34 Chapter 2 Data analysis Data analysis was concurrent with data collection. Audio recordings were transcribed verbatim, de-identified and entered into Atlas Ti Qualitative Analysis Software (Scientific Software 2009) by a master student experienced in transcribing audio recordings. Transcripts were not returned to participants for corrections. Transcripts were coded and analyzed using grounded theory and included a systematic set of phases of open coding, axial coding and selective coding respectively (Corbin & Strauss, 2008; Glaser & Strauss, 2017). Participant’s quotes were hereby the starting point in constructing themes and categories, meaning a bottom-up approach. In the open coding phase, transcripts were analyzed by identifying and categorizing common segments found in the data. These segments were labeled and compared continuously to each other. During the process of axial coding, the data segments were reassembled into categories. During the last phase of selective coding, categories were compared to each other and then the themes were constructed. MS and SK coded the majority of interviews together. SK is a researcher experienced in qualitative research and methodology. Through discussion and agreement over discrepancies, consensus was reached. Results Current state of adherence to the Dutch guideline All participants were asked if their healthcare organizations fully applied the national ASD guideline. Guideline adherence means: 1) using the Van Wiechen Scheme for general surveillance, and 2) using the CoSoS (ESAT) as a specific screener when red flags for ASD were found. In total, all PCPs mentioned that they use the Van Wiechen Scheme for general health surveillance. However, the vast majority of PCPs stated that, in case of suspicion, they do not follow up with the CoSoS as a specific screen for ASD. This practice is not in accordance with the guideline and perceived as a barrier in early detection of ASD. Barriers in early detection of ASD and adherence to the Dutch ASD guideline. Six overall barriers in early detection of infants and toddlers with (symptoms of) ASD faced by PCPs were extracted from the data. These themes can be summarized by knowledge, professional attitude, discussing initial worries with parents, screening instruments, cultural and language differences and availability of healthcare services. A description of each theme is given below. Representative quotes are presented in Table 1.
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