Desarrollo del proceso histórico de la Educación Pública en el Uruguay

3.1. Introduction

The findings from the systematic review suggested that most of the non-English speaking countries investigated attempted to adapt screening instruments. Increasingly, the adaptation of screening instrumentation is becoming an acceptable and fast method by which to create a valid screening instrument. This is especially true for those with limited resources or expertise in this field. However, the results of the literature review (Chapter 2) revealed that the adaptation process in non-English speaking countries is not adequate, and that this requires future consideration if sufficient detail on the adaptation process is to be reported. This may involve using a framework to guide the process, acknowledging the investigator’s proficiency in the adapted culture or investigating the challenges to and facilitators of introducing screening instruments in the selected setting. This was suggested as a means of evaluating the effectiveness of the adaptation process, improving the rigorous nature of the adapted instrument, or facilitating a feasible and effective screening process.

From this perspective, it is clear that Oman needs to dedicate a great deal of attention to the adaptation and validation of culturally appropriate instruments. A recent study in Oman has developed and piloted a mobile application known as “Autism Fingerprint.” This application aims to help families screen their children for ASD, using a reliable, culturally appropriate and “easy-to-use” instrument (Klein et al., 2015). Autism fingerprints are based on an adapted version of the M-CHAT, and are supported with clarifying animations and comparative images, customised for the Omani culture, in order to reduce ambiguity and misunderstanding. This application demonstrated high sensitivity (0·89) and specificity (0·82), as well as strong test-retest reliability (correlation coefficient, r=0·86), suggesting that it may be a promising instrument for use in screening for ASD in the Arabic context. Another ongoing study is examining an adapted version of the M-CHAT-R/F in all Omani governorates. However, this area of research in Oman is very recent and any screening instrument will require time for validation in order to prove its rigorousness and adequacy among Omanis. In addition, the information provided by each of these studies was brief in terms of the effectiveness of the instrument. For example, the finger print publication did not detail information relating to the adaptation process, which would have enabled other researchers to examine the extent to which this instrument followed cultural adaptation strategies. The hope is that future publications consider detailing this information to enable the enrichment of knowledge in this area.

By continuing to test, develop, and adapt screening instruments, it is hoped that an adequate screening instrument will be available in the near future. However, little is known about screening settings, and whether a screening programme for ASD can be achieved across countries. The findings from Chapter 2 highlighted the fact that health care settings are distinctly varied between countries, in terms of their services, infrastructure and resources. Therefore, exploring the potential barriers to and facilitators of screening for ASD is an important first step in producing a smooth, successful, and culturally acceptable screening procedure. However, there is no survey questionnaire available in the literature to address this. Furthermore, no previous studies have been undertaken to examine the readiness or capacity for screening children for ASD within the Omani PHC setting, and the effectiveness of current surveillance and well check visits in identifying developmental abnormalities or ASD has not yet been examined. Most of the recognisable work in this area is of a quantitative nature, involving the development of structured questionnaires, generally by the researchers, and the testing of a limited number of participants from Muscat institutions. Thus, the underpinning perspectives in the area of ASD identification have yet to be explored.

This thesis therefore aims to qualitatively explore the views of Omani PHPs on potential facilitators of and barriers to screening for ASD, and to produce a questionnaire, examining this aspect from a wider perspective, in a following quantitative phase. This thesis also endeavours to propose pragmatic solutions to overcome constraints, strengthen facilitators and implement culturally acceptable screening processes. This may provide recommendations for the education and training of PHPs, in relation to assessing and screening children for ASD. In order to achieve these aims, the study has adopted an exploratory mixed-method design that includes two studies: a qualitative study and a quantitative study. Both are detailed in this thesis.

3.2. Research questions

1. What aspects do PHPs perceive as opportunities for facilitating screening for ASD within the PHC settings in Oman?

2. What do PHPs’ perceive as the barriers to screening for ASD within the PHC settings in Oman?

questionnaire identifying the potential barriers to and facilitators of screening children for ASD in Oman?

4. What characteristics (age, gender, experience, position, nationality, level of education and workload) are perceived by PHPs as being barriers to and facilitators of screening for ASD in Oman?

5. Can the views of the PHPs on barriers and facilitators be generalised across Oman?

3.3. Organisation of the study

To meet the aims and answer the research questions, the researcher has organised this thesis into eight chapters. The first two chapters (i.e. 1, introduction and 2, systematic review) introduce the main ideas of the research and identify any gaps in the literature. The third chapter discusses the aims of the study and the research questions to be addressed, based on information from previous chapters. The fourth chapter describes the method underpinning the study. Chapter 5 outlines the processes undertaken, as part of the qualitative study, and the outcomes achieved. Chapter 6 discusses the development of the questionnaire. Chapter 7 analyses the quantitative study process and results, while Chapter 8 highlights the studies undertaken and provides conclusions.

3.4. Chapter summary

This chapter introduced the reader to the main aims of the project and outlined the reasons for selecting the project topic. It also highlighted the research questions to be answered as well as the studies undertaken to meet these aims. Finally, this chapter described the structure of the thesis.