Provider Perspective on Benefits and Challenges of Mhealth Autism Screeners in Underserved Families

Purpose/Objectives: To understand factors affecting equity in use of mHealth autism screening tools from the perspective of primary care providers (PCPs) and Early Intervention/Early Childhood Special Education providers (EIPs).

Design/Methods: We conducted qualitative interviews about mHealth autism screening tools, with 9 PCPs and 9 EIPs in 6 states. Interviews were conducted by a PCP or Speech Language Pathologist. The interview guide was reviewed by parents and 2 PCPs for content validity. Providers were given 3 hypothetical scenarios, in which a parent presents to care with test results they drew from autism screeners. In each scenarios the provider was presented with one of 10 online or app based screening tool screeners identified through a comprehensive search by the study team. They were to discuss their clinical approach and critically review the tool’s ability to meet family needs. Each transcript was audio-recorded, transcribed, and coded by team members using QSR nVivo 12; coding differences were resolved through mutual discussion. A phenomenological approach was used to develop key themes and recommendations.

Results: PCPs and EIPs identified 4 themes and 17 subthemes describing mHealth benefits and challenges (Table). Clinical and business factors included integration with the EHR, role in clinical efficiency, and scope of practice. Validity and trustworthiness factors included face validity, tool recognition/familiarity, privacy and security concerns, and credibility/authority. Family interaction factors included tool starts a conversation about ASD, supports family advocacy, provides information, and resources, and affects family anxiety or provides/emotional support. Accessibility factors included time burden, English proficiency/language issues, cultural inclusivity, and literacy/educational level. Providers suggested modifications such as portraying diverse families, reducing the reading level of text and making tools shorter to better fit clinical context

Conclusion/Discussion: mHealth ASD screening tools have many benefits and challenges when reaching underrepresented families. Shedding light on these challenges can inform more equitable tool design.