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The purpose of this qualitative Participatory Action Research study was to describe key school stakeholders' perceptions of their current concussion management processes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Seventeen focus groups, two dyad, and nine individual interviews were conducted with stakeholders (<jats:italic>n<\/jats:italic>\u2009=\u200995) from six secondary schools and healthcare clinics, exploring their perceptions of barriers and facilitators to concussion management. We used thematic analysis to analyze data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Our analysis identified five overarching and inter\u2010relating themes: Hit or miss, the need for a clear pathway; the school context; aligning attitudes and enacting values; concussion knowledge and education; and complexity of concussion. The effectiveness of concussion management in secondary school settings is shaped by the dynamic interaction of these five themes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Implications for School Health Policy, Practice, and Equity<\/jats:title><jats:p>These findings highlight the need to develop a context\u2010sensitive framework that can assist schools with real\u2010world implementation of concussion management guidelines, for both sports and non\u2010sports related concussions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The intent to support students was evident among most stakeholders yet appeared to be limited by lack of structured processes to follow, resources, unfavorable attitudes towards concussion management, and lack of knowledge.<\/jats:p><\/jats:sec>","DOI":"10.1111\/josh.13544","type":"journal-article","created":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T06:33:04Z","timestamp":1737441184000},"page":"317-331","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Slipping Through the Cracks? Concussion Management in Aotearoa New Zealand Secondary Schools"],"prefix":"10.1111","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1254-8308","authenticated-orcid":false,"given":"Danielle","family":"Salmon","sequence":"first","affiliation":[{"name":"Injury Prevention and Player Welfare, New Zealand Rugby  Wellington New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8443-9173","authenticated-orcid":false,"given":"Marelise","family":"Badenhorst","sequence":"additional","affiliation":[{"name":"Sports Performance Research Institute New Zealand, School of Sport and Recreation Auckland University of Technology  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8860-0267","authenticated-orcid":false,"given":"Anja","family":"Zoellner","sequence":"additional","affiliation":[{"name":"Sports Performance Research Institute New Zealand, School of Sport and Recreation Auckland University of Technology  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8271-0221","authenticated-orcid":false,"given":"Debbie","family":"Skilton","sequence":"additional","affiliation":[{"name":"Sports Performance Research Institute New Zealand, School of Sport and Recreation Auckland University of Technology  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4309-4778","authenticated-orcid":false,"given":"Kate","family":"Mossman","sequence":"additional","affiliation":[{"name":"Centre of Health, Activity, Rehabilitation Research, School of Physiotherapy University of Otago  Dunedin New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3726-6617","authenticated-orcid":false,"given":"Patricia","family":"Lucas","sequence":"additional","affiliation":[{"name":"Sports Performance Research Institute New Zealand, School of Sport and Recreation Auckland University of Technology  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8257-0220","authenticated-orcid":false,"given":"Kylie","family":"Thompson","sequence":"additional","affiliation":[{"name":"Sports Performance Research Institute New Zealand, School of Sport and Recreation Auckland University of Technology  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6467-4982","authenticated-orcid":false,"given":"Simon","family":"Walters","sequence":"additional","affiliation":[{"name":"Sports Performance Research Institute New Zealand, School of Sport and Recreation Auckland University of Technology  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5642-058X","authenticated-orcid":false,"given":"Sierra","family":"Keung","sequence":"additional","affiliation":[{"name":"Sports Performance Research Institute New Zealand, School of Sport and Recreation Auckland University of Technology  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1632-0338","authenticated-orcid":false,"given":"Gisela","family":"Sole","sequence":"additional","affiliation":[{"name":"Centre of Health, Activity, Rehabilitation Research, School of Physiotherapy University of Otago  Dunedin New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,20]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports\u20102020\u2010102967"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2018.01.075"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1159\/000505424"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2020.11.006"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports\u20102023\u2010106898"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports\u20102022\u2010106682"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/2325967117745033"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.15617"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports\u20102016\u2010097415"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0000000000000413"},{"issue":"6","key":"e_1_2_10_12_1","first-page":"e310","article-title":"Premature Return to Play and Return to Learn After a Sport\u2010Related Concussion: Physician's Chart Review","volume":"60","author":"Carson J. 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