A Systematic Review of What Barriers and Facilitators Prevent and Enable Physical Healthcare Services Access for Autistic Adults.
David Mason, Barry Ingham, Anna Urbanowicz and 8 others
PMID 31124030WHAT IT FOUND
Autistic adults reported healthcare barriers including communication, sensory overload, appointments, and provider assumptions.
Accommodations such as written notes, quiet waiting, and individual plans were suggested; this review does not prove any single approach works.
Key findings
01Communication, sensory sensitivities, and provider-level barriers such as knowledge, assumptions, and willingness to accommodate were reported across included studies.
02In one longitudinal included study, 65.8% reported not knowing where to find help, 52.6% reported overwhelming steps to seek help, and 47.4% reported negative experiences with professionals; over 75% endorsed three or more barriers.
03One single-arm toolkit evaluation reported self-reported barriers fell from mean 4.1 to 2.8, and satisfaction with patient-provider communication rose from 30.9 to 32.6.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
Only six studies met the inclusion criteria, so the barriers and facilitators are not definitive. Sample sizes ranged from 10 to 209, and one included study did not report sample size. Two included studies used self-reported autism diagnosis, and one study did not provide participant information. Quantitative measures were heterogeneous, and some were not validated for autistic adults. The review excluded studies that did not report autistic participants separately, so autistic people with intellectual disability were not covered. The toolkit evaluation was single-arm pre/post, so it cannot separate the toolkit effect from time or other factors. There is no agreed taxonomy for grouping barriers, so studies labelled and organised barriers differently.
The easy way to misread this
Do not read the toolkit results as proof that the toolkit improves health or works in all clinics. It was a single-arm pre/post evaluation, and the review says the barriers and facilitators are not definitive.