Abstract
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. 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 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. 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.
Highlights
Reliable cognitive assessment for non-western cultures is difficult given that mainstream tests typically rely on western concepts, content and values
The mismatch between western and Aboriginal values and practices contributed to poor engagement, borne out by a lack of perceived assessment importance, lack of motivation during assessments, and a historical mistrust of mainstream service providers
It’s pretty hard even to get them in here... they’re not motivated to do their best necessarily. They might be tired, they might think ‘what’s this idiot whitefella talking to me about this [stuff] that doesn’t make sense for?’...There are not many we see on an ongoing basis... and the ones who are engaged in therapy would probably not be impaired”. (Chantelle)
Summary
Reliable cognitive assessment for non-western cultures is difficult given that mainstream tests typically rely on western concepts, content and values. Cognitive status for Aboriginal people has historically been very difficult to establish given the bias of mainstream cognitive assessment tools towards ‘western’ cultures (Davidson, 1995; Drew, 2000). Standardised cognitive tests are most often developed and interpreted within the scientific and cultural framework that dominates western or developed cultures (Dingwall & Cairney, 2010). This typically emphasises the assessment of literacy and numeracy, and concepts such as prediction, problem solving and memory for world facts. Tests have consequences and if error is increased, as is often the case in cross-cultural assessment, adverse consequences are increased (Goodnow, 1988)
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