Exploration of a stroke population's experiences of a digital cognitive assessment: a think-aloud and interview study

Introduction: With technology advancing, digital cognitive assessments, including unsupervised cognitive assessments, are evolving and being used more frequently in both research and clinical settings. Yet little is known about the experience and perceptions of digital cognitive assessments from the direct perspective of service users who have experienced a stroke. This study aimed to address this gap by investigating how service users, who have had a stroke, experience a digital cognitive screen. Method: The study invited people who have had a stroke to complete a digital fixed battery cognitive assessment called the Amsterdam Cognition Scan (ACS). They were asked to ‘think aloud’ or ‘talk aloud’ about their experiences whilst completing the cognitive assessment, as well as answering a few questions before and after the assessment about their experiences. This data were analysed using reflexive thematic analysis to develop themes and subthemes. Results: The analysis uncovered 3 central themes focused around 1. past experiences: the service user’s previous experiences and how these influence their experience and perception of the cognitive assessment; 2. direct and immediate experiences: responses and feelings evoked by the cognitive assessment and 3. potential future experiences: the utility of digital cognitive assessments with the stroke population going forwards. Discussion: A narrative overview of the key findings is discussed, including the perceived benefits and limitations of digital cognitive assessments; the future of digital cognitive assessments; directly evoked feelings from cognitive assessments such as fear, anger, and sadness; the paradox of knowing cognitive difficulties, and the importance of experts by experience involvement within research. Practitioner recommendations for administering digital cognitive assessments to the stroke population are also discussed.