Comparing NCAA Division II Athletes’ Perceptions of Social Support Following Injury,
Illness, or Other Identified Life Stressors.

A DISSERTATION
Submitted to the Faculty of the School of Graduate Studies and Research of California
University of Pennsylvania in partial fulfillment of the requirements for the degree of
Doctor of Health Science (DHSc) in Health Science and Exercise Leadership

By
Martha Jane Anderson

Research Advisor, Linda Meyer, EdD, LAT, ATC
California, Pennsylvania
2021

CALIFORNIA UNIVERSITY OF PENNSYLVANIA
CALIFORNIA, PA
DISSERTATION APPROVAL

Health Science and Exercise Leadership

We Hereby Approve the Dissertation of

Martha Jane Anderson
Candidate for the Degree of Doctor of Health Science (DHSc)
Date

Faculty

April 17, 2021

__________________________________________
Linda Meyer, Ed.D., LAT, ATC, Advisor

April 21, 2021
April 21, 2021

__________________________________________
Ellen West, Ed.D., LAT, ATC

April 21, 2021

__________________________________________
Tom West, Ph.D., LAT, ATC

ACKNOWLEDGEMENTS
I would like to thank my friends and family for their support through this process. Most of
all, I would like to thank my committee members for all of their help, knowledge, and
expertise. I could not have done this without you. A huge thank you to the Alvernia
University Library, for allowing me to use your space to do my work.

CONTENTS
List of Figures……………………………………………………………………… ...... i
List of Tables……………………………………………………………………………ii
Abstract………………………………………………………………………………… iii
Introduction……………………………………………………………………… ..........1
Methods………………………………………………………………………………....7
Research Design...................................................................................................7
Participants ...........................................................................................................9
Instruments ...........................................................................................................10
Demographic Survey ...............................................................................10
Perceived Stress Scale..............................................................................11
Multidimensional Scale of Perceived Social Support ..............................12
Athletic Multidimensional Scale of Perceived Social Support ................13
Procedures ............................................................................................................14
Data Analysis ...................................................................................................................16
Results ..................................................................................................................17
Demographics and Tabling of Statistics ..............................................................17
Hypothesis Testing...............................................................................................20
Additional Findings .............................................................................................24
Gender ..........................................................................................24
Year of Athletic Eligibility ..........................................................25
Discussion ........................................................................................................................28
Perceived Social Support .....................................................................................28
Comparisons of Providers of Social Support ......................................................32
Family ......................................................................................................33
Significant Others ....................................................................................33

Athletic Trainers, Teammates, Friends, and Coaches..............................34
Stress Buffering and Main Effects .......................................................................35
Integrated Model of Response to Sport Injury.....................................................36
Additional Findings .............................................................................................37
Gender ......................................................................................................38
Year of Athletic Eligibility ......................................................................40
Conclusion .......................................................................................................................42
Future Research ...............................................................................................................45
References ........................................................................................................................46
Appendices .......................................................................................................................63
Appendix A, Review of Literature...................................................................................63
Introduction ......................................................................................................................64
Stress ................................................................................................................................66
Injury as a Stressor ...............................................................................................67
Illness as a Stressor ..............................................................................................67
Other Identified Life Stressors .............................................................................68
Perception ........................................................................................................................70
Cognitive Appraisal .........................................................................................................72
Primary and Secondary Cognitive Appraisals .....................................................73
Personal Factors ...................................................................................................75
Athletic Identity .......................................................................................75
Mental Toughness ....................................................................................76
Hardiness..................................................................................................77
Additional Personal Factors .................................................................................78
Situational Factors ...............................................................................................79
Psychosocial Factors ............................................................................................80
Teammates ...............................................................................................82
Coaches ....................................................................................................84

Athletic Trainers ......................................................................................85
Friends......................................................................................................86
Family ......................................................................................................87
Significant Others ...................................................................................87
Social Support ..................................................................................................................89
Types of Social Support .......................................................................................91
Perceived Social Support .....................................................................................92
Stress Buffering Process ......................................................................................94
Main Effects Model .............................................................................................95
Self-Efficacy ........................................................................................................95
Theoretical Models ..........................................................................................................98
Comparison of Theoretical Models .....................................................................100
Integrated Model of Response to Sport Injury.....................................................101
Measurement Instruments ................................................................................................105
Multidimensional Scale of Perceived Social Support ..........................................106
Athletic Multidimensional Scale of Perceived Social Support ............................107
University Stress Scale ........................................................................................108
Perceived Stress Scale..........................................................................................108
Conclusion .......................................................................................................................110
Appendix B, Problem Statement......................................................................................112
Appendix C1, Collegiate Athletes’ Perceptions of Social Support Survey .....................115
Appendix C2, Additional Methods, Introductory Letter to Athletes ...............................128
Appendix C3, Athletic Director and Athletic Trainer Contact Information ....................130
Appendix C4, Email to Athletic Administrators..............................................................132
Appendix C5, Email to Designated Contact Athletic Trainers ........................................134
Appendix C6, Quick Response Code...............................................................................140
Appendix C7, Thank-you Email to Athletic Trainers ......................................................142
Appendix C8, IRB Review Request ................................................................................144

IRB Survey/Interview/Questionnaire Consent Checklist ....................................150
IRB Review Request Checklist ............................................................................152
IRB Director’s Certification ................................................................................154
IRB Approval Letter ............................................................................................155
Appendix C9, References ................................................................................................157
Appendix C10, Supporting Materials ..............................................................................185
Curriculum Vitae .................................................................................................186
C.I.T.I. Training Certificates................................................................................190
Copyright Permission...........................................................................................193

List of Figures
Figure 1. Conceptual Map of the Social Support Process................................................90
Figure 2. Integrated Model of Response to Sport Injury .................................................102

List of Tables
Table 1. Classification of Injury Based on Time to Return to Activities ........................8
Table 2. Age and Sex of Participants ...............................................................................18
Table 3. Ethnicity of Participants.....................................................................................18
Table 4. Total Number and Percentages of Respondents Who Indicated Days of
Activity Missed Due to Significant Injury, Illness and Stressors ......................19
Table 5. Means, Standard Deviations, and Scale Score and Level of Perceived Social
Support ...............................................................................................................21
Table 6. Comparisons by Group for Perceived Social Support .......................................23
Table 7. Means and Standard Deviations for Gender and Level of Perceived Social
Support ...............................................................................................................24
Table 8. Significance of Female Gender and Providers of Perceived Social Support…. 27
Table 9. Means, Standard Deviations, Mean Support Scale Score and Level of Perceived
Social Support and Year of Athletic Eligibility .................................................26
Table 10. Effects of Year of Eligibility on Perceived Social Support .............................27
Table 11. Comparison of Theoretical Models .................................................................99

iii

Abstract
A social support network is something people need in difficult times. Athletes may
have even more of a need for their social support network. The purpose of this research
was to explore National Collegiate Athletic Association (NCAA) Division II athletes'
perceived social support networks, which compared friends to teammates, family to
coaches, and significant others to athletic trainers following injury, illness, or other
identified life stressors. In this quantitative study, 546 participants completed a four-part
survey that included a demographic section with the University Stress Scale, the
Multidimensional Scale of Perceived Social Support, the Athletic Multidimensional Scale
of Perceived Social Support, and the Perceived Stress Scale. Results indicated athletes
perceived social support in the following hierarchical order from family, significant
others, coaches, teammates, friends, and athletic trainers. There were significant
differences across all groups when comparing the groups to one another for perceived
social support. There were no significant differences in perceived support between friends,
coaches, teammates, significant others, and family. All 546 participants reported feeling
stress, with 352 stating moderate stress. Additional significant findings indicated that
females compared to males preferred the support of friends, significant others, and athletic
trainers; freshmen and sophomores perceived more social support from friends than did
seniors. The results suggest differences exist when comparing perceived social support
following injury, illness, or other identified life stressors.
Keywords: Social Support, Multidimensional Scale of Perceived Social Support,
Perceived Stress Scale, Athletic Multidimensional Scale of Perceived Social Support,
Division II Athletes, Integrated Model of Response to Sport Injury

Comparing NCAA Division II Athletes’ Perceptions of Social Support Following
Injury, Illness, or Other Identified Life Stressors.
Stress, regardless of whether experienced due to an injury, illness, or other
identified life stressor, can disrupt the collegiate athlete's quality of life. College sportsrelated injuries were estimated to be approximately six injuries per 1000 exposures out of
a total of 176.7 million exposures to potential injury (practice and competition) from
2009 to 2014 (Kerr et al., 2015). The effects of acute or chronic illnesses and other
identified life stressors on college athletes’ mental health have not received much
attention in the literature. A majority of the previous research on emotional and social
support focused more on elite and adolescent athletes (Arvinen-Barrow et al., 2014;
Brewer et al., 2010; Evans et al., 2017; Roy et al., 2015). The NCAA (2019) stated in
their Inter-Association Consensus Document, "Mental health is an important and often
overlooked dimension of overall student-athlete health and optimal functioning. (p. 5).”
Social support is one way to improve one's mental health (Acharya & Collins,
2018; Agbarov et al., 2012; Covassin et al., 2014; Petrie et al. ,2014; Sheridan et al.,
2014). Lazarus (1990) noted the stress response occurs when the person's ability to
appraise an event or situation cognitively exceeds their available resources to cope with
the stressor. Saleh et al. (2017) suggested students’ stress "involves all aspects of life's
difficulties, including psychological discomfort and each student deals with stress
differently (p.1)." Collegiate athletes represent a unique population transitioning to
adulthood, learning to live independently, and learning new coping skills (Gerlach,
2018). Athletes must navigate a new social environment, academic challenges, and an
upward shift in the athletic talent with which they must compete.

According to Goodman et al. (2018), higher injury rates were reported for
freshmen athletes than older, more experienced athletes. Also, "sharply increased
workload presents a potential opportunity for fatigue in those who have not yet mentally
and physically adjusted to the transition from high school to college sports (p. 364)."
College athletes are more vulnerable to increased stress than non-athletes due to failing to
identify social support networks and other resources which may help decrease their stress
and reactions to those stressors (Bulo & Sanchez, 2014).
Athletes are members of a team; therefore, they may be more socially welladjusted compared to non-athletes (Son et al., 2018) and possess improved social
adjustment by belonging to a group or team which already has similarities established
(Wilson & Pritchard, 2005). However, athletes who are injured, ill, or dealing with other
identified life stressors may have difficulty coping socially, emotionally, and physically
(Malinauskas & Malinasukiene, 2018).
Injury, illness, or other identified life stressors represent an abrupt change to an
athlete's familiar environment, and therefore a cognitive appraisal of their new
circumstances must occur. The resulting emotional responses will be either positive or
negative, resulting in positive or negative behaviors (Arvinen-Barrow et al., 2014; Podlog
et al., 2015). At one-week post-injury, Albinson and Petrie (2003) found the more
negative the secondary and emotional appraisal of injury, the more avoidance and coping
behaviors were evident. Daly et al. (1995) reported those athletes who were injured had
increased perceptions of stress and less ability to cope. One's athletic success may result
from their ability to identify with, adjust to, and positively or negatively respond to this
changing environment (Madrigal et al., 2017).

There can be many factors affecting cognitive appraisal. One of the personal factors
affecting the cognitive appraisal of injury, illness, and stress may be gender (Acharya et
al., 2018). Year of athletic eligibility and playing time may also affect cognitive appraisal
(Bulo & Sanchez, 2014; Madrigal & Robbins, 2020). Other individual differences such as
personality, coping skills, psychological skills, athletic identity, previous injury
experience, or social support experience may also influence how an athlete responds to
these stressors. (Weise-Bjornstal et al., 1998; Brewer, 2010)
Roy et al. (2015) noted initial negative appraisal following an athletic injury. They
stated this initial appraisal resulted from the influence of an athlete’s personal and
situational factors and how these affect their psychological responses to injury or stress.
Weiss and Troxell (1986) identified the potential for these responses to adversely affect
the athlete’s rehabilitation outcomes, be more detrimental to return to participation, result
in decreased motivation, and had the potential to worsen over the competitive season.
Several authors have suggested that injured athletes will often turn to their support
networks in times of distress which may include family and friends, teammates, coaches,
and athletic trainers (Bennett et al., 2016; Malinasuskas & Malinauskiene, 2018; Mankad
et al., 2009; Newman & Weiss, 2017). Social networks are a crucial component for
health, well-being, and the learning and transfer of skills (Chiaburu et al., 2010;
Umberson & Montez, 2010). Collegiate athletes are more likely to reach out to those they
have the most in common such as teammates, coaches, and athletic trainers (Bianco &
Elklund, 2001; DeFreese & Smith, 2014; Fletcher & Sarkar, 2012). Lakey (2010) noted
that social support might include social integration, perceived support, and received
support, and suggests, at times, the perceived support and received support may not

always be reciprocal. The theoretical model which best incorporates perceived, received,
and reciprocal support, the influence of pre-existing factors, in addition to the timing of
that support, is the Integrated Model of Response to Sport Injury, introduced by WieseBjornstal et al. (1998).
The Integrated Model of Response to Sport Injury is a model explicitly used with
an athletic population (Wiese-Bjornstal et al., 1998). The integrated model considers the
influence of personality, previous experiences, coping behaviors, and prior interventions
the athlete may have utilized before an injury and in their cognitive appraisal of a new
injury or stressor. The proceeding emotional and behavioral responses (psychosocial
responses) resulted from the ongoing cognitive appraisals that may have occurred
throughout the injury, illness, and stress processes. As these theories and theoretical
models were being developed and becoming more accepted for an athletic population, the
need to measure social support in athletes also became apparent.
Several instruments exist to measure social support's different aspects; included in
this study are the Multidimensional Scale of Perceived Social Support, the University
Stress Scale, and the Perceived Stress Scale. The Multidimensional Scale of Perceived
Social Support (MSPSS) (Appendix C1) (Zimet et al., 1988) measures an individual's
perception of the availability of social support from three distinct groups: friends, family,
and significant others. Even though the MSPSS is not a test designed to apply to athletes,
it has been used successfully in this population (Lu & Hsu, 2013; Malinauskas, 2010;
Malinauskas & Maulinauskiene, 2018).
A modified version of the MSPSS, the Athletic Multidimensional Scale of
Perceived Social Support (AMSPSS) (Appendix C1), modified by the primary

investigator, measures the perceived support from teammates, coaches, and athletic
trainers. These groups represent whom athletes will often turn to for support (Bennett et
al. 2016; Malinauskas & Malinauskiene, 2018; Mankad et al. 2009; Newman & Weiss,
2017).
The University Stress Scale (USS) (Appendix C1) was designed by Hurst (2008)
and modified by Stillman and Hurst (2016), which measures specific stressors and their
intensity in college students. For this study, the USS use will identify the single most
significant stressor the college athlete has experienced in the past 12 months before
completing the survey. Intensity will not be measured. A better way to determine the
amount of stress one perceives to experience is through using the Perceived Stress Scale
(PSS).
The PSS-14 by Cohen et al. (1983) measures how much perceived stress is
associated with different situations in an individual's life. The scale evaluates how
unpredictable, uncontrollable, and overloaded individuals find their lives, ranging from
low, medium, and high stress (Cohen et al., 1983). For this investigation, the PSS-10
(Cohen & Williamson, 1998) (Appendix C1) was used, with one modification by the
researcher to assess the level of stress an athlete has experienced during the past 12
months versus the suggested time of one month. (Cohen et al., 1983; Cohen &
Willamson, 1988). This adaptation to the scale was that athletes needed to recall their
most significant injury in the past 12 months on the survey. The author felt the PSS
modification would align better with the length of one year before completing the study.
These measurement tools used together assess athletes' response to injury, illness, and

other identified life stressors and whom these athletes turn to for social support after
experiencing the stressors.
Therefore, the stated hypothesis driving this research is: there will be greater
perceived social support from teammates compared to friends; coaches compared to
family; and athletic trainers compared to significant others following injury, illness, or
other identified life stressors.

Methods
This study was a non-experimental group comparison research design. This
section reviews the research design, subjects, instruments, procedures, and data analysis.
Research Design
A non-experimental research design is one in which there is no random
assignment of subjects to any independent variables. In this study, the investigator looked
for a correlational relationship between the independent and dependent variables without
manipulating them. Independent variables were the college athletes' injury history (injury
or no injury), illness history (illness or no illness), and perceived life stress history (low,
moderate, or high). Injury, illness, or other identified life stressors had to occur in the
previous 12 months. Dependent variables were the perceived social support from the six
social support providers (friends, family, significant others, teammates, coaches, or
athletic trainers).
Injuries were categorized as described by Alles et al. (1979): minor or significant.
Significant was further categorized as moderate, major, and severe (See Table 1). The
classification of injury severity was the time it took to return to activity. The USS
classified other identified life stressors (Stallman and Hurst 2016).

Table 1
Classification of Injuries Based on Time to Return to Activity
Minor injury:
Significant injury: Moderate:
Major:
Severe:

return between 1 - 7 days
return between 8-22 days
return after 22 days
disabling injury (amputation, quadriplegia, death)

Adapted from: “The National Athletic Injury/Illness Reporting System 3-Year Findings
of High School and College Football Injuries,” by W. F. Alles, J. W. Powell, W. Buckley,
& E. E. Hunt Jr., 1979, Journal of Orthopaedic & Sports Physical Therapy, 1(2), p. 104.
https://doi.org/10.2519/jospt.1979.1.2.103

The PSS indicated perceived stress levels (Cohen et al., 1983 and Cohen and Williamson,
1988. Othman et al. (2019) identified three levels of stress. A score of 0-13 indicated low
stress, moderate stress was a score of 14-26, and high stress was a score of 27-40.
Dependent variables were the athletes’ perception of social support from
teammates, coaches, athletic trainers, friends, family, and significant others. This design's
strengths were the accessibility to the population to be examined, the potential for a more
significant number of subjects, and separating them by injury, illness, or other identified
life stressors. There was no manipulation of the independent or dependent variables.
The Multidimensional Scale of Perceived Social Support (MSPSS) and the
Athletic Multidimensional Scale of Perceived Social Support (AMSPSS) surveys were
brief, easy to administer, and easy to complete. With these instruments and their
subscales, it was possible to identify the individual(s) whom athletes perceived as
providing them with the most social support. Past studies suggest that MSPSS and PSS
are reliable and valid (Denovan et al., 2019; Lee, 2013; Zimet et al., 1988; ErmisDemirtas et al., 2018).

Participants
This study's participants represented a sample of convenience of male and female
student-athletes, 18 years of age or older from 14 of the 18 universities, which comprise
the Pennsylvania State Athletic Conference (PSAC). The universities who participated in
this study were Bloomsburg, California University of Pennsylvania, Clarion, Edinboro,
Indiana University of Pennsylvania, Kutztown, Lock Haven, Mansfield, Mercyhurst,
Shepherd, Shippensburg, Slippery Rock, the University of Pittsburgh-Johnstown, and
West Chester. As of 2018, the total number of student-athletes participating in sports in
this conference was 7,978 athletes (US Department of Education, 2020). Respondents
participated in those sports recognized as varsity sports at each institution within the
PSAC. Bloomsburg, Clarion, Edinboro, and Lock Haven sponsor Division I Wrestling,
and Lock Haven sponsors Division I Field Hockey. The majority of the athletes in the
PSAC represented Division II sports, but there was participation from the Division I
athletes. The athletes identified their division and sport in the survey's demographic
section.
Participants who were 18 years of age or older voluntarily participated in the
study at each PSAC university (Appendix C2). Athletes had to be officially rostered
student-athletes for the 2020-2021 school year and met all qualifying standards for
athletic participation in the varsity sports sponsored by each university. The study
included those athletes granted a medical hardship waiver or redshirt from their
university or the NCAA. All athletes agreed to the informed consent (Appendix C2). A
list of all NCAA-sponsored sports was comprised by reviewing each university's official

athletics website. The complete list of sports appeared on the demographic portion of the
survey.
Athletes who experienced an injury, illness, or stressor had to recollect and
specify the length of time missed from lifting, conditioning, practice, or games. The
participants' injuries were self-reported as no days missed; one week or less missed; eight
to twenty-one days missed; or twenty-two or more days missed and did return to
participation, and twenty-two or more days missed and did not return to participation.
Other identified life stressors were self-reported on the PSS, which measured low,
moderate, and high-stress levels. Athletes completed the MSPSS evaluating the perceived
social support from friends, family, and significant others. The AMSPSS evaluated the
perceived social support received from teammates, coaches, and athletic trainers.
Instruments
The survey was a four-part instrument designed using SurveyMonkey®,
consisting of a demographic questionnaire, the PSS, MSPSS, and AMPSS. The USS, in
the demographic section (Appendix C1), identified types of stressors, and the PSS
(Appendix C1) measured levels of perceived stress, and the MSPSS and AMSPSS
(Appendix C1) measured perceived social support. Athletes who did not complete the
survey in its entirety were not included in data analysis, and their data was discarded.
Demographic Survey. The demographic questions (Appendix C1) obtained
background information on the athletes and their experience with injuries and other
identified life stressors. Demographic questions included age, gender, ethnicity, year of
athletic participation, primary sport, and had the athlete experienced an injury, illness,
and stressors within the last 12 months. Also, participants indicated how many practices,

games, conditioning, or lifting days they missed due to injury, illness, and life stressors.
Athletes also identified the single most significant life stressor from the past 12 months
using the University Stress Scale (USS), which identified the most common of college
student stressors (Stillman & Hurst, 2016) (Appendix C1). Finally, the athletes indicated
whether they had returned to play during their competitive season.
Perceived Stress Scale. The PSS measures the degree to which individuals
appraise situations as stressful. Items evaluate how unpredictable, uncontrollable, and
overloaded individuals find their lives. Scores were ranked as low, moderate, and high
perceived stress (Cohen et al., 1983; Cohen & Williamson, 1988). Cohen et al. (1983)
first introduced the stress scale that consisted of 14 questions. Cohen and Williamson
(1988) later modified the scale to only consist of 10 questions and suggested the modified
scale be used instead of the original 14 question scale.
Many studies have identified the PSS as the most widely used scale to measure
perceived stress (Denovan et al., 2019; Lee, 2013; Mills et al., 2017; Mozumder, 2017;
Othman et al., 2019; Sun et al., 2019). The PSS is a widely used instrument; the scale has
demonstrated that it also maintains its reliability and validity, even when modified in
different languages. Sun et al. (2019) used the scale in Chinese and reported reliability as
.95 and validity .81. Nordin and Nordin (2013) noted internal validity and reliability
between .80 and .86, respectively, when used with Swedish participants. Mills et al.
(2017) reported the reliability as .86 and .84 for perceived self-efficacy and perceived
helplessness, respectively, when used with Lupus patients.
Othman et al. (2019) stated three levels of perceived stress, based upon the
scoring used by Cohen and Williamson (1988). Scoring the PSS, as suggested by Cohen

and Williamson (1988), is accomplished by the following: reversing responses (e.g., 0 =
4, 1 = 3, 2 = 2, 3 = 1 and 4 = 0) to the four positively stated items (items 4, 5, 7, & 8) and
then summing across all scale items. Othman et al. (2019) noted low stress was indicated
with a 0-13 score, moderate stress scored 14-26, and high stress scored 27-40.
Multidimensional Scale of Perceived Social Support. The MSPSS (Zimet et al.,
1988) (Appendix C1) measures the perceived social support received from friends,
family, and significant others. There were 12 questions; four for each subscale of friends,
family, and significant others, rated on a 7-point Likert scale ranging from very strongly
disagree (scored with a 1) to very strongly agree (scored with a 7). Scoring for each
subscale was achieved by adding the Likert scores for each subscale and dividing them
by 4. The instrument's total score is factored in by adding all 12 questions' Likert scores
and dividing them by 12. Zimet et al. (1988) stated that for both the subscale and total
scale scores, low support indicated a mean score of 1 to 2.9; moderate support indicated a
3-5 total mean score, and high support indicated a total mean score of 5.1 to 7.
Zimet et al. (1988) reported initial reliability for the three subscales of friends was
.85; family was .87, and significant others were .91. The reliability for the entire scale
scoring was .88. Test-retest reliability was .75 for friends, .85 for family, and .72 for
significant others (Dahlem et al., 1991; Kazarian & McCabe, 1991; Zimet et al., 1988).
Ermis-Demirtas et al. (2018) reported the internal consistency of the MSPSS with
Cronbach's α to be .92. Internal consistency and reliability were calculated in this study
and reported to be .93 for family support, .91 from friends, and .94 from a significant
other. DeMaria et al. (2018) noted similar results for internal consistency of the MSPSS

when used with people with chronic diseases. Validity was also tested with confirmatory
factor analysis and yielded significance from .79 or greater with a p < .001.
Guan et al. (2015) also reported reliability ranging from .89 to .90 for the three
subscales, and test-retest reliability was .71 with p < .01. In addition, validity was noted
to be .82 to .92 with a p < .01. The MSPSS used friends, family, and significant others,
and the AMSPSS used teammates, coaches, and athletic trainers. The MSPSS did not
have any other changes or modifications.
Athletic Multidimensional Scale of Perceived Social Support. There are no
reliability and validity scores available for the AMSPSS (Appendix C1). The instrument's
structure is identical to the MSPSS; however, the author modified social support
providers to be teammates, coaches, and athletic trainers, versus friends, family, and
significant others found on the MSPSS. In an email exchange with Dr. Zimet which he
stated the reliability and validity should not change on the AMSPSS from the MSPSS.
“This is due in part to the fact that the only items that are different between the two tests
are the names of the providers of social support” (G. Zimet, personal communication,
November 19, 2019).
Scoring for the AMSPSS and the MSPSS was the same; 12 questions total, with
four questions for each subscale of teammates, coaches, and athletic trainers,
respectively. Questions used a 7-point Likert scale, ranging from very strongly disagree
(score of 1) to very strongly agree (score of 7). Scoring for each subscale was achieved
by adding the Likert scores for each subscale and dividing them by 4. The instrument's
total score is factored in by adding all 12 questions' Likert scores and dividing them by
12.

Procedures
Following California University of Pennsylvania’s IRB approval, contact was
made via email and telephone to the administrators from each PSAC university for their
interest in being included in the study. Athletic Administrators consisted of Athletic
Directors, Directors of Intercollegiate Athletics, Senior Women's Administrators,
Executive Director of Athletics, or Vice President of Athletics. These individuals will be
identified as either AA or AAs from this point forward. The AAs were contacted via
telephone (Appendix C3) if there were no responses to the email (Appendix C4). The
AAs were informed of the study and given information regarding the study's purpose,
study design, risks, and the informed consent statement (Appendix C4). AAs had the
primary investigator's contact information, and AAs had to confirm their agreement for
their university participating by sending an email back to the primary researcher. The
AAs were asked to retain the researcher's information for future contact if they had any
questions, concerns, or issues regarding participation in the study.
Following AA approval, the primary researcher contacted each institution's
designated contact athletic trainer via email and telephone (Appendix C5). The
designated athletic trainer was either the head athletic trainer for their athletic department
or was an athletic trainer with whom the primary investigator had a professional
relationship. In this communication, the study's purpose, study design, methods, a copy of
the instruments, and the consent statement were forwarded via email to the designated
athletic trainer from each university for informative purposes only (Appendix C5).
Included in the email were the QR code (Appendix C6) and hyperlink to the surveys so
that the athletic trainers could distribute the information to the athletes on their respective

campuses. The designated athletic trainers distributed the instructions via email, text, or
any other electronic team communication method each university employed to contact
the athletes. All designated athletic trainers chose to contact their athletes via electronic
means versus the flyers and posters.
The designated athletic trainers' only responsibilities were distributing the
introductory letter to the students with the hyperlink and QR code. The designated
athletic trainer or staff member did not have any other involvement with data collection,
data storage, or statistical analyses. After dispersing the electronic communication, all the
student-athletes needed to scan was the QR code with their smartphone if they choose to
participate.
They also could access the SurveyMonkey® site’s hyperlink to the survey if they
choose to take the survey on a computer or laptop/tablet device. After reading the QR
code, the athletes were directed to the Survey Monkey® site, where they were to
complete the survey. When using the hyperlink to access the survey, it referred them to
the first page of the Survey Monkey® survey.
Completion of the survey took on average ten minutes or less to complete. Data
were stored on the Survey Monkey® website and were password protected by the
primary researcher. An explanation of the study and a statement of implied consent was
available before beginning the survey. Athletes completed the four-part survey. If
participation in the study caused an increase in emotions or feelings, a list of free
resources was available after the survey. There was a message on the final screen
thanking the subjects for participating in the study. The designated athletic trainers
received a thank-you email following the study's end (Appendix C7).

Data Analysis
The main effects between the perceived level of social support from each support
provider were dependent upon the severity of injury, illness, or other stressors measured
using multifactorial analysis of variance (MANOVA). Examining the interactions
between social support providers' perceived level of social support was done using posthoc testing. Factorial MANOVAS separately compared demographic differences of
gender and year of athletic eligibility to the perceived social support subscales. Each of
the six social support providers was examined for any interactions and correlations,
utilizing a multifactorial MANOVA.
Data analysis occurred using The Statistical Package for the Social Sciences
(SPSS) statistical software with an α ≤ .05. MANOVAs compared the six subscales'

means: friends to teammates, family to coaches, and significant others to athletic trainers.
Also, MANOVAs were used to test for the main effects of injury status (injured or noninjured), illness, and other identified stressors.
There is one hypothesis that drove this research study. There will be greater
perceived social support from teammates compared to friends, coaches compared to
family, and significant others compared to athletic trainers, following injury, illness, and
other identified life stressors experienced by each participant.

Results
The purpose of this research was to explore the individual social support
following injury, illness, or other identified life stressors NCAA Division II athletes
perceived from friends compared to teammates, family compared to coaches, and
significant others compared to athletic trainers. This research also explored the effect of
two independent variables on social support. The examined variables were gender and
year of athletic eligibility. Assessment occurred with these two independent variables’
influence upon the six dependent variables of perceived social support from friends,
family, significant person, teammates, coaches, and athletic trainers. This section
includes demographics, hypothesis testing, tables of descriptive statistics, and additional
findings.
Demographics and Tables of Descriptive Statistics
Approximately 4,325 male and female athletes from the PSAC received the
survey via electronic means, and 654 responded. However, only 546 completed the
survey in its entirety. The participants were NCAA Division II athletes who participated
in NCAA sanctioned varsity male and female athletic teams on the campuses at 14 of 18
institutions within the PSAC. Participants had to be 18 years of age or older to complete
the survey. The mean age and gender of the participants are in Table 2.

Table 2
Age (in years) and Gender of
Participants
Variable

Minimum Maximum

Male

170

19.3

1.21

Female

376
546

19.5
19.4

1.57
1.33

18
18

22
25

The participants represented all ethnic choices on the survey (Table 3). Eleven
respondents chose not to answer the ethnicity question, and one respondent replied other.
The majority of participants were white (84.2%), with 10.1% representing African
Americans and 2.9% indicating Hispanic ethnicity.
Table 3
Ethnicity of Participants

White
African American
Hispanic
Asian
Alaskan Native
Native Hawaiian
No Answer
Other

n
460
55
16
1
1
1
11
1
546

% of Participants
84.2%
10.1%
2.9%
0.2%
0.2%
0.2%
2.0%
0.2%
100%

Participants recalled any significant injury, illness, or other identified stressor they
experienced in the past 12 months before completing the survey. The respondents
indicated the number of days of participation they missed due to the significant injury,
illness, or other identified stressor. Of the 546 athletes surveyed, 330, or 60.4%, stated

they experienced a significant injury (See Table 4). Respondents identified the body part
which was injured. Injuries to the knee (21% of all injuries), ankle (18.7% of all injuries),
and shoulder (13.6% of all injuries) were the most prevalent in those individuals who
identified having an injury.
Table 4
Total Number and Percentage of Respondents Who Indicated Days of Activity Missed
Due to Injury, Illness, or Stressors

No injury or illness
Did not miss any days
Missed less than a
week
Missed 1 to 3 weeks
Missed Longer than 3
weeks, able to return
the same competitive
season
Missed longer than 3
weeks, unable to
return the remainder
of the competitive
season
Severe injury
resulting in permanent
disability (Loss of
limb, quadriplegia,
death)
Other

Injury
Incident
148
11

Percent of
total
participants
28%
2%

Illness
Incident
148
3

Percent of
total
participants
28%
1%

Stressor
Incident
N/A
10

Percent of
total
participants
N/A
2%

71
65

13%
12%

25
33

2%
6%

408
75

75%
14%

14%

107

20%

0
68
546

0%
11%
100%

0
330
546

0%
61%
100%

N/A
N/A
546

N/A
N/A
100%

Those athletes who experienced a significant illness comprised 11% (n=68) of the
total respondents, with the other 89% (n=478) of the respondents stating no illness in the
past 12 months. Of those athletes who noted a significant illness, 51% (n=28) said they
missed less than a week of participation, 34% (n=33) missed one to three weeks of
participation but were able to return to competition. In comparison, 6% (n=4) could not
return to competition (See Table 4).
All of the 546 participants reported experiencing stress (See Table 4). Seventyfive percent (n=418) stated they missed at least one day of participation but less than a
week due to the impact of that stressor (See Table 4). The USS (Stallman, 2008; Stallman
& Hurst, 2016) was used to identify the respondents' specific stressors. Of the total
participants, the two most significant life stressors experienced were academics and
coursework (25% or 137 of all respondents) and mental health issues (20% or 109 of all
respondents). The PSS (Cohen et al., 1983) identified perceived stress levels. Twentyeight percent of respondents indicated low levels of stress (n=153) of respondents, 64%
indicated moderate levels of stress (n=352), and the remaining 8% (n=38) indicated high
levels of stress.
Hypothesis Testing
The hypothesis tested in this research study is the following.
H1: There will be greater amounts of perceived social support from teammates
compared to friends, coaches compared to family, and athletic trainers compared to
significant others (α=p< .05 was considered statistically significant).

To test the hypothesis, a repeated measures MANOVA was performed to evaluate
if a significant difference existed between the six dependent variables evaluating each
source of perceived social support using the MSPSS (Zimet et al., 1988) and the
AMSPSS. The seven-point Likert scores ranged from very strongly disagree (1 point) to
very strongly agree (7 points). The possible score of perceived social support from each
provider of social support ranged from 7-28. Mean perceived social support scores are in
Table 5. Also in table 5 are the Scale Scores. A low scale score of perceived support was
from 1-2.9, moderate support was from 3-5, and high support was from 5.1 to 7 (Zimet et
al., 1988).
Table 5
Means, Standard Deviations, Scale Score, and Level of Perceived Social Support
Provider of Social Support
Family
Friends
Significant Other
Teammates
Coaches
Athletic Trainers

Scale Score

23.14
20.92
23.09
21.22
21.53
20.18

4.92
4.73
5.26
5.23
5.32
5.34

5.78
5.23
5.77
5.30
5.38
5.04

Level of
Support
High
High
High
High
High
Moderate

A repeated measures MANOVA was calculated to evaluate if a significant
difference existed between the six dependent variables evaluating the source of social
support. A significant difference was found between the 6 groups (F(4.177,2277) =
54.55, p = < .001). Differences between groups utilized follow-up post-hoc testing by
running paired t-tests. As there are 15 paired samples, the significance level needed to be

corrected top < .00333. Paired sample t-tests demonstrated several significant differences
between support groups.
Friends, teammates, and coaches indicated a significant difference to family,
significant others, and athletic trainers. Family had a significant difference compared to
friends, coaches, and athletic trainers. Significant others showed a significant difference
to friends, teammates, coaches, and athletic trainers. Athletic trainers had significant
differences when compared to all other support groups. These results suggest significant
differences in perceived support based on support providers. The comparisons of
perceived social support and providers of social support and level of significance are in
Table 6.

Table 6
Comparisons by Group for Perceived Social Support
Social Support Group Comparisons
Significant Other/ Friend
Significant Other/Athletic Trainer
Significant Other/Teammates
Significant Other/Coaches
Family/ Friends
Family/ Athletic Trainer
Family/ Teammates
Family/ Coach
Athletic Trainer/ Teammates
Athletic Trainer/ Coaches
Friends/ Athletic Trainer
Friends/ Coaches
Friends/ Teammates
Significant Other/ Family
Teammates/ Coaches
Note. *statistically significant at p < .00333

Mean
Difference
2.17
2.91
1.87
1.56
2.21
2.96
1.92
1.61
-1.04
-1.35
0.75
-6.04
-0.30
-0.05
-0.31

4.870
6.380
5.990
5.975
4.648
5.927
5.458
5.382
4.901
5.343
5.553
5.562
4.682
4.695
4.579

10.386
10.673
7.295
6.103
11.113
11.668
8.201
6.974
4.977
5.920
3.152
2.539
1.471
0.228
1.580

545
545
545
545
545
545
545
545
545
545
545
545
545
545
545

<.001*
<.001*
<.001*
<.001*
<.001*
<.001*
<.001*
<.001*
<.001*
<.001*
.002*
0.011
0.142
0.820
0.115

Additional Findings
Gender
A repeated measures MANOVA was calculated to compare the effect of gender
on the six providers of perceived social support. The means and standard deviations for
gender and social support can are in Table 7. A significant effect was found (λ (6,538 =
.974, p = .028). Tukey HSD post hoc testing indicated that gender significantly affected
perceived social support from friends, significant others, and athletic trainers (See Table
8). Women perceived greater social support than men from friends, significant others,
and athletic trainers.

Table 7
Means and Standard Deviations for Gender and Level of Perceived Social Support
Provider of Support
Friends

Male/Female

Male
Female*
Family
Male
Female
Significant Other
Male
Female*
Teammates
Male
Female
Coaches
Male
Female
Athletic Trainer
Male
Female*
Note. * indicates significance.

Mean
Scale
Score

20.31
21.20
23.04
23.19
22.20
23.49
20.73
21.44
21.34
21.61
19.46
20.51

5.110
4.541
4.951
4.912
5.708
5.010
4.968
5.342
4.938
5.488
5.222
5.367

169
376
169
376
169
376
169
376
169
376
169
376

5.07
5.30
5.76
5.79
5.55
5.87
5.18
5.36
5.33
5.40
4.86
5.12

Level of
Social
Support
Moderate
High
High
High
High
High
High
High
High
High
Moderate
High

Table 8
Significance of Female Gender and Providers of Perceived Social Support

Provider of Support
Friends
Significant Other
Athletic Trainer
Teammates
Coaches
Family

Type III SS
92.723
196.062
127.027
57.967
8.573
2.534

df
1
1
1
1
1
1

MS
92.723
196.062
127.027
57.967
8.573
2.534

F
4.154
7.151
4.484
2.120
0.303
0.104

p
0.042*
0.008*
0.035*
1.460
0.583
0.747

Note. *indicates statistically significant p < .05
Year of Eligibility
A repeated measures MANOVA was calculated examining the effect of year of
eligibility on perceived social support providers. Table 9 displays the means and standard
deviations of perceived social support by year of eligibility: Freshmen, Sophomore, Junior,
Senior, and 5th-year Senior. A significant effect was found (λ (24,1871.091 = .930, p = .025).
Significance testing indicated that year of eligibility had a significant effect on friends' and
coaches' perceived social support (see Table 10). A post hoc Tukey HSD revealed no
significance for years of eligibility with coaches as perceived social support providers.
Freshmen and sophomores perceived more social support from friends than compared to
seniors.

Table 9
Means, Standard Deviations, Mean Support Scale Scores, Level of Perceived Social Support,
and Year of Athletic Eligibility
Provider of
Support

Year of
Eligibility

Freshman@ 21.33
Sophomore $ 21.28
Junior
20.88
Seniors @$
19.22
5th Yr Senior 20.96
Family
Freshman
23.55
Sophomore
23.58
Junior
22.74
Senior
22.04
5th Yr Senior 22.20
Significant Other
Freshman
23.70
Sophomore
22.86
Junior
22.95
Senior
22.09
5th Yr Senior 22.80
Teammates
Freshman
21.63
Sophomore
21.13
Junior
21.52
Senior
20.05
5th Yr Senior 20.64
Coaches
Freshman
22.30
Sophomore
21.55
Junior
20.79
Senior
20.43
5th Yr Senior 21.20
Athletic Trainer
Freshman
19.89
Sophomore
20.25
Junior
20.67
Senior
19.79
5th Yr Senior 21.40
Note. *@$ Indicates Significance p < .05
Friends

SD
4.533
4.583
4.504
5.44
5.029
4.608
4.538
5.122
5.909
4.924
4.941
5.217
5.219
6.160
5.261
4.465
5.467
5.396
6.224
5.765
4.475
5.883
5.368
6.089
5.331
4.963
5.750
5.316
5.558
5.575

n
211
134
100
76
25
211
134
100
76
25
211
134
100
76
25
211
134
100
76
25
211
134
100
76
25
211
134
100
76
25

Mean
Support
Scale
Score
5.33
5.32
5.22
4.80
5.24
5.88
5.89
5.68
5.51
5.55
5.92
5.71
5.73
5.52
5.70
5.40
5.28
5.38
5.01
5.15
5.57
5.38
5.19
5.10
5.30
4.97
5.06
5.16
4.94
5.35

Level
of Support

.008*
.020*
.935
.020*
.496
1.000
1.000
.658
.148
.693
.599
.599
.768
.152
.928
.910
.910
1.000
.162
.900
.705
.705
.131
.065
.863
.975
.975
.751
1.00
.669

High
High
High
Moderate
High
High
High
High
High
High
High
High
High
High
High
High
High
High
Moderate
High
High
High
High
High
High
Moderate
Moderate
High
Moderate
High

Table 10
Effect of Year of Eligibility on Perceived Social Support

Provider of Support
Type III SS
Friends
271.500
Coaches
273.446
Family
190.930
Significant Other
164.604
Teammates
156.852
Athletic Trainer
91.013
Note. *indicates significance p < .05.

df
4
4
4
4
4
4

MS
67.89
68.36
47.73
41.15
39.21
22.75

F
3.075
2.445
1.987
1.492
1.438
0.798

p
0.016*
0.046*
0.095
0.203
0.220
0.527

Discussion
The challenge in supporting current collegiate athletes is assisting them as they
navigate being on their own, face new academic challenges, be competitive collegiate
athletes, and oversee their physical and mental well-being. For these reasons, many
different individuals provide social support for collegiate athletes. Current research
identifies teammates, coaches, and athletic trainers as a strong support network (Bejar et
al., 2019; Clement et al., 2015; DeGroot et al., 2018; Bennett et al., 2016; Newman &
Weiss, 2017). Others recognize that friends and family support these athletes (Agbarov et
al., 2012; Lu & Hsu, 2013; Malinauskas, 2010; Malinauskas & Malinaskeine, 2018). The
current study identifies those individuals whom athletes perceive as providing them with
the most significant social support. The results provide more insight into whom athletes
may seek out for social support and how they perceive the level of that support following
injury, illness, or other identified life stressors.
Perceived Social Support
When comparing the mean scores on the MSPSS and AMSPSS, athletes reported
perceiving greater social support from family, significant others, teammates, coaches,
friends, and athletic trainers, respectively. These results would appear to support the
hypothesis partially. The median teammates' scores were 21.22 compared to 20.92 to that
of friends’, supporting the hypothesis. However, the median family support score was
23.14 compared to the coaches' scores of 21.53. The median score for significant others
was 23.09 compared to the athletic trainers' scores of 20.18, neither of which supports the
hypothesis (Table 5). Only athletic trainers scored as providing moderate levels of
perceived social support, compared to all other groups who provided high social support

levels. When comparing the means and standard deviations of the instruments' scores, it
is evident the scale scores are closely related for all groups and fall between a rating of 5
to 7 (agree to very strongly agree) for each of the four questions relating to the specific
provider of support. What appears to be a statistically significant difference in scores on
the MSPSS and AMSPSS, in reality, the scores are very similar to one another.
The expectations of this study were that teammates would provide more social
support compared to friends, coaches compared to family, and athletic trainers compared
to significant others. Several of the group comparisons were of significance. (Table 6).
Significant others compared to athletic trainers were statistically significant, as were
family compared to coach. The comparison which showed no significant differences was
friends compared to teammates. None of these results support the hypothesis, but they
offer some insight into whom athletes perceive to receive social support.
At first glance, these results may seem to be surprising since teammates, coaches,
and athletic trainers might be more than likely providing the college athlete more inperson contact and support than compared to family, friends, and significant others
(DeGroot et al., 2018; Bejar et al., 2019). Looking more closely at the results, it is evident
that although the results were significant for varying levels of perceived social support
from the support providers, the scores from the MSPSS and AMSPSS are still very close
in proximity. What is of concern is that athletic trainers' scores indicated only providing
moderate support levels compared to all other groups who provided high levels of
perceived social support.
Sixty-one percent of athletes noted injury as their most significant stressor,
compared to 11% citing illness and 28% reporting no injury or illness. However, all

participants reported experiencing some degree of stress. Sixty-four percent noted
moderate levels of stress. Athletic trainers are mentioned in the literature as important
social support providers (Bejar et al., 2019; Bennett et al., 2016; Clement and Shannon,
2011; DeGroot et al., 2018; Newman & Weiss, 2017). DeGroot et al. (2018) stated that
the athletic trainer is thought to be the most important support system for the injured
athlete because of their constant interaction throughout rehabilitation. With two-thirds of
the athletes noting an injury, one would expect the athletic trainer would be more
involved in the treatment of those participants and be ranked higher in providing social
support than they were compared to the other providers.
Additionally, all athletes noted some stress level; surprisingly, the athletic trainer
was not more involved in assisting those athletes in dealing with their stress if athletic
trainers are as crucial to the stressed athlete as they are to the injured athlete. Compared
to current literature, these individual scores for providing social support contradict studies
where the athletic trainer was identified as providing more support than coaches or
teammates. Comparing the scores on the AMSPSS/MSPSS, they show more support
from parents or friends compared to coaches or athletic trainers, which agrees with the
literature, as noted by Agbarov et al. (2012); Covassin et al. (2014); and Sullivan et al.
(2020).
As was suggested by Gabana et al. (2017), if athletes have positive relationships
with those who provide social support, they are more likely to retrieve those positive
memories and overcome future hardships. Judging from the results of the MSPSS and
AMSPSS, it is possible that all of the athletes had already established some degree of
positive relationships or had a more positive emotional climate with all of those who

provided them with social support. However, some of those relationships ranked higher
depending upon each individual's level of positive interactions with those individuals
who provided support to them at one point or another (Mankad et al., 2009). In this study,
the result was that athletic trainers were ranked the lowest, but again it does not imply
that they were providing less impactful levels of social support.
It is also possible that because these are collegiate athletes, they have already
attained some level of emotional intelligence when it comes to dealing with an injury,
illness, or other life stressors. This increased emotional awareness can also attribute to
higher scores on the MSPSS and AMSPSS. Increased perceptions of social support could
be the result of athletes who also had increased levels of emotional intelligence and
emotional climate, which would, in turn, may also lead to improved emotional well-being
(Bolling et al., 2019; Gayles & Baker, 2015; Madrigal & Robbins, 2020; Malinauskas &
Malinasukiene, 2018). Improved emotional well-being is the whole purpose of social
support.
From the results of the MSPSS and the AMSPSS, one cannot understand what
type of social support athletic trainers are providing compared to the other groups. Is it
possible athletic trainers provide more informational and task challenge support (Bennett,
2016; Robbins & Rosenfeld, 2001; Surya et al., 2015; Unruh 2005) and friends,
teammates, coaches, significant others, and family provide more emotional and tangible
support (Poucher et al., 2018; Wayamount & Huffman, 2020), and the athlete perceives
this to be more important? However, these scores may imply that this study did not
examine the type of support perceived by athletes, so it is not easy to make those
assumptions based on the study's data.

Another question would be, do athletic trainers need to be more reflective and
aware of the type of support they provide for all athletes, not just those injured or ill?
According to the NCAA, mental health and well-being are the responsibility of all
university members' athletic support networks (NCAA, 2016; NCAA, 2019). Hagiwara et
al. (2017) stated that social support occurs between individuals who have had, on some
level, an interpersonal relationship, and the social support was an interactive, positive
experience between these individuals.
It appears that athletic trainers may need to provide slightly more support than
they are currently giving or improve the support and emotional environment they are
making available to the athletes, especially compared to the other five groups involved in
this study. Again, the scores were so closely aligned, and the instruments are not
identifying athletic trainers as not providing any social support. Perceived social support
from athletic trainers did score the lowest on the AMSPSS, compared to the other groups
on the MSPSS and AMSPSS.
Comparisons of Providers of Social Support
Eleven of the fifteen comparisons were statistically significant, based upon their p
values being less than the set α level of .05. None of these comparisons supported the
hypothesis that teammates, coaches, and athletic trainers would provide more social
support when compared to friends, family, and significant others. The four comparisons
which had no statistical significance were perceived social support from friends
compared to coaches; friends compared to teammates; significant others compared to
family, and teammates compared to coaches (See Table 6). The lack of significance

would indicate that friends and teammates may provide similar social support levels, but
one is not greater than the other.
Family
Perceived social support from family scored the highest compared to friends and
significant others on the MSPSS, coaches, teammates, and athletic trainers on the
AMSPSS; however, these results were not significant. One of the reasons for this highest
score could be that the family provided the most basic social support, as they may only be
getting the athlete's perspective of the situation. The social support athletes are likely to
receive would be listening and emotional social support (Poucher, 2018; Wyamount &
Huffmanm, 2020). While friends or teammates could also provide this type of support, it
seems to apply to the family the best. This result fits because the family and the athlete
will have the longest relationship. The athlete can receive more individualized support,
and it is more than likely what the athlete is seeking initially in terms of social support.
They need someone to listen to their problems and support them, someone who is readily
available and can be communicated with in-person, over the phone, through video, or
other technologies.
Significant Others
The perceived social support from significant others scored higher than friends on
the MSPSS and athletic trainers, teammates, and coaches on the AMSPSS. Freeman
(2020) identified a significant other as an individual who has expertise and similarity to
the individual receiving the support. Using this definition, a more robust relationship than
merely friends or teammates is suggested. The significant others share many more things
in common and, in confidence, can give the athlete another perspective when

understanding the social support received and how it relates to their return to activity
(Agbarov et al., 2012; Fletcher & Sarkar, 2012; Mitchell et al., 2014).
Social support from a significant other may also be more meaningful to the athlete
when compared to the other providers of social support. This more meaningful support
may result from the significant other and athlete having a deeper interpersonal
relationship, as Hagiwara et al. (2017) suggested. Also, the type of social support
provided can make a difference. By using Pines et al.'s (1981) definition of reality
confirmation where the support provider has values similar to their own, in that case, the
significant other could also confirm the athlete's perceptions of the social support
(Richman et al., 1993). In Pines et al.'s (1981) definition of task challenge support, a
significant other may also challenge the athletes' perception of the task or activity to
provide motivation and positively respond to social support. Athletic trainers, teammates,
friends, and coaches may provide task challenge support and reality confirmation, but
significant others may be more likely to provide emotional and tangible assistance.
Athletic Trainers, Teammates, Friends, and Coaches
Athletic trainers, teammates, friends, and coaches are in a unique position. They
may spend a significant amount of time with the athlete, especially following injury or
illness, or even other stressors, thereby providing different support types and support
levels as they progress back into activity. These additional support types and levels may
also explain why athletic trainers scored so closely with teammates, friends, and coaches
on the MSPSS and the AMSPSS. These were the groups with whom the athlete would
have had the most physical and social contact (Bennett et al., 2016; Robbins &
Rosenfeld, 2001).

Perhaps what differentiates these social support providers from one another is
whom the athlete feels more comfortable reaching out to for support. It is also possible
that the athlete may realize they might receive and benefit from any one of the eight types
of support from these different individuals at any given point in time (Pines et al., 1981;
Richman et al., 1993). This support would need to occur following any combination of
injury, illness, or other identified stressors. The person or persons providing the support
must give positive messages in the support they are offering to the athlete.
Stress Buffering and Main Effects
The athletes in this study identified their most significant injury, illness, or other
identified life stressor in the past 12 months before taking the survey. An athlete could
have encountered all three of these circumstances and acknowledged them on the survey.
Of particular note, all of the 546 participants indicated some stress level in the 12 months
before completing the survey, with 64% (n = 352) experiencing moderate stress. Also,
61% (n = 330) noted an injury in the year before completing the survey, and 11% (n=68)
cited an illness. At any one point in time, the perceived social support could provide one
or both of the stress-buffering effect or main effects component of social support.
The eight types of social support can act as the stress-buffering or palliative
pathway in protecting the individual from the adverse psychological and physiological
responses to stress (Cohen & Wills, 1985; Hornstein & Eiesenberger, 2016; Lakey et al.,
2015; Mitchell et al., 2014). The stress buffer acts as a safeguard to the athletes from
negative responses. However, social support can also act as the main effect or
preventative pathway.

The social support received would have had a positive impact regardless of the
level of stress the athlete may be experiencing (Bianco & Eklund, 2001; Cohen et al.,
2000; Hartley and Coffee, 2019). Both physiological and psychological responses to
perceived social support ideally would result in the decreased response to the stressor and
the athlete's ability to better cope with the stressors, therefore, preventing the stressor's
negative impact on the individual (Mitchell et al., 2014). It is also important to remember
that the athlete may not experience all social support as positive. While the provider of
support's intention may be to provide positive support, the athlete may perceive it as more
negative and not helpful to their return to sport. The support perceived from individuals
tends to occur in a cyclical pattern throughout experiencing the stressor and their return to
activity so that support can differ throughout this cycle.
Integrated Model of Response to Sport Injury
These cyclical patterns of experiencing and responding to a stressor (injury,
illness, or other identified life stressor) are the foundation of the Wiese-Bjornstal et al.
(1998) Integrated Model of Response to Sport Injury. This model recognizes the
importance of personal and situational factors before and after responding to a stressor.
After experiencing these personal and situational factors, the individual will produce
cognitive, emotional, and behavioral responses to sport injury, illness, or other identified
life stressors (Wiese-Bjornstal et al., 1998). Wiese-Bjornstal et al. (1998) stated, "The
core of the integrated model posits that cognitions, such as self-perceptions, are important
because they, in turn, influence the emotional and behavioral responses of athletes to
injury (p. 50)." The athletes most likely would have demonstrated a need for assistance in
their responses to these stressors, whether it was a positive or negative response.

Based on the responses to this study, it was clear that athletes experiencing
stressors sought to receive some social support from various individuals throughout the
reaction to the stressor. Although the scores were similar and there was significance
between groups in the scoring of the MSPSS and the AMSPSS, there was no one group
of individuals which scored exceptionally higher when compared to the other groups.
It was more than likely that the athletes were all in different coping stages with
their stressors when they completed the study. Some may have had to recall how they
felt after an injury, illness, or other stressor and the support they received, while others
may have been experiencing their response to stressors when they took the survey. There
was no differentiation between these differences in this study. Some participants (61%,
n = 330) in the survey recalled an injury, while others identified their stressors as
academic and course work (25% of total respondents). Others identified mental health
issues (20% of total respondents) as their most significant stressor, as determined on the
USS in the survey's demographic portion. Also, procrastination and life/study balance
were each ranked as significant by approximately 9% of the respondents, respectively.
Regardless of the stressor, it was evident that all the participants in this study needed to
cognitively appraise where they were mentally, identify their emotional response, and
rate how they perceived the social support from the groups identified. Based on the
responses and results of the MSPSS and the AMSPSS, it seems all of the providers of
social support provided some level of positive support.
Additional Findings
This study also examined the effects of gender and year of athletic eligibility on
perceived social support. The hypothesis is that there would be gender differences when

athletes rated perceived social support from the six providers of social support examined
in this study. An additional hypothesis was that there would be differences in perceived
social support based on the year of athletic eligibility.
Gender. In this study, females perceived more significant social support than
males when friends, significant others, and athletic trainers provided the social support
(See Table 8). This finding could result from the higher percentage of cisgender women
(69%) than cisgender men (31%) completing the survey. Unruh et al. (2005) reported that
more high-profile sports reported more satisfaction with their athletic trainer when
compared to lower-profile sports. This satisfaction was especially true for female athletes
when compared to males. Cooper et al. 2017 noted higher rates of stressors for those
higher-profile sports when compared to the lower-profile sports. It is possible in this
study that females represented more high-profile sports and possibly experienced more
stressors than their male counterparts, thus perceiving more social support from their
athletic trainer, significant other, and friends. In this study, there was more representation
from females in the high-profile sports: Women's Soccer (9.7% of respondents)
compared to Men's Soccer (3.4% of respondents), Softball (9.9% of respondents)
compared to Baseball (6.6% of respondents), and Football (9.9% of respondents)
represented high-profile sports, followed by Women's Track (5.3% of respondents)
compared to Men’s Track (2.1% of respondents) and Women’s Basketball (5.4% of
respondents) compared to Men’s Basketball (1.8% of respondents).
The current study did not compare types of injuries but did compare females to
males when it came to perceived social support. In terms of gender, Kontos et al. (2013)
examined gender differences in concussion compared to orthopedic injuries. They found

that females tended to appraise their injury more negatively when compared to males,
thus needing more social support than the men. This appraisal resulted from males
reporting more pressure to return to their sport than females. There is the suggestion that
males should portray a more masculine sport culture, such as that which occurs in
recognizing pain (Christopher et al., 2020), in showing a more masculine athletic identity
(Watson, 2016), and possessing mental toughness (Madrigal et al., 2015), and hardiness
(Salim et al. (2016). Li et al. (2017) found that males who reported depression and
anxiety were more likely to suffer an injury and needed more support in their study of
male and female athletes.
There were 170 male athletes in the present study compared to 376 female
athletes. It is possible that because the comparison of male to female athletes was
disproportionate, that females would have automatically reported higher levels of
perceived social support from all providers of social support. The mean numbers were
significantly different when comparing females' to males' social support from friends,
significant others, and athletic trainers. Suppose cisgender females were more satisfied
with their athletic trainer's social support. In that case, it could indicate that females tend
to seek more social support than cisgender males, especially when it comes to stress from
an athletic injury (Madrigal & Robbins, 2020). Because of the pressure to maintain an
athletic identity of strength and hardiness, males may under-report the need for social
support from friends, significant others, and athletic trainers. Therefore, social support
should be available to both males and females equally, understanding that males may
need more social support than they seek, especially from friends, significant others, and
athletic trainers.

Year of Athletic Eligibility. In this study, freshmen and sophomores reported
more social support from friends compared to seniors. When comparing freshmen,
sophomore, juniors, and senior athletes and their social support needs, there can be many
different personal characteristics to consider. First-year students and sophomores are
more likely to have less emotional intelligence (Goodwin et al., 2018), lack mental
toughness (Madrigal, 2015) and hardiness (Salim et al., 2016) in competing at the college
level, and have yet to establish their own athletic identity (Watson, 2016). They may be
less likely to cope with emotional trauma based upon their social support network
structure. Lan and Xuebing (2018) reported first-year students and sophomores had more
concern about their health when compared to juniors and seniors in college. Wu et al.
(2018) also said first-year students and sophomores had lower positive mental health
when compared to juniors and seniors.
Freshmen may be more likely to turn to their friends or family for support than
their teammates or coaches. The support that friends offer may differ from teammates
because interpersonal relationships between the team's older members and the coaching
staff have yet to materialize. Freshmen and sophomores have a stronger bond with their
friends. They have maintained characteristic similarities (Mitchell et al., 2014) and are
more than likely to have had similar life experiences until this point in their athletic
careers (Christino et al., 2015; Lan & Xuebing, 2018). Malinauskas and Malianuskiene
(2018) reported similar findings. This stronger bond would result in more beneficial
social support from their friends when compared to teammates, coaches and athletic
trainers, significant others, and even family. Therefore, it is not surprising that freshmen

and sophomores perceived more social support from their friends than other support
providers.
However, there were many more freshmen and sophomores in this study than
juniors and seniors. There were 211 freshmen and 134 sophomores compared to 100
juniors and 76 seniors (See Table 9). Had the numbers of freshmen and sophomores been
more comparable to juniors and seniors, the results may not have been as significant.
Madrigal and Robbins (2020) did not report any differences between the year of athletic
eligibility when identifying stressors. Juniors may not have been relying as much on their
social support networks because they had already established their athletic identity,
mental toughness, hardiness, and ability to cope with more adversity than compared to
freshmen and sophomores (Christino et al., 2015; Hardy et al., 1991).

Conclusion
Sustaining injuries, experiencing an illness, or dealing with other identified life
stressors can occur at any point in time with athletes of all ages, but even more so with
collegiate athletes. Collegiate athletes have high demands placed on them with academic
pressures and athletic performance pressures. Any disturbance to this delicate balancing
act can have detrimental effects physically and psychologically if not dealt with
promptly.
It is clear from the current research and the present study that athletes seek out
social support from various people (Bennett et al., 2016; Malinauskas & Malinauskeine,
2018; DeFreese & Smith, 2014; Fletcher & Sarkar, 2017). The statements made by the
NCAA support this research (NCAA, 2014; NCAA, 2019; NCAA, 2020). In this study,
athletes noted perceiving high social support from all groups, except for athletic trainers,
who were rated as only provided moderate support. However, males rated both friends
and athletic trainers as only providing moderate support when compared to females.
Athletic trainers may need to improve their ability to understand the individual athlete's
cognitive appraisal of their stressors and adjust their support accordingly and consider the
sex of the athlete. Without a qualitative component, it is not easy to understand why
athletic trainers scored as only providing moderate social support.
Athletes' appraisals of their situation are individualized. Those athletes dealing
with an injury may have different needs than an athlete dealing with an illness or other
identified life stressor, and vice versa. What is essential to understand is the athletes have
demonstrated a need for social support from all individuals. Providers of social support
need to be prepared to recognize this need, meet those needs, and provide adequate

support to these athletes. In this study, 64% of the respondents indicated experiencing
moderate levels of stress, and 7% noted high levels of stress, and only 28% noted low
levels of stress. These stress levels demonstrate the need for social support, even in the
absence of injury or illness.
Clinicians especially need to challenge the athletes and be aware of the athletes'
cognitive appraisals at the interactions' time. According to the Integrated Response to
Sport Injury Model (Wiese-Bjornstal et al., 1998), these appraisals will constantly be
changing, so providers of social support need to adjust their types of support accordingly.
With positive social support, athletes may be better prepared to deal with adversity
without having detrimental effects on their academic and athletic performances. Of
utmost importance is providing support for their mental health as the athlete progresses
from the onset of injury, illness, or other identified life stressors throughout their
response to those stressors and how they cope and return to activity.
Gender and year in school are also considerations when identifying those that
need social support. Most studies agree that women seek out more support when
compared to men. However, disproportionate ratios of males to females in these studies
may skew this information. Men and women will seek out different support types based
on their athletic identity and possibly even their sport. Freshmen and Sophomores
demonstrated receiving more support from friends when compared to juniors and seniors,
which decreased as the year of eligibility increased. This support could result from more
significant numbers of freshmen and sophomores than juniors and seniors in this study.
There is a need to identify freshmen and sophomores' needs compared to juniors and

seniors. By identifying their needs, social support's type and frequency can be better
suited to meet these different needs.
Validity and reliability were not evaluated for the AMSPSS, so it is uncertain if
this measurement instrument is appropriate for this population. Comparing it to the
MSPSS, a valid and reliable tool, using the AMSPSS may be suggested for future studies
to measure perceived social support from teammates, coaches, and athletic trainers. A
limitation of this study design was the lack of a qualitative component to understanding
the athlete's perceptions of social support providers following injury and other identified
life stressors. Another limitation of the study could be the more significant number of
females to males and freshmen and sophomores than juniors and seniors. This limitation
may have influenced the results' significance. However, the results are still an important
finding in understanding the perception of social support from friends, family, significant
others, teammates, coaches, and athletic trainers.

Future Research
This study has helped identify how athletes perceive they receive the most social
support following injury, illness, or other identified life stressors. No individual
exclusively provides social support to the athletes; social support is perceived differently
from all groups assisting the athlete. Future research could also investigate whether the
athletes felt the social support was adequate or needed more beneficial support. Adding a
qualitative component to the study would also help understand how the different types of
perceived social support impact the athlete and their response to injury, illness, and other
identified life stressors.
Identifying what type of support athletes perceive from these different social
support providers could also help educate the providers in the future. The support
providers would better understand their impact upon the injured, ill, or stressed athlete
and their various roles in the athlete's recovery from injury, illness, or other identified life
stressors. The effects of gender and year of athletic eligibility on social support are still
not conclusive, and examining these two factors should continue.
This study specifically examined NCAA Division II athletes. It is uncertain if
these results apply to other divisions or athletes in general or if these findings are unique
to Division II athletes. These results would have to be explored by studies in the future.
Also, instead of having athletes recall the events of a whole year of competition, it may
be more beneficial to assess their stress levels across their competitive season. It is also
unclear how much the response to the COVID 19 pandemic influenced the athletes' stress
levels in this study. Only ten of the 546 participants specifically identified COVID 19 as
their stressor.

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Appendix A
Review of the Literature

Comparing NCAA Division II Athletes’ Perceptions of Social Support Following
Injury, Illness, or Other Identified Life Stressors.
In 2016, the NCAA completed a study entitled Growth, Opportunities,
Aspirations, and Learning of Students in College (GOALS) (NCAA, 2016). Two items in
the survey that Division I, II, and III student-athletes completed were regarding their
health and well-being and the college social experience. The NCAA (2016) reported
athletes' expectations were less than accurate regarding expectations about the athletes'
athletics and social experience. The NCAA (2016) noted increases in athletes who noted
mental health issues such as anxiety and depression compared to the 2010 GOALS study.
Only 40 percent of those athletes who reported seeking mental health assistance from
team or college personnel stated they had high satisfaction levels. Almost 30% of female
student-athletes reported experiencing difficulties that they had trouble overcoming in the
month before completing the 2019 GOALS (NCAA, 2020b), compared to the one-quarter
of male athletes who reported similar difficulties. These numbers are up for female
athletes, and the numbers for males are decreasing compared to the 2016 GOALS
(NCAA, 2020b). This disparity demonstrates the need for better mental health assistance
and services available to male and female athletes and continues to be an issue for many
college campuses.
College students represent a part of our culture transitioning to adulthood,
learning to live independently, and learning new coping skills (Gerlach, 2018). This
unfamiliar personal growth process also comes with its challenges and is often magnified
for collegiate athletes. There are more time requirements, academic responsibilities, and
pressure to succeed in the classroom and athletics (Comeaux & Harrison, 2011). Thus,

there is increased visibility to the public, placing them in more vulnerable situations than
non-athletes (Egan, 2019). In addition to these stressors, the NCAA states that
“Participation in intercollegiate athletics involves unavoidable exposure to an inherent
risk of injury” (NCAA, 2014, p.4).
Collegiate athletes may perceive these injuries, illnesses, or other identified life
stressors as threats or challenges. The response to these stressors may result in difficulty
coping socially, emotionally, and physically (Acharya et al., 2018; Goodman et al.,
2018). The athlete's response to stress can increase if they lack the experience, ability,
and support to deal with this type of stress (Evans & Hardy, 1995). In response to these
stressors, the athletes may search for support and guidance from several sources.
Whether the athlete has a positive or negative appraisal of their stressors, they are
most likely to share these experiences with those in their support network. (Rosenfeld et
al., 1989). This support network can include friends, family, significant others,
teammates, coaches, and athletic trainers (Bianco & Eklund, 2001). It is undetermined
which group of individuals are most influential and likely to provide social support to the
college athlete. To better evaluate which individuals a college athlete may turn to for
support, it is essential to understand how individuals respond to stress and how the
cognitive appraisal process operates.

Stress
Increased stress may occur in response to an interaction, a situation, or the
environment. In collegiate athletes, stress can manifest itself in several different ways. An
injury, illness, or another stressor may prove an overwhelmingly negative situation for
the collegiate athlete. Common emotional reactions after suffering an injury, illness, or
other stressors can include anger, frustration, loss, decreased self-esteem, decreased selfconfidence, decreased mood states, and emotional volatility (Malinauskas, 2010; Tracey,
2003; Wiese-Bjornstal et al., 1998; Wilson & Pritchard, 2005). Lazarus (1990) defined
stress as the following:
In a transaction, a stressor taxes or demands a person's resources to
appraise or react to the challenge. This transaction or appraisal of the
environment, situation, or collective stressors results in the individual's
appraisal of the threat of harm or challenges. The stress response occurs
when the culmination of a person's assessment of the situation exceeds
their available resources to meet or cope with those demands (pp. 3-4).
Pensgaard and Roberts (2000) state that the amount of stress an athlete can
challenge is whether or not the athlete believes these events to be within or beyond their
control. If the athlete believes the stress to be within their control, then their response to
that stressor will most likely be positive. If they feel the stressor is beyond their control,
they are more likely to view that stressor more negatively (Pensguard & Roberts, 2000).
There are several demands placed upon collegiate athletes compared to nonathletes. Like non-athletes, athletes have academic demands, social needs, and demands
from friends and family. The difference is that collegiate athletes are trying to balance

academics and athletics commitments while also trying to meet the expectations of
teammates, coaches, athletic trainers, friends, and family (Surujlal et al., 2013). When an
athlete experiences an injury, this most likely results in a negative response.
Injury as a Stressor
Meeuwisse et al. (2003) noted that 40%-50% of athletes face at least one injury
resulting in significant time loss in participation during their college years. The NCAA
reported that most injuries caused three to six days of time loss from injury; however,
19.5% of injuries accounted for 21 or more missed participation days (NCAA, 2016).
Those athletes who had more severe injuries also had higher amounts of perceived stress
than athletes with minor or no injuries (Malinauskas, 2010). Christopher et al. (2020)
noted in their study of the epidemiological profile of pain that one-half of female athletes
reported pain more compared to only one-third of males. Madrigal and Robbins (2020)
surveyed 525 collegiate student-athletes; 101 had current injuries. Forty-eight percent of
the injured athletes attributed their stress to the injury, while the remaining attributed it to
alternative stress types.
Illness as a Stressor
Illness, both acute and chronic, also can act as a stressor. More than 50% of acute
conditions reported during athletic competitions were upper respiratory tract infections
(URTI) (Schwellnus et al., 2016). URTIs can also include the following illnesses:
bronchitis, pharyngitis, sinusitis, influenza, infectious mononucleosis, and pertussis
(Jaworski & Rygiel, 2019). Other acute illnesses may include urinary tract infections,
gastrointestinal illness, such as diarrhea, sexually transmitted diseases, and influenza
(Jaworski and Rygiel, 2019). Chronic illness may consist of Diabetes Mellitus Type 1 or

Type 2, mental health illness, such as anxiety and depression, autoimmune disorders,
such as rheumatoid arthritis or Crohn's disease (Layberger, 2019). Walsh (2016) also
noted that the psychological stress response to increased training loads might also
decrease the immune system's ability to fight off infection, thus increase the likelihood of
illness.
Other Identified Life Stressors.
Malinauskas (2010) also identified life event stress as another factor impacting an
athlete's life satisfaction. These life stressors can include but are not limited to academic,
personal, and emotional challenges, social isolation and life, sport, and academic balance
(Malinauskas, 2010; Stallman & Hurst, 2016; Watson, 2016; Wilson & Pritchard, 2005).
The college athlete deals with those stressors and stressors associated with sport such as
training demands, missing classes due to travel, studying, the pressure to win, and
conflict with teammates and coaches (Watson, 2016).
A more recently identified life stressor would be the COVID-19 pandemic. The
pandemic has affected athletes in many different ways, including suspension of sports,
lack of ability to train for their sport, resocialization to their sport, no live team or coach
interactions, and restrictions on other activities of daily living (Pennsylvania Department
of Health, 2020; NCAA 2020a). Response to the pandemic is proving to be a constant
stressor and dealing with other stressors that may be present.
In the case of injury, illness, or other identified life stressors, the initial reaction to
these stressors can be negative (Daly et al., 1995; Mankad et al., 2009; Tamminen et al.,
2016). The perception of the initial reaction may be threatening or harmful. These
stressors are often unanticipated, thus making the response to that stressor more intense

and dangerous. The stressor's response may only occur after an athlete can perceive and
cognitively appraise each stressor's meaning.

Perception
Johns and Saks (2001) defined perception as “the process of interpreting the
messages of our senses by sorting and organizing these messages to provide order and
meaning (p. 207).” Bruner and Postman (1949) viewed perception as an instrumental
activity influenced by motives, predispositions, and past experiences. Simply put,
perception is the recognition, interpretation, and response to sensory stimuli.
Bruner and Postman (1949) also view perception as a highly complex series of
psychological processes that involve expectancy about an individual's environment to be
true or not true. In other words, seeing what you want to see or hearing what you want to
hear. Johns and Saks (2001) define this as a perceptual defense. Perceptual defense
serves as a protective mechanism, so an individual does not interpret the target as
threatening or harmful.
Johns and Saks (2001) and Bruner and Postman (1949) suggested similar
perceptual process components. There is a perceiver (person experiencing the stimulus),
target (or the trigger), and the situational context in which this process is occurring.
Combining the situation and target will influence the perceiver's impression or
interpretation (Johns & Saks, 2001). In the Bruner and Postman (1949) model, the
perceiver encounters an unfamiliar target; he/she tries to collect more information about
the target, and he/she must categorize the target. In the categorization stage, cues can be
ignored, distorted, and one's perception becomes more selective until he/she composes
their picture of the target (Bruner & Postman, 1949).
Previous experiences, emotions, and their own needs influence the perceiver's
impressions of the target (Wiese-Bjornstal et al., 1998). Previously experienced injuries

and emotions can affect the injury's perception (the target). An athlete may experience
perceptual defense as a protective mechanism, so the individual does not interpret the
target as threatening or unfavorable. An individual's length of time will stay in this stage
of denial depends on their cognitive appraisal and perceptions of the injury.
Even though an athlete may have had the experience of an injury or other
identified life stressor before, they may recall the process of injury, injury rehabilitation,
return to play, and all the struggles and successes which may have occurred during that
time. From a situational perspective, if an athlete has had a previous negative experience,
he/she may automatically make the association that the current target will also be harmful
and respond accordingly with negative emotions.
Conversely, if the previous experience was perceived more confidently with
positive emotions, the individual will interpret the target differently and have a more
confident response. Bolling et al. (2019) suggested that injury definition and severity can
be two factors in an athlete's perception of an injury. These perceptions will also impact
the emotional climate of the response to injury, the injury rehabilitation process, and
return to play progression.
From a team perspective, emotions expressed while in team members' presence
may be vastly different from those displayed when away from the group interaction. An
athlete is maintaining their outward athletic identity of being strong and able to overcome
anything, not imply they would need assistance from their support network results in a
difference of emotions. (Mankad et al., 2009)

Cognitive Appraisal
Cognitive appraisal is a critical component in understanding how athletes respond
to stress. Lazarus and Monat (1974) defined the concept of cognitive appraisal as one
which:
"Expresses the evaluation of the significance of a transaction for the
person's well-being and the potential for the mastery in the continuous and
constantly changing interplay between the person and the environmental
stimulus configuration (p. 322)."
In the athletic population, athletes are part of a unique culture where athletic
participation evolves around an ever-changing environment, a dynamic support network,
and varying responsibilities within the team. Therefore, an athlete’s cognitive appraisal
and reaction to a stressor may frequently change to adapt to their environment as their
athletic, academic, and personal environment changes. An athlete’s success relies on
his/her ability to identify with, adjust to and respond to this changing environment
(Gayles & Baker, 2015). Every individual appraises a situation based upon their
differences, which will elicit a unique response to that athlete.
For example, participating in athletics may include dealing with pain, which may
occur daily. As such a common occurrence, which can impact performance outcomes,
playing in pain could be considered one of the more dominant cultural norms in an
athletic population. (Christopher et al., 2020). Experiencing pain can occur with or
without being associated with an injury. Pain may be regarded as a task threat or task
challenge and depends on how the individual athlete cognitively appraises their pain.
(Madrigal et al., 2016). Albinson and Petrie (2003) also examined how cognitive

appraisal, stress, and coping influenced athletes’ psychological adjustment before and
after injury.
Primary and Secondary Cognitive Appraisals
Like Daly et al. (1995), Albinson and Petrie (2003) identified athletes who
experience primary and secondary cognitive appraisals of their injuries. Lazarus and
Folkman (1984) defined the primary appraisal as "concerning mainly the discrimination
between transactions in which there are some personal investment and those that are
irrelevant for the person's well-being (p. 382)." For example, an injury, illness, or other
identified stressors may occur. The college athlete must decide if this stressor may affect
their athletic participation or not have any effect on their athletic participation.
In contrast to the primary appraisal, Lazarus and Folkman (1984) state,
“secondary appraisal takes into account which coping options are available, the
likelihood that a given coping option will accomplish what it is supposed to, and the
likelihood that one can apply a particular strategy or set of strategies effectively (p.35)."
At this point, if the college athlete feels they can accomplish a positive outcome of this
cognitively appraised event, then their secondary cognitive appraisal will be positive and
thus more helpful. If the college athlete feels they cannot apply any strategies effectively,
this indicates a negative response and will most likely have had deleterious effects.
The college athlete must go through this process of primary and secondary
appraisals, often throughout coping with an injury, illness, or other identified life
stressor(s). At any point in time, the appraisal can change from positive to negative, or
vice versa, thus changing their coping behaviors. These processes' outcome depends on
how the college athlete appraises each situation. Coping strategies were indicative of the

athletes' ability to appraise the injury cognitively. For example, the more negative an
athlete's secondary appraisal indicated more negative emotional appraisal of the injury,
the more their avoidance coping behaviors were evident at one-week post-injury
(Albinson & Petrie, 2003).
Previous experiences or inexperience influence the cognitive appraisals of an
injury, illness, or other stressors (Wiese-Bjornstal et al., 1998). Coping and emotional
responses are dependent upon one another, and the emotional reactions are unique to each
individual. Roy et al. (2015) noted the initial or primary appraisal was negative in
response to an athletic injury and stated this initial appraisal results from the influence of
each athlete's personal and situational factors and how these affect their psychological
responses to injury. Wadey et al. (2012) suggested that how an athlete copes with reinjury anxiety may have important implications for whether the symptoms manifest
themselves in adaptive or maladaptive ways.
These maladaptive responses included not actively participating in rehabilitation,
decreased interaction with teammates, and demonstrating avoidance behaviors.
Conversely, adaptive responses are more positive and mean a college athlete will be more
involved in setting rehabilitation goals and continuing contact with the team and a
willingness to do what they need to do to return to participation (Wadey et al., 2012). The
maladaptive responses lead to an increased potential for re-injury upon return to sport
participation. Several authors posit that personal factors influence cognitive appraisals
(Brewer 2007; Brewer et al., 2010; Wiese-Bjornstal et al., 1998; Andersen & Williams,
1988).

Personal Factors
Personal factors such as athletic identity, mental toughness, hardiness, and
demographic qualities are related to personality, disposition, and self-perception. Brewer
et al. (2010) examined the effects on athletic identity as a means of self-protective
changes following anterior cruciate ligament reconstruction. Those athletes who
experienced a threat to their athleticism, such as an athletic injury, may have responded
by disengaging themselves from the one identity by which they defined themselves. In
doing so, they reduced the threat or negative emotions they experienced from the injury
(Brewer et al., 2010).
Athletic Identity. Brewer (1994) defined athletic identity as the lengths a person
will portray as an athlete and receive acknowledgment for their athletic prowess.
Individuals with a robust athletic identity place greater importance on the role athletics
plays in their lives and evaluate their overall competence or worth as a person through the
lens of their athletic accomplishments (Watson, 2016). This need to place greater
importance on athletics may have included any previous or present athletic experiences
and athletic success or failures. Those athletes who reported stronger athletic identities
were also more likely to spend their time with others who would further improve their
athletic identities, such as coaches, teammates, and other athletes (Horton & Mack,
2000).
Having a robust athletic identity may help athletes have a more positive cognitive
appraisal of their athletic injury since they believed it to be a challenge that they may
conquer. However, this athletic identity strength may also influence more negative
cognitive appraisals following injury. In this case, an injury may negate their athletic

identity because they cannot participate in the essential thing they identify; they cannot
see themselves as anything but an athlete. This lack of athletic identity may also have
increased their risk for anxiety, depression, and an overall impairment to their well-being
(Miller & Kerr, 2002).
Tracey (2003) described decreases in athletic identity were more drastic when the
participants experienced slower than expected recovery rates, rehabilitation milestones,
and function was less than anticipated at the return to activity. Tracey (2003) suggested
two possible explanations: athletes with months of rehabilitation ahead of them may have
been slower to accept their injury status and the possibility that athletic identity tended to
decrease when age increases. Regardless of how these behavioral and emotional
responses manifest themselves, should they continue to escalate, it may have resulted in
psychological changes which may have further impeded the recovery process.
Mental Toughness. Madrigal et al. (2015) defined mental toughness as coping to
maintain determination, confidence, and control under pressure. Nicholls et al. (2008)
mentioned a link between mental toughness and other cognitive factors, such as coping
styles, positive attitudes, and other behavioral tendencies. Guiccardi et al. (2009)
identified a working definition of mental toughness as:
"The presence of some or the entire collection of experientially developed
and inherent values, attitudes, emotions, cognitions, and behaviors that
influence how an individual approach, responds to and appraises both
negatively and positively construed pressures, challenges, and adversities
to consistently achieve his or her goals (p. 68)."

Several authors suggested that high levels of mental toughness are positively
related to the problem of coping strategies and less linked to avoidance coping strategies
(Andersen & Williams, 1998; Mahoney et al., 2014; Madrigal et al., 2016; Madrigal et
al., 2017; Nicholls et al., 2008). Mahoney et al. (2014) examined different mental
toughness interpretations between Australian workers, students, athletes, and the military.
Their findings concluded that mental toughness is a characteristic adaptation to a stressor
and influenced by contextual or social factors, such as coping styles and self-beliefs.
Cowden et al. (2014) found similar results in their study of elite tennis players.
Coaches in the Cowden et al. (2014) study identified the four most important aspects of
mental toughness were: "not giving up in difficult situations'; 'having what it takes to
perform well under pressure'; 'not becoming angry and frustrated when things do not go
one's way'; and 'regaining one's composure if one has momentarily lost it (p. 10)".
Compared to the coach, the athlete may have had a different perception of their mental
toughness and the qualities of mental toughness as it relates to themselves.
Hardiness. Kobasa (1979) conceptualized hardiness as another personality trait that
was important to one’s cognitive appraisal of an athletic injury. Kobasa (1979) noted that
individuals who had stressful life events did not experience any adverse effects on their
health. The three C's of hardiness: commitment, control, and challenge, limited any
negative impact on their health. Wadey et al. (2012) simplified their findings in the
following way: “Individuals high in hardiness feel deeply involved in or committed to the
activities in their lives, believe that they can at least partially control an event they
experience, and consider change as an exciting challenge to further development
(p.105)”. Chung (2012) also examined the direct and moderating effects of hardiness

throughout the sports injury process and had similar results.
Salim et al. (2016) and Udry (1997) examined sports-related growth due to high
hardiness. Those athletes who demonstrated high and low hardiness felt both negative
and positive emotions at the injury time. However, those who were deficient in hardiness
spent more time dwelling on their perceptions of loss and the negative aspects of their
injuries and adverse effects on their sports performance than those who were high in
hardiness. Those who had higher levels of hardiness could grow from their injuries
because they may have an emotional outlet compared to those low in hardiness (Salim et
al., 2016; Udry, 1997). Another aspect that represents the potential to influence cognitive
appraisal and the injury and rehabilitative processes is the athlete's demographic
characteristics.
Additional Personal Factors. The demographic qualities commonly cited in the
literature are age and gender (Acharya et al., 2018; Bulo and Sanchez, 2014; DeFroda et
al., 2018). Abgarov et al. (2012) examined interuniversity swimmers' experience with
social support throughout the injury process and considered the differences in age,
gender, and different swimming abilities. These demographic differences influenced the
student-athlete's response to their appraisal of the perceived interactions with teammates,
coaches, and athletic therapists. In terms of gender responses, only slight differences
occurred. However, the total number of participants was low (five females, seven males),
and age (20-28) did not indicate a significant finding.
In contrast, Mitchell et al. (2014) evaluated 319 recreational to international level
athletes (258 males/61 females) with a mean age of 27.27 (SD=9.4). The authors did not
identify the type of sport. Because the number of males to females was so

disproportionate, the authors decided not to evaluate gender. However, the authors did
note that social support providers and those receiving social support should have similar
characteristics to prompt more positive response to social support based on their findings.
Also, the more significant number of opportunities for males' participation than females',
females' experiences may have been vastly different from males.
Kontos et al. (2013) examined gender differences in concussion response
compared to orthopedic injuries. The females in this study tended to appraise their
injuries more negatively than males. This negative appraisal was attributed to females
using more active coping skills, instrumental support, and humor. Also, males reported
more pressure to return to activity sooner than their female counterparts, and the authors
suggest this is the result of the masculine culture associated with male sports. Gender
differences were explored in many studies, with mixed results, when considering
cognitive appraisal. (Druckman et al., 2019; Hawley et al., 2016; Thompson, 2010).
Situational Factors
Also, situational factors play an essential role in the cognitive appraisal of injury,
illness, and other identified life stressors. Situational factors may include the year of
athletic eligibility. Goodman et al. (2018) examined the epidemiology of shoulder and
elbow injuries and noted freshman wrestlers had more elbow and shoulder injuries when
compared to senior wrestlers. Increased workload, length of the season, tougher opponent
competition, and not being physically or emotionally adjusted to the transition from high
school to college attributed to increased injuries. Defroda et al. (2018) examined NCAA
baseball players' Ulnar Collateral Ligament (UCL) injuries and also supported the theory
that increased injury to younger players was due to increased workload.

Madrigal and Robbins (2020) noted no differences in stress when comparing
academic year or year of athletic eligibility. Lan and Xuebing (2018) reported greater
difficulty with freshmen's well-being and decreasing as their eligibility year increased.
Conversely, Wu et al. (2020) noted that freshmen and seniors had a lower level of
positive mental health. Their first year is a "transitional year" as they move from high
school to college athletics for freshmen. For seniors, their stress was related to the
transition from college to the working world and being completely independent.
Regardless of the reason for stress, Wu et al. (2020) noted mental health education should
be tailored to meet the athlete's needs depending on their year in college.
Of all the factors related to sport, the most important indicator of potential
problems may be when the injury occurs (pre-season, regular season, post-season play,
championship tournament). Gayman and Crossman (2003) noted that the pre-season was
a time for establishing "team cohesion on an emotional and physical level." As the season
progresses, this bond will grow stronger amongst the team members. This time in the
season is a time for athletes to prove their abilities, establish a starting role, and come
together as a team unit. Injury at the end of the playing season is likely a more negative
event due to the team playing to get the opportunity to play in the post-season or the
individual establishing their position for the following playing season (Gayman &
Crossman, 2003). This influence of the situational factors will also play a role in the
athlete's psychosocial factors.
Psychosocial Factors
Psychosocial factors influence cognitive appraisal in several ways. This influence
is mainly due to different social factors and their significance before the injury, following

injury recovery, and return to sport participation. Martikainen et al. (2002) defined the
term psychosocial as "pertaining injury to the influence of social factors on an
individual's mind or behavior, the interrelation of behavioral and social factors (p. 1091)."
Psychosocial factors can also be considered any person, or to a lesser extent, the
environment, which directly or indirectly affects the behavioral and emotional responses
the athlete may experience. Psychosocial factors may include parents, coaches,
teammates, medical staff, other friends or influences of their support system, and even the
team climate. Psychosocial factors may also influence perception, cognitive appraisal,
and motivation to deal with injury, illness, or other identified life stressors.
Christino et al. (2015) identified self-esteem as "an overall sense of self-worth and
personal value (p. 502)." Comparing a freshman to a senior athlete, the freshman may
lack self-esteem as they adjust to their new environment. The senior athlete may have had
higher self-esteem levels based on their age, experiences, and perceived value to the
team. These two athletes may have perceived their injury differently based on these
factors.
The seniors will have already demonstrated their value throughout their athletic
participation on the collegiate level. On the other hand, the freshman will not have had
that opportunity, which could decrease their self-esteem and their athletic identity as a
potential four-year contributor to the team (Gayman & Crossman, 2003). The result may
be increased emotional responses for the freshman, which could later manifest in
negative behavioral responses. Environmental factors, such as accessibility to
rehabilitation and rehabilitation environment, also can affect how an athlete responds
throughout the injury recovery and return to play (Bejar et al., 2019). Another

environmental factor that has had the most impact on sports has been the Covid-19
pandemic.
The effect of the abrupt stopping of all athletic activity and stay-at-home orders
for three months has had yet to be determined. Schinke et al. (2020) noted the ripple
effect the pandemic has had on athletes and coaches and the accompanying psychological
and emotional challenges for all. This situation can impact athletic identity, mental and
physical health, and well-being. (Shinke et al., 2020). It is still unclear how much the
pandemic has affected Division II athletes and athletes in general. The pandemic is a
situational factor that has been unprecedented, and the effects are yet to be fully
appreciated or understood.
In addition to the environmental, situational factors and psychosocial factors may
have proven to be the most impactful on motivation for the mental and physical aspects
of recovering from an athletic injury. These psychosocial factors may positively or
negatively affect the athlete's cognitive appraisal of the interactions between teammates,
coaches, and athletic trainers.
Teammates. Teammates are an integral part of the group dynamic in athletics. An
injury or response to another identified life stressor by an athlete can affect the entire
team. Should the athlete's injury or response to other identified life stressors render them
unable to participate, the remaining teammates must now try to maintain the group
dynamic's existing complexity.
Campo et al. (2017) took this concept one step further and examined interpersonal
regulation, defined as "emotions modulated and regulated by others" (p.380). They also
examined emotion regulation, which Gross (1998), as cited in Campo et al., 2017, stated

as "the process by which individuals influence which emotion they have when the athlete
has them, and how they experience these emotions" (p. 380). For example, if one of the
starting players is injured or dealing with another identified life stressor, this can change
the group dynamic.
Surya et al. (2015) did qualitative interviews of male basketball players on the
effects of the injury on group interactions. There was a shift in team strategies, role
adjustments, perceptions of opportunity or threat, emotional climate changes, and
interpersonal tension development. This shift in the team strategies and the team
environment resulted in a "cascade of downstream effects" (p. 62). An injury to one
athlete can upset the entire team environment. Everyone is now learning their new roles
and can create more dysfunction within the team than before the injury or other identified
life stressor.
Robbins and Judge (2010) anticipated there would be conflicts within the group at
some point in time. Evans et al. (2012) attribute this intragroup conflict to the fact that
athletes are so intertwined in the group dynamics of the team by sharing the same
experiences, meanings, and goals that an injury, illness, or other life stressors experienced
by a teammate may have influenced the social processes of the group. The group also
affects the social processes of the injured or stressed individual. This conflict within the
group is defined best by Wall and Callister (1995): "conflict is a process by which one
party perceived that its interests are being opposed or negatively affected by another
party (p. 517).”
Throughout this change in the group dynamic, the athlete-coach relationship was
also instrumental in dealing with illness or other identified life stressors and how the

remaining team members responded to the athlete's vacancy in team activities (Surya et
al., 2015). Some teammates may resent the injured, ill, or athlete responding to another
identified life stressor because their roles on the team have now changed.
Coaches. How a coach leads the team may change based on different personal
and environmental factors (Kim & Cruz, 2016). A player's satisfaction may increase and
improve the cohesion of the team. Amorose and Nolan-Sellers (2016) stated the quality
and frequency of encouraging words and actions of the coach improved the athletes'
perceptions of competence. Noble et al. (2016) said that perceptions of confidence and
motivation are a product of their surrounding environment. The coach created this
environment and exercised control over the individual athletes and team's culture.
Jowett (2017) stated, “the coach and the athlete need one another to develop,
grow and succeed” (p. 3). This interdependence affects and is affected by how each part
of this team concept thinks, feels, and behaves. Therefore, one part of the team is not
more important than the other; they need each other to succeed. Without the dyadic
relationship, neither party can grow and expand their knowledge or enhance their
performance.
Davis and Jowett (2014) suggested an effective coach was responsive to the
athlete's needs, provided advice and guidance, and supported the athlete's autonomy.
Davis and Jowett (2014) also stated the coach represented a target for proximity, a safe
haven, and a secure base. With this type of athlete-coach relationship, the coach can be an
ally with the athletic trainer as they both assisted the athlete following injury. This third
party is needed to foster this relationship of positivity, growth, and communication.

Athletic Trainers. Athletic trainers are often the first person to whom athletes
turn to when they experienced the emotions commonly associated with injury (Clement et
al., 2015; Yang et al., 2010). Injured athletes also felt they had a stronger rapport with
athletic trainers than coaches, teammates, or significant others when dealing with an
injury (Clement & Shannon, 2011). In a study by Unruh et al. (2005), college athletes
evaluated their satisfaction with their athletic trainer. High-profile sports reported more
satisfaction with their athletic trainer when compared to low-profile sports. Females who
participated in high-profile sports also reported higher satisfaction when compared to
males in lower-profile sports.
Unruh et al. (2005) suggested: "treating all athletes with dignity and respect,
providing emotional support and considering each athlete's perspective (p. 55)" as a way
to improve the interactions between athletic trainers and athletes. Ryan and Deci (2000)
suggested the three basic needs be met when increasing one's motivation were:
autonomy, competence, and relatedness. To improve an athlete's motivation to recover
emotionally and physically from an athletic injury, athletic trainers must utilize these
strategies when dealing with injured athletes. Athletic trainers must provide an
environment where they and the athlete provide meaningful and reciprocal input, have
the confidence in their ability to treat the whole athlete, and create the sensation of being
valued and cared for by others (Unruh et al., 2005).
Surya et al. (2015) also noted that the interactions' frequency and quality might
influence the athlete's cognitive appraisal and psychosocial responses to injury. An
athletic trainer is in the position to do just that, as they will, in most collegiate settings,
have daily one-to-one contact with the injured athlete. In this way, athletic trainers can

influence the psychosocial reactions to injury and provide much-needed social support to
the injured athlete.
Robbins and Rosenfeld (2001) suggested that athletic trainers provided more
social support to the injured athlete than coaches and assistant coaches. Athletic trainers
offered different types of resources throughout the injury, injury rehabilitation, and return
to play progression of the injured athlete. Bennett et al. (2016) suggested the athletic
trainer was a stakeholder in the sports environment and compared their function as a
comprehensive rehabilitation manager. Therefore, the athletic trainer is responsible for
the physical rehabilitation aspect of injury recovery and the psychological aspect. These
responsibilities facilitate an atmosphere where the student-athlete perceived a positive
environment to rehabilitate their injury. Not only are the sport-related support networks
critical, but support from friends, family, and significant others has provided social
support to the athlete who is suffering from injury, illness, or other identified life
stressors.
Friends. Sullivan et al. (2020) found that teammates and "non-athletic persons"
were both significant sources of social support. Friends, for this research, were
considered people athletes had a relationship with and were not related to their sport
participation, such as their teammates. Covassin et al. (2014) compared those athletes
who had suffered a concussion to those who had orthopedic injuries and identified as
support providers.
The concussed group was most satisfied with the support they received from
friends, family, and teammates, respectively, compared to coaches, athletic trainers, and
physicians. The orthopedic injury group was more satisfied with the overall support from

family, friends, and teammates than from athletic trainers, coaches, and physicians.
Studies have shown similar results, where friends, family, and teammates had provided
more social support (Wiese-Bjornstal et al., 1998; Yang et al., 2010). However, other
studies have shown that athletes were more satisfied with the social support they received
from coaches, athletic trainers, and physicians (Bianco & Eklund, 2001, DeFreese &
Smith, 2014; Newman & Weiss, 2017; Tracey, 2003). Sullivan et al., 2020 refer to
friends and family as "built-in support systems" unique to each athlete.
Family. Many athletes may turn to their family members for social support
following an injury. Clement et al. (2015) noted that NCAA division II athletes had fewer
resources available to them in terms of coaches and athletic trainers and therefore had to
rely more on family and significant others for social support. Poucher et al. (2018)
examined female Olympian athletes' social support networks. They reported that athletes
did not want informational support from their families but needed more emotional and
tangible support. This need for more emotional and tangible support was also the case in
the study conducted by Wyament and Huffman (2020). Family members are generally
very close to the athlete, as they have been a part of their lives until this point and have
intimate knowledge of how they typically respond to stress.
Significant Others. Poucher et al. (2018) also note that significant others were
said to know each other for seven years before the athletes needing support. Significant
others also provide meaningful social support to those individuals who are coping with
injury or stress (Freeman, 2020; Mitchell et al., 2014; Agbarov et al., 2012; Fletcher &
Sarkar, 2012). Freeman (2020) also notes that social support is more beneficial when
provided by an individual who has expertise and similarity to the individual receiving the

support. Also, the provider should share a similar identity to the person who is the
receiver of the social support.
A significant person could be considered a close friend, a romantic partner, or
even an athletic trainer or other professional. Regardless of who they are, they provide
more meaningful social support than just an acquaintance would. No matter the athlete's
relationship, the individual(s) who provide social support are essential in how an athlete
copes with injury, illness, or other identified life stressors. Personal factors, situational
factors, and psychosocial factors indicate the complexity of the social support provided
by their support networks.

Social Support
Hagiwara et al. (2017) stated that social support occurs between individuals who
have had, on some level, an interpersonal relationship, and the social support was an
interactive experience between these individuals. Shumaker and Brownell (1984)
identified social support as "an exchange of resources between two individuals perceived
by the provider or recipient to be intended to enhance the well-being of the recipient" (p.
21). Yang et al. (2010) defined social support for an athletic population as an "athlete's
appraisal of the support that might be available to them from their social network and
how satisfied they were with that support (p. 374)."
Regardless of the definition used, social support's primary function is to improve
the receiver's well-being (Hardy et al., 1991; Udry, 1997; Rees et al., 2010; Poucher et
al., 2018, Yang et al., 2015). Wiese-Bjornstal et al. (1998) suggested social support can
modify an athlete's cognitive appraisal and influence the resulting psychosocial
behaviors, which is a combination of emotional and behavioral responses. See Figure 1.
for Bianco and Eklund's (2001) conceptional map of social support.

Figure 1
Conceptual Map of the Social Support Process

PROVIDER AND RECIPIENT CHARACTERISTICS

Sociocultural
Context

Relationship
Characteristics

SOCIAL SUPPORT
Structural Features
(Support Networks)

Functional Features
(Support Exchanges)

Instrumental Goals
Relief from Distress
Enhanced Coping

Perceptual Features
(Support Appraisals)

Relational Goals
Relationship Formation
Relationship Maintenance

Stress-Buffering Effect

Main Effect

Palliative Pathway

Preventative Pathway

IMPROVED HEALTH AND WELL-BEING
Figure 1. Conceptual Map of the Social Support Process. From “Conceptual considerations for
social support research in sport and exercise settings: The case of sport injury.” By T. 3
(Bianco and R.C. Eklund, 2001. Journal of Sport and Exercise Psychology, 23(2), p. 88.

https://doi.org/10.1123/jsep.23.2.85

Types of Social Support
Richman et al. (1993) reference eight types of social support identified by Pines et
al. (1981). They are the following: listening support, emotional support, emotional
challenge support, reality confirmation support, task appreciation support, task challenge
support, tangible support, and personal assistance. Listening support is the perception
that someone is listening but does not advise or provide judgments on one's activity.
Emotional support is the perception that someone will provide comfort and caring and
indicate that they are on the athlete’s side. (Richman et al., 1993) Emotional challenge
support is the perception that someone is challenging the athlete to re-evaluate their
feelings and attitudes. Reality confirmation is the perception of the receiver of support
that the provider of the support has values similar to their own and can confirm the
receiver’s perceptions (Richman et al., 1993).
Richman et al. (1993) defined task appreciation as the perception that someone
acknowledges and supports the receivers' determination and expresses their gratitude for
their efforts. Task challenge challenged the receiver to re-evaluate their thoughts on a
task or activity to motivate and positively respond to the task at hand. Tangible assistance
occurred when another individual provides the receiver with monetary support, gifts, or
other concrete awards (Richman et al., 1993). Personal assistance provided the receiver
with services or help, such as helping with daily living activities. Richmond et al. (1993)
noted the following to be essential items to consider in the acquisition of social support:
"the recipient of the support, the provider of the support, the interactional exchange
process between the provider and recipient, and the outcomes of the exchange process (p.
291)."

Berg and Warner (2019) referred to social support as more of a sense of
community that is an essential factor for athlete development. Social support can be an
integral influence on first-year non-athlete university students' physical activity
(Scarpachia et al., 2017). In a study by Deliens et al. (2015), lack of social support was
identified as one of the influencing variables that impeded participation in physical
activity in non-athletes. Suppose non-athlete university students struggle to have
adequate social support from their support network. In that case, it only stands to reason
that there would be similar, if not higher, levels of decreased social support available for
collegiate student-athletes.
Perceived Social Support
Perceived support was crucial in athlete's psychological well-being by several
researchers (Cranmer & Sollitto, 2015; DeFreese and & Smith, 2014; Gabana et al.,
2017; Hornstein & Eisenberger, 2017; Jeon et al., 2016; Lakey et al., 2015; Malinauskas
& Malinasukiene, 2018). Gabana et al. (2017) examined the mediating role of social
support and its effects on gratitude, burnout, and sport satisfaction among college
athletes. Lambert et al. (2009) define gratitude as the "recognition of the value of a
benefit or that one has received a valuable benefit from others (p. 274)."
Gabana et al. (2017) also noted that gratitude could improve one's ability to
retrieve those positive memories from their thought-action repertoires, adding to their
ability to have more social support resources and overcome future hardships. These
positive memories also influenced their perceptions of received support. Those
individuals who were grateful were more appreciative of the support versus those who
were ungrateful, as they perceived the support as being more harmful and less helpful.

Hornstein and Eisenberger (2017) concluded from their study that social support
prevented the development of fear associations, therefore reducing threat-related
stressors. DeFreese and Smith (2014) also noted that social support positively contributed
to well-being across the competitive sports season. Malinauskas and Malinasukiene
(2018) reported a significant relationship between emotional intelligence and perceived
social support on athletes' well-being. Those athletes who scored higher in emotional
intelligence reported increased social support perceptions, leading to improved emotional
well-being.
Lakey et al. (2015) also note that ordinary social interaction was the main effect
between perceived social support and positive affect. Therefore, any positive social
interaction would be likely to improve well-being. Jeon et al. (2016) concluded that selfcompassionate attitudes mediated the role between social support and subjective wellbeing in elite Korean athletes. Based on the differences and similar findings in these
studies, it is clear the amount of perceived support can have a positive effect on
subjective well-being.
Again, many authors caution that social support can have a detrimental impact on
the athlete's well-being if perceived negatively and unhelpful (Bianco & Eklund, 2001;
Sarason et al., 1994; Abgarov et al., 2012; Mitchell, 2011). Social support effects occur
through several processes. Mitchell (2011) noted several different factors might
complicate social support processes, such as two of the primary effects of perceived
social support: the stress-buffering and the main effects processes.

Stress-Buffering Process
The stress-buffering process is considered an integral component of the stressinjury relationship (Hartley & Coffee, 2019; Hornstein & Eisenberger, 2016; Lakey et al.,
2015; Lu & Hsu, 2013; Mitchell et al., 2013; Andersen & Williams, 1998; Yang et al.,
2010). In simple terms, the stress-buffering hypothesis states that social support acts as a
buffer or mediator between individuals and their psychological and physiological threat
responses and perceived social support (Hornstein & Eisenberger, 2016, Lakey et al.,
2015; Mitchell et al., 2014). Cohen and Wills (1985) state that the stress-buffering effect
is a process of support that protects an individual from the potential of adverse events in
response to stress.
For instance, an athlete dealing with the stress of an injury and their ensuing
psychosocial and physiological responses to the injury will look to their social support
network for assistance in dealing with these responses. The buffering effect effectively
reduces the stress response if the perceived social support matches injury responses
(Cohen & Wills, 1985). Stress-buffering also decreases the frequency of burnout, which
is the inability to meet sport's physical and psychological demands (Bianco & Eklund,
2001; Cohen & Wills, 1985; Hartley & Coffee, 2019; Mitchell et al., 2014). This model is
most effective when the individuals, such as teammates, coaches, and athletic trainers,
who are giving the support are closest with the individual under stress (Hornstein &
Eisenberger, 2016). In contrast to the stress-buffering process, the main effects model
suggests received social support is more important than perceived support.

Main Effects Model
The main effects model suggests that social support received will directly affect
the individual, whether or not the athlete is experiencing higher or lower stress levels
(Bianco & Eklund 2001; Cohen & Wills, 1985; Hartley & Coffee, 2019). The main
effects model will also result in a decreased response to a stressor and increase one's
ability to cope with stress (Mitchell et al., 2014). However, Mitchell (2011) suggests the
main effects of received support may not be as impactful as the buffering effects of
perceived support.
Injury in collegiate student-athletes represents a change in the usual feelings of
well-being in a healthy athlete. At this point, their perception of support and received
support can vary, as can the individuals from whom they seek this support. Bianco and
Eklund (2001) also noted that athletic injury impacts the social support activities and
support messages, the support networks, support behaviors, and appraisals of support.
Bianco and Eklund (2001) also caution that support activities may not always result in the
desired positive response.
Self-Efficacy
Another essential component of social support and injury recovery is selfefficacy. Bandura (1997) has defined self-efficacy as "beliefs in one's capabilities to
organize and execute the courses of action required to produce given attainments" (p. 3).
It is a concept which Bandura (1997) proposed is task-centered, affects a person's
decision making, level of persistence, and effort expenditure. Lazarus (1980) suggests
individuals will fear aversive events due to inefficacy, which leads to decreased
performance. Bandura (1983) states, "the less efficacious subjects judge themselves to be,

the more fear they experience when they later perform the threatening task (p. 466).”
Conversely, suppose individuals have increased self-efficacy and believe they can
exercise control over an aversive event. In that case, they are more likely to have minor
impairment in completing the task and improve performance outcomes.
As a person responds to a stressor, their self-efficacy will have either positive or
negative physiological, behavioral, or psychological responses, which, in turn, will affect
one’s mental health (Schönfeld et al., 2017). Bandura (1997) also suggests four sources
of self-efficacy: the direct influence of personal experiences of success and mastery;
observations of social models which succeed or fail; encouragement by verbal persuasion
that can alleviate doubts and foster the belief that one can achieve their desired goals, and
the interpretation of physiological reactions to stressors. In the sports context, this could
be considered the ability to apply previous experiences with injury and skill mastery and
apply these experiences to the athlete’s current injury or other identified life stressor. The
verbalized support from coaches, teammates, and athletic trainers that the athlete receives
can allow the athlete to reach their goals and overcome the physiologic reactions to the
stressful situation, such as the injury, illness, other identified life stressor, or even
rehabilitation. This verbalized support illustrates the importance of social support and its
influence on whether an individual interprets a positive or negative stressor.
McCann and Gribble (2016) explored the impact of self-efficacy on the
rehabilitation from lateral ankle sprains. They suggest that the environmental factors and
social attitudes surrounding themselves influence a patient's perceived ability to cope
with an injury. Social attitudes can include the team members' and coaches' sports culture
and attitudes, positively or negatively influencing the injured athletes. Positive attitudes

would lead to better rehabilitation adherence, and negative attitudes would lower
rehabilitation adherence.
Sari and Bayazit (2017) also concluded in their study between perceived coaching
behaviors, motivation, and self-efficacy in wrestlers. These authors suggested that
individual characteristics, such as sports experience and gender, and family attitudes
about sport may also affect the perceived social support behaviors and intrinsic
motivation for athletes to excel. Sari and Bayazit (2017) caution that this support may
also be detrimental to performance and depends on the individual.
There are many different factors to consider in athletic participation, and an
injury, illness, or other identified stressors can bring participants to a screeching halt. The
stressor may have either positive or detrimental effects on the athlete, depending on their
cognitive appraisal, perceptions, and support systems. To better explain the response to
stressors and one's cognitive appraisal of the stressor, several authors have developed
their theoretical models to explain these concepts (Andersen & Williams, 1988; Brewer,
1994; Brewer et al., 2002; Kubler-Ross, 1969; Wiese-Bjornstal et al., 1998).

Theoretical Models
There are several different models which address how athletes respond to athletic
injury. These models include the stage model (Kubler-Ross, 1969); the stress and injury
model (Andersen & Williams, 1988); the cognitive appraisal model (Brewer, 1994); the
biopsychosocial model (Brewer et al., 2002) and the integrated model of response to
sports injury (Wiese-Bjornstal et al., 1998). These models share similar components;
however, there are also some differences between models. Table 11 shows a comparison
of the models and what factors make up each model.

Table 11
Comparison of Theoretical Models

Coping Resources
Anger
Denial
Bargaining
Depression
Acceptance
Pre-Injury Factors
Stress Response
Sport Injury
Personal Factors
Situational Factors
Cognitive Appraisal
Behavioral Response
Emotional Response
Recovery Outcomes
Physiological
Psychological
Biological
Biopsychological
Psychosocial

Stage Model
Kubler-Ross,
1969
X
X
X
X
X

Stress-Injury
Model
Andersen &
Williams, 1988

X
X
X
X
X
X

Cognitive
Appraisal
Model
Brewer, 1994

X
X
X
X
X
X

Integrated
Model of
Response to
Sport Injury
WieseBjornstal, 1998

X
X
X
X
X
X
X
X
X
X
X
X

Biopsychosocial
Model
Brewer, 2007

X
X
X
X
X
X
X
X
X
X
X
X
X
X

100

Comparison of Theoretical Models
At the core of all five theoretical models of response to injury is the cognitive
appraisal. The Stage Model by Kubler-Ross (1969) does not explicitly recognize
cognitive appraisal as a factor. However, when dealing with emotions in response to a
stressful event, there must be some level of cognitive appraisal. Cognitive appraisal in all
the other models acts as a means to identify and understand the emotions one is
experiencing (Andersen & Williams, 1988; Brewer, 1994; Brewer, 2002; Lazarus &
Monat, 1974; Wiese-Bjornstal, 1998).
After cognitively appraising the event, the models concur that an emotional
response occurs as a response to the injury, illness, or other identified life stressor. The
appraisal and response process may be slightly different in each model and may influence
this appraisal. All authors agreed that the response to these factors could positively or
negatively impact the continuing process of cognitive appraisal and injury recovery and
the response to stressors. (Andersen &Williams, 1998; Brewer, 1994; Brewer et al., 2002;
Kubler-Ross, 1969; Wiese-Bjornstal, 1998). The level of importance these influences
have on an athlete's response to injury and stress varies slightly between models.
For instance, the cognitive appraisal model focuses on the perception of an event
and the cognitive appraisal afterward. The cognitive appraisal theory does not elucidate
the impact these appraisals will have on the injury appraisal and outcomes compared to
the biopsychosocial and integrated models. In the biopsychosocial and integrated models,
perception and cognitive appraisal occurs first and then supports these appraisals'
influences on the injured or stressed athlete's personal and situational factors. In contrast,
the stage model only focuses on the different response stages following the injury but

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does not explore the influence of perception and cognitive appraisals. However, these
must occur to progress to the next step.
In the cognitive appraisal, biopsychosocial, and integrated models, the
individual's unique assessment of the injury or stressor is essential. There is recognition
of personal and situational factors' level on the cognitive appraisal. The cognitive
appraisal and biopsychosocial models do not associate these responses to previous
stressors and personal factors before the event's cognitive appraisal. In contrast to these
models, the integrated model considers the strong influence of earlier factors on how
individuals will cognitively appraise each injury or stressful event.
The Integrated Model of Response to Sport Injury
The Integrated Model of Response to Sport Injury (Wiese-Bjornstal et al., 1998)
is a combination of the cognitive appraisal model first introduced by Brewer (1994), the
stress and injury model suggested by Andersen and Williams (1988), and the
psychological response to athletic injury and rehabilitation theory proposed by WieseBjornstal et al., (1995). The Integrated Model by Wiese-Bjornstal et al. (1998) resulted
from blending these three models. Refer to Figure 2 for a schematic of the Integrated
Model of Response to Sport Injury. In the Wiese-Bjornstal et al. (1995) model, response
to athletic injury and rehabilitation follows cognitive appraisal and response. There is a
cyclical stress-response progression, which occurs continually throughout the
rehabilitation process, as recovery is at the center of this progression. The emotional and
behavioral responses will continue to impact the recovery from injury and throughout the
rehabilitative process. There are mediators (personal and situational factors) and

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moderators (coping resources, stressors, intervention, personality), which impact the
response to injury and rehabilitation.
Figure 2
The Integrated Model of Response to Sport Injury

“Integrated Model of Response to Sport Injury.” From “An integrated model of response to sport injury: Psychological and
sociological dynamics,” D.M. Wiese-Bjornstal, A. M., Smith, S. M., Shaffer, and M.A.Morrey. 1998, Journal of Applied Sport
Psychology, 10(1), p. 49. https://doi.org/10.1080/10413209808406377. Image courtesy of Open Learn
https://www.open.edu/openlearn/ocw/mod/oucontent/view.php?id=85696&extra=thumbnailfigure_idm45931025697280

In the Wiese-Bjornstal et al. (1998) Integrated Model of Response to Sport Injury,
the emotional and behavioral responses act as more contributors to the recovery
outcomes. These responses will continue to change as all the factors impact one another.

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Thus, the response to injury will have multiple cognitive appraisals and emotional
reactions to those appraisals throughout the response to injury, illness, or other identified
life stressors. The cognitive appraisals, emotional and behavioral responses may affect
recovery outcomes.
An injury appraisal goes one step further than the other models in the Integrated
Model. It identifies pre-existing factors such as coping resources, previous injury or
stressors, and the individual's personality and how this collectively influences each
athlete's personal and situational factors. How these responses will affect the recovery
outcomes are the emphasis. The cognitive appraisal model and biopsychosocial model
suggest that the personal and situational factors only influence the response to injury or
stress.
The most significant difference in the Integrated Model compared to the other
models is that the model notes that perception and cognitive appraisal will elicit and
influence emotional and behavioral responses. This influence will continue to evolve and
change, as perception and cognitive appraisal are changing rapidly throughout the injury,
illness, or stress process and return to activity. The biopsychosocial and cognitive
appraisal models do not recognize the influences of the perceptions and appraisal of the
injury or stressor on interventions. The Integrated Model distinguishes this as an essential
factor.
Walker and Heany (2013) noted a limitation of the Biopsychosocial Model
compared to the Integrated Model. It lacked a description of the relationships between
psychological factors such as the psychologically-based models. However, this model
does go into greater detail about the influence of biological, social, and psychological

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inputs during the rehabilitation of a sports injury (Brewer et al., 2002). One model is not
better than the other; however, Walker and Heaney (2013) caution that the
biopsychosocial model does not have as much research supporting its use in the athletic
environment as the Integrated Model.
Although the Integrated Model does not include the biological element, its
application in athletes' context has been more widely used and accepted as a more
appropriate model to address this population's needs. (Albinson & Petrie, 2003; Clement
et al., 2015; Bianco & Eklund, 2001; Conti et al., 2019; Roy et al., 2015). WieseBjornstal et al. (1998) also noted the "depiction and discussion of this model would
continue to evolve as elements are tested (p. 48)." Therefore, for this study, the concepts
and properties represented in the Integrated Model of Response to Sport Injury are
referenced.
In the Integrated Model, perception and cognitive appraisal are vital components
to how an athlete copes with an athletic injury. The combination of cognitive appraisal
and perception will influence emotional, psychological, and behavioral responses
following exposure to a stressor and injury. Andersen and Williams (1988) suggest the
process of cognitive appraisal can last "from weeks to months." In contrast, the Integrated
Model offers cognitive appraisals are fluid and continuously changing process. The
changing functions are attributed to appraisals or self-perceptions because both factors
will continually impact the emotional and behavioral responses to athletic injury, illness,
and stress.
One of the more essential components of applying these theoretical models is
having a measurement scale or instrument to identify which stage of the model an athlete

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may be going through at any given time. None of the models have an instrument that can
evaluate every stage of the model. Considering every stage may not be necessary to
identify the model; however, it can be an essential piece of the puzzle in understanding an
athletes' perceptions and cognitive appraisals of an adverse event. Evaluation of social
support has used several different instruments; however, no instrument is used
exclusively for social support and athletes.
Measurement Instruments
Over the previous decades, there have been many different instruments measuring
social support. The Social Support Questionnaire developed by Sarason et al. (1983)
measures those individuals to whom an individual can turn to and rely on for social
support and indicates the satisfaction of the social support received. On a similar scale,
The UCLA Social Support Inventory (Dunkel-Schetter et al., (1986) measured the needs
of social support, the extent to which support was sought out and received, and the
satisfaction of this support. Compared to the Social Support Inventory developed by
Brown et al. (1988), it measures social support resources' adequacy. Sherbourne and
Stewart developed the Medical Outcomes Study Social Support Survey (MOS-SSS) in
1991. This instrument was used with patients suffering from chronic conditions, such as
diabetes. This survey measured emotional, informational, tangible, affectionate, and
positive social interactions. These scales' common factor is they do not address the
athletic population's unique needs for social support.
Richman et al. (1993) developed the Social Support Survey (SSS). The Social
Support Survey evaluates the recipient, interactions, outcomes, and understanding of the
social support process. Athletic populations have used this instrument, but it has not been

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used explicitly with an athletic population. Bianco and Eklund (2001) suggested social
support measures should be relevant to the population they are assessing.
The Perceived Available Support in Sport Questionnaire (Freeman et al., 2011),
explicitly designed for an athletic population, measures the following four types of social
support: emotional, esteem, informational and tangible. It also measures the perceived
types of support which one would subjectively identify from friends, family, teammates,
and coaches. However, this test's weakness was the lack of consistent and acceptable
reliability and validity. This instrument's use with an athletic population has not been
widely used (Gabana et al., 2019; Freeman et al., 2011).
Multidimensional Scale of Perceived Social Support (MSPSS)
The MSPSS, developed by Zimet et al. (1988), remains a widely used instrument.
The purpose of the MSPSS is to subjectively assess social support and social support
adequacy from three distinct sources: family, friends, and significant others. The MSPSS
was found to have good reliability, factorial reliability, and construct validity (Zimet et
al., 1988). This instrument has been modified and adapted to be cross-culturally
accessible and administered to various populations while still retaining its validity and
reliability.
In terms of validity and reliability, one study included comparing perceived social
support of pregnant women, adolescents living in Europe with their families and pediatric
residents (Zimet et al., 1990); clinical nurse specialists (Hardan-Khalil & Mayo, 2015);
Hispanic college students (Ermis-Demirtas et al.,2018) and university students (Guan et
al., 2015). From 1995 to 2016, there were over 20 different language translations to the

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original survey, and the MSPSS continues to maintain its reliability and validity (Dambi
et al., 2018). The MSPSS is the most commonly used measurement of social support.
Athletic Multidimensional Scale Perceived Social Support (AMSPSS)
Use of the AMSPSS has not occurred in any research before this study. The
primary researcher modified it to measure the perceived social support an athlete receives
from teammates, coaches, and athletic trainers following injury, illness, or response to
other identified life stressors. Teammates, coaches, and athletic trainers represent whom
athletes will often turn to for support (Bennett et al., 2016; Malinauskas &
Malinauskiene, 2018; Mankad et al., 2009; and Newman & Weiss, 2017).
Malinasukas and Malinasikiene (2018) examined the relationships between
emotional intelligence, well-being, perceived social support, and perceived stress in 398
male athletes. The authors used the MSPSS and the PSS to measure perceived social
support and perceived stress, respectively. Malinasukas and Malinaskikiene (2018) found
that perceived social support and perceived stress mediates the relationship between
emotional intelligence and well-being. This relationship's mediation may be attributed to
individuals with higher levels of emotional intelligence. They are more adept at
recognizing and managing other individuals' emotions, and therefore will be better
equipped to seek social support. This process will then result in greater feelings of wellbeing for the individual.
Malinasukas (2010) found that perceived social support and perceived stress did
not influence athletes' well-being with minor injuries, but perceived social support and
stress affected athletes' well-being with significant injuries. Perceived stress and social
support from family and friends were influential in predicting the feelings of well-being

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in athletes with significant injuries. The higher the perceived stress and the less social
support perceived from friends and family, the more the decrease in the athlete’s feeling
of well-being, and vice versa. Other authors have also supported these findings (Bianco
& Eklund, 2001; DeGroot et al., 2018; Malinasukas & Malinasikiene, 2018). Based on
these studies' results, which utilized the MSPSS and the PSS-10, these instruments would
be a good fit to address the influence of injury and stress on perceived social support.
University Stress Scale (USS)
Stallman and Hurst (2016) developed the USS, which measures the stress and
intensity of college students' specific stressors. The USS, comprised of 21 specific
academic categories, and the instrument examines are the following:
academic/coursework demands, procrastination, university environment, finances/money
problems, housing, transportation issues, mental health issues, physical issues, issues
with friends, family, and relationships, parental expectations, study/life balance,
discrimination, language/cultural issues, and other demands (Stallman & Hurst, 2016).
The USS, used in several different studies, notes the Chronbach’s alpha to be between .80
to.84 (Kyani et al., 2018; Lyvers et al., 2019; Stevens et al., 2019). While these stressors
are not a comprehensive or all-inclusive list of stressors that may occur in a college
student's life, this list represents the more common stressors that college students may
experience.
Perceived Stress Scale-10 (PSS)
The PSS was not explicitly designed for athletes but is used with populations with
at least a junior high education (Cohen et al., 1983; Cohen & Williamson, 1988). The
PSS measures how much perceived stress is associated with different situations in an

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individual's life. The questions are structured to be very general in their content, allowing
their use across diverse populations versus being more specific, narrowed questions that a
large population would not necessarily use. This non-specific quality makes this
instrument one of the most widely used to assess perceived amounts of stress in an
individual (Denovan et al., 2019; Othman et al., 2019; Sun et al., 2019).
The foundation of PSS's success is the design to identify how unpredictable,
uncontrollable, and overloaded respondents find their lives (Cohen et al., 1983; Cohen &
Williamson, 1988). The PSS measures the stress experienced in the month before testing.
Other authors have made no modifications to investigate perceived stress in the 12
months before the instrument is administered. Since the PSS has proven to be a reliable
and valid instrument (Malinasukas, 2010; Malinasukas & Malinasikiene, 2018; Othman
et al., 2019; Sun et al., 2019), especially in combination with the MSPSS, there is
adequate evidence that supports the use of these three instruments in the present study.
This combination of instruments may help identify weaknesses within an athlete's
support network and better understand the more common stressors and the perceived
stress that athletes are dealing with in their personal lives and how this affects their
athletic participation. Also, the instruments may help identify social support levels to
these athletes in need, thus improving their well-being and athletic performance.

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Conclusion
From Kubler-Ross’s (1969) initial identification of a theoretical model to clarify
how an athlete responds to an injury using the stage model, to the Wiese-Bjornstal et al.,
(1998) Integrated Model of Response to Sport Injury, the concepts of cognitive appraisal
and social support have continued to evolve. Athletes' perception, athletic identity,
mental toughness, and hardiness represent this population's unique attributes compared to
non-athletes. These attributes develop for many years by dedication to the sport of one's
choice.
The athlete, teammates, coaches, athletic trainers, friends, family, significant
others, and other people in the athlete's social support network and their interactions form
the athlete's environment. All these individuals help shape the perceptions and influence
both the individual athlete's emotions and behaviors. Injury, illness, and other identified
life stressors represent an abrupt change to this environment, thus altering the athlete's
perceptions, appraisals, and responses. Collegiate athletes must also deal with these
stressors and learn to cope with them while still maintaining their athletic identity.
It has yet to be determined if these other identified life stressors have the same
impact on the collegiate athlete as an injury or illness would. The importance of social
support to these stress responses in the athletic population is examined. By adjusting the
timing and type of social support, the athlete can reduce the severity of their emotional
and behavioral responses. These lessened responses may help improve their response to
athletic injury, illness, and other identified life stressors and possibly return to sport with
less emotional and physical difficulty.
To identify the effectiveness of these interventions, using a measurement
instrument that explicitly addresses this unique population would be advantageous. The

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AMSPSS was adapted from the MSPSS by the primary researcher to address athletes
specifically and identify individuals in the sport context who are most likely available to
offer social support- teammates, coaches, and athletic trainers. Using this measurement
instrument on athletes, especially those in the collegiate setting, may allow for more
proactive actions to be taken before and following injury, illness, or response to other
identified life stressors to help them cope with these stressors.
This study aims to compare support providers in an athletic environment to social
support providers outside of the athletic context. Using the three subgroups identified in
the MSPSS and the AMSPSS accomplishes this comparison. The subgroups include
friends, family, significant others, teammates, coaches, and athletic trainers. Examining
similarities or differences between these six subgroups and the perceived social support
provided to the athletes will occur.
Therefore, these comparisons will drive the hypothesis that there will be more
significant amounts of perceived social support from teammates than friends, coaches
compared to family, and athletic trainers compared to significant others following injury,
illness, or other identified life stressors.

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Appendix B
Problem Statement

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Problem Statement
The NCAA Sports Medicine Handbook (2014) states, “Participation in
intercollegiate athletics involves unavoidable exposure to an inherent risk of injury
(p.4).” When an athlete experiences an injury, they may perceive the injury negatively,
see it as a threat; or appraise it positively and perceive it as a challenge. Cognitive
appraisal influences perception, which Lazarus (1982) defined as the means to mediate
the relationship between an individual and their environment. This process is fluid and
continually changing based on an athlete’s perception of their environment.
The Integrated Model of Response to Sport Injury best represents the process
developed by Wiese-Bjornstal et al. (1998). In this model, demographics, personal and
situational factors, previous injury experience, and social support experience influence
the perception of injury and proceeding cognitive appraisals (Burland et al., 2018; Russell
& Wiese-Bjornstal, 2015). The collegiate athlete, identified by Malinasuskas &
Malinauskiene (2018), identified social support networks are family, friends, teammates,
coaches, and athletic trainers. Bianco and Eklund (2001) and DeFreese and Smith (2014)
identify the individuals who the collegiate athlete is more likely to reach out to those they
have the most in common teammates, coaches, and athletic trainers.
Collegiate athletes are in a unique situation, where they may not have as much
access to friends, family, or significant others when compared to the more immediate
availability of teammates, coaches, and athletic trainers. The NCAA has been working
towards improving athlete well-being to support the ultimate goal of enhancing the
athlete's academic and social development (NCAA, 2019). This social environment can
make a difference in an injury's perception and cognitive appraisal. Therefore, it is

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essential to identify those individuals who recognize their social support network
following injury, illness, or other identified life stressors.
Identifying athletes' social support networks may help practitioners gain a more
thorough understanding of how they perceive social support from those closest to them.
Understanding athletes' social support networks may also help develop strategies to assist
those athletes who need social support following injury, illness, or responding to other
identified life stressors. Therefore, the hypothesis driving this research is there will be
more significant amounts of perceived social support from teammates than friends,
coaches compared to family, athletic trainers compared to significant others dependent
upon injury status, illness, and other identified life stressors.

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Appendix C1
Additional Methods
Collegiate Athletes’ Perceptions of Social Support Survey

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PERCEPTIONS OF SOCIAL SUPPORT: PART I
Informed Consent Letter

Dear PSAC Athlete:
This survey has been approved by the California University of Pennsylvania
Institutional Review Board. This approval is effective nn/nn/nn and expires
mm/mm/mm.
Please read through this informed consent in its entirety to make sure you fully
understand the purpose of the study and your role in the study should you agree to
voluntarily participate.
Introduction
You are invited to participate in a research study which is designed to get a better
understanding of who PSAC athletes seek out for social support following injury, illness
or other life stressors. You are eligible to participate if you are 18 years of age or older
and are currently rostered on an NCAA athletic team at your University. This research
study is being conducted by Ms. Martha Anderson, MS, LAT, ATC, who is a doctoral
student at California University of Pennsylvania. This study is in partial fulfillment of the
Doctorate of Health Science program requirements.
Purpose
Through your participation in this study, we hope to gain a more thorough
understanding of who collegiate athletes seek out for social support following
injury, illness and other life
stressors. This study may also assist in developing strategies to improve the available
social support for collegiate athletes following injury, illness or other life stressors.
Consent & Procedures:
You must be 18 years of age to participate. Your participation is voluntary. By finishing
the survey and submitting your data implies consent to use the data. Your participation
may be discontinued at any time, without penalty and any data will be discarded. The
survey consists of three sections. It should take approximately 10 minutes to complete
the entire survey.
Confidentiality
All surveys are stored on the Survey Monkey® website and the CalU Cloud storage
with password protection, and only the primary researcher will have access to the
data. At the conclusion of the study, the data will be stored on the password protected

117
Cloud for a period of 3 years. At the end of 3 years, the data will be erased. Your
participation and results are completely confidential and anonymous. There is no
monetary benefit for participating in this study.
Risks and Benefits
It is highly unlikely you will experience any increased emotions or feelings by
completing this survey. However, if you do experience any increased emotions or
feelings, there is contact information for free resources available to you that are listed
at the end of the survey.
You may contact the primary researcher or research advisor with any questions via
email or telephone:
Primary Researcher: Martha Anderson, MS, LAT, ATC / and9222@calu.edu /484332-6780 Research Advisor: Dr. Linda Meyer, EdD, LAT, ATC / meyer@calu.edu
/ 814-442-6843

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* 1. What is your age?
Under 18
18
19
20
21
22
23
24
Other (please specify)

These questions are pertaining to the SINGLE MOST SIGNIFICANT INJURY you have experienced in the
past 12 months.
*2. In the past 12 months, which body part was involved in the single most significant injury?
I did not have a significant injury.

Torso

Head

Spine

Shoulder

Hip

Elbow

Knee

Wrist

Lower leg

Hand

Ankle
Foot

*
*
*
*
3. Please choose which type of head injury you sustained:
Concussion

Laceration
Contusion
Fracture

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* 4. Referring to the body part you listed in the previous question, please choose the type of significant
injury you experienced in the past 12 months.
Contusion
Laceration
Strain
Sprain
Fracture

Other Injury (for example: ACL tear, stress fracture, hamstring tendon tear)

* 5. In the past 12 months, how many days of lifting, conditioning, practice or games did you miss because of
this single most significant injury?
Did not miss any days
Missed less than a week
Missed 1 to 3 weeks
Longer than 3 weeks but able to return in the same competitive season
Longer than 3 weeks, but unable to return for the remainder of the competitive season
Severe injury resulting in permanent disability (loss of limb, quadriplegia)
Other (please specify)

* 6. Please explain any type of significant illness you experienced in the past 12 months.
I did not have any significant illness.
Please specify the significant illness you had in the past 12 months. (For example: Mononucleosis, staph infection, flu)

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* 7. In the past 12 months, how many days of lifting, conditioning, practice or games did you miss because of this
single most significant illness?
Did not miss any days
Missed less than a week
Missed 1 to 3 weeks
Longer than 3 weeks but able to return in the same competitive season
Longer than 3 weeks, but unable to return for the remainder of the competitive season
Severe injury resulting in permanent disability (loss of limb, quadriplegia)
Other (please specify)

* 8. Please identify the single most significant life stressor you have experienced in the last 12 months.
Academic and coursework demands

Procrastination

University environment

Finances or money problems

Housing or accommodations

Transportation issues

Mental health issues

Physical health issues

Family problems

Friends problems

Relationship problems

Romantic relationship problems

Work issues

Parental expectations

Studying and life balance

Sexual orientation issues

Discrimination

Language/cultural issues

Other (please explain)

* 9. In the past 12 months, think about the single most significant life stressor you experienced. How many
days of lifting, conditioning, practice or games did you miss because of this significant life stressor?
Did not miss any days
Missed less than 1 week
Missed 1 to 3 weeks
Longer than 3 weeks but able to return in the same competitive season

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Longer than 3 weeks, but unable to return for the remainder of the competitive season
Other (please specify)

The following questions refer to your EMOTIONAL WELL-BEING over the past 12 months.
Click on the circle which corresponds with your thoughts for each question.

* 10. In the last 12 months, how often have you been upset because of something that happened
unexpectedly?
Never

Almost Never

Sometimes

Fairly Often

Very Often

* 11. In the last 12 months, how often have you felt that you were unable to control the important things in your
life?
Never

Almost Never

Sometimes

Fairly Often

Very Often

* 12. In the last 12 months, how often have you felt nervous and “stressed”?
Never

Almost Never

Sometimes

Fairly Often

Very Often

* 13. In the last 12 months, how often have you felt confident about your ability to handle your personal
problems?
Never

Almost Never

Sometimes

Fairly Often

Very Often

* 14. In the last 12 months, how often have you felt that things were going your way?
Never

Almost Never

Sometimes

Fairly Often

Very Often

* 15. In the last 12 months, how often have you found that you could not cope with all the things that you had to
do?
Never

Almost Never

Sometimes

Fairly Often

Very Often

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* 16. In the last 12 months, how often have you been able to control irritations in your life?
Never

Almost Never

Sometimes

Fairly Often

Very Often

* 17. In the last 12 months, how often have you felt that you were on top of things?
Never

Almost Never

Sometimes

Fairly Often

Very Often

* 18. In the last 12 months, how often have you been angered because of things that were outside of your
control?
Never

Almost Never

Sometimes

Fairly Often

Very Often

* 19. In the last 12 months , how often have you felt difficulties were piling up so high that you could not
overcome them?
Never

Almost Never

Sometimes

Fairly Often

Very Often

* 20. What is your current year of athletic eligibility? Please choose one answer from the drop down menu
below:

* 21. What is your primary sport? Please choose an answer from the drop down menu below:

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* 22. Which of the following best describes your ethnicity?
White or Caucasian

Black or African

American Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Choose not to answer

Other (please specify)

* 23. On which sport roster are you an NCAA participant?
Men's Sport

Women's Sport

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PERCEPTIONS OF SOCIAL SUPPORT: PART II

Multidimensional Scale of Perceived Social Support
Read each statement carefully. Indicate how you feel about each statement by clicking the circle
which best corresponds with your answer.
* 24. There is a special person who is around when I am in need.
Very Strongly Disagree

Strongly Disagree Mildly Disagree

Neutral

Mildly Agree

Strongly Agree

Very Strongly Agree

Neutral

Mildly Agree

Strongly Agree

Very Strongly Agree

Neutral

Mildly Agree

Strongly Agree Very Strongly Agree

Mildly Disagree

Neutral

Mildly Agree

Strongly Agree

Very Strongly Agree

Mildly Disagree

Neutral

Mildly Agree

Strongly Agree

Very Strongly Agree

* 25. My family is willing to help me make decisions.
Very Strongly Disagree

Strongly Disagree Mildly Disagree

* 26. I have friends with whom I can share my joys and sorrows.
Very Strongly Disagree

Strongly Disagree

Mildly Disagree

* 27. I can talk about my problems with my family.
Very Strongly Disagree

Strongly Disagree

* 28. My friends really try to help me.
Very Strongly Disagree

Strongly Disagree

* 29. I can count on my friends when things go wrong.
Very Strongly Disagree

Strongly Disagree

Mildly Disagree

Neutral

Mildly Agree

Strongly Agree

Very Strongly Agree

* 30. I have a special person who is a real source of comfort to me.
Very Strongly Disagree

Strongly Disagree

Mildly Disagree

Neutral

Mildly Agree

Neutral

Mildly Agree

Strongly Agree

Very Strongly Agree

* 31. I can talk about my problems with my friends.
Very Strongly Disagree

Strongly Disagree Mildly Disagree

Strongly Agree

Very Strongly Agree

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* 32. I get the emotional help & support I need from my family.
Very Strongly Disagree

Strongly Disagree Mildly Disagree Neutral

Mildly Agree

Strongly Agree

Very Strongly Agree

Strongly Agree

Very Strongly Agree

* 33. There is a special person in my life who cares about my feelings.
Very Strongly Disagree

Strongly Disagree

Mildly Disagree Neutral

Mildly Agree

* 34. My family really tries to help me.
Very Strongly Disagree
Strongly Agree

Strongly Disagree

Mildly Disagree

Neutral

Mildly Agree

Strongly Agree

Very

Strongly Agree

Very

* 35. There is a special person with whom I can share joys and sorrows.
Very Strongly Disagree Strongly Disagree
Strongly Agree

Mildly Disagree

Neutral

Mildly Agree

PERCEPTIONS OF SOCIAL SUPPORT: PART III
Athletic Multidimensional Scale of Perceived Social Support
Read each statement carefully. Indicate how you feel about each statement by clicking the
circle which best corresponds with your answer.
* 36. There is an athletic trainer who is around when I am in need.
Very Strongly Disagree
Strongly Agree

Strongly Disagree

Mildly Disagree

Neutral

Mildly Agree

Strongly Agree Very

* 37. I can talk about my problems with my teammates.
Very Strongly Disagree Strongly Disagree Mildly Disagree
Strongly Agree

Neutral

Mildly Agree

Strongly Agree

Very

126

* 38. My coach is willing to help me make decisions.
Very Strongly Disagree Strongly Disagree
Agree

Mildly Disagree Neutral

Mildly Agree

Strongly Agree

Very Strongly

* 39. There is an athletic trainer who cares about my feelings.
Very Strongly Disagree
Strongly Agree

Strongly Disagree

Mildly Disagree

Neutral

Mildly Agree

Strongly Agree

Very

* 40. I have teammates with whom I can share my joys and sorrows.
Very Strongly Disagree
Strongly Agree

Strongly Disagree

Mildly Disagree

Neutral

Mildly Agree

Strongly Agree

Very

Neutral

Mildly Agree

Strongly Agree

Very

Mildly Agree

Strongly Agree

Very

* 41. I can talk about my problems with my coaches.
Very Strongly Disagree
Strongly Agree

Strongly Disagree Mildly Disagree

* 42. I can count on my teammates when things go wrong.
Very Strongly Disagree
Strongly Agree

Strongly Disagree

Mildly Disagree

Neutral

* 43. My teammates really try to help me.
Very Strongly Disagree
Agree

Strongly Disagree

Mildly Disagree

Neutral

Mildly Agree

Strongly Agree

Very Strongly

Strongly Agree

Very Strongly

* 44. I have an athletic trainer who is a real source of comfort to me.
Very Strongly Disagree
Agree

Strongly Disagree Mildly Disagree

Neutral

Mildly Agree

127

*
45. I get the emotional help and support I need from my coaches.
Very Strongly Disagree
Agree

Strongly Disagree

Mildly Disagree Neutral

Mildly Agree

Strongly Agree

Very Strongly

Mildly Agree

Strongly Agree

Very Strongly

* 46. My coaches really try to help me.
Very Strongly Disagree Strongly Disagree Mildly DIsagree Neutral
Agree

* 47. There is an athletic trainer with whom I can share my joys and sorrows.
Very Strongly Disagree Strongly Disagree
Strongly Agree

Mildly Disagree

Neutral

Mildly Agree

Strongly Agree

Very

Thank you for participating! Please click the DONE button at the bottom of the page to finish!
If you or anyone you know are having difficulty dealing with any emotions or feelings you or they
may
be experiencing, please utilize any of the free resource providers listed
below.
FREE RESOURCES:
Service Access Management (SAM): Available 24/7 877236-4600 Are you okay? (RUOK): Available 24/7 Text
RUOK to 7865
OR
contact your athletic trainer, local mental health provider, campus counseling center, if available,
or call 911

128

Appendix C2
Introductory Letter to Students

129

Dear PSAC Athlete,
My name is Martha Anderson, and currently a doctoral student at California University of PA
and an athletic trainer at Kutztown University. I am conducting a research study on who
collegiate athletes seek out for social support following injury, illness, or other stressors, and you
could really help me out by volunteering to participate in my study. You must be 18 years of age
or older to participate in the study. I am asking for participation from all team rostered PSAC
universities’ athletes because you represent one of the largest conferences in all of Division II
athletics, and you are a unique group of athletes.
Participation is completely voluntary, confidential, and anonymous. The survey should take
approximately 10 minutes to complete. If you would like to participate in the study, please
follow this link or scan the QR Code:

https://www.surveymonkey.com/r/Z8JYZKV

If you have any questions, you may reach me at 484-646-4284 or via email at
and9222@calu.edu
Thank you so much for your willingness to participate in this study so that we may better
understand the important role social support plays following injury, illness, or other stressors. It
is greatly appreciated.
Again, thank you for your participation,
Martha Anderson, ABD, LAT, ATC, CES, PES

130

Appendix C3
Athletic Director and Athletic Trainer Contact Information

131
University

Bloomsburg
California U. of PA
Clarion
East Stroudsburg
Edinboro
Gannon
Indiana U. of PA
Kutztown
Lock Haven
Mansfield
Mercyhurst
Millersville
Univ. of Pitt-Johnstown
Seton Hill
Shepherd
Shippensburg
Slippery Rock
West Chester
University

Bloomsburg
California U. of PA
Clarion
East Stroudsburg
Edinboro
Gannon
Indiana U. of PA
Kutztown
Lock Haven
Mansfield

Administrator

Dr. Michael
McFarland
Dr. Karen Hjerpe
Dr. Wendy Snodgrass
Dr. Gary Gray
Dr. Katherine Robbins
Lisa Goddard
McGuirk
Todd Garzarelli
Greg Bamberger
Dr. Tom Gioglio
Peggy Carl
Bradley Davis
Miles Gallagher
Pat Pecora
Chris Snyder
Chauncey Winbush
Jeff Michaels
Paul Lueken
Terry Beattie
Athletic Trainer

Email address

mcfarland@bloom.edu
hjerpe@calu.edu
wsnodgrass@clarion.edu
ggray2@esu.edu
krobbins@edinboro.edu

570-389-4050
724-938-4167
814-393-1997
570-422-3689
814-871-7664

mcguirk@gannon.edu
tgarzare@iup.edu
bamberger@kutztown.edu
tmg252@lockhave.edu
pcarl@mansfield.edu
bdavis@merchurst.edu
mgallagher@millersville.edu
ppecora@pitt.edu
csnyder@setonhill.edu
cwinbush@shepherd.edu
jamich@ship.edu
paul.lueken@sru.edu
tbeattie@wcupa.edu

814-871-7664
724-357-4295
610-683-4096
570-484-2102
570-662-4636
814-824-3101
717-871-7694
814-269-2000
724-830-1895
304-876-5155
717-477-1711
724-738-2767
610-436-3555

Email Address

alarsen@bloomu.edu
zema@calu.edu
jthornton@clarion.edu
cshotwell@esu.edu
ghanna@edinboro.edu
roth031@gannon.edu
jbaum@iup.edu
manderso@kutztown.edu
yingram@lockhaven.edu
lzaparzy@mansfield.edu

Millersville
Univ. of Pitt-Johnstown
Seton Hill
Shepherd

Allen Larsen
Scott Zema
Jim Thornton
Colleen Shotwell
Gary Hannah
Andrea Roth
Jessica Baum-Mehus
Martha Anderson
Yvette Ingram
Laurie Zaprazynski
Andy SimonWambach
Wendy WheelerDetrich
Elissa Till
Peggy Fillinger
Shatora Lane

Shippensburg
Slippery Rock
West Chester

Miranda Fisher
Molly Parsons
Lindsay Keenan

mfisher@ship.edu
molly.parsons@sru.edu
lmcguire@wcupa.edu

Mercyhurst

Phone Number

Phone number

570-389-4369
724-884-5104
814-393-2456
570-422-3165
814-732-1860
814-871-5300
724-357-2756
484-332-6780
570-484-3098
570-662-4467

asimonwambach@mercyhurst.edu

814-824-2259

wendy.wheelerdietrich@millersville.edu
till@pitt.edu
mfillinger@setonhill.edu
slane@shepherd.edu

717-871-4227
814-824-2259
724-522-4324
304-876-5348
717-477-1749
x3
724-738-4240
610-436-2753

132

Appendix C4
Email to Athletic Administrators

133

_____________________________________________________________________________________
Martha Anderson, MS, LAT, ATC
Phone: 484-646-4284
Fax: 610-683-4664
and9222@calu.edu

August 28, 2020

Dear Athletic Administrators,
I am pursuing my doctoral degree in California University of Pennsylvania’s Health Science and
Exercise Leadership program, and I am also an athletic trainer for Kutztown University. I am
asking for your approval and confirmation to allow the athletes from your university to
participate in a study. I am investigating who athletes perceive as providing them with social
support following injury or response to other stressors identified life stressors - friends, family,
significant others, teammates, coaches, or athletic trainers.
I will be working with one of your athletic trainers for student-athlete recruitment for
participation in this study. Their responsibilities are to display the posters and flyers with the QR
code and weblink to the survey in the athletic training room, team locker rooms, and weight
room. They will also be encouraged to share the information electronically via any of the team
communication methods your student-athletes may use to communicate team information.
Athletes who choose to participate will complete an electronic survey that will take less
than 10 minutes to complete. If the athlete chooses, they may exit the study at any time, and their
data will be discarded. Participation will be voluntary and anonymous.
There is no cost or remuneration associated with participation, and there is minimal risk
to the athletes. The minimal risk may be an increase in emotions after recalling a recent injury.
There will be phone numbers of available free resources at the end of the survey of for
individuals who feel they may need assistance as a result of experiencing these emotions.
I have received approval from California University of Pennsylvania’s Institutional Review
Board to perform the study from July 20, 2020 to July 19, 2021. Please respond to me via email
for confirmation or denial of your university’s athletic department participation in this study. The
anticipated dates to make the electronic survey available to the athletes is August 3rd thru
August 24th, 2020. Again, I am asking you to either email or call me to confirm your
institution’s participation in this study no later than July 31, 2020. I look forward to hearing from
you.If there are any questions, I can be reached via Email: and9222@calu.edu or by phone:
484-332-6780.
Sincerely,
Ms. Martha J. Anderson, MS, LAT, ATC
Dr. Linda Meyer, California University of Pennsylvania Research Advisor
Email: meyer@calu.edu or Office Phone: 814-442-6843

134

Appendix C5
Email to the Designated Contact Athletic Trainers

135

_____________________________________________________________________________________
Martha Anderson, MS, LAT, ATC
Phone: 484-646-4284
and9222@calu.edu
Fax: 610-683-4664

Dear Athletic Trainers,
I am a doctoral student in the California University of Pennsylvania’s Health Science and
Exercise Leadership program and an athletic trainer at Kutztown University. I am investigating
who athletes perceive as providing them with social support following injury or response to other
stressors-their friends, family, significant others, teammates, coaches, or athletic trainers.
I have received Cal U’s IRB approval from July 20, 2020, through July 19, 2020, and
approval from your Athletic Director to perform the survey research on your campus. Your
administrative assistance will be paramount in the recruitment of volunteer subjects. I will be
providing posters and flyers with QR codes to be posted in your athletic training room(s), team
locker rooms, weight rooms, and anywhere else which may be visible to your athletes. You may
also post or distribute the QR Code through team communications, social media or via studentathlete email.
The research consists of one survey with three brief sections, which can be completed in
about 10 minutes. It will consist of demographic questions, Perceived Stress Scale (PSS) the
Multidimensional Scale of Perceived Social Support (MSPSS), and an adaption of the MSPSS,
the Athletic Multidimensional Scale of Perceived Social Support (AMSPSS). Surveys will be
delivered via a QR Code that will be linked to the Survey Monkey® survey. There is no cost or
remuneration for participation. There is minimal risk to the student-athletes. The minimal risk
may be an increase in emotions after recalling a recent athletic injury. There will be phone
numbers of available free resources for assistance organizations. Participation is confidential and
anonymous. If the athlete chooses, they may exit the study at any time, and their data will be
discarded.
We are hoping to get as much participation as possible in order to improve the strength of
the study. The posters and QR Codes should be distributed tentatively from August 3, 2020,
through August 24, 2020. Should you require more materials, please contact me, and I will mail
them to you. If there are any questions or difficulties in accessing the study, please contact me
directly. I have included copies of the separate surveys so you are aware of the questions that
will be asked. I am asking that you do not take the actual survey, as this will interfere with the
data collection.
Your participation is truly appreciated,
Martha Anderson, MS, LAT, ATC, Primary Researcher
Office: 484-646-4284 Cell: 484-332-6780
Dr. Linda Meyer, EdD, LAT, ATC, California University of Pennsylvania Research Advisor
Office Phone: 814-442-6846 / Email: meyer@calu.edu
Research Committee Members:
Dr. Tom West PhD, LAT, ATC (west_t@calu.edu)
Dr. Yvette Ingram, PhD, LAT, ATC (ingram@lockhaven.edu)
Dr. Ellen West, EdD, LAT, ATC (west_e@calu.edu)

136

PERCEIVED STRESS SCALE: The questions in this scale ask you about your feelings and
thoughts during the last month. In each case, you will be asked to indicate by circling how often
you felt or thought a certain way.
Name _______________ Date ______________ Age _______ Gender (Circle): M F Other
0= Never 1 = Almost Never 2 = Sometimes 3 = Fairly Often 4 = Very Often
In the last 12 months, how often have you been upset because of something that happened
unexpectedly?
0

In the last 12 months, how often have you felt that you were unable to control the important
things in your life?
0
1
2
3
4
In the last 12 months, how often have you felt nervous and “stressed”?
0

In the last month, how often have you felt confident about your ability to handle your personal
problems?
0
1
2
3
4
In the last 12 months, how often have you felt that things were going your way?
0

In the last 12 months, how often have you found that you could not cope with all the things that
you had to do?
0

In the last 12 months, how often have you been able to control irritations in your life?
0

In the last 12 months, how often have you felt that you were on top of things?
0

In the last 12 months, how often have you been angered because of things that were outside of
your control?
0

In the last 12 months, how often have you felt difficulties were piling up so high that you could
not overcome them?
0

137

Multidimensional Scale of Perceived Social Support Instructions:
We are interested in how you feel about the following statements. Read each statement
carefully. Indicate how you feel about each statement.
Circle the “1” if you Very Strongly Disagree, Circle the “2” if you Strongly Disagree, Circle the
“3” if you Mildly Disagree, Circle the “4” if you are Neutral, Circle the “5” if you Mildly Agree,
Circle the “6” if you Strongly Agree, Circle the “7” if you Very Strongly Agree
1. There is a special person who is around when I am in need.

1234567

2. There is a special person with whom I can share joys and sorrows.

1234567

3. My family really tries to help me.

1234567

4.I get the emotional help & support I need from my family.

1234567

5. I have a special person who is a real source of comfort to me.

1234567

6 My friends really try to help me.

1234567

7. I can count on my friends when things go wrong.

1234567

8. I can talk about my problems with my family.

1234567

9. I have friends with whom I can share my joys and sorrows.

1234567

10. There is a special person in my life who cares about my feelings.

1234567

11. My family is willing to help me make decisions.

1234567

12. I can talk about my problems with my friends.

1234567

138

Athletic Multidimensional Scale of Perceived Social Support Instructions:
We are interested in how you feel about the following statements. Read each statement
carefully. Indicate how you feel about each statement.
Circle the “1” if you Very Strongly Disagree, Circle the “2” if you Strongly Disagree, Circle the
“3” if you Mildly Disagree, Circle the “4” if you are Neutral, Circle the “5” if you Mildly Agree,
Circle the “6” if you Strongly Agree, Circle the “7” if you Very Strongly Agree
1. There is an athletic trainer who is around when I am in need.

1234567

2. There is a athletic trainer with whom I can share joys and sorrows.

1234567

3. My coach really tries to help me.

1234567

4.I get the emotional help & support I need from my coach.

1234567

5. I have an athletic trainer who is a real source of comfort to me.

1234567

6 My teammates really try to help me.

1234567

7. I can count on my teammates when things go wrong.

1234567

8. I can talk about my problems with my coach.

1234567

9. I have teammates with whom I can share my joys and sorrows.

1234567

10. There is an athletic trainer in my life who cares about my feelings.

1234567

11. My coach is willing to help me make decisions.

1234567

12. I can talk about my problems with my teammates.

1234567

139

University Stress Scale
How often have each of the following caused you stress in the past few weeks. If any are
not applicable to you, tick Not at all.
Not at all 0
Sometimes 1
Frequently 2
Constantly 3
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*

Academic/coursework demands
Procrastination
University/college environment
Finances and money problems
Housing/accommodation
Transport
Mental health problems
Physical health problems
Parenting issues
Childcare
Family relationships
Friendships
Romantic relationships
Relationship break-down
Work
Parental expectations
Study/life balance
Discrimination
19. Sexual orientation issues
Language/cultural issues
Other demands

SCORING
USS Total = sum of items 1– 21
Range = 0 to 63
REFERENCES
Measure
Stallman, H. M. (2008). University Stress Scale. Brisbane: Queensland University
of Technology.
Psychometric Properties
Stallman, H. M., & Hurst, C. P. (2016). The University Stress Scale: Measuring Domains
and Extent of Stress in University Students. Australian Psychologist, 51(2), 128-134.
doi:10.1111/ap.12127

140

Appendix C6
Quick Response Code

141

STUDENT ATHLETES:
Would you like to help yourself, your teammates,
coaches and athletic trainers?

We are looking for NCAA athletes to volunteer to
participate in a study that is examining who
athletes turn to for social support. The study takes
less than 10 minutes to complete.
If you’re interested, scan the code below and it will take
you to the survey.

OR if you are on your computer, click on the link:
https://www.surveymonkey.com/r/2020SocialSupport2
(You must be 18 or older to participate)

142

Appendix C7
Thank you Email to Athletic Trainers

143

_____________________________________________________________________________________
Martha Anderson, MS, LAT, ATC
Phone: 484-646-4284
and9222@calu.edu
Fax: 610-683-4664

Ms. Martha Anderson, MS, LAT, ATC
228 Sycamore Road
West Reading, PA 19611
Dear Athletic Trainers,
I would like to offer my sincerest thanks and gratitude for your participation and administrative
assistance in my dissertation study. It is my hope that with the addition of a sport-specific
instrument to measure perceived social support, members of the athletic community will have
more knowledge about the importance of their support needed by those student-athletes who have
sustained an injury. Hopefully, we can gain insight into this critical aspect of athletic injury
recovery for the athletes for whom we provide services.
Should you have any questions, please contact me via phone or email.
Thank you again for your participation and assistance,
Martha Anderson, MS, LAT, ATC
(o) 484-646-4284 (c) 484-332-6780
Email: and9222@calu.edu

144

Appendix C8
IRB Review Request

145
Proposal Number
19-067______
Date Received
8/25/20

IRB Review Request
Institutional Review Board (IRB) approval is required before beginning any research and/or
data collection involving human subjects
Submit this form to instreviewboard@calu.edu or Campus Box #109

Project Title: Identifying collegiate athletes’ social support networks following injury, illness and response to other
identified life stressors.
Researcher/Project Director

Martha J. Anderson

Phone # 484-332-6780

E-mail Address and9222@calu.edu

Faculty Sponsor (if researcher is a student)
Department

Dr. Linda Meyer, EdD, LAT, ATC

Exercise Science and Sports Studies

Anticipated Project Dates

July 20, 2020

July 19, 2021

Sponsoring Agent (if applicable)
Project to be Conducted at
Project Purpose:

Pennsylvania State Athletic Conference Universities

Thesis

Research

Class Project

X Other: Dissertation

Keep a copy of this form for your records.
Required IRB Training
All researchers must complete an approved Human Participants Protection training course. The training requirement can
be satisfied by completing the CITI (Collaborative Institutional Training Initiative) online course at
http://www.citiprogram.org New users should affiliate with “California University of Pennsylvania” and select the “All
Researchers Applying for IRB Approval”course option. A copy of your certification of training must be attached to this IRB
Protocol. If you have completed the training within the past 3 years and have already provided documentation to the IRB,
please provide the following:

146

Previous Project Title
Date of Previous Project IRB Approval

Provide an overview of your project-proposal describing what you plan to do and how you
will go about doing it. Include any hypothesis(es)or research questions that might be involved
and explain how the information you gather will be analyzed. All items in the Review Request
Checklist, (see below) must be addressed.

1. Please attach a typed, detailed summary of your project and complete
items 2-6.
The aim of the present study seeks to identify those individuals whom NCAA
collegiate athletes from the Pennsylvania State Athletic Conference (PSAC) universities
seek out for social support following injury, illness, or other identified life stressors.
There are two hypotheses which are driving this research study. First, there will be
greater amounts of perceived social support from teammates, coaches, and athletic
trainers than from friends, family, and significant others, dependent upon injury status
(injured vs. non-injured), illness (illness vs. no illness), and other identified life stressors.
Second, differences in age, gender, ethnicity, sport, and year of athletic eligibility will
influence the perception of social support from teammates, coaches, athletic trainers,
friends, family and significant others.
The participants of this study will represent a sample of convenience of male and
female student-athletes, 18 years of age or older. These subjects will be current athletes
from the 18 universities which comprise the PSAC. The research design for this study is a
non-experimental group comparison. Independent variables are the college athletes’
injury history over the previous 12 months (injury or no injury), illness over the previous
12 months (illness or no illness), and perceived life stress history over the previous 12
months (stressor or no stressor) and the specific demographics of gender, ethnicity, sport
and year of athletic eligibility. Dependent variables will be the athletes’ perception of
social support from teammates, coaches, athletic trainers, friends, family, and significant
others.
Following California University IRB approval, Athletic Administrators (AA) from
each PSAC University will be contacted via email and/or telephone, in order to obtain
consent for their university’s participation in the study. Following AA consent, the
designated contact athletic trainer at each institution will be contacted by the primary
researcher via email and/or telephone. Communication with the athletic trainer will
include the purpose of the study, study design, methods and a copy of the instruments
which will be used in the study, which will be used solely for informational purposes.
Both hypotheses will be tested through the administration of an online survey
accessed from the Survey Monkey® website. All participation will be voluntary,
confidential, and anonymous. Due to the potential of COVID-19 influencing on-campus

147

operations, there will be two scenarios for disseminating the information to the
participants. Scenario I, is that athletes are on campus, volunteer athlete participants
will be asked to participate through the use of informational posters which will contain a
Quick Response code (QR Code) and a Post-It Note® type pad which has the QR code
and hyperlink to the survey on each page of the pad. Athletes may take that information
with them. In addition, the information may be delivered via any source of electronic
team communication (text message, twitter, etc.) used by each university to communicate
with athletes. Scenario II is that athletes have not returned to campus, so volunteer
athlete participants will be sent the hyperlink via email or any other electronic means of
communication that institution is using to communicate with its athletes.
The survey consists of three sections: demographic questions and the Perceived
Stress Scale (PSS), the Multidimensional Scale of Perceived Social Support (MSPSS),
and the Athletic Multidimensional Scale of Perceived Social Support (AMSPSS). There
are up to 21 questions on the demographic portion, which is dependent upon whether or
not the participant had an injury, illness or stressor, or a combination of the three; and
the level of stress using the 10 question Perceived Stress Scale (PSS). The second and
third portion of the survey are the 12 questions on the MSPSS and the 12 questions on the
AMSPSS, respectively. The PSS, MSPSS, and AMSPSS are rated using a Likert scale. The
entire survey should take approximately 10 minutes to complete. The informed consent
letter can be seen in Appendix A7, page 25.
2. Section 46.11 of the Federal Regulations state that research proposals involving human
subjects must satisfy certain requirements before the IRB can grant approval. You
should describe in detail how the following requirements will be satisfied. Be sure to
address each area separately.
(text boxes will expand to fit responses)
a.
How will you ensure that any risks to subjects are minimized? If there are
potential risks, describe what will be done to minimize these risks. If there are risks,
describe why the risks to participants are reasonable in relation to the anticipated
benefits.
All participants will be made aware of the possible minimal risks of experiencing
an increase in emotional and/or psychological responses while answering the
questions in the survey This statement is made in the informed consent letter. There
will be contact information for free resources to assist the participants should they
have increased emotional and/or psychological responses. This information will be
available and accessible at the end of the study.
These minimal risks are reasonable due to the fact the subjects are simply recalling
feelings and not experiencing the stressor for the first time and will therefore be less
likely to experience a stressful event when completing the survey. The benefits of this
study are being able to identify those individuals and resources athletes are more or
less likely to utilize in times of experiencing injury, illness or stress. With this
knowledge, the individuals who are likely to have contact with these athletes may be
better prepared to anticipate the need to provide support. Gaining this information

148
may in fact help minimize the stress athletes may experience in the future and, and thus
outweighing the potential harm of these minimal risks.

b.
How will you ensure that the selection of subjects is equitable? Take into
account your purpose(s). Be sure you address research problems involving vulnerable
populations such as children, prisoners, pregnant women, mentally disabled persons, and
economically or educationally disadvantaged persons. If this is an in-class project
describe how you will minimize the possibility that students will feel coerced.
Any athletes who are not 18 or older will be excluded from the study. This will be
stated on the posters advertising the study. Further, it is the first question on the
survey. If the student answers that they are not 18, the subject will be directed to the
end of the survey. There is equal opportunity for both male and female athletes to
participate, as no NCAA varsity sports sponsored by the Pennsylvania State Athletic
Conference (PSAC) have been excluded from the study. Posters and flyers for
participation in the study will be posted where all athletes will have the same
opportunity to respond to the surveys. This will include the coeducational athletic
training rooms, weight rooms and individual team locker areas. Campus emails or
other means of electronic communication (Text message, GroupMe, etc.) will be used
to contact the athletic teams if the students are not on campus. The way in which the
athletes will receive the study information will be at the discretion of the designated
contact athletic trainer. Participation is completely voluntary and there will be no
coercion to participate.
c.
How will you obtain informed consent from each participant or the subject’s
legally authorized representative and ensure that all consent forms are appropriately
documented? Be sure to attach a copy of your consent form to the project summary.
There is an informed consent letter which needs to be reviewed prior to beginning the
survey. By using an electronic questionnaire format, consent is implied if they
continue to participate in the study. By continuing to the end of the study and
submitting their data, the participants are granting implied consent to use their data.
This statement is also in the informed consent letter.
d.
Show that the research plan makes provisions to monitor the data collected to
ensure the safety of all subjects. This includes the privacy of subjects’ responses and
provisions for maintaining the security and confidentiality of the data.
All data will be password protected on the Survey Monkey® website for one year after
data collection and the Cal U Cloud for three years after data collection. Only the
primary researcher will have the password and thus have the only access to the data.
There will be no unique identifiers assigned to the participants and none of their vital
information, such as name, date of birth, social security number will be requested.

3. Check the appropriate box(es) that describe the subjects you plan to target.

149

Adult volunteers

Mentally Disabled People

[X] CAL University Students

Economically Disadvantaged People

[X] Other Students

Educationally Disadvantaged People

Prisoners

Fetuses or fetal material

Pregnant Women

Children Under 18

Physically Handicapped People

Neonates

4. Is remuneration involved in your project?

5. Is this project part of a grant?
information:

Yes or [X] No. If yes, Explain here.

Yes or [X] No

If yes, provide the following

Title of the Grant Proposal
Name of the Funding Agency
Dates of the Project Period
6.

Does your project involve the debriefing of those who participated?

Yes or [X] No

If Yes, explain the debriefing process here.

7. If your project involves a questionnaire or interview, ensure that it meets the
requirements indicated in the Survey/Interview/Questionnaire checklist.

150

California University of Pennsylvania Institutional Review Board
Survey/Interview/Questionnaire Consent Checklist (v021209)
This form MUST accompany all IRB review requests
Does your research involve ONLY a survey, interview or questionnaire?
YES—Complete this form
NO—You MUST complete the “Informed Consent Checklist”—skip the remainder of this form

Does your survey/interview/questionnaire cover letter or explanatory statement include:
[X] (1) Statement about the general nature of the survey and how the data will be
used?
[X] (2) Statement as to who the primary researcher is, including name, phone, and
email address?
[X] (3) FOR ALL STUDENTS: Is the faculty advisor’s name and contact information
provided?
[X] (4) Statement that participation is voluntary?
[X] (5) Statement that participation may be discontinued at any time without penalty
and all data discarded?
[X] (6) Statement that the results are confidential?
[X] (7) Statement that results are anonymous?
[X] (8) Statement as to level of risk anticipated or that minimal risk is anticipated?
(NOTE: If more than minimal risk is anticipated, a full consent form is required—and
the Informed Consent Checklist must be completed)
[X] (9) Statement that returning the survey is an indication of consent to use the data?
[X] (10) Who to contact regarding the project and how to contact this person?
[X] (11) Statement as to where the results will be housed and how maintained?
(unless otherwise approved by the IRB, must be a secure location on University
premises)
[X] (12) Is there text equivalent to: “Approved by the California University of

Pennsylvania Institutional Review Board. This approval is effective nn/nn/nn and
expires mm/mm/mm”? (the actual dates will be specified in the approval notice from
the IRB)?
[X] (13) FOR ELECTRONIC/WEBSITE SURVEYS: Does the text of the cover
letter or

151

explanatory statement appear before any data is requested from the participant?
[X] (14) FOR ELECTONIC/WEBSITE SURVEYS: Can the participant discontinue
participation at any point in the process and all data is immediately discarded?

152

California University of Pennsylvania Institutional Review Board
Review Request Checklist (v021209)

This form MUST accompany all IRB review requests.
Unless otherwise specified, ALL items must be present in your review request.
Have you:

[X] (1.0) FOR ALL STUDIES: Completed ALL items on the Review Request Form?
Pay particular attention to:
[X] (1.1) Names and email addresses of all investigators
[X] (1.1.1) FOR ALL STUDENTS: use only your CalU email
address)
[X] (1.1.2) FOR ALL STUDENTS: Name and email address of your
faculty research advisor
[X] (1.2) Project dates (must be in the future—no studies will be approved
which have already begun or scheduled to begin before final IRB approval—
NO EXCEPTIONS)
[X] (1.3) Answered completely and in detail, the questions in items 2a through
2d?
[X] 2a: NOTE: No studies can have zero risk; the lowest risk is
“minimal risk”. If more than minimal risk is involved, you MUST:
[_] i. Delineate all anticipated risks in detail
[_] ii. Explain in detail how these risks will be minimized
[_] iii. Detail the procedures for dealing with adverse outcomes
due to these risks.
[_] iv. Cite peer reviewed references in support of your
explanation.
[X] 2b. Complete all items.
[X] 2c. Describe informed consent procedures in detail.
[X] 2d. NOTE: to maintain security and confidentiality of data, all
study records must be housed in a secure (locked) location ON
UNIVERSITY PREMISES. The actual location (department, office,
etc.) must be specified in your explanation and be listed on any
consent forms or cover letters.
[X] (1.4) Checked all appropriate boxes in Section 3? If participants under the
age of 18 years are to be included (regardless of what the study involves) you
MUST:
[_] (1.4.1) Obtain informed consent from the parent or guardian—
consent forms must be written so that it is clear that the
parent/guardian is giving permission for their child to participate.
[_] (1.4.2) Document how you will obtain assent from the child—
This must be done in an age-appropriate manner. Regardless of
whether the parent/guardian has given permission, a child is
completely free to refuse to participate, so the investigator must
document how the child indicated agreement to participate
(“assent”).
[_] (1.5) Included all grant information in section 5?

153

[X] (1.6) Included ALL signatures?
[_] (2.0) FOR STUDIES INVOLVING MORE THAN JUST SURVEYS,
INTERVIEWS, OR QUESTIONNAIRES:
[_] (2.1) Attached a copy of all consent form(s)?
[_] (2.2) FOR STUDIES INVOLVING INDIVIDUALS LESS THAN 18
YEARS OF AGE: attached a copy of all assent forms (if such a form is used)?
[_] (2.3) Completed and attached a copy of the Consent Form Checklist? (as
appropriate—see that checklist for instructions)
[X] (3.0) FOR STUDIES INVOLVING ONLY SURVEYS, INTERVIEWS, OR
QUESTIONNAIRES:
[X] (3.1) Attached a copy of the cover letter/information sheet?
[X] (3.2) Completed and attached a copy of the
Survey/Interview/Questionnaire Consent Checklist? (see that checklist for
instructions)
[X] (3.3) Attached a copy of the actual survey, interview, or questionnaire
questions in their final form?
[X] (4.0) FOR ALL STUDENTS: Has your faculty research advisor:
[X] (4.1) Thoroughly reviewed and approved your study?
[X] (4.2) Thoroughly reviewed and approved your IRB paperwork? including:
[X] (4.2.1) Review request form,
[X] (4.2.2) All consent forms, (if used)
[_] (4.2.3) All assent forms (if used)
[X] (4.2.4) All Survey/Interview/Questionnaire cover letters (if used)
[X] (4.2.5) All checklists
[X] (4.3) IMPORTANT NOTE: Your advisor’s signature on the review
request form indicates that they have thoroughly reviewed your proposal and
verified that it meets all IRB and University requirements.
[X] (5.0) Have you retained a copy of all submitted documentation for your records?

154

Project Director’s Certification

Program Involving HUMAN SUBJECTS

The proposed investigation involves the use of human subjects and I am submitting the complete
application form and project description to the Institutional Review Board for Research Involving
Human Subjects.
I understand that Institutional Review Board (IRB) approval is required before beginning any
research and/or data collection involving human subjects. If the Board grants approval of this
application, I agree to:
1. Abide by any conditions or changes in the project required by the Board.
2. Report to the Board any change in the research plan that affects the method of using
human subjects before such change is instituted.
3. Report to the Board any problems that arise in connection with the use of human subjects.
4. Seek advice of the Board whenever I believe such advice is necessary or would be
helpful.
5. Secure the informed, written consent of all human subjects participating in the project.
6. Cooperate with the Board in its effort to provide a continuing review after investigations
have been initiated.
I have reviewed the Federal and State regulations concerning the use of human subjects in
research and training programs and the guidelines. I agree to abide by the regulations and
guidelines aforementioned and will adhere to policies and procedures described in my
application. I understand that changes to the research must be approved by the IRB before they
are implemented.

Professional (Faculty/Staff) Research
Project Director’s Signature

Student or Class Research
MS, LAT, ATC

Student Researcher’s Signature
Supervising Faculty Member’s Signature
ACTION OF REVIEW BOARD (IRB use only)
The Institutional Review Board for Research Involving Human Subjects has reviewed this application to
ascertain whether or not the proposed project:
1.
2.
3.
4.
5.

provides adequate safeguards of the rights and welfare of human subjects involved in the
investigations;
uses appropriate methods to obtain informed, written consent;
indicates that the potential benefits of the investigation substantially outweigh the risk involved.
provides adequate debriefing of human participants.
provides adequate follow-up services to participants who may have incurred physical, mental, or
emotional harm.

Approved[_________________________________]
___________________________________________
Chairperson, Institutional Review Board

Disapproved

Date

155

Institutional Review Board
California University of Pennsylvania
Morgan Hall, 310
250 University Avenue
California, PA 15419
instreviewboard@calu.edu
Melissa Sovak, Ph.D.

Dear Martha,
Please consider this email as official notification that your proposal
titled “Identifying Collegiate Athletes’ Social Support Networks
Following Injury, Illness, and Response to Other Identified Life
Stressors” (Proposal #19-067) has been approved by the California
University of Pennsylvania Institutional Review Board as submitted.
The effective date of approval is 7/20/20 and the expiration date is
7/19/21. These dates must appear on the consent form.
Please note that Federal Policy requires that you notify the IRB
promptly regarding any of the following:
(1) Any additions or changes in procedures you might wish for your
study (additions or changes must be approved by the IRB before they
are implemented)
(2) Any events that affect the safety or well-being of subjects

156

(3) Any modifications of your study or other responses that are
necessitated by any events reported in (2).
(4) To continue your research beyond the approval expiration date of
7/19/21 you must file additional information to be considered for
continuing review. Please contact instreviewboard@calu.edu
Please notify the Board when data collection is complete.
Regards,
Melissa Sovak, PhD.
Chair, Institutional Review Board

157

Appendix C9
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158

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Appendix C10
Supporting Materials

186

MARTHA J ANDERSON, MS, LAT, ATC
228 Sycamore Road, West Reading, PA 19611 | 484-646-4284 | manderso@kutztown.edu
EDUCATION

California University of Pennsylvania
Doctor in Health Science & Exercise Leadership
California University of Pennsylvania
Master of Science in Intercollegiate Athletic Administration
2015 Presidential Scholar
California University of Pennsylvania
Post Master’s Certificate in Sport Psychology

2017- Present

2014-2015

2011

California University of Pennsylvania
Post Master’s Certificate in Wellness and Fitness
Personal Trainer

2009

California University of Pennsylvania
Post Master’s Certificate in Rehabilitation Science
Performance Enhancement Specialist

2008

California University
Post Master’s Certificate in Rehabilitation Science07
Corrective Exercise Specialist
University of Pittsburgh
Master of Science in Athletic Training and Exercise Physiology
Graduate Project: The Effects of a Plyometric Exercise Program on the
Upper Extremity Proprioception of Collegiate Female Volleyball Players
Kutztown University of Pennsylvania
Additional 18 Graduate Level Credits
Bachelor of Science in Art Education
Instructional I Certificate

1994-1996

1992-1994
1987-1991

West Chester University
Summer Athletic Training Program

1993

Lehigh County Community College
Anatomy and Physiology Prerequisites

1991-1992

PROFESSIONAL EXPERIENCE
Kutztown University of Pennsylvania
Faculty Athletic Trainer
Promoted to Assistant Professor
Tenured

2004-Present
2009
2010

Westminster College/Sharon Regional Health System
Clinical Outreach Staff Athletic Trainer

1998-2004

West Snyder High School/Lewistown Hospital
Clinical and Clinical Outreach Staff Athletic Trainer

1996-1998

Carlow College/University of Pittsburgh
Head Athletic Trainer/Graduate Assistantship

1995-1996

187
PROFESSIONAL CERTIFICATIONS
Athletic Training Certification
National Athletic Trainers’ Association
Athletic Training State License
Commonwealth of Pennsylvania

Member Number 099402509
License Number RT001363A

American Heart Association
Basic Life Support Provider CPR/First Aid/AED

2015-Present

American Red Cross
Community First Aid/CPR/AED Instructor
Mercer County, PA Chapter
Berks County, PA Chapter

2002-2006
2004 – 2014

American Red Cross
Professional Rescuer CPR/First Aid Certification

2005 – 2014

Ténica Gavilán PTB® Certified
Instrument Assisted Soft Tissue Mobilization Technique

2013

National Academy of Sports Medicine
Corrective Exercise Specialist
Performance Enhancement Specialist
Certified Personal Trainer

Credential # 189443
Credential # 231945
Credential # 1365187

PROFESSIONAL AFFILIATIONS
Eastern Athletic Trainer’s Society
Pennsylvania Athletic Trainer’s Society
State Emergency Registry of Volunteers in Pennsylvania

1994–Present
1994 – Present
2011 – Present

PROFESSIONAL ACCOMPLISHMENTS
National Athletic Trainer’s Association
NATA Convention abstract proposal reviewer

2015-Present

Pennsylvania State System of Higher Education
Peer Reviewer for Grant Proposals

2012 - Present

Kutztown University of Pennsylvania
Developed Intercollegiate Athletics Mental Health Policy and Procedures and Emergency Action Plan
Concussion Study with Chestnut Hill College
Preceptor for Athletic Training Students
West Chester University
East Stroudsburg University
Alvernia University
Temporary Exercise Physiology Professor
Developed Department of Athletic Faculty Procedures for Promotion and Tenure Guidelines
Kutztown University Health and Wellness Expo Presenter
First Aid for Common Weekend Warrior Injuries
Stretching Philosophy and Techniques
Body Fat Analysis
CONTINUING PROFESSIONAL EDUCATION
NATA Virtual Symposium
The 2018 Micheli Lecture: Psychology of Sport Injury & Rehabilitation
Boston, MA
Annual Central Pennsylvania Sports Medicine Symposium
Hershey, PA
PROFESSIONAL CONTINUING EDUCATION CONTINUED

2018
2018
2019
2014 – Present
2015 – Present
2012
2012
2010-2014

2020
2018

2020, 2018

188
Penn Medicine Sports Performance Symposium
Philadelphia, PA
Rothman Institute
13th Annual Sports Medicine Symposium
PSAC Team Physician and Athletic Trainer Meeting
Lock Haven, PA
PSAC Mental Health Symposium
Lock Haven, PA
NCAA Mental Health Symposium
Lock Haven, PA
Understanding Evidence-Based Practice and Patient Reported Outcomes
Allentown, PA
Eastern Athletic Trainer’s Association 66th Annual Convention
Mashantucket, CT
COMMITTEE INVOLVEMENT
Kutztown University
Wellness Committee
General Education Assessment Committee Rater
Institution Review Board Committee
Head Lacrosse Coach Search Committee Member
Commission on the Status of Women
Honorary Doctorate Committee, Chair
Honorary Doctorate Committee
ChairNet, Secretary
Commission on Human Diversity
University Calendar Committee
Certified Athletic Trainer Search Committee, Chair
Associate Athletic Director Search Committee
CAS: Sports Medicine Services Program Review Committee
Kutztown University, Department of Athletic Faculty
Department Promotion Committee Chair
Department Chairperson
Acting Department Chairperson for Promotion Applicants
Performance Evaluation Team, Annual Reviews for Athletic Department Faculty
SPECIAL EVENT EXPERIENCE
Kutztown University
NCAA Field Hockey National Championship Tournament
PSAC Indoor Track and Field Championships
PSAC Outdoor Track and Field Championships
PSAC Field Hockey Championships
PSAC Outdoor Track and Field Championships
NCAA Division II Regional Men’s Basketball Tournament
PSAC Men’s Basketball Conference Championship
PSAC Men’s Basketball Conference Championship
NCAA Division II Softball National Championship Tournament
NCAA Division II Eastern Regional Wrestling Championship Tournament
NCAA Division II Super Regional Softball Tournament
PSAC Softball Conference Championship Tournament
NCAA Division II Eastern Regional Field Hockey Tournament
NCAA Division II National Wrestling Championship Tournament
PSAC Wrestling Conference Championship Tournament
PSAC Volleyball Conference Championship Tournament
NCAA Division II North Atlantic Regional Baseball Championship Tournament
PSAC Baseball Conference Championship Tournament
PSAC Women’s Basketball Conference Tournament

2018
2018
2019
2018
2017
2016
2014

2019
2019
2016-2018
2017
2015-2017
2015
2014-2015
2011-2014
2012-2013
2008-2015
2007
2006
2006

2015, 2014
2011-2014
2011, 2017
2006-Present

2019
2017-2019
2019
2018
2018,2019
2016
2016
2015
2012
2006- 2012
2006-2012
2006-2012
2007-2008
2006
2006-2011
2005-2012
2005
2005
2005

189
ECAC Division II Indoor Track and Field Championships

1992

Westminster College
ECAC Division III Women’s Basketball Championship Tournament
PAC Track and Field Conference Championships
NCAA Division III Women’s National Soccer Championship Tournament
NCAA Division III Men’s National Soccer Championship Tournament

2004
2003
2002-2003
2002

Sharon Regional Health System
WPIAL Wrestling Tournament
WPIAL Track Meet
WPIAL Basketball Tournament

2002-2003
2002
2001-2002

190

191

192

193