PERCEPTIONS OF THE ATHLETIC TRAINING PROFESSION BY A
COLLEGIATE ATHLETE PATIENT POPULATION
Introduction
Study of patient satisfaction within health care professions began in the mid-1900s.20
The motivation was to improve care by evaluating the quality of services from a patient’s
perspective. Quality health care service that promotes patient satisfaction contains two
components: technical performance and interpersonal relationship.21 Technical performance is
the knowledge used to arrive at the appropriate method of care and the skills used to implement
those methods. Interpersonal relationship is the display of virtues that are expected to meet
individual and social standards to allow for clear communication of necessary information to
reach a diagnosis.21 Evaluation and application of technical performance and interpersonal
relationship of health care service vary by health care setting based on the characteristics of care
provided.21
The health care setting of an athletic trainer is unique from other health care professions.
Athletic trainers specialize in treating the physically active population;1 this often requires being
present with student-athletes rather than having student-athletes come to them. The first and most
consistent contact a student- athlete has with the health care system at the professional, collegiate,
and high school level is an athletic trainer.2,3 As health care professionals, athletic trainers should be
concerned with patient satisfaction because they bridge the gap between the student-athlete and the
medical community.4 Athletic trainers provide student-athletes with their primary source of care and
connect the student-athlete to more health care providers when necessary.4 Patient satisfaction is
strongly linked to behavioral intentions which drive the success of health care professions.5,6 Thus, if
athletic training is going to progress as a profession, it is necessary to have an evaluation of patient
satisfaction to ensure long-term success and advancement.5,14
The alternative hypothesis being tested is that higher levels of patient satisfaction with
care received from a certified athletic trainer is related to positive perception ratings of the
athletic training profession. A thorough evaluation of patient satisfaction and its effect on an
athlete’s perception of athletic training will be assessed by administration of a questionnaire to a
collegiate student-athlete population.
History
The first research on patient satisfaction with athletic training services was published in
1989 by Foster; he studied the function of athletic trainers at the1985 Junior Olympic Games.22
Reliable and consistent research methods were not used, and grammatical and structural errors
were present throughout the article; nevertheless this research provides a foundation for future
studies on patient satisfaction in athletic training. The results of the study indicated that athletes
and physicians were pleased with the services athletic trainers provide and deem them a
competent, efficient member of the sports medicine team.22
Since 1989, few studies on patient satisfaction with athletic training care have been
published. Unruh is the lead author of two studies addressing collegiate athletes’ perception
and satisfaction with athletic training services.3,7 Unruh’s first study7 was published in 1998
and evaluates collegiate athletes’ perception of athletic training services. Unruh structured his
analysis according to gender, athletic division, and sport profile. High-profile sports include
men’s football, men’s and women’s basketball, and men’s baseball; all other sports are
considered low profile.7 Results indicate a significant difference between male and female
cumulative satisfaction scores, revealing that male athletes were more satisfied than female
athletes.7 Results also revealed a significant difference between sport profiles; athletes in high
profile sports are more satisfied with the care provided by their athletic trainers.7 No significant
difference was found between athletic divisions.7
Unruh’s second study3, published in 2005, focuses on athletes’ satisfaction with services
rendered by athletic trainers rather than the perception of these services.3 Both gender and sport
profile were found to have significant differences, and athletic division was not significant. In
contrast to his previous research,7 this study indicates that men in low profile sports are least
satisfied, and women in high profile sports are most satisfied.3 A potential reason for differences
in satisfaction between sport profiles could be staffing issues; if not enough staff is available, low
contact and profile sports may receive less care.3 Data collected in both of Unruh’s studies3,7
demonstrated that student-athletes, as a whole, are highly satisfied with the care they receive
from athletic trainers, but some student-athletes think their athletic trainers demonstrate different
levels of treatment to their student-athletes.7 Inconsistent treatment of student-athletes by athletic
trainers may cause athletes to have a warped perception of the entire profession.
As a follow-up to Unruh’s studies,3,7 Porterfield investigated whether gender, sport played,
or level of competition affects perception of care provided by athletic trainers in 2006. 8 Sport
played and level of competition had a significant effect on athletes’ perception of care while gender
did not.8 Though not organized by sport profile, sport played displayed significant differences and
sports that would have been deemed “high-profile,” according to Unruh,3,7 were found to be most
satisfied. Division II and Division III student-athletes were surveyed and Division III student-
athletes were significantly more satisfied than Division II. Unruh surveyed Division I and Division
II athletes,3,7 rather than Division II and Division III, which could cause the contradictory results
seen here. Unruh’s studies conflicted on which gender had higher levels of satisfaction3,7 and
Porterfield saw no significance in gender.8 Reasons behind the gender discrepancies may lie in
fewer number of subjects or the location of Porterfield’s research.8
In 2015, Foster furthered the investigation of patient satisfaction in athletic training but
also branched to investigate new ideas. He looked at the difference in satisfaction between
services rendered by full-time athletic trainers and graduate athletic trainers and what an athlete
identifies as the three most valuable qualities in an athletic trainer.4 Foster’s research
illuminates that athletes are satisfied with overall athletic training care, which is consistent with
previous research.3,7,8 Inadequate sample size caused skewed results in satisfaction between
full-time and graduate athletic trainers; more athletes who had primary exposure to graduate
athletic trainers were surveyed than those with primary exposure to a full-time athletic trainer.
Thus, the results of athletes being seven times more satisfied with graduate athletic trainers,
should be evaluated with caution. The top three valuable qualities selected by athletes include
knowledge, availability, and communication.4 While Foster advanced the knowledge of athletic
training patient satisfaction, the implementation of questions addressing full-time athletic
trainers compared to graduate athletic trainers and valuable qualities in an athletic trainer make
his research distinct from Unruh3,7 and Porterfield.8
The studies by Unruh, Porterfield, and Foster are pivotal when researching care rendered by
athletic trainers because they created a reliable foundation of information specific to athletic
training.3,4,7,8 Agreement exists that student-athletes have a high level of satisfaction with care
given by athletic trainers, but this result is not consistent among all athletic teams.3,4,8
Research in Other Professions
Health care professions such as physical therapy and physiotherapy are comparable to
athletic training because of their heavy focus on musculoskeletal conditions. Other health care
professions, such as physicians and nurses, are minimally comparable to athletic training
simply because of the broad difference in scope of practice. No matter the similarities or
differences, research on patient satisfaction in all health care professions can benefit research
in athletic training. Areas that other health care professions define as significant determining
factors of patient satisfaction should also be true of athletic training. These significant
determining factors include characteristics of patients, characteristics of health care providers,
and the fulfillment of expectations.
Characteristics of patients are influential on patient satisfaction because they affect
how patients understand and accept diagnoses and treatment.9,11,13 A patient’s age, health
status and education are all predictors of patient satisfaction, but they tend to be less impacting
predictors when compared to characteristics of health care providers.11,13
Characteristics of health care providers are influential because they also affect how
patients understand and accept diagnosis and treatment.9,11,13 Patient satisfaction with rendered
care is highly correlated to the quality of contact and communication between the health care
provider and patient.9,10 Patients tend to have lower levels of satisfaction when a health care
provider does not properly understand the pathology of a patient or what action is necessary to
address the condition.11,13 Patient satisfaction is negatively affected when health care providers do
not communicate in an appropriate and effective manner.11,13 To ensure patient satisfaction,
health care providers must sustain high levels of skill, knowledge, and communication.9
Satisfied patients tend to return to the same health care provider until they are no longer
satisfied with the care they receive or the provider can no longer meet their needs.10 Most health
care professions depend on these loyal patients to promote and sustain business.24 Athletic
training in the traditional setting (high school, college, professional) does not rely on typical
patient satisfaction factors because athletic trainers are assigned to teams or schools. The athletes
on these teams or at these schools do not have the option to choose a different athletic trainer if
they are not satisfied with the one assigned to them. Without the risk of decreasing patient
numbers and thereby diminishing business, do athletic trainers provide appropriate and
satisfactory care? Does their satisfaction with care affect how an athlete perceives the entire
profession?
Practice in Athletic Training
Athletic trainers traditionally care for athletes at the high school, collegiate, and professional
level but have extended to treating the physically active population in sport medicine clinics,
physician offices, and industrial plants.25 The five domains define the minimum skill and knowledge
required to practice as an athletic trainer according to the Board of Certification: injury/illness
prevention and wellness protection (Domain 1), clinical evaluation and diagnosis (Domain 2),
immediate and emergency care (Domain 3), treatment and rehabilitation (Domain 4), and
organization and professional health and well-being (Domain 5).26
Domain 1, injury/illness prevention and wellness protection, requires athletic trainers to
ensure safe performance and function by educating their patients and managing risk.26 Domain
2, clinical evaluation and diagnosis, involves implementing evaluation skills and developing a
clinical impression to direct course of action.26 Domain 3, immediate and emergency care,
necessitates the application of standard care procedures for “efficient and appropriate care” of an
injury.26 Domain 4, treatment and rehabilitation, encompasses reconditioning patients for ideal
performance and function.26 Domain 5, organization and professional health and well-being,
includes the adherence to approved organizational and professional practices and guidelines to
guarantee the well-being of the individual and organization.26
It is the athletic trainer’s duty to fulfill all five domains to meet the minimum
requirements of the profession.26 At the high school and collegiate setting, athletic trainers and
team physicians are responsible for the health of a team as a whole while also needing to
provide appropriate care for individual players.27 Meeting the requirements of the profession
can be difficult when faced with these two dynamics of care and the demands of a student-
athlete, coach, or parent.28
Athletic trainer-athlete rapport is important when making medical decisions and when
providing quality care.2 Athletes are more likely to communicate with their athletic trainer and
adhere to treatment and rehabilitation protocols when they have a good rapport with their
athletic trainer.29-31 To establish good athletic trainer-athlete rapport, athletic trainers must
demonstrate the characteristic of a “quality” athletic trainer: communication, compassion,
commitment, integrity, and knowledge.16
The five characteristics of a “quality” athletic trainer align with the two components of
quality service. Technical performance is based on the knowledge used to arrive at the
appropriate method of care and the skills used to implement those methods.21 Interpersonal
relationships allow for clear communication of necessary information to reach a diagnosis.21
Interpersonal care includes numerous virtues that are expected to meet individual and social
standards.21 Without the appropriate interpersonal care, a diagnosis is difficult to reach and
technical care is compromised. Interpersonal relationship is the “vehicle by which technical
care is implemented and on which its success depends.”21
A vital component of interpersonal care and characteristic of an athletic trainer is
communication.21 Communication is not only speaking but also listening. Athletes
communicate the necessary information to reach a diagnosis while athletic trainers diligently
listen.21 Upon reaching a diagnosis and determining the best avenue of care, athletic trainers
must then effectively communicate with athletes, parents, coaches, and physicians on levels
they understand.16 An athletic trainer should continually develop their communication skills to
help their athletes fully understand their injury and how it will be treated and
rehabilitated.29,31,32 The process of communication between athletes and their athletic trainers is
constantly evolving; maintaining a friendly, approachable, and trustworthy demeanor allows
athletic trainer-athlete communication to improve.29
Student-athletes are more likely to approach their athletic trainer when they know athletic
trainers care about them.16 Compassion and empathy are crucial components of interpersonal
relationships because it allows the student-athlete to know that their athletic trainer cares about
them.21 Compassion is a trait an athletic trainer can show by spending time listening to athletes
and providing them with hope and encouragement.2,16,33 By being compassionate and providing
emotional, physical, psychological, and social support to athletes, athletic trainers promote
stronger interpersonal relationships and enhance quality service.2,3,16,34,35
Commitment is a characteristic of interpersonal care that clears the path for open communication
and compassion.16,21 Athletic trainers show commitment by making themselves available to their
athletes at practice, competition, and in the athletic training facility.16 Athletes want to know that
their athletic trainer will always be there when they need them; it helps athletes view their
athletic trainer as dependable and trustworthy.16
Trustworthiness is not attained by commitment alone, but also integrity.16 Quality
athletic trainers never intentionally mislead their athletes or coaches by using vague dishonest
answers or explanations.16 An athlete will not trust an athletic trainer they believe has lied or
misled them.16 Integrity, the last characteristic of interpersonal relationships, is an essential
component of satisfaction in athletic training.16,21
Riding on the “vehicle” of interpersonal relationships, technical performance is based on
the knowledge used to arrive at the appropriate method of care and the skills used to implement
those methods.21 Athletic trainers have knowledge in a variety of areas and should strive to
secure more knowledge to advance the care they provide.16 Quality athletic trainers take
opportunities to share their vast knowledge, yet common athletic trainers tend to have difficulty
presenting their range of knowledge.16,36 By continually desiring to garner more knowledge and
share it with their patients, athletic trainers will advance their technical performance and
increase patient satisfaction.16,21
Satisfying the five domains of athletic training care and displaying high levels of
interpersonal care and technical performance by striving to embody all five characteristics of a
“quality” athletic trainer will ensure patient satisfaction in the athletic training profession. The
question remains, does patient satisfaction with services provided by athletic trainers affect
their view of the profession?
Athletic Population
Typical athletes at high school and collegiate institutions have one thing in common, their
drive to compete.27 The sports medicine team, including athletic trainers, is uniquely skilled in
aggressively treating athletes and returning them to play as quickly as possible.27Athletes who
have positive previous experience with athletic trainers tend to have higher expectations of their
athletic trainers concerning treatment, rehabilitation, and personal commitment.32 Athletes with
positive experience, along with those who have negative previous experience or no experience at
all, need their athletic trainers to be positive sources of support and effective
communication.29,32,35 Athletes claim to look to their athletic trainer as their primary means of
support and strength during the rehabilitation process.33-35 Athletes desire competition, but
athletic trainers cannot let that desire overshadow the overall health of an athlete.4 Disregarding
the support and encouragement athletes need for complete and effective recovery to focus on an
aggressive return to play criteria could result in re-injury and decrease athlete satisfaction,
resulting in a skewed perception of the profession.
Behavioral Intention
Behavioral intention is the action taken by a patient after receiving services and is
commonly identified as loyalty to a provider, recommending service, speaking positively about the
service and servicer, and willingness to pay more for the same services.6,15,17 Positive behavioral
intention promotes profitability and long-term success of health care professions because it is the
conclusive determinate of financial well-being in the health care system.5,6
Behavioral intention not only promotes success but can also reveal patient satisfaction.6
Research holds that patient satisfaction is of upmost importance when predicting behavioral
intention.6 If patients are satisfied, they are more willing to spread positive word-of-mouth.6 The
strong relationship between patient satisfaction and behavioral intention stresses the influence of
patient satisfaction on patient loyalty and success.5 Behavioral intention, when based on their
exposure to multiple professionals in the same health care profession, is a form of measuring
patient perception of an entire profession.
Conclusion
Athletic training is behind the curve when it comes to measuring and assessing patient
satisfaction. Research in other health care professions helps guide future studies on patient
satisfaction in athletic training because of the limited research currently available specific to
athletic training. More research on patient satisfaction in athletic training is necessary because
athletic training has a job description unique to any other health care profession and patient
satisfaction is the driving force behind behavioral intentions, which promotes profitability and
long-term success of a profession.5,6
The present study furthers the body of knowledge on collegiate student-athletes’
satisfaction with athletic training care by increasing the pool of student-athlete surveys. This
research is different from previous studies because it provides athletic trainers with a better
understanding of how the care they provide affects a patient’s perception of the athletic
training profession.
