Primary care providers’ beliefs, intentions, behaviors, and capabilities: Implications for workforce readiness in pediatric autism care

BACKGROUND: Workforce shortages, training gaps, and role ambiguity among primary care providers (PCPs) contribute to delays in pediatric autism identification and management. PURPOSE: This study's aim is to examine PCPs' beliefs, intentions, behaviors, and capabilities related to pediatric autism care and identify factors associated with workforce readiness. METHODOLOGY: Guided by the Reasoned Action Approach, this cross-sectional survey included 107 PCPs nationwide. The questionnaire assessed Beliefs, Intentions, Behaviors, and Capabilities. Multivariate analyses tested differences by provider type, years in practice, and practice setting, with follow-up analysis of variance used to identify contributing items. Linear discriminant analysis and path modeling examined interdomain relationships. RESULTS: Provider type was the most consistent predictor of differences across domains. Significant multivariate effects were observed for Beliefs and Capabilities, whereas fewer differences emerged for Intentions and Behaviors. Nurse practitioners demonstrated greater alignment across domains compared with physicians and physician assistants but reported lower diagnostic confidence. Practice setting influenced referral behaviors, with rural providers reporting greater reliance on specialists. Path analysis indicated that Capabilities mediated the relationship between Beliefs and both Intentions and Behaviors. CONCLUSIONS: Primary care providers readiness for autism care varied primarily by provider type, with additional influence from practice setting and limited effects of years in practice. Although nurse practitioners demonstrated a consistent readiness profile, gaps in diagnostic confidence may constrain independent management. IMPLICATIONS: Targeted training, decision-support tools, and tiered diagnostic models may strengthen PCP capacity and support earlier autism identification and management in primary care.