Exploring current practices and opportunities to address cognitive changes post-stroke: a qualitative study of health professionals

Addressing cognitive impairment is a longstanding challenge in post-stroke care. This study explored current practices of health professionals addressing cognition of people with stroke, and barriers and facilitators to following best-practice guidelines. Twenty Australian health professionals from various disciplines and settings were purposively recruited. Semi-structured interviews were conducted individually, and transcripts were analysed using framework analysis. Identified barriers and facilitators were organised according to the COM-B model of behaviour change. Addressing cognition was identified as a process involving five stages: (1) "Inform" staff and services on addressing post-stroke cognition, (2) "Initiate" relevant stage(s) to address cognition, (3) "Identify" cognitive changes, (4) "Investigate" cognitive changes, and (5) "Intervene" with cognitive changes. Each stage was composed of distinct behaviours, but current practice varied depending on health professional skills and awareness (Capability), confidence to address cognitive difficulties (Motivation), and availability of resources to do so (Opportunity). Results can be used by health professionals to identify gaps in care and create and integrate relevant training, assessment, and intervention procedures to improve how cognition is addressed within their unique settings. Further research is required to understand the feasibility and effectiveness of current practice behaviours to improve outcomes for people with stroke.