They smirk ‘but you're not dying’ and other (mis)understandings about communication and concussion navigated by youth: An arts-based reflexive collective case study

Communication is essential to everyday life; however, youth experiences of post-concussion communication changes are often overlooked and misunderstood. Researchers have yet to investigate how socio-cultural values, assumptions and beliefs about communication and concussion shape youths’ concussion recoveries. Concussions are commonly misunderstood as ‘mild’ injuries with limited impact on daily life. However, approximately 30% of youth experience far-reaching, complex or prolonged concussion symptoms, including changes in communication. Ecocultural theory provided the framework for this arts-based reflexive collective case study. The study aimed to explore (mis)understandings of communication and concussion that youth aged 16–25 years navigated during their recoveries. Five youths participated in in-depth interviews and contributed arts-based materials representing their experiences. Using multiple forms of participant communication, including verbal expression, artwork, poetry, journal entries and photography, enriched the understanding of the cases. Family member interviews further explored socio-cultural and relational understandings and expectations of communication and concussion recovery. Reflexive thematic analysis yielded themes of normative communication, hard work, time and independence. Navigating (mis)understandings of post-concussion communication changes and assumptions about ‘typical’ concussion recoveries added to the unseen and unacknowledged recovery burden the youth experienced, and affected their sense of identity and participation in daily activities. Identifying and challenging these (mis)understandings of concussion and communication changes is an essential first step to easing the burden experienced by youth navigating these changes and creating more inclusive communication environments. Research findings emphasise the need to conduct studies that not only include but also prioritise the perspectives and experiences of young people who communicate in varied ways by using methods that allow participants to draw on their communication strengths and express their experiences across multiple modalities. This information is essential for guiding the development and implementation of youth-centred communication interventions, education programs, and advocacy activities.