Salmon, DanielleBadenhorst, MareliseZoellner, AnjaSkilton, DebbieMossman, KateLucas, PatriciaThompson, KylieWalters, SimonKeung, SierraSole, Gisela2025-04-172025-04-172025-01-20Journal of School Health, ISSN: 0022-4391 (Print); 1746-1561 (Online), Wiley, 95(4-5), 317-331. doi: 10.1111/josh.135440022-43911746-1561http://hdl.handle.net/10292/19103Background Concussion-related guidelines appear to be inconsistently implemented in secondary schools in Aotearoa New Zealand. The purpose of this qualitative Participatory Action Research study was to describe key school stakeholders' perceptions of their current concussion management processes. Methods Seventeen focus groups, two dyad, and nine individual interviews were conducted with stakeholders (n = 95) from six secondary schools and healthcare clinics, exploring their perceptions of barriers and facilitators to concussion management. We used thematic analysis to analyze data. Results Our analysis identified five overarching and inter-relating themes: Hit or miss, the need for a clear pathway; the school context; aligning attitudes and enacting values; concussion knowledge and education; and complexity of concussion. The effectiveness of concussion management in secondary school settings is shaped by the dynamic interaction of these five themes. Implications for School Health Policy, Practice, and Equity These findings highlight the need to develop a context-sensitive framework that can assist schools with real-world implementation of concussion management guidelines, for both sports and non-sports related concussions. Conclusions The intent to support students was evident among most stakeholders yet appeared to be limited by lack of structured processes to follow, resources, unfavorable attitudes towards concussion management, and lack of knowledge.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. © 2025 The Author(s). Journal of School Health published by Wiley Periodicals LLC on behalf of American School Health Associationhttps://creativecommons.org/licenses/by/4.0/adolescentconcussionimplementationsecondary schools3901 Curriculum and Pedagogy39 Education42 Health SciencesClinical Research1117 Public Health and Health Services1302 Curriculum and PedagogyPublic Health3902 Education policy, sociology and philosophy4206 Public healthHumansBrain ConcussionNew ZealandFocus GroupsHealth Knowledge, Attitudes, PracticeQualitative ResearchAdolescentSchool Health ServicesMaleFemaleSchoolsAthletic InjuriesInterviews as TopicStudentsJournal ArticleOpenAccess10.1111/josh.13544