55 Parental experiences with early identification and care 3 an additional, exploratory focus group (N=10) to gain more in-depth insight into shared impressions of our target group (Rubin & Rubin, 1995). Ethical approval was obtained from local institutional review boards (CMO Radboud University Medical Centre and Karakter Child and Adolescent Psychiatry University Centre and Leo Kannerhuis). For the qualitative part of the study, the authors followed the Consolidated Criteria for Reporting Qualitative Research (COREQ; Tong, Sainsbury, & Craig, 2007) (see Supplementary Table 1). Inclusion, recruitment and procedures Online survey An estimated 300 parents of children diagnosed with ASD at age six or younger diagnosed (between 2016 and 2018) were approached and invited to participate in reflecting back on their experiences pre-diagnosis through an online survey. The only exclusion criterion was insufficient mastery of the Dutch language to complete an online survey. Recruitment efforts occurred via a national expert network of clinicians and researchers involved in early autism. Experts from leading mental healthcare organizations across the Netherlands, who are participating in this network, were encouraged to approach parents from their caseloads. Eventually, a total of six mental healthcare organizations spread across the country (central, northern and eastern region of the Netherlands) recruited potential participants. The potential participants received an e-mail invitation via the organization they were linked to (the research team had no direct access to most of the potential participants) containing full information on the nature of the study and including a link to the online survey. The online survey could only be completed when parents had given informed consent. The survey was fully anonymous with no personal identifying information. Because of this, non-responders could not be identified and no reminders could be sent by the research team, causing a low response rate (estimated <15%). In order to gain more in-depth insight in the experiences of parents with the process of early identification, the second step was hosting a focus group. Focus group Parents of children diagnosed with ASD at six years or younger were asked to participate. Again, the only exclusion criterion was insufficient mastery of the Dutch language to participate in a group discussion. Recruitment efforts occurred through contacting healthcare professionals at two specialized mental healthcare centers in the eastern region of the Netherlands. These healthcare professionals were encouraged to approach suitable parents from their caseloads. Furthermore, recruitment efforts consisted of posting flyers in the offices of general practitioners and in well-baby clinics and by posting flyers on social media. Ten parents who were interested to participate in a focus group discussion contacted the research team by e-mail. Then, after receiving full information of the study by phone and signing the informed consent form, all parents were invited to participate in the focus group discussion. Recruitment stopped after the maximum number of participants (N=10)
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