection with any gambling activity.

3.12 Cooperates with BOC investigations into alleged illegal or unethical
activities; this includes but is not limited to, providing factual and non-misleading
information and responding to requests for information in a timely fashion.

3.13 Does not endorse or advertise products or services with the use of, or by
reference to, the BOC name without proper authorization.

Code 4: Research

The athletic trainer or applicant who engages in research:

4.1 Conducts research according to accepted ethical research and reporting
standards established by public law, institutional procedures and/or the health
professions.

4.2 Protects the rights and well being of research subjects.

43 Conducts research activities with the goal of improving practice, education
and public policy relative to the health needs of diverse populations, the health
workforce, the organization and administration of health systems and healthcare

delivery.

20

Code 5: Social Responsibility

The athletic trainer or applicant:

5.1 Uses professional skills and knowledge to positively impact the community.
Code 6: Business Practices

The athletic trainer or applicant:

6.1 Refrains from deceptive or fraudulent business practices.

6.2 Maintains adequate and customary professional liability insurance.

Any proven failure of a certified athletic trainer to comply with the Code
can result in disciplinary action by the BOC including suspensions or revocation
of the ATC® credential (BOC, 2006). Given the strict standards of athletic
training as stated above, it can be assumed that the services provided by
certified athletic trainers are very similar in nature.

Satisfaction of Athletic Training Services

Studies on the perception and/ or satisfaction with the services of athletic
trainers by their patients are very limited. In fact, I have only located two
published studies and one undergraduate research study which are directly
related to satisfaction with the services of athletic trainers. Unmh (1998)
published a study in the Journal of Athletic Training titled “Perception of Athletic
Services by Collegiate Student-Athletes: A Measurement of Athlete Satisfaction.”
Unruh sought to establish whether the perception of the athletic trainer and the
athletic training services differed according to athletes of different sex, sport

profiles and/ or levels of competition. Athletes participating in 14 schools in the

Southeast Conference and 17 schools in the Gulf South Conference volunteered

21

for this study. The Southeast Conference consists of National Collegiate Athletic
Association (NCAA) Division I schools while schools in the Gulf South
Conference compete at the NCAA Division II level. All schools employed athletic
training services. Unruh (1998) identified sports as “High or Low Profile Sports”
using information gathered from sport information directors. The sports that
received the greatest number of requests for information were determined to be
the “High Profile Sports”, while all others were considered as “Low Profile
Sports”. Therefore, football, basketball and baseball were classified as “High
Profile Sports.” The authors developed a questionnaire using the duties as
described in the BOC Role Delineation Study. Unruh (1998) determined face and
content validity for the questionnaire. Face validity means that the instrument in
question looks like it will measure what it was created to measure. Unruh
obtained face validity for his instrument from professionals within the athletic
training profession (Unruh 1998). Reliability of the questionnaire was proven
using a split test for internal consistency (0.8211) and a Cronbach coefficient
alpha test (0.9017). This questionnaire was comprised of 50 questions. Thirty-six
questions were designed to collect responses on a five-point Likert Scale:
strongly agree, moderately agree, neutral, moderately disagree and strongly. The
other 14 questions were designed to collect “Yes” or “No” responses.

In order to complete a quantitative analysis of the data collected by the
questionnaire, point values were attached to each response: strongly agree
(4),moderately agree (3), neutral (2), strongly disagree (1),

moderately disagree(0), yes (1), no (0).

22

Questions left unanswered were scored as a neutral response. In examining
differences between sexes, sports profile and athletic division, Unruh (1998)
used a t-test to compare the cumulative mean scores of each group. The study
found that all athletes had a positive view of their athletic trainer. However, male
athletes and high profile sports athletes had a higher perception score of the
services offered by their athletic trainers compared to female athletes and
athletes in low profile sports. No significant differences were observed between
athletes competing at NCAA l and NCAA II athletic divisions (Unruh, 1998).

In 2005, Unruh et al. conducted a follow-up study titled “Collegiate
Student-athlete’s Satisfaction with Athletic Trainers.” This study was similar to the
one described above. The authors investigated whether satisfaction would differ
according to sex of the athlete, different sport profiles and/or levels of
competitions. The sport profiles were divided into “High and Low Profile Sports
using the same criteria as recorded by Unruh (1998). The study used NCAA
division I or II athletes from randomly selected programs across the United
States. Subjects were selected from schools in the four US Time Zones: East,
Central, Mountain and Pacific. Site administrators were paid at each site to
distribute and collect questionnaires. The questionnaire designed to obtain
responses that would rate the student-athletes’ satisfaction with the services
provided by their athletic trainer was a modification of the questionnaire used
from the Unruh (1998) study. The BOC Role Delineation was also used to
develop this questionnaire (Unruh et al 2005). The questionnaire was

comprised of 50 questions. Thirty-five questions were designed to collect

23

responses on a five-point Likert Scale: strongly agree, moderately agree, neutral,
moderately disagree and strongly. The other 15 questions were designed to
collect “Yes” or “No” responses.

The data collected by the questionnaire were scored similarly to the
Unruh(1998) study: very satisfied (5), moderately satisfied (4), undecided (3), not
satisfied (2), very dissatisfied (1), yes (2), No (1). Cumulative scores of the
responses of completed questionnaires were calculated and used in the data
analysis for this study. Unruh et al (2005) used a linear regression model to
identify whether any of the independent variables were predictors of the
cumulative score. The results of Unruh et al.’s (2005) study supported most of
the findings in the first study (Unruh 1998). Student-athletes competing in high
profile sports and male athletes were more satisfied with services provided by
their athletic trainer than student-athletes who belonged to low profile sports and
or female student athletes respectively (Unruh, Marta, & Seshadri 2005). Athletic
division was not a significant predictor of student athlete’s satisfaction with
athletic training services. In conclusion the authors noted that the participants In
the study demonstrated a high level of satisfaction with the quality of the services
provided by their athletic trainers. However, the results also show significant
differences exist in satisfaction with athletic training services across some sports.

In 2007, Maresh and Peterson investigated the satisfaction of student-
athletes with the services provided by the athletic training staff at the University
of Wisconsin at Eau Claire. The university is a member of the Wisconsin

Intercollegiate Athletic Conference, a NCAA division Ill conference.

24

Questionnaires were sent to a random sampling of athletes at the University via
email. The questionnaire consisted of 25 questions created under the guidance
of the certified athletic trainers at The University of Wisconsin at Eau Claire to
address the six domains of athletic training, determined by the BOC Role
Delineation Study. Responses to the questionnaire were collected on a 5 point
Likert scale. Each question on the Maresh & Peterson(2007) questionnaire
required two sets of reponses, for two service providers: certified athletic trainers
and athletic training students. In order, to quantify the data in this study numerical
values were attached to each response as done in the previously discussed
studies: strongly agree (5), agree (4), indifferent/ NA (3), strongly disagree (2),
disagree (1). Data analysis was conducted by combining “the results of each
question to create cumulative scores and averages for each of the domains”
(Maresh & Peterson, 2007). The results of this study also supported the previous
two studies. Student-athletes in the high profile sports indicated a higher
satisfaction for the services provided by their athletic trainers than the student-
athletes who belonged to lower profile sports. The results also indicated that
satisfaction with the services provided by the athletic training program at the
University of Wisconsin at Eau Claire was “generally good” (Maresh & Peterson,
2007). It must be noted the Maresh and Peterson (2007) study was an
undergraduate research study which was not published in a peer reviewed
scientific journal. Therefore the results of this study may not be valid. However,
Maresh & Peterson(2007) presents another way of analyzing qualitative data and

displaying the results. The authors calculated the response total, the response

25

average and the average frequency of reponses for each question . Tables and
graphs were used to displayed these results.

The results of the above studies all support the statement that collegiate
student-athletes exhibit satisfaction with athletic training services. However, the
same results also suggest that the level of satisfaction varies across different
collegiate student-athletes populations. The studies above have investigated the
effect of sex, athletic division, sport profile and time zone on collegiate student-
athletes’ satisfaction with the services provided by their athletic trainer. To date,
no research has investigated if United States athletes differ on their level of
satisfaction compared to Trinidad and Tobago athletes competing at American
Universities. As the NATA seeks to globalize the profession of athletic training, it
would be beneficial to establish the level of satisfaction with athletic training
experience by patients/athletes of different nationalities. The data gathered on a
study of the perception of athletic training services by people of different cultures
may help the NATA tailor athletic training services to be more appealing to the
global public.

Globalization and Athletic Training Services

Currently, there are several international athletic training organizations
that exist, specifically, the Japanese Athletic Training Association, Taiwan
Athletic Trainers Society, and the Korean Athletic trainers’ Association. There are
also several study abroad opportunities available to athletic training students.
The University of Georgia Athletic Training Education Program in association

with the National Taiwan Sport University (NTSU) provides an athletic training

26

student summer experience in Taiwan (http:/lwww.coe.uga.edu/atsatl). Ball State
University athletic training program coordinates a summer study abroad program
to Australia (httpzllwww.bsu.er1plweblaflsmfy). The College of Educational
Studies’ Athletic Training Education Program at Chapman

University (httpzl/www.chapman.edu_/ces/atep/) also coordinates a clinical
education experiences for athletic training students in Australia. These study
abroad opportunities allow athletic training students to interact with a different
culture while working with sports teams and medical professionals in different
countries.

In 1998, the NATA Board of Directors under then president Kent Falb
determined that globalization was important for the development of the
profession of athletic training (Ferrara, 2006). The World Federation of Athletic
Training and Therapy (WFATT) was formed in 2000, to provide a forum for the
exchange of ideas and knowledge between healthcare professionals around the
world (Ferrara, 2006)The WFATT has 21 member organizations (See Appendix
A — Table 17). The WFATT has embarked on two projects that will enhance the
“knowledge and understanding of the athletic trainer” (Ferrara, 2006). The first
project involved a self-study and the development of a Mutual Recognition
Arrangement (MRA). In July 2005, the NATA and the Canadian Athletic Therapist
Association (CATA) signed an MRA that allows NATA and CATA candidates to
also become certified by the CATA and NATA respectively. This MRA also allows
professional organizations from different countries with similar educational and

credentialing systems to initiate the process to join the current MRA. The second

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project the WFATT conducted was a Global Analysis Study. The Global Analysis
Study is very similar to the BOC Role Delineation Study. However, the WFA'I'I'
has developed and defined four domains (assessment, intervention,
administration and education) compared to the BOC’s six domains. The WFATT
hopes to use this study to validate the practice domains of the global athletic
trainer with additional information which would allow the athletic trainer to
function in different countries.

Trinidad and Tobago Athletes and Athletic Training Services

Trinidad and Tobago are the most southern islands of the Caribbean. The
twin island state, approximately 5,128 sq km in total area, is located seven miles
off the northeast coast of Venezuela. The World Factbook estimates the
population of Trinidad and Tobago to be approximately 1.2 million people as of
July, 2009 (Central Intelligence Agency, 2009). Although a small country,
Trinidad and Tobago is well represented in the world of international sports. The
Trinidad and Tobago Olympic Committee is affiliated with 37 organizations. Each
organization represents a different sport (see Appendix B — Table 18; Trinidad
and Tobago Olympic Committee, 2008).

Football (soccer) is the most popular sport in Trinidad and Tobago. The
country dominates the sport in the Caribbean region having won the (Caribbean
Football (Soccer) Championships eight times, the most by any Caribbean Nation
(McKain, 2008). In 2006, Trinidad and Tobago became the smallest English-
speaking nation to ever qualify for the FIFA (Men) world cup soccer

championships. This feat was followed up with qualifications for the FIFA U-17

28

and U-20 World Cups in 2007 and 2009, respectively. Trinidad and Tobago will
host the FIFA (Women) U-17 World Cup Championships in 2010 after hosting
the male version of this tournament in 2001(FIFA.COM, 2009).

While not as dominant as Trinidad and Tobago’s football team, other
sporting disciplines have also produced successful athletes on the international
stage. At the 2009 World Track and Field Championships in Berlin Germany,
Renny Quow and Josanne Lucas captured bronze medals in the 400m and 400m
hurdle events, respectively. At the same meet, 17-year-old Jehue Gordon placed
4th in the 400m hurdles becoming the youngest ever finalist of any sprint event in
the history of the World Track and Field Championships (Hunt, 2010). Trinidad
and Tobago also gained two silver medals at the last Olympic Games in 2008.
Richard Thompson placed second in the 100m and helped the men’s relay team
to second place in the 4x100m relay race (TTOC, 2009). Regionally, Trinidad
and Tobago athletic team have also produced good results. In the 2007 Pan
American Games in Brazil, the Trinidad and Tobago team returned with 1 silver
and 3 bronze medals. Emile Abraham won silver in cycling while Cleopatra Borel-
Brown (shot putt), George Bovell III (swimming) and Chinedum Osuji (tae kwon
do) placed third in their respective events (TTOC, 2009).

Many athletes from Trinidad and Tobago attend colleges in the United
States (US) and participate in Intercollegiate Athletics including Josanne Lucas
(Auburn University), Cleopatra BoreI-Brown (University of Maryland, Baltimore
County), Richard Thompson (Louisiana State University) and Renny Quow

(South Plains College) (TTOC, 2008). As these athletes complete their athletic

29

careers at colleges/universities in the US, many of them will interact with athletic
trainers. For Trinidad and Tobago athletes participating n US intercollegiate
athletics, the role of the athletic trainer will be a new addition to the sports team.
The sports medicine system in Trinidad and Tobago is very different compared to
the American sports medicine system, particularly athletic training. There are no
athletic trainers in the high school system in Trinidad and Tobago; first-aiders are
usually present for most competitions. Coaches and parents often serve as the
first-aiders for these high school’s athletic teams. The University of Trinidad and
Tobago is the only educational institution staffed with sports medicine personnel.
Many athletes in Trinidad and Tobago do not interact with a sports medicine
specialist unless they are seriously injured; qualify to travel with a national team
or join an international team such as a US collegiate team (Gulston, 2010).
While there are physical therapists present in Trinidad and Tobago; there is not a
strong athletic training presence. In fact, the NATA lists only two athletic trainers
currently residing in Trinidad and Tobago. It is my belief that an increase in
athletic trainers in Trinidad & Tobago will benefit the athletes and sports industry
of Trinidad & Tobago. Any study that determines that athletes of Trinidad &
Tobago perceive athletic training services as satisfactory and beneficial to their
success as an athlete will support my belief that athletic trainers would have a

positive impact on the athletes of Trinidad & Tobago.

30

Summary

Studies in patient satisfaction with athletic training services using patients
of different cultural origins can help us explore the global role of the athletic
trainer. Research suggests that athletes are satisfied with the services provided
by athletic trainers (Unruh, 2005, 2007; Maresh & Peterson, 2007); however,
none of the studies identified the cultural background of its subjects. Therefore,
conducting a study with a recognized cultural group can help identify the
satisfaction level of that group. More specifically, comparing Trinidad and
Tobago student-athletes to US student-athletes on their satisfaction of athletic
training services can help determine if athletes of Trinidad & Tobago have similar
perceptions of athletic training services when compared to American athletes.
This study can also help determine if Trinidad & Tobago athletes competing in
intercollegiate athletics in the United States of America are satisfied with the

athletic training services received from their athletic trainer.

31

CHAPTER 3
METHODS

Introduction

This chapter includes the following sections: research design, subjects,
instrumentation, procedures, and data analysis for both study 1 and study 2.
Study 1

Research Design

This research study used a questionnaire to gather data; therefore, it was
considered a cross-sectional design. The independent variable for the hypothesis
was student-athletes’ nationality (Trinidad & Tobago vs USA). The independent
variables for the exploratory questions were athletic divisions (NAIAl NCAA
Divisions) and sex of the athlete. The dependent variable for this study was
student-athletes’ level of satisfaction with athletic training services as measured
by a questionnaire.

Subjects

A database of Trinidad & Tobago athletes competing in intercollegiate
athletics in the United States of America was created by following intercollegiate
athletics competition results of these athletes published in the print media of
Trinidad & Tobago and searching the 2009-10 rosters of 100
colleges/universities in the US for athletes of Trinidad and Tobago decent. Some
of the schools on the list were selected at random while others were either listed
in the Trinidad & Tobago print media or found on the website socawarriors.net.

The site socawarriors.net maintains a list of Trinidad & Tobago soccer player

32

currently attending and representing colleges/ universities in the USA. The
colleges and players on the list were confirmed as current student-athletes by
comparing the names with the varsity soccer team list of each university/college.
All varsity teams from the schools identified were also searched for other
Trinidad and Tobago athletes. This database of athletes offered a convenient
sample of 190 Trinidad & Tobago athletes. Invitations to participate in Study 1
were sent to 161 Trinidad & Tobago student-athletes; 38 surveys were collected
from this group. The student-athletes from Trinidad & Tobago had a response
rate of 23%. A sample of USA athletes were created by asking the teammates of
Trinidad & Tobago athletes to participate in the study. Participants were chosen
from four conference divisions: NCAA I, NCAA ll, NCAA III, and NAIA. After
collecting the data, the statistical power was calculated for the number of
responses received to determine the significant effect of the results of the study.

Instrumentation

The questionnaire used in this study was the same questionnaire used in
the Unruh et al. (2005) study (see Appendix C). However, the demographic
section was adjusted to include the subject’s country of citizenship, the sex of the
athletes’ athletic trainer, the rank/title of the athletic trainer, the availability of the
athletic trainer for travel to competitions and how often each athlete visited the
athletic trainer. In addition, NCAA Division III and NAlA were added to the
institutions competitive level. The questionnaire consists of 50 questions divided
into two sections. The first section contained 35 questions designed to rank

answers along a five point Likert scale, while the second section had 15

33

questions designed for “yes” or ”no” responses. Unruh et al. (2005) developed
the questions from material presented in each section of the Role Delineation
Study. The author noted, “that each question was constructed in a manner that
best elicited responses reflective of the student-athlete’s satisfaction with his or
her athletic trainer and the services provided” (Unruh et al., 2005). The
questionnaire included questions that tested the satisfaction of athletic training
services relative to the athletic trainer’s knowledge of injuries, discretion, level of
care and concern regarding the athletes’ injury and if the athletic trainer was
readily available to handle acute and chronic injuries.

The questionnaire used by Unruh et al. (2005) is a modification of the
survey used in the initial study in 1998. Unruh (1998) established face and
content validity for the instrument used in that study. Face validity was
established by having certified athletic trainers review the instrument. The author
established content validity by wording the questions to address job
responsibilities identified by the Role Delineation Study (Unruh, 1998). Unruh
(1998) also tested the questionnaire for reliability using two different types of
reliablity analysis: a split-half test for internal consistency and a Cronbach
coeffiecient a test. The results for the split-half test (r=0.82) and the Cronbach
coeffiecient a test proved the instrument to be reliable ( g =0.902).

Data Collection Procedures

Prior to data collection, the Institutional Intemal Review Board exempted
this study from further review. Subjects were contacted via Facebook. Facebook

is a social networking site with over 400 million users. Facebook reports that 50%

34

of its active users log on to the network each day (Facebook, 2010). On the
Facebook web site, a Facebook event was created for potential subjects.
Participants (n= 161) with accounts on Facebook were added to the event. Each
participant that accepted the invitation to participate in the study was asked to
add other US Intercollegiate athletes from Trinidad and Tobago to this event. On
the page of the Facebook event, explicit instructions were posted (see Appendix
D). For example, athletes were told that their participation in this study was
voluntary and that they may choose to not respond to certain questions without
being penalized. By completing and returning the online survey, it was implied
that the athletes gave consent to participate in the study. The Facebook event
page contained a hyperiink to the survey, which was hosted by
surveymonkeycom. Facebook allowed the posting of a link to the questionnaire
for access by the Facebook event group members. On completion of the
questionnaire, each Trinidad and Tobago athlete was asked to fonNard the link to
one/ two American teammate(s) or add that teammate to the Facebook group.
This will ensure that the American athlete was matched on sport and sex.
Individual Facebook messages were sent to all members of the event
group inviting them to participate in the study. Messages were also sent to
selected persons asking them to forward the message containing the invitation to
participate in this study to other Trinidad & Tobago athletes and also their
teammates. Follow up messages were sent out via Facebook on May 15‘, 2010.
The questionnaire was available for completion for one month: April 5, 2010 at

12:00pm through May 7, 2010 at 12:00pm. The questionnaire was stored on

35

SurveyMonkey.com and was available 24 hours a day for the one month testing
period. A link to the Survey Monkey questionnaire was placed on Facebook for
easy access by the subjects.

Data Analysis

Demographic information and scores from the survey were summarized
using descriptive statistics. The survey utilized numerical values for each Likert
scale response along the 5-point Likert scale to quantify the responses of the
participant. A point value of 5 represented very satisfied, a point value of 4,
represented moderately satisfied, a point value of 3, represented undecided/
neutral, a point value of 2, represented not satisfied, and a point value of 1,
represented very dissatisfied (Unruh 2005). A ‘yes’ response was weighted with
a score of 2, and a 'no’ response was weighted with a score of a 1 (Unruh 2005).
The cumulative scores for each question were calculated as well as the total
cumulative score for each athlete completing a questionnaire. A higher
cumulative score represented a higher level of perceived satisfaction with athletic
training services by the athlete(s). The mean cumulative scores of the
questionnaire were calculated for each group (US athletes and Trinidad and
Tobago athletes). A univariate analysis of variance (ANOVA) was performed to
determine differences in the athletes’ level of satisfaction with athletic training
services according to country of origin (Trinidad & Tobago vs. US), athletic
division (NCAA I, II, III, NAIA) and sex (male vs. female). The statistical
significance level was set prior at p<0.05. The frequency of responses for each

question was also calculated along with the mean and median value for each

36

question. Data was analyzed using the Statistical Package for the Social
Sciences (SPSS) 17.0 software.
Study 2

Research Design

The research design of the second study was very similar to that of the
first study. This study used the same questionnaire as the first study. The
independent variables for this study were 1) sex of athletic trainer and 2) rank/
title of the athletic trainer. The dependent variable was the athletes’ satisfaction
with athletic training services as measured by the Athletic Training Patient
Satisfaction Questionnaire. The athletes’ sex, sport and division of play were
controlled for this study.

Subjects

Subjects were recruited from field hockey teams competing in the NCAA
Division I. The Associate Head Coach of field hockey at Michigan State
University, Mrs. Helen Knull emailed the recmitment letter for Study 2 to all
NCAA l field hockey coaches. The email also contained a link to electronic
questionnaire located on surveymonkey.com. The coaches were asked to
fonivard the email to their athletes. There are 1,678 field hockey student-athletes
on the roster of 79 NCAA | teams. There were 163 surveys submitted in Study 2;

the response rate was 10%.

37

Instrumentation

The questionnaire used in this study was the same as the one used in the
first study. Only the demographics section was altered to accept more countries
of citizenship and collect data on the athletic trainer.

Data Collection Procedures

The Associate Head Coach for field hockey at Michigan State University,
Mrs. Helen Knull, was asked to send an email to all coaches and assistant
coaches for Division I field hockey teams requesting their help in the completion
of the Athletic Training Patient Satisfaction Questionnaire. The emailed contained
a link to the questionnaire on survey monkey and asked the coaches to fonivard
this link to the members of their field hockey teams. The data collected in study 2
was stored and analyzed separately to the data collected in the first study. The
testing schedule for the second study was April 22 - May 18.

Data Analysis

The collected data was analyzed using the same methods as the first
study. A univariate analysis of variance (ANOVA) was performed to determine
differences in the athletes’ level of satisfaction with athletic training services
according sex (male vs. female) and experience of the athletic trainer. The
statistical significance level was set prior at p<0.05. Data was analyzed using the

Statistical Package for the Social Sciences (SPSS) 17.0 software.

38

CHAPTER 4
RESULTS

Introduction

In this chapter, you will find demographic data and the results of the
statistical analysis performed on the data collected using the Athletic Training
Patient Satisfaction Questionnaire for both studies. The results of this study will
be presented in two parts: Study 1 and Study 2. The results of Study 1 will focus
on the examination of the hypothesis and exploratory questions 1 and 2; while
the results of Study 2 shall provide answers to exploratory questions 3 and 4.
Study 1

Demographic Data

At the end of the testing schedule, 54 subjects completed the Athletic
Training Patient Satisfaction questionnaire. After perusal of the data, 16 athletes
were excluded from data analysis due to the following: Country of citizenship (4),
incomplete questionnaires (7), student-athletes from athletic divisions not
included in study (4), the responses from NCAA Division III athletes were not
analyzed as there was only one completed survey. The completed
questionnaires of 38 student-athletes were analyzed in study 1. The majority of
these athletes represented NCAA Division I (N=20), followed by NCAA ll (N=12),
and NAIA (N=6) (see Table 1). A total of 22 males and 16 females volunteered
for the study (see Table 2). These student-athletes were members of several
sports teams (field hockey, track 8. field, soccer, swimming/diving) and were at

different years in their academic careers (see Table 3 and 4 respectively). Of the

39

38 student-athletes in the sample population, only 2 reported that they have

never visited with their athletic trainer (see Table 5). The same number of male

and female athletic trainers worked with the sample of student-athletes (see

Table 6). Staff and graduate assistant athletic trainers were the popular

representation of athletic trainers for this sample of student-athletes (see Table

7). Most of these athletic trainers traveled to all competitions (see Table 8).

TAB LE 1: Percentage of Trinidad and Tobago and American Student-Athletes in
the Sample Population Representing NCAA Divisions

 

 

 

 

 

 

 

 

NCAA Number of Percent Number of Percent
Division Particitgnts Participants
Trinidad & Tobago USA
I 15 51.7% 5 55.6%
ll 8 27.6% 4 44.4%
NAIA 6 20.7% 0 0.0%
TOTAL 29 100.0% 9 100.0%

 

 

 

TABLE 2: Distribution of Student-A thletes according to Sex, Athletic Division and

 

 

 

 

 

Country of Origin
NCAA Trinidad 8 Tobago Athlete USA Athlete
Division Female I Male Female 1 Male
l 5 10 2 3
ll 3 5 4 0
NAIA 2 4 0 0
Total 1 0 1 9 6 3

 

 

 

40

TABLE 3: Distribution of Athletes according to Sports Team, Sex and Country of

 

 

 

 

 

 

 

Origin
Sport Trinidad 8. Toba o Athlete USA Athlete

Team Female Male Female Male
Field hockey 1 0 0 0
Track/Field 4 3 2 3
Soccer 3 1 6 4 0
Swimming/Diving 2 0 0 0
Total 10 19 6 3

 

 

TAB LE 4: Distribution of Athletes according to Year in School, Sex and Country

 

 

 

 

 

 

of Origin
Year Trinidad & Toba o Athlete USA Athlete
In School Female Male Female Male
Graduated 1 I 2 0 0
1 0 3 0 0
2 2 3 2 3
3 2 5 2 0
4 5 4 2 0
5 0 2 0 0
Total 1 0 1 9 6 3

 

 

 

41

TABLE 5: Distribution of Athletes according to Frequency of visits to their Athletic
Trainer, Sex and Country of Origin

 

 

 

 

 

 

Visits to ATC Trinidad & Toba o Athlete USA Athlete
Female T Male Female Male
Once per
Week 3 5 1 1
2-3 visits
Per Week 0 5 2 0
Once per
Month 4 6 1 1
Everyday 3 2 1 1
Never 0 1 1
0
Total 1 0 1 9 6 3

 

 

 

TAB LE 6: Distribution of Athletes according to Athletic Trainer Sex, Athlete Sex
and Country of Origin

 

 

 

 

 

 

ATC Trinidad & Toba o Athlete USA Athlete

Sex Female Male Female Male
Female 5 7 6 1

Male 5 12 O 2

Total 10 19 6 3

 

 

 

42

TABLE 7: Distribution of Athletes according to Athletic Training Rank/ Title, Sex
and Country of Origin

 

 

 

 

 

 

Visits to ATC Trinidad & Toba o Athlete USA Athlete
Female Male Female Male
Undergraduate
AT Student 0 4 0 0
Graduate
Assistant 5 2 4 1
Staff
Athletic Trainer 4 12 2 2
Intern Athletic 0 0 0 0
Trainer
Don’t Know 1 1 O 0
Total 10 19 6 3

 

 

 

TABLE 8: Distribution of Athletes according to Athletic Training Travel, Sex and
Country of Ori in

 

 

 

 

 

 

Does Your Trinidad & Toba o Athlete USA Athlete
ATC Travel to Female Male Female Male
Competitions
Yes 4 1 3 5 3
No 5 3 0 0
Some
Competitions 1 3 1 0
Total 10 19 6 3

 

 

 

43

Athletic Training Patient Satisfaction Questionnaire

The means for the responses for the Athletic Training Patient Satisfaction
Questionnaire broken down by question and country exhibited a pattern of right
skewness (See Appendix E). On a 5 point Likert scale (1 =very dissatisfied, 2:
not satisfied, and, 3=undecided/ neutral, 4: moderately satisfied, 5= very
satisfied), more subjects selected the “4= moderately satisfied and 5= very
satisfied” compared to the “1 =very dissatisfied, 2: not satisfied “options. Also, the
mean score of each independent variable group was above 80% (164) of the
maximum achievable score with the exception of the NAIA athletic division which
had a cumulative mean score of 164 (see Table 9). These results demonstrated
a pattern of satisfaction among the student-athletes completing the
questionnaires for this study for the athletic training services provided by their
athletic trainer.

However, the results of a univariate analysis of variance revealed no
significant difference between citizen (p=.50), NCAA Divisions (p=.461), and sex
(p=.169) (see Table 9) of the athletes in their athletic trainer patient satisfaction.
Specifically, hypothesis 1 was supported as there were no difference in level of
satisfaction in athletic training services between US based student-athletes
originating from Trinidad and Tobago and US student-athletes. However,
exploratory questions 2 and 3 were not supported as there were no significant
differences in the level of satisfaction in athletic training services between NCAA
divisions and sex of the athlete. It should be noted that the observed power of the

citizenship, NCAA division and sex was 0.101, 0.172 and 0.276 respectively.

44

TABLE 9: Mean Scores for the independent Variable {cups of Study 1

 

 

 

 

Independent variables Mean scores

Males 1 80.27

Females 1 66.38

TT 1 77.90

USA 1 58.38

NCAA 1 178.80

NCAA 2 173.00

NAIA 162.67

Study 2
Demographic Data

At the end of the testing schedule for Study 2, 10% subjects (n=163)
completed the Athletic Training Patient Satisfaction questionnaire. After perusal
of the data, 31 athletes were excluded from data analysis due to the following:
incomplete questionnaires or responses from student-athletes who did not
identify the rank/ title of their athletic trainer were not analyzed. The completed
questionnaires of 81% of the field hockey respondents (n=132) were analyzed in
Study 2. The student-athletes were at different years in their academic careers
(see Table 10) and represented 6 countries with 92% of this population
representing the US (see Table 11). Of the 132 student-athletes, 8% reported
that they have never visited with their athletic trainer (see Table 12). There were

more female athletic trainers than males (see Table 13) and most of these

45

athletic trainers (82%) traveled to all competitions (see Table 14). Staff (67%)
and graduate assistant athletic trainers (22%) were the popular representation of

athletic trainers for this sample of student-athletes (see Table 16).

TABLE 10: Distribution of Athletes according to Year in School

 

 

 

 

 

Years in School 1 2 3 4 5
Number of
Athletes 37 44 35 1 5 1
Percentage of
Athletes 28 33 27 1 1 1

 

TABLE 11: Distribution of Athletes According_to Country of origin

 

 

 

 

 

Country Number of Percent
Participants
Australia 2 2
Barbados 1 1
England 2 2
Netherlands 2 2
New Zealand 2 2
South Africa 1 1
USA 1 21 92

 

TABLE 1 2: Distribution of Athletes according to Number of Visits to A TC

 

 

 

 

Visits to Once per 2-3 Visits per Once per
ATC Week Week Everyday Month Never
Number of
Athletes 37 25 30 30 10
Percentage 28 1 9 23 23 8

 

46

TABLE 1 3: Distribution of Athletes accordingto Sex of Athletic Trainer

 

 

ATC Sex Female Male
Number of

Athletes 96 36
Percentage 73 27

 

 

TABLE 14: Distribution of Athletes according to Athletic Trainer Traveling to

 

 

Competitions
Does your ATC travel to all Some
Competitions? Yes No Competitions
Number of Athletes 108 9 15
Percentage 82 7 1 1

 

 

 

TABLE 1 5: Distribution of Athletes according to Athletic Trainer Title

 

 

 

Graduate
ATC Title Undergrad Assistant Staff ATC Intern ATC
Number of
Athletes 9 29 88 6
Percentage 7 22 67 5

 

 

Athletic Training Patient Satisfaction Questionnaire

Similarly to Study 1, the results for Study 2 also demonstrated a pattern of
satisfaction among the student-athletes completing the questionnaires for the
athletic training services provided by their athletic trainer. The cumulative mean
score for the responses of each independent variable group was above 80%
(164) of the maximum achievable score (see Table 16).

However, the univariate analysis of variance revealed no significant
difference in the level of satisfaction in athletic training services between the sex
of athletic trainers (p=.169), or according to the rankl title of the athletic trainer
(p=.297) (see Table 16). For the exploratory questions 3 and 4 no significant

47

difference in satisfaction with athletic training services were observed. The title
(p.297) and sex (p=.169) of the athletic trainer did not affect the student -athlete
level of satisfaction with their athletic trainers. It should be noted that the

observed power of the athletic trainer rankl title and athletic trainers’ sex were

 

 

0.326 and.0069 respectively.
TAB LE 16: Mean Scores for the independent Variable groups of Study 2
Independent variables Mean scores
Males (ATC) 178.06
Females (ATC) 1 78.79
Athletic Training Student 175.11
Graduate Assistant ATC 188.31
Staff ATC 175.47
Intern ATC 182.67

 

 

48

CHAPTER 5
DISCUSSION
3 Introduction

The results of the Study 1 showed a pattern of satisfaction with athletic
training services among the student-athletes completing the Athletic Training
Patient Satisfaction Questionnaire. The null hypothesis for Study 1 was
supported; no significant differences were found in the level of satisfaction with
athletic training services among student-athletes from different countries:
Trinidad and Tobago and USA. Furthermore, no significant differences in the
level of satisfaction with athletic training services were observed between NCAA
divisions, athletes’ sex. Also, in Study 2 no significant differences in the level of
satisfaction with athletic training services were observed between athletic
trainers’ sex or according the rankl title of their athletic trainer.

Study 1

The results of the current study found that while the student-athletes were
generally satisfied with athletic training services; there were no significant
differences in satisfaction with these services between American student-athletes
and Trinidad and Tobago student-athletes participating in US Intercollegiate
athletics. Similarly, Unruh (1998), Unruh et al. (2005) and Maresh and Peterson
(2007) also found a general pattern of student-athletes being satisfied with their
athletic training services. However, no studies have explored the effect of cultural

background on the perception of satisfaction with athletic training services.

49

There are several possible reasons why American student-athletes and
Trinidad and Tobago student-athletes participating in US Intercollegiate athletics
have similar levels of satisfaction with their athletic trainer. First, it may be
possible that Trinidad and Tobago student-athletes are just as satisfied as
American student-athletes due to both groups currently having access to this
sports medical care. These athletes recognize the importance of having a
professional to coordinate the healthcare services for the student-athletes.
Second, athletic trainers are skilled professionals who complete a standardized
educational process from an accredited program and pass a board certification
program. The Commission on Accreditation of Athletic Training (CAATE)
continuously monitors and evaluates athletic training education programs
(ATEPS) to ensure that all accredited programs are following CAATE guidelines.
Accredited athletic training education programs must follow CAATE’s guidelines
to maintain their accreditation. It can be assumed that certified athletic trainers
will have similar knowledge and at least a minimal standard ability to perform
their duties as an athletic trainer. Thus, athletes should show similar pattems in
satisfaction with athletic training services. The practice of athletic training is also
standardized as all certified athletic trainers are required to maintain the BOC
Standards of Professional Practice. Specifically, Code 1.1 reads, “the athletic
trainer of applicant renders quality patient care regardless of the patient’s race,
religion, age, sex, nationality, disability, social/ economic status or any other

characteristic protected by law". Therefore, no significance difference in levels of

50

satisfaction with athletic training services should be observed between athletes of
different nationalities.

The findings from this study also found no significant differences between
the level of satisfaction in athletic training services between NCAA divisions. In
concordance with these findings, Unruh (1998) and Unruh et al. (2005) did not
find a significant difference between the athletic divisions in their studies.
Specifically, according to Unruh (1998) and Unruh et al. (2005) all students-
athletes who participated in their study belonged to low profile sport teams
(soccer, track & field, field hockey, swimming); therefore, they should have
similar perceptions of athletic training services. Also, as previously discussed, the
perception of care should not vary much across athletic divisions as all athletic
trainers should be providing a quality standard of care at all times.

No significant differences were observed in student-athlete’s level of
satisfaction with athletic training services according to the athlete” sex. In contrast
to this study, Unruh (1998) found “female athletes did not perceive their athletic
trainers as positively as did other athletes”. However, no numbers were given for
females participating in low profile sports. Their results may have been biased by
the female athletes completing in lower level profile sports. In the current study,
all athletes belong to low profile sports which were determined by the
requirements listed by Unruh (1998; 2005). Therefore, no difference in levels of

satisfaction would be observed in the current study.

51

Study 2

In regard to athletic trainers’ sex, there were no significant differences
between the levels of satisfaction with athletic training services. In contrast,
Drummond et al. (2007) found the athletes’ comfort levels significantly varied
between treatments by male and female athletic trainers. The differences in
comfort levels were also specific to sex related injuries and conditions. However,
the current study investigated student-athletes’ satisfaction with the service
provided by athletic trainers. There are no questions that examined the comfort
level with the male athletic trainer compared to the female athletic trainer. There
are also no questions that examined the student-athletes’ satisfaction with the
athletic training services when the injury or condition is sex specific. Moreover,
Drummond et al. never questioned the student-athletes’ level of satisfaction with
the athletic training service. It is a possibility that an athlete can be uncomfortable
when interacting andl or receiving treatment from the athletic trainer, but satisfied
with the outcome of the service.

Clinical Implications for Athletic Trainers and Athletes

As the NATA seeks to globalize the profession of athletic training; the
results of the current study demonstrates that there may be a market for athletic
trainers in Trinidad and Tobago. The results of this study showed that the
student-athletes (US, Trinidad & Tobago) experienced a similar quality of athletic
training services across sexes, citizenship (US, Trinidad & Tobago) and NCAA
athletic divisions. Similarly to Ato Boldon, the student-athletes from Trinidad and

Tobago demonstrated satisfaction with athletic training services. In comparison

52

to student-athletes from the US, there were no significant differences in this level
of satisfaction. The results also lend support to the current athletic training
education policies that are involved in the mass production of athletic trainers.
Therefore, the athletic training service and education seems to be ready for
exportation to Trinidad and Tobago.

Limitations of Study

One limitation of this study is that we had to rely on the honest and
unbiased completion of the questionnaires by the student-athletes. The study
was also limited as the Facebook event gathered poor support as many people
either declined or simply ignored the invitation to join the event. Facebook
messages were also sent to all potential subjects. However, Facebook has an
anti-spam feature which alerted me that l was sending too many messages and
threatened to shut down my Facebook account if I did not slow my messaging
activity. This slowed down my recruitment of subjects but I was able to escape
this feature by recruiting Trinidad and Tobago athletes to send emails to their
peers on my behalf.

Although, the procedure for this study was easy to implement; the subject
response was quite poor. The poor response achieved by this study was
understandable as there was little or no incentive to join the Facebook event or
complete the Athletic Training Patient Satisfaction Questionnaire. It easy for
potential subjects to decline or ignore the invitation to participate in this study as
a Facebook user receives many invitations every day on their account. However,

I still believe that the procedures used in this study could work in future research,

53

but there is a definite need for strong incentive especially when the subject pool
is not clearly defined. Research using a Facebook event to distribute
questionnaires would work better if the study had subjects whom had already
agreed to participate in the study or if there was someone at each location to
follow up with the subjects.

We must also note that the observed power for each result was very poor.
No power values were calculated before the commencement of this study. The
study used a convenient sample which resulted in a small sample size. This
small sample size will negatively affect the power of the study and increase the
risk of a type 2 error. Thus, the results of this study cannot be applied to the
general population represented by the sample. Also, each group within the
independent variables contained a different number of subjects. This inequality
between the groups could lead to an unequal weighting of the responses and a
bias against the bigger groups

Future Research

There is need for the continuance of studies such as this one. Future
researchers can continually evaluate the perception of the athletic training
service across different populations including patients at clinics, high schools and
universities/ clinics. As the world changes, studies like this one will also help the
athletic training profession to stay current with the needs of its customers. This
study could also be expanded to include more nationalities and investigate the
interaction between different variables such as sex and low profile sports or

athletic division and high profile sports.

54

Conclusions

The results of this study found that both groups of student-athletes
(Trinidad & Tobago and United States of America) expressed similar satisfaction
levels with athletic training services. As a result, athletic training may prosper in
Trinidad and Tobago. In addition, the sex and experience of the athletic trainer
do not seem to affect the level of satisfaction with athletic training services
experienced by athletes from both Trinidad and Tobago and America. Finally,
the NCAA Division I field hockey athletes exhibited satisfaction with athletic

training services regardless of the athletic trainers sex or experience level.

55

APPENDICES
Table 17

Appendix A: The Member Organizations of World Federation of Athletic Training
and Therapy

 

 

 

 

 

 

 

 

 

Name Country
CHARTER MEMBERS
Association of Chartered Physiotherapists United kingdom
in Sports Medicine
Biokinetics Association of South Africa South Africa
Canadian Athletic Therapists' Association Canada
Japan Sports Association Japan
Japan Athletic Trainers' Organization Japan
National Athletic Trainers' Association USA
Taiwan (Republic of China) Athletic Taiwan (ROC)

Trainers' Society

 

 

 

MEMBERS
Board of Certification (BOC) USA
Federazione Italiana Fisioterapisti Italy

 

Japan
Japan Athletic Trainers' Association for

Certification

 

 

 

 

56

TABLE 17 (CONT’D)

 

 

 

Korean Association of Certified Exercise Korea
Professionals
Ontario Athletic Therapists' Association Canada
Spanish Association of Sport Nurses Spain

 

Society of Tennis Medicine and Science

 

 

 

University of Bedfordshire United Kingdom
Korean Athletic Trainers' Association Korea
Japan Amateur Sports Association Japan

 

EDUCATIONAL INSTITUATION MEMBERS

 

The University of Texas Health Science USA

Center at San Antonio

 

 

 

Purdue University USA
Weber State University USA
University of Wisconsin - La Crosse USA

 

 

 

 

57

Table 18

Appendix B: Trinidad 8 Tobago Olympic Committee ’3 Affiliation with 37

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Organizations
SPORT AFFILIATE j

ATHLETICS National Amateur Athletics Association of Trinidad 8 Tobago I
32333 g M National Ballroom Dance Association of Trinidad 8 Tobago
BADMINTON Trinidad 8 Tobago Badminton Association

BASKETBALL National Basketball Federation of Trinidad 8 Tobago

BOBSLEIGH Trinidad 8 Tobago Bobsleigh Federation

BOXING (Amateur) Trinidad and Tobago Amateur Boxing Association

CANOE/Kayak Trinidad 8 Tobago Canoe/Kayak Association

(BDFOIIBEREACT Trinidad 8 Tobago Contract Bridge Association

CHESS Trinidad 8 Tobago Chess Association

CRICKET Trinidad 8 Tobago Cricket Board

CUE SPORTS Trinidad 8 Tobago Cue Sports Foundation ]
CYCLING Trinidad 8 Tobago Cycling Federation

DARTS Trinidad 8 Tobago Darts Association

EQUESTRIAN Trinidad 8 Tobago Equestrian Association I
FIGURE SKATING Trinidad 8 Tobago Figure Skating Association J
FOOTBALL Trinidad & Tobago Football Federation J
GYMNASTICS Trinidad 8 Tobago Gymnastics Association I
iHOCKEY Trinidad 8 Tobago Hockey Board

JUDO Trinidad 8 Tobago Judo Association

KARATE Trinidad 8 Tobago Karate Union ]
NETBALL Trinidad 8 Tobago Netball Association Inc. |
PARALYMPICS Paralympic Organization of Trinidad and Tobago I
PIGEON RACING National Pigeon Racing Commission of Trinidad and Tobago j
gRlFLE Trinidad Rifle Association ]
EggngALL Trinidad & Tobago Rugby Football Union
{SAILING Trinidad 8 Tobago Sailing Association
iSNOWSPORTS Trinidad 8 Tobago Snowsports Federation l
SQUASH Trinidad 8 Tobago Squash Association J

58

Table 18 (Cont’d)

 

 

 

 

 

 

 

 

 

 

 

SWIMMING Amateur Swimming Association of Trinidad and Tobago
TABLE TENNIS Trinidad 8 Tobago Table Tennis Association

TAE KWON DO TAE KWON DO

”TARGET .. .
ARCHERY Trinidad and Tobago Target Archery Federatlon
TENNIS Tennis Association of Trinidad and Tobago
TRIATHLON Trinidad and Tobago Triathlon Association
VOLLEYBALL Trinidad and Tobago Volleyball Federation
WEIGHTLIFTING Trinidad and Tobago Weightlifting Association
WUSHU Wushu Association of Trinidad and Tobago

 

 

59

Appendix C: Athletic Training Patient Satisfaction Questionnaire
(Provided through kind courtesy of Dr. Scott Unruh)

This questionnaire is part of a study to research the satisfaction of care provided
to intercollegiate student-athletes by their athletic trainers. Your participation is
requested. Nowhere on this questionnaire will you be identified and all of the
information you provide will be kept anonymous. Answering this questionnaire
indicates your consent to participate.

Indicate Country of citizenship (please select one)
Trinidad 8 Tobago USA Other

Sport in which you participate (please select one)
Track 8 Field
Soccer (football)
Swimming
Field Hockey
Basketball
Other

 

Year in School (please select one)
1 2 3 4 5

 

What is your sport’s athletic division (please select one)
NCAA Division I NCAA Division II NCAA Division III NAIA Other

Sex (please select one) Male Female

How often do you visit your athletic trainer? (please select one)
1 x Week
2-3 times per week
1 per month
Every day
Never

What is the sex of the athletic trainer who is in charge of your sport?( please
select one)
Male Female I don’t have an athletic trainer

60

My athletic Trainer is (please select one)
Undergraduate Student
Graduate Student
Intern
Staff (not in school)
N/A

Please select the response that best suits your satisfaction with your primary
athletic trainer(s) and the services they provide.

VS= Very Satisfied, MS= Moderately Satisfied, U= Unsure, NS= Not
Satisfied, VD= Very Dissatisfied.

 

 

 

 

 

 

 

(1) I am with the quality of care provided by my athletic trainer.
VS MS U NS VD
(2) I am with the courtesy shown to me as an athlete by my
athletic trainer.
VS MS U NS VD
(3) I am that my athletic trainer provides a safe environment.
VS MS U NS VD
(4) I am with the knowledge demonstrated by my athletic
trainer regarding my injuries.
VS MS U NS VD
(5) I am with the terms my athletic trainer uses when
explaining my injury to me.
VS MS U NS VD
(6) I am with the level of confidentiality demonstrated by my
athletic trainer concerning my medical information. .
VS MS U NS VD
(7) I am with my athletic trainers’ method for proper
rehabilitation of athletic injuries.
VS MS U NS VD

61

(8) I am that the answers to my questions provided to me by
my athletic trainer are accurate.

 

 

 

 

 

 

 

 

VS MS U NS VD
(9) I am that my athletics trainer views each injury equally
important.

VS MS U NS VD
(10) I am with how my athletic trainer demonstrates
appropriate concern for my feelings and emotions following an injury.

VS MS U NS VD
(11) I am with amount of time it takes for an athletic trainer to
approach me for consultation once I enter the athletic training room.

VS MS U NS VD
(12) I am with the level of concem my athletic trainer
expresses about each injury regardless of how many I have had in the past.

VS MS U NS VD
(13) I am with my athletic trainers’ initial response time to my
injury during a practice or game.

VS MS U NS VD
(14) I am that the location of my athletic trainer during
practice is such that he/she is capable of responding quickly and properly to an
injury.

VS MS U NS VD
(15) I am with the athletic training room hours prior to
practice/competition.

VS MS U NS VD
(16) I am with my athletic trainers control of emergency
sfiuafions.

VS MS U NS VD

62

(17) I am with my athletic trainers utilization of other athletic
trainers or other medical professionals when he/she is unsure of an injury.

 

 

 

 

 

 

 

 

 

VS MS U NS VD
(18) I am with my athletic trainers’ explanation of the opinions
provided by the physician.

VS MS U NS VD
(19) I am with the time lapsed between when I am referred to
see a physician until the time I see the physician.

VS MS U NS VD
(20) I am with the clarity of language in which my athletic
trainer uses when explaining the nature of my injury to me.

VS MS U NS VD
(21) I am with the level of concern my athletic trainer portrays
toward each athlete no matter what sport they are in.

VS MS U NS VD
(22) I am with the quality of care provided to each athlete no
matter what gender they are.

VS MS U NS VD
(23) I am that the time my athletic trainer takes to get to
practice is appropriate to provide proper medical supervision.

VS MS U NS VD
(24) I am with the amount of medical supplies provided for
use by athletic trainers.

VS MS U NS VD
(25) I am that my athletic trainer provides me with the
information I need to prevent re-injury after sustaining an initial injury.

VS MS U NS VD
(26) I am with the availability of my team physician.

VS MS U NS VD

63

 

(27) I am with the time it takes from when I get injured until
the time the coaching staff is aware of my injury.

 

 

 

 

 

 

 

 

VS MS U ' NS VD
(28) I am with the conduct in which my athletic trainer carries
him/herself.

VS MS U NS VD
(29) I am with the rehabilitation techniques provided to me by
my athletic trainer.

VS MS U NS VD
(30) I am with the level of respect my athletic trainer gives
me.

VS MS U NS VD
(31) I am with the assessment process my athletic trainer
uses to evaluate my injuries.

VS MS U NS VD
(32) I am with the treatment my athletic trainer uses to
rehabilitate my injury.

VS MS U NS VD
(33) I am with how my athletic trainer communicates with my
coaching staff about my illness or injury condition.

VS MS U NS VD
(34) I am with the amount of time spent from injury onset to
when I see an appropriate medical professional.

VS MS U NS VD
(35) I am with my athletic trainer's skill in various taping and

 

wrapping techniques.

64

 

Please select Y (Yes) or N (No). Your response should represent your
satisfaction with your athletic trainer(s) and the services they provide.

(36) My athletic trainer brings enough medical supplies when the team is on the
road.
Y N

(37) I am confident that my athletic trainer is competent and knowledgeable.
Y N

(38) I feel comfortable when approaching my athletic trainer about injuries or
iHness.
Y N

(39) I am satisfied with the way my athletic trainer personally treats me.
Y N

(40) I am satisfied that my athletic trainer is truly interested in helping me fully
recover from my injury in a timely fashion so that I can return to competition.
Y N

(41) I feel my athletic trainer is competent with new uses of treatments.
Y N

(42) I am satisfied with my athletic trainer’s desire to become a better athletic
trainer.

Y N
(43) My athletic trainer is present and in position to assist me in the event that I
am injured.

Y N

(44) My athletic trainer is knowledgeable with current trends in athletic training.
Y N

(45) All of the athletic trainers trust one another to property assist me as an
athlete.
Y N

(46) I am satisfied with the quality of care I receive in the training room.
Y N ’

(47) The training room is equipped with the necessary tools for quality care.
Y N

65

 

(48) I am confident in the athletic trainer’s decision to remove me from a game
or practice due to my injury or illness.
Y N

(49) I am satisfied with the training room hours of availability to athletes prior to
practice or competition.
Y N

(50) Overall, I am satisfied with the athletic training services.
Y N

 

66

Appendix D: Recruitment Letter

Dear Student-Athlete:

I am a Michigan State University master’s degree candidate from the Republic of
Trinidad 8 Tobago. I am requesting your assistance to complete my thesis titled: “Does
the Country of Origin of Collegiate Student-Athletes’ affect their Satisfaction with Athletic
Trainers: Trinidad 8 Tobago Athletes vs USA Athletes”. To assess how the collegiate
student-athletes' country of origin affects their satisfaction with athletic training services;
an Athletic Training Patient Satisfaction Questionnaire will be distributed to collegiate
student-athletes across the US. The questionnaire contains 59 questions: 9 introduction
questions, 35 questions designed to accept answers on a 5 point Likert scale and 15
questions with “yes” or “no” answers. The questionnaire is based on the Board of
Certification Delineation Study which describes the, services an athletic trainer should
provide to their athlete/ patient.

There are no identifying questions on this survey. Your responses will be
returned to the survey website as anonymous data. You will indicate your voluntary
agreement to participate in this research by completing and submitting the survey. If you
choose to participate you may chose to not answer certain questions or withdraw at any
time without consequence. You must be 18 or older to participate in this research study.

Please click on the link below to begin the survey. The survey will take you
approximately 10 minutes to complete. Your participation in this study is confidential.
The results of this study may be published in a peer-reviewed journal; however any
information that could identify you will not be included. This study has been approved by
the human subjects committee at Michigan State University. Any questions about this
study may be addressed to either myself or to the undergraduate Athletic Training
Program Director, Dr. Tracey Covassin, Ph.D., ATC at 517-353-2010. Thank you for
your participation and support.

httoszllwwwsiurvevmonkevcom/s

Sincerely,

Jason Pilgrim, ATC
Graduate Assistant
Michigan State University
pilgrimj@msu.edu

67

Table 19

Appendix E: The means for the Athletic Training Patient Satisfaction
Questionnaire broken down by question and country

 

 

 

 

 

 

 

 

 

Question 1
Country N Mean SD (+I-) VD NS U MS VS
Trinidad 8 Tobago 29 4.34 0.77 0 1 2 12 14
USA 9 4.11 1.05 0 1 1 3 4
Question 2
Country N Mean SD (+l-) VD NS U MS VS
Trinidad 8 Tobago 29 4.52 0.95 1 1 0 7 20
USA 9 4.22 0.97 0 1 0 4 4
Question 3
Country N Mean SD (+I-) VD NS U MS VS
Trinidad 8 Tobago 29 4.62 0.56 0 0 1 9 19
USA 9 4.33 1.00 0 1 0 3 5
Question 4
Country N Mean SD (+l-) VD NS U MS VS
Trinidad 8 Tobago 29 4.17 0.97 0 3 - 2 11 13
USA 9 4.22 1.09 0 1 1 2 5
Question 5
Country N Mean SD (+I-) VD NS U MS VS
Trinidad 8 Tobago 29 4.45 0.74 0 1 1 11 16
USA 9 4.22 0.97 0 1 0 4 4
Question 6
Country N Mean SD (+I-) VD NS U MS VS
Trinidad 8 Tobago 29 4.24 1.06 0 3 4 5 17
USA 9 4.22 0.97 0 1 0 4 4
NOTE:

VD=very dissatisfied, NS= not satisfied, U=undecided/ neutral,
MS= moderately satisfied, VS= very satisfied)

68

 

Table 19 (Cont’d)

 

 

 

 

 

 

 

 

 

 

Question 7
Country N Mean SD (+I-) VD NS U MS VS
Trinidad 8 Tobago 28 4.11 0.96 0 3 2 12 1 1
USA 9 3.89 1.45 1 1 0 3 4
Question 8
Country N Mean SD (+l-) VD NS U MS VS
Trinidad 8 Tobago 27 4.19 0.74 0 1 2 15 9
USA 9 4.11 1.27 0 2 0 2 5
Question 9
Country N Mean SD (+l-) VD NS U MS VS
Trinidad 8 Tobago 29 4.07 1.03 0 2 8 5 14
USA 9 3.44 1.33 1 1 2 3 2
Question 10
Country N Mean SD (+l-) VD NS U MS VS
Trinidad 8 Tobago 29 4.14 1.06 0 4 2 9 14
USA 9 4.00 1.00 0 1 1 4 3
Question 11
Country N Mean SD (+I-) VD NS U MS VS
Trinidad 8 Tobago 29 4.00 1.13 0 6 0 11 12
USA 9 3.89 1.17 0 2 0 4 3
Question 12
Country N Mean SD (+l-) VD NS U MS VS
Trinidad 8 Tobago 29 4.24 0.95 0 2 4 8 15
USA 9 4.11 1.05 0 1 1 3 4
Question 13
Country N Mean SD (+l-) VD NS U MS VS
Trinidad 8 Tobago 29 4.28 0.96 0 3 1 10 15
USA 9 3.56 1.33 0 3 1 2 3
NOTE:

VD=very dissatisfied, NS= not satisfied, U=undecided/ neutral,
MS= moderately satisfied, VS= very satisfied)

69

 

Table 19 (Cont’d)

 

 

 

 

 

 

 

 

 

 

Question 14
Country N Mean SD (+I-) NS U MS VS
Trinidad 8 Tobago 29 4.48 0.83 2 0 9 18
USA 9 4.00 1.12 1 2 2 4
Question 15
Country N Mean SD (+l-) NS U MS VS
Trinidad 8 Tobago 29 4.31 0.66 1 0 17 11
USA 9 3.56 1.24 3 0 4 2
Question 16
Country N Mean SD (+l-) NS U MS VS
Trinidad 8 Tobago 29 4.52 0.63 0 2 10 17
USA 9 4.00 1.00 1 1 4 3
Question 17
Country N Mean SD (+I-) NS U MS VS
Trinidad 8 Tobago 29 4.48 0.78 0 5 5 19
USA 9 3.78 1.2 2 1 3 3
Question 18
Country N Mean SD (+l-) NS U MS VS
Trinidad 8 Tobago 29 4.48 0.83 1 3 6 19
USA 9 4.00 1.00 1 1 4 3
Question 19
Country N Mean SD (+I-) NS U MS VS
Trinidad 8 Tobago 29 4.00 1 .04 2 3 13 10
USA 9 3.44 1.51 2 1 2 3
Question 20
Country N Mean SD (+l-) NS U MS VS
Trinidad 8 Tobago 29 4.48 0.69 0 3 9 17
USA 9 4.1 1 0.93 1 0 5 3
NOTE:

VD=very dissatisfied, NS= not satisfied, U=undecided/ neutral,
MS= moderately satisfied, VS= very satisfied)

70

 

Table 19 (Cont’d)

 

 

 

 

 

 

 

 

 

 

Question 21
Country N Mean SD (+l-) NS U MS VS
Trinidad 8 Tobago 29 4.07 1.22 6 2 5 16
USA 9 3.67 1.32 3 0 3 3
Question 22
Country N Mean SD (+l-) NS U MS VS
Trinidad 8 Tobago 29 4.41 0.78 1 2 10 16
USA 9 3.78 1.39 3 0 2 4
Question 23
Country N Mean SD (+l-) NS U MS VS
Trinidad 8 Tobago 29 4.38 0.86 2 1 10 16
USA 9 4.00 1.22 2 . 0 3 4
Question 24
Country N Mean SD (+l-) NS U MS VS
Trinidad 8 Tobago 29 4.38 0.98 3 1 7 18
USA 9 3.89 1.45 1 0 3 4
Question 25
Country N Mean SD (+l-) NS U MS VS
Trinidad 8 Tobago 29 4.21 0.82 2 1 15 11
USA 9 3.67 1.58 2 0 2 4
Question 26
Country N Mean SD (+l-) NS U MS VS
Trinidad 8 Tobago 29 3.79 0.94 4 4 15 6
USA 9 3.25 1.49 2 1 2 2
Question 27
Country N Mean SD (+l-) NS U MS VS
Trinidad 8 Tobago 29 4.41 0.87 2 1 9 17
USA 9 3.78 1.09 2 0 5 2
NOTE:

VD=very dissatisfied, NS= not satisfied, U=undecided/ neutral,
MS= moderately satisfied, VS= very satisfied)

71

 

Table 19 (Cont’d)

 

 

 

 

 

 

 

 

 

 

Question 28
Country N Mean SD (+I-) NS U MS VS
Trinidad 8 Tobago 29 4.55 0.74 1 1 8 19
USA 9 4.22 0.97 1 0 4 4
Question 29
Country N Mean SD (+I-) NS U MS VS
Trinidad 8 Tobago 29 4.38 0.78 1 2 11 15
USA 9 3.78 1.39 1 0 4 3
Question 30
Country N Mean SD (+I-) NS U M8 vs
Trinidad 8 Tobago 29 4.66 0.55 0 1 8 20
USA 9 4.56 0.53 0 0 4 5
Question 31
Country N Mean SD (+l-) NS U MS VS
Trinidad 8 Tobago 29 4.52 0.63 0 2 10 17
USA 9 3.89 1.45 1 0 3 4
Question 32
Country N Mean SD (+l-) NS U MS VS
Trinidad 8 Tobago 29 4.26 0.81 1 3 11 12
USA 9 3.89 1.45 1 0 3 4
Question 33
Country N Mean SD (+l-) NS U MS VS
Trinidad 8 Tobago 28 4.07 0.98 3 3 11 11
USA 9 3.78 1.20 2 1 3 3
Question 34
Country N Mean SD (+I-) NS U MS VS
Trinidad 8 Tobago 29 4.17 0.89 2 3 12 12
USA 9 3.78 1.20 2 1 3 3
NOTE:

VD=very dissatisfied, NS= not satisfied, U=undecided/ neutral,
MS= moderately satisfied, VS= very satisfied)

72

 

Table 19 (Cont’d)

 

 

 

 

 

 

 

 

 

 

 

Question 35
Country N Mean SD (+I-) NS U MS VS
Trinidad 8 Tobago 29 4.59 0.73 1 1 7 20
USA 9 4.33 1.00 1 0 3 5
Question 36
Country N Mean SD (+l-) Yes No
Trinidad 8 Tobago 29 1.90 0.31 26 3
USA 9 1.89 0.33 8 1
Question 37
Country N Mean SD (+I-) Yes No
Trinidad 8 Tobago 29 1.90 0.31 26 3
USA 9 1.89 0.33 8 1
Question 38
Country N Mean SD (+I-) Yes No
Trinidad 8 Tobago 29 1.83 0.38 24 5
USA 8 1.75 0.46 6 2
Question 39
Country N Mean SD (+I-) Yes No
Trinidad 8 Tobago 29 1.9 0.31 26 3
USA 9 2.00 0.00 9 0
Question 40
Country N Mean SD (+I-) Yes No
Trinidad 8 Tobago 28 1.86 0.36 24 4
USA 9 2.00 0.00 9 0
Question 41
Country N Mean SD (+I-) Yes No
Trinidad 8 Tobago 29 1.83 0.38 24 5
USA 9 1.78 0.44 7 2
NOTE:

VD=very dissatisfied, NS= not satisfied, U=undecided/ neutral,
MS= moderately satisfied, VS= very satisfied)

73

Table 19 (Cont’d)

 

 

 

 

 

 

 

 

Question 42
Country N Mean SD (+I-) Yes No
Trinidad 8 Tobago 29 1.90 0.31 26 3
USA 9 1.78 0.44 7 2
Question 43
Country N Mean SD (+l-) Yes No
Trinidad 8 Tobago 29 1.90 0.31 26 3
USA 8 1.88 0.35 7 1
Question 44
Country N Mean SD (+I-) Yes No
Trinidad 8 Tobago 29 1.93 0.26 27 2
USA 9 1.78 0.44 7 2
Question 45
Country N Mean SD (+I-) Yes No
Trinidad 8 Tobago 29 1.79 0.41 23 6
USA 9 1.33 0.50 6 3
Question 46
Country N Mean SD (+I-) Yes No
Trinidad 8 Tobago 29 1.86 0.35 25 4
USA 9 1.67 0.50 6 3
Question 47
Country N Mean SD (+l-) Yes No
Trinidad 8 Tobago 28 1.79 0.42 22 6
USA 9 1.89 0.33 8 1
Question 48
Country N Mean SD (+l-) Yes No
Trinidad 8 Tobago 29 1.79 0.41 23 6
USA 9 1.67 0.50 6 3

 

 

74

 

Table 19 Cont’d

 

 

 

 

Question 49
Country N Mean SD (+l-) Yes No
Trinidad 8 Tobago 29 1.93 0.26 27 2
USA 9 1.67 0.50 6 3
Question 50
Country N Mean SD (+I-) Yes No
Trinidad 8 Tobago 29 1.83 0.38 24 5
USA 9 1.56 0.53 5 4

 

75

 

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