33 Perspectives of preventive care physicians on early detection of autism spectrum disorder 2 Development of measure The topic list was developed in two phases. During the first phase, (unpublished) data from another study were used. This is a study on the effect of a Live Online educational program (van ‘t Hof et al., 2020) where PCPs in a specific area were asked to prepare three complex case studies related to early detection of ASD and difficulties with referral. In order to develop the topic list, case studies were analyzed using grounded theory (Glaser & Strauss, 2017). Six global pre-selected themes related to difficulties in early detection of ASD were constructed during analyses: (1) screening and detection of ASD symptoms, (2) therapeutic alliance, (3) cultural background (4) multidisciplinary teamwork and referral, (5) stigma and parental acceptance, and (6) knowledge of red flag symptoms and diagnostics. Pre-selected themes were critically evaluated by the authors. Based on clinical experiences, two extra probe questions about peer feedback and knowledge about available healthcare services were added. These pre-selected themes were only used as a guide during interviews. During the second phase of developing the topic list, a concept was pilot tested during two interviews with physicians. No changes were made after pilot testing. The full topic list is available from the corresponding author. Interviews and participants In total, 12 PCPs working at well-baby clinics from 12 different provinces of the Netherlands were interviewed. All were native Dutch individuals. The majority (all but one) of the participants were female with an average of 9.04 years of work experience (ranged 0.5 – 30 years). Two physicians had only obtained their medical degree and had yet to specialize in child development, but the majority of participants was fully trained. Most interviews (10) were held through phone and video calls. Two interviews were held face-to-face in the researcher’s workplace, where there was no one else present besides the participant and researcher. Interviews were conducted by MS, a female PhD candidate with a background in behavioral psychology, who received training on qualitative research and interviewing. Prior to the interviews, the reasons for the interview were explained to all participants. Interviews took 40-60 min and were audio-recorded upon receiving verbal consent, to ensure accuracy in data capture. Each interview started with an open question to begin the conversation. Then the question ‘could you please tell me how early detection of ASD is handled within your work?’ followed. The conversation flowing from this question checked all global themes included in the topic list. When themes did not flow from the conversation, probe questions were asked. Data saturation was reached after 9 interviews. However, the authors chose to complete interviews with all 12 participants, due to possible regional differences. No repeat interviews were carried out and no field notes were made. Data collection took place between June 2019 and September 2019.
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