Feasibility of the Autism Navigator® Training in South Africa

Background:  Across the globe autism spectrum disorder (ASD) is generally diagnosed long after parents first express concern about their child’s development, and long after the age at which red flags can now reliably be identified. To help address this knowledge-practice gap, researchers at Florida State University developed the Autism Navigator® for Primary Care, a web-based professional development course with extensive video illustrations of over 2-dozen toddlers 18-24 months of age with ASD and families participating in early screening, diagnosis, and intervention. There are immense training needs in South Africa with respect to all aspects of ASD, including early detection. Time and cost-effective evidence-based training is essential to lower the age of detection of ASD and improve access to services.

Objectives:  This study examined the feasibility of using the Autism Navigator for Primary Care® course in the Western Cape of South Africa. Professionals who may be the first person a family consults with concerns about their child’s development were recruited from a range of sectors including public and private health, public education, autism-specific NGOs, undergraduates, and postgraduate medical students.

Methods:  Participants were asked to complete Units 1-3 of the course as these were considered to be the most universally applicable in content. Changes in knowledge as well as satisfaction with the content and technology of the training in the South African context were examined using a mixed methods approach. Quantitative data included a researcher-constructed 18-item knowledge scale completed before and after the training and a survey of training variables. The impact of demographic characteristics on these measures was also examined. Qualitative data were collected to determine participants’ views on the relevance and feasibility of the training.

Results: Seventy-nine participants gave consent for the training and 61 (77%) completed Units 1-3. Of the completers, 50 (82%) returned the post-training forms. Second language English speakers spent significantly longer completing the built-in learner assessments for all three content units. Lower self-ratings of computer proficiency were also associated with longer time spent in Unit 3. Initial scores on the knowledge instrument were significantly related to level of experience with ASD. The group demonstrated significant improvements in knowledge on this instrument from before to after the training, with smaller changes associated with more experience. Thirty-eight participants took part in group or individual feedback interviews. Comments regarding relevance of the training in their local contexts were very positive. Suggestions for local translations and adaptations were also made. The most commonly mentioned benefit of the training was the extensive library of videos to illustrate red flags. Barriers to the feasibility included length of the training, and technology access barriers.

Conclusions:  Results indicate the feasibility of this web-based training in a low-resource setting and suggest that the Autism Navigator for Primary Care® may have valuable potential to improve knowledge of the early flags of ASD in South Africa. Findings highlight the need to consider language and technology demands of the web-based training and knowledge measurement across professionals with differing experience.