45 Perspectives of preventive care physicians on early detection of autism spectrum disorder 2 between preventive healthcare and specialized mental healthcare, as the intervention is carried out by a preventive healthcare professional and supervised by an ASD expert. Through this collaboration, preventive care is able to offer a short and semi-specialized intervention for young children at risk of ASD, without the need of referral to the specialized mental healthcare and without the need of a diagnosis. Therefore, these kinds of close collaborations are hypothesized to improve the accessibility and availability of healthcare and improve early detection of ASD. Strengths and limitations To capture the full range of experiences of PCPs about early detection of ASD, one representative per geographical region of the Netherlands was included and extra interviews were conducted after data saturation was reached. Therefore, the study’s results may represent the views of a larger preventive care physicians’ community in the Netherlands. However, participants only shared own experiences and did not speak for their colleagues. PCPs volunteered to participate in this study, indicating their interest in screening for ASD. Thus, it is possible that there might have been a self-selection bias. Therefore, the results might not be representative for all PCPs. Next, this study was conducted in the healthcare system of The Netherlands and should therefore be viewed in this context. However, our results show a great overlap with results of similar studies in other countries, suggesting barriers regarding early detection of ASD to be shared, at least in western countries. Third, only physicians participated in the current study and no other preventive care professionals (i.e. nurses). To completely understand barriers and views about early detection of ASD in primary care, further studies could explore the experiences and perspectives of a wider range of primary care providers. Finally, a characteristic of qualitative research is that data analysis entails coding and categorization in themes, which involves interpretation of the researchers. To limit subjectivity, the analytic process was done by multiple researchers with different educational backgrounds and extensive discussions regarding coding and developing themes were held. Conclusion and clinical implications In conclusion, there is no full adherence to the Dutch guideline. Based on a qualitative approach, we provide a theory about guideline-related, external and personal constraints that limit PCPs’ use of the Dutch ASD guideline and what prevents them to discuss developmental concerns and the suspicion of ASD with parents. Targeting these barriers demands a national and integrative approach and requires a close collaboration between preventive healthcare workers and ASD experts. Innovative ideas (e.g. BEAR parent training) regarding this subject are momentarily being developed and thoroughly examined. Furthermore, it is vital that the importance and benefits of early detection of ASD is brought to the attention of policymakers, governments and municipalities. In order to improve early detection of ASD in preventive care and reach and preserve guideline adherence continuous investment in active screening and additional training in preventive care is demanded.
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