“You’ve got to make it relevant”: barriers and ways forward for assessing cognition in Aboriginal clients

Background: Reliable cognitive assessment for non-western cultures is difficult given that mainstream tests typically rely on western concepts, content and values. Despite recognition of the scarcity of appropriate tests for Aboriginal people over many years, limited practical development has occurred. This study aimed to identify barriers to assessment for clinicians working with Aboriginal people in a remote context, and evaluate characteristics of assessments that clinicians considered to be more or less appropriate and thereby identify potential ways forward. Methods: Semi-structured interviews with 22 health professionals working with Aboriginal clients in central and northern Australia enquired about cognitive assessment practices for Aboriginal people. Themes related to common barriers, useful approaches and areas of need are reported. Results: Results demonstrated that engagement, diversity and the lack of appropriate resources were seen as the most significant barriers to effective assessment. Appropriate tools should be visually engaging, brief, portable, relevant, focus on identifying strengths and cater to diversity whilst also being standardised and scientifically valid. Conclusions: Despite the obvious challenges, further development is required to increase available resources and evidence base. Specifically, assessments suitable for younger populations and measuring substance misuse related impairments and change over time in a clinical setting were highlighted as important areas of need. A comprehensive assessment should include collection of data from multiple sources with clear interpretation guidelines.