Factors Influencing Healthcare Satisfaction in Adults with Autism Spectrum Disorder
Objectives: The current study examined healthcare satisfaction and factors contributing to satisfaction in adults with ASD.
Methods: The sample consisted of 92 adults with ASD, ranging in age from 18 to 64 years (M=31.1 years, SD=12.6). Participants were divided into young adults (< 26 years of age; 46%), and adults (≥ 26 years of age). This cut point was selected because in the US a number of significant health care transitions take place by age 26. 76 participants completed an Autism Diagnostic Observation Schedule, second edition (ADOS-2). All participants, recruited from community service agencies and clinicians, entered the study with a diagnosis of ASD and/or met criteria for ASD on the ADOS-2. 62 participants had a parent or guardian available to complete a Vineland-II questionnaire. Participants or their caregiver completed a survey about their experiences with their primary care physician, dentist, vision care practitioner, and mental health clinician. Each practitioner was rated on a 1-5 scale (1=extremely dissatisfied, 5=extremely satisfied). A total healthcare satisfaction score was computed by averaging the four satisfaction subscales. All participants completed this questionnaire.
Results: In contrast to previous reports, study participants were highly satisfied with their healthcare (M=4.39, SD=0.88). The mean adaptive skills score of study participants (M=52.3, SD=19.7) was two standard deviations below average, indicating significant impairment. The majority of participants in the study were living in their family home (68%). 97% of the sample had public and/or private health insurance. While 60% were their own guardians, only 30% completed the satisfaction questionnaire on their own, and only 29% were involved in their own healthcare decisions. A series of correlation analyses revealed age to be the only significant predictor of satisfaction, r(90) = .24, p < .05. Specifically, participants below 26 (M = 4.62) were more satisfied with their healthcare than participants 26 and older (M = 4.19). Further analysis demonstrated that participants under 26 were significantly more likely to live at home, χ² (1) = 31.24, p < .001, have private health insurance, χ² (1) = 18.03, p < .001, have someone else complete the questionnaire, χ² (1) = 11.34, p < .01, and have others make their healthcare decisions, χ² (1) = 10.62, p < .01, than participants 26 and above. Additionally, participants below 26 (M = 67.76, SE = 3.64) had significantly greater communication skills than participants 26 and older (M = 47.21, SE = 4.78), t(57.72) = 2.59, p < .05.
Conclusions: Healthcare satisfaction, in a significantly impaired adult ASD population, can be high in a community that emphasizes family care, adequate health insurance and supportive services. Future studies need to define the context as well as correlated factors associated with satisfaction.