32 Chapter 2 Although, there are high standards of primary and preventive healthcare and a great amount of scientific and clinical knowledge about (the importance of) early detection and intervention of ASD in the Netherlands, signals from the clinical field give the alarming impression that children at high risk of ASD are identified too late. Furthermore, there are clinical signs that the Dutch ASD guideline is not fully applied in PCPs’ daily work although formal knowledge regarding guideline adherence is lacking. Therefore, the aim of the current study is to gain insight into the experiences and perspectives of PCPs regarding early detection of ASD at well-baby clinics. Three specific questions will be addressed: 1) what are PCPs’ observations on the current state regarding adherence to the Dutch ASD guideline, 2) which barriers do PCPs face concerning detection, screening and referral of young children with (symptoms of) ASD and 3) which strategies are needed, in their view, to overcome these barriers and optimize preventive care? Methods Study design This study was conducted by an institute for child and adolescent psychiatry in the Netherlands. A qualitative research design was used to explore the experiences and perspectives of preventive care physicians (PCPs) regarding ASD-specific healthcare (detection, screening, and referral) for children aged 0-4 years. Following informed consent, PCPs were invited to complete an individual semi-structured in-depth interview. Based on a topic list, PCPs were invited to discuss their experiences regarding early detection of ASD at well-baby clinics and working in accordance with the national guideline. The focus was on barriers and recommended facilitators. Ethical approval was obtained from local institutional review boards. The authors followed the Consolidated Criteria for Reporting Qualitative Research (COREQ; Tong, Sainsbury, & Craig, 2007) (see Supplementary table 1). Recruitment of participants Preventive healthcare organizations, 27 in total, spread across the 12 provinces of the Netherlands were contacted by phone or through e-mail and were informed about the aim of the study. Regional differences in healthcare organizations can be quite sizable, hence the researchers’ intent to gain participation of one PCP per province. Organizations were requested to identify PCPs willing to participate. PCPs were provided with a fact sheet about the study and received an online registration form. A total of 28 PCPs registered. Purposive sampling was used to obtain a diverse sample reflecting a broad scope of experiences and views. In total, 12 physicians (one per province) were selected. As a sign of appreciation participants received a €40,- gift card.
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