Knowledge, Attitudes, Practices, and Factors Associated with Care of Children with Autism Spectrum Disorders at a Tertiary Hospital in Kenya: A Mixed-Methods Study

Abstract Background Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition whose outcomes are improved by timely recognition, family support, and coordinated multidisciplinary care. Healthcare providers are often the first professional contact for caregivers concerned about developmental differences, yet limited knowledge, uncertain attitudes, and inconsistent practices can delay diagnosis and intervention. This study assessed knowledge, attitudes, practices, and factors influencing ASD care among healthcare providers in paediatric services at Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Methodology : We adopted a sequential explanatory mixed-methods design. Quantitatively, a descriptive cross-sectional study of eligible healthcare providers involved in the care of children aged under fourteen years was conducted. A self-administered questionnaire captured sociodemographic characteristics, ASD awareness, knowledge, attitudes, and practice responses. Knowledge was summarized as percentage scores and categorized using Bloom’s cut-off criteria. Qualitatively, focus group discussions and key informant interviews were conducted to better understand the quantitative findings. Quantitative data were analysed using R version 4.2.1, and qualitative data were analysed thematically using NVivo. Results Among 116 healthcare providers, 82 (70.7%) were female and the overall mean age was 38 years (± 6.6). All respondents had heard of autism, but only 25 (21.5%) had additional ASD training. Knowledge was good in 5 (4.3%), moderate in 73 (62.9%), and poor in 38 (32.8%) participants. The overall mean attitude score was 3.5, indicating a generally positive attitude, although negative attitudes persisted around early diagnosis and parents’ ability to recognize symptoms. Fifty-five (47.4%) had participated in ASD care, but only 11 (20.0%) of these had used screening or diagnostic tools. Most referred children elsewhere for management, and referral challenges included lack of finances, lack of referral protocols, and caregiver unwillingness. Qualitative findings showed that knowledge gaps stemmed from inadequate pre-service and continuing education, limited training in diagnostic tools, absence of care protocols, weak multidisciplinary coordination, and poor links to community and educational support services. Conclusions Healthcare providers at MTRH demonstrated moderate ASD knowledge, generally positive attitudes, and variable practice. Strengthening undergraduate and in-service ASD training, introducing screening and referral protocols, and improving multidisciplinary and community-linked care pathways may improve early recognition and management of children with ASD.