Designing for Implementation: A Cognitive Task Analysis of Intimate Partner Violence Screening in Hospital Trauma Care in Alberta, Canada

Abstract

Intimate partner violence (IPV) has serious health consequences, yet routine IPV screening remains inconsistently implemented in hospital trauma centres. Despite evidence supporting screening, implementation challenges persist. This study used Cognitive Task Analysis (CTA) to examine how trauma care providers perceive and enact IPV screening, with attention to cognitive processes, barriers, and facilitators to implementation. Methods: We conducted CTA group interviews with nine trauma care providers from two trauma centers in Edmonton, Alberta, Canada. Participants included trauma surgeons, nurse practitioners, social workers, and patient care managers. Using a structured interview guide and concept mapping techniques, we elicited knowledge structures, decision-making processes, and perceived constraints related to IPV screening. We applied an interpretive qualitative approach to uncover underlying themes related to cognitive work and task complexity. Grounded theory techniques, such as open and axial coding, were used in conjunction with CTA to analyze how participants reasoned through clinical scenarios. We paid close attention to how providers assessed cues, coordinated across roles, shifted priorities, and navigated organizational constraints. This hybrid approach allowed us to bridge systems-level implementation science with cognitive insights, drawing conceptually on CFIR and Proctor et al.'s implementation outcomes to generate actionable knowledge for IPV screening interventions in trauma care settings. Results: Themes were synthesized into six overarching cognitive domains: trauma care workflow, team collaboration and knowledge, critical situations and decision-making, IPV screening practices and challenges, understanding patient experiences, and 3 institutional support. These were further illustrated through refined concept maps that visually represented participants' mental models, task sequences, and decision-making strategies. Conclusion: Trauma care providers are well-positioned to identify IPV, yet screening is constrained by limited institutional support, unclear procedures, and poor integration into trauma workflows. Findings highlight the need for system-level strategies that align IPV screening with the cognitive and organizational realities of trauma care. By applying CTA, this study informs the design and implementation of context-sensitive IPV screening interventions that are more acceptable, appropriate, and feasible in hospital trauma settings. Furthermore, this study informs implementation strategies for integrating IPV screening interventions into trauma care, with particular implications for improving the acceptability, appropriateness, feasibility, and sustainability of evidence-based practices.