In the current study, child healthcare workers were relatively young, with comparatively short work experience. Another feature of these healthcare workers was the relatively low level of education. None of the participants had more than a university level education (i.e., none of them possessed a master’s degree). Demographic variables indicated an obvious lack of child healthcare professionals among primary health organizations in China, which may be a challenge to the quality of child health care, especially facing the two-child policy in China (10-12).
Among the study cohorts, the scores reflect deficits in knowledge about childhood ASD. In comparison to participants working at community health service centers, participants at town health service centers lacked more knowledge of ASD in Chongqing. It is probable that the urban-rural gap in medical human resources influences the knowledge of children with ASD (19, 20). Childhood neurodevelopmental disorders are increasingly being recognized along with demands for earlier diagnosis and intervention. However, the total mean of 7.3 ± 2.19 out of 12 possible scores on the knowledge of childhood ASD questionnaire in the study group is low, and it reflects the deficits in knowledge, education and awareness about childhood autism among the primary child healthcare workers working at grassroots health service institutes in Chongqing, China.
Multivariate analysis also showed that there was a significant association between knowledge of childhood ASD and work experience with ASD/suspected ASD. Participants with experience scored higher regarding their knowledge of childhood ASD than those who did not, which was consistent with prior research (8). Presumably, such experience could increase the understanding of children with ASD in general. It was found that about thirty percent had work experience with ASD/suspected ASD among all the child healthcare workers in this study. Lack of such experience may indicate a lack of knowledge of childhood ASD, which directly leads to signs and symptoms that may not be recognized in children with ASD, especially in children with early atypical main festations and signs. The other reason for lack of such experience maybe because parents with ASD children prefer to choose large hospitals (such as public children hospitals), rather than primary medical organizations (21, 22).
Higher education levels may have also contributed to the score during the current study. Within the current sample, education level did have a significant effect on knowledge of ASD: child healthcare workers with college instruction scored significantly higher on ASD knowledge tests than those with lower levels of academic instruction.
Furthermore, child healthcare workers’ knowledge of ASD was also affected by their area of specialty in this study. Participants with a clinical medicine specialty had significantly higher knowledge scores than those with a nursing specialty. Multivariate analysis also showed that there were significant associations between scores of knowledge of childhood ASD and specialty. Monday et al. reported that medical students had a statistically higher score of ASD knowledge than nursing students (15). The difference in knowledge found among the healthcare workers between doctors and nurses in our study is likely to be due to the discrepancies of schools curricula, as well as occupational history.
As previous research has shown (6, 8), there were no significant associations among childhood ASD knowledge, age and work duration for healthcare workers. Those who are older and probably with more years of experience may not necessarily score higher on the knowledge of childhood ASD questionnaire.
In this study, we found that 79% of child healthcare workers did not believe the prevalence of autism in China was approximately 1%. In their opinions, the prevalence of ASD in China was much lower than 1%, and none of them thought it was approximately 1%. Sun reported that available studies had methodological weaknesses, and therefore previous results about autism prevalence suffered from lack of comparability with studies from developed countries. One study showed autism prevalence was approximately 10.3/10000 based on eight epidemiological studies in the mainland of China (5). There has not been a multicenter study of prevalence on childhood ASD. Further studies about a relatively accurate prevalence of ASD are needed in China.
In the eyes of 38% of participants, traditional Chinese medical science should be chosen as a way of treatment, although 97% did not think traditional Chinese medicine was the most effective treatment for children with ASD. It is reported that ASD could be improved to a certain degree by Chinese acupuncture. Nevertheless, tolerability and safety of acupuncture was not the focus of any of the previous studies (13). While serious side effects are rare when acupuncture is performed by an experienced acupuncturist, potential serious side effects can occur. A multicenter controlled double-blinded study of acupuncture treatments in children with ASD is needed.
Overall, the current results indicated the lack of knowledge about childhood ASD among child healthcare workers in grassroots health care institutes in Chongqing, China. Furthermore, the demographic variables affecting knowledge of ASD were region, educational level, area of specialty and work experience of ASD/suspected ASD. Multicenter controlled double-blind studies on the prevalence of acupuncture treatments in children with ASD is needed. It is encouraging that the government has been paying a large degree of attention to child healthcare and primary medical services in China, which may benefit the early development of children and to children with ASD.
4.1. Limitations of the Study
The current study has its limitations. The sample size of this study was not large. A larger sample size may have provided more insight into the reliability of the translated measure. Additionally, relying completely on the knowledge of a childhood ASD questionnaire to assess child healthcare workers’ knowledge of ASD may have limited the results. Another instrument may have created different results or may have provided additional information on the knowledge of ASD among healthcare workers. However, no other instruments have been recommended for use in China, and this instrument would be the most applicable for this context.
4.2. Conclusions
The scores reflect deficits in knowledge about childhood autism among the study cohorts. Primary child healthcare workers are expected to provide holistic care and appropriate counselling to the families of these children. Unfortunately, in this environment, there is not enough knowledge about childhood ASD. Further education on childhood autism is therefore needed, and can be provided through continuing medical education in professional training. This will enhance early identification and diagnosis of childhood autism with early intervention which is known to improve prognosis. Lastly, policies are needed to create more involvement of primary child healthcare professionals in these institutions and to provide children with ASD more help.
Some participants did not agree that the prevalence of ASD in China is approximately 1%, and they thought it was much lower than 1%. Further studies need to be administered on ASD in China, especially about the comparatively accurate prevalence and treatment using traditional Chinese medical science.
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