Perceptions of Canadian Armed Forces Health Services health care professionals on cognitive assessment processes

LAY SUMMARY Canadian Armed Forces (CAF) Service Members (SMs) experience mild traumatic brain injuries (mTBI) which can affect cognitive functioning. Adequate cognitive functioning is needed to perform military duties safely and function in all aspects of life. A standardized process that includes cognitive screen/assessment within an mTBI rehabilitation strategy is not widely utilized within Canadian Forces Health Services (CFHS). A qualitative thematic analysis nested within an implementation science approach was used to explore the experiences of 17 CFHS health care professionals who perform cognitive screens/assessments. Perceived facilitators, barriers, and recommendations for improving cognitive assessment practices for injured CAF-SMs were identified within five themes. Development and implementation of cognitive screen/assessment policies and protocols will enable CFHS to best assess and treat cognitive dysfunction among CAF-SMs. Introduction: Canadian Armed Forces (CAF) service members (CAF-SMs) experience a higher prevalence of mild traumatic brain injuries (mTBI) compared with Canadian civilians. As cognitive dysfunction may be experienced after injury or illness, assessment of cognitive functioning is necessary to ensure CAF-SMs can safely and efficiently perform their duties post-injury. Effective treatment and rehabilitation to address cognitive dysfunction can be prescribed once reliable, valid, specific, and evidence-based cognitive screening/assessment are performed by health care professionals. To date, a standardized process that includes cognitive screen/assessment within an mTBI rehabilitation strategy is not widely utilized within Canadian Forces Health Services (CFHS). The objective of this study was to explore the experiences of CFHS health care professionals who perform cognitive screens/assessments, identifying specifically: 1) perceptions of facilitators and barriers to cognitive assessment practices and 2) recommendations for improving the practice of cognitive assessment for injured CAF-SMs. Methods: A qualitative thematic analysis, nested within an implementation science approach, was performed. Seventeen CFHS health care professionals were interviewed, with the data being transcribed, coded, and analyzed. Results: Themes focused on facilitators, barriers, and recommendations associated with: 1) education and knowledge of clinicians and staff regarding mTBI and cognitive screens/assessments, 2) multidisciplinary collaboration, 3) stigma, awareness, and attitudes of CAF-SMs, 4) availability of resources, and 5) cognitive screen/assessment tools. Discussion: Development and implementation of cognitive screen/assessment policies and protocols will enable CFHS health care professionals to best assess, treat, and rehabilitate cognitive dysfunction among CAF-SMs.