Support for contextual control in primary care: a qualitative analysis

Providing support for high-level cognitive performance is largely missing in many decision support designs. Most development in this area is structured to minimize attention, decrease the need for deeper processing and limit intense goal-directed cognitive processing. However, from a dual process perspective, both automatic and deliberative processes need to be supported. The purpose of this qualitative analysis is to explore complex cognitive processing. We used the Contextual Control Model to guide the analysis. Transcripts from 33 taped primary care visits across 4 locations in the VA were analyzed using iterative process of construct and thematic development. Five themes related to high-level cognitive processes were identified: 1) Joint Exchange and Patient Activation; 2) Planning and Proactive Problem Solving; 3) Script and heuristic processing; 4) Time perspectives and 5) Uncertainty management. Results are discussed in terms of the need to support integrated views for complex situation mental models.