Disparities in the quality of and access to services in\xa0children with autism spectrum disorders: a structural equation modeling

Mohammad Asghari Jafarabadi,Akbar Ghiasi,Hamid Pourasghari,Kamal Gholipour,Ayyoub Malek,Shabnam Iezadi,Hassan Shahrokhi

doi:10.1186/s13690-021-00577-5

Abstract

BackgroundSocioeconomic disparities in health and healthcare are global issues that affect both adults as well as children. Children with exceptional healthcare needs, especially those with developmental impairments, including Autism Spectrum Disorders (ASD), encounter major disparities in access to and quality of health services. However, disparities in the population of children are rarely studied. The main aim of this paper is to study the socioeconomic disparities in children with ASD by examining the association between their Social Determinants of Health (SDH) status and access to and the quality of services.MethodsThis is a cross-sectional study on 202 children with ASD conducted in 2019 in two provinces including Ardabil and East-Azerbaijan, in the North-West of Iran. A structured, valid questionnaire was used to collect data on demographic, SDH status, quality of services, and access to services in a population of children with ASD aged 2–16-year-old. Around 77% participants were male and the mean age of children was 2 years and 6 months. Structural Equation Modeling (SEM) were used to assess the relationship.ResultsBased on the results of this study, the overall mean scores of the quality of services, access to services, and SDH status were 61.23 (30.01), 65.91 (21.89), and 29.50 (22.32) out of 100, respectively. All the associations between the quality and access dimensions and quality (B: 0.464–0.704) and access (B: 0.265–0.726) scales were statistically significant (P < 0.001). By adjusting to covariates, the access was also significantly related to service quality (P = 0.004). Finally, the associations between SDH score with service quality (P = 0.039) and access (P < 0.001) were positively significant.ConclusionsThere are socioeconomic disparities in the quality of and access to services among children with ASD, who use ASD services, in the North-West of Iran. We recommend health/medical centers, where children are diagnosed with ASD, conducting SDH screening and providing families of low-SDH status with specific information about the quality of and access to services for children with ASD. Additionally, medical universities must have a plan to routinely monitor the quality of and access to services provided for the children with low SDH.

Highlights

Socioeconomic disparities in health and healthcare are global issues that affect both adults as well as children
According to evidence provided by the World Health Organization (WHO), individuals with Autism Spectrum Disorders (ASD) have higher rates of forgone health-care needs compared to the rest of the population, and their access to services and supports is inadequate [3]
There is no evidence to conclude that autism occurrence depends on the families’ characteristics, such as ethnicity, income, lifestyle, and education [4], some studies on the association among sociodemographic characteristics, diagnosis, and health care services for children with ASD have revealed socioeconomic and racial/ethnic disparities [5,6,7]

Summary

Introduction

Socioeconomic disparities in health and healthcare are global issues that affect both adults as well as children. Children with exceptional healthcare needs, especially those with developmental impairments, including Autism Spectrum Disorders (ASD), encounter major disparities in access to and quality of health services. The main aim of this paper is to study the socioeconomic disparities in children with ASD by examining the association between their Social Determinants of Health (SDH) status and access to and the quality of services. There is no evidence to conclude that autism occurrence depends on the families’ characteristics, such as ethnicity, income, lifestyle, and education [4], some studies on the association among sociodemographic characteristics, diagnosis, and health care services for children with ASD have revealed socioeconomic and racial/ethnic disparities [5,6,7]. Access to evidence-based, high-quality services for children with ASD is a major public health issue [8]. Lack of access to services and supports is an important issue for people with autism, but in low- and middle-income countries (LMICs) there is a lack of data on this problem [16]

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