Development and Psychometric Testing of the Healthcare Provider Self-Efficacy Scale – Adult Autism

Background: A growing number of studies show that autistic adults experience significant healthcare disparities and that healthcare providers are ill-equipped to provide high-quality care to adult patients on the autism spectrum. Interventions to improve care must be informed by providers’ specific training needs which may be assessed using measures of providers’ self-efficacy. However, there are no existing validated instruments to assess provider self-efficacy in caring for adult patients on the spectrum.

Objectives: Develop and psychometrically test the Provider Self-Efficacy Scale - Adult Autism, a measure of providers’ self-efficacy in providing healthcare to autistic adults.

Methods: We used a community-based participatory approach throughout the project, in partnership with academic researchers, autistic adults, supporters, and healthcare providers. We used our prior qualitative research and our team’s expertise to create a 1-page questionnaire for primary care providers. The new self-efficacy scale includes 6 items prompting providers to rate their confidence in several aspects of providing care to adult patients on the autism spectrum. Response options use a 5-point Likert scale (1=not at all confident to 5=very confident). The 6 items were dichotomized at 4-5=high confidence and totaled (range 6-30). The survey also includes 2 items on how challenging or rewarding providers felt it was to provide high-quality care to adults on the autism spectrum (0=not at all to 10=extremely) and 7 items on demographic characteristics, training, and experience. We surveyed 143 primary care providers from 8 primary care clinics in Oregon and California, USA. Approximately half practiced internal medicine and half practiced family medicine. We assessed the self-efficacy scale’s internal consistency reliability using Cronbach’s alpha and convergent validity using pair-wise correlations and t-tests.

Results: The Provider Self-Efficacy Scale-Adult Autism had good internal consistency reliability with an alpha of 0.87. It showed strong convergent validity, as follows: Participants who had provided care to 6 or more autistic adults had higher self-efficacy scores than those with less experience (mean 19.8 vs 17.6, p=0.006). Self-efficacy was positively correlated with providers’ ratings of how rewarding it is and negatively correlated with ratings of how challenging it is to provide care to adults on the spectrum (r=0.24, p=0.005; r=-0.5, p<0.0001, respectively). A minority of providers reported high confidence in: communicating with patients (25%); performing physical exams or procedures (43%); accurately diagnosing and treating other medical issues (40%); helping patients stay calm and comfortable during visits (38%); identifying accommodation needs (14%); and making necessary accommodations (16%). There was no difference in self-efficacy score by provider gender, degree (MD/DO vs NP/PA), specialty, or training status. There was a slight positive association between self-efficacy score and provider age (r=0.17, p=0.04).

Conclusions: The Provider Self-Efficacy Scale-Adult Autism demonstrated strong internal consistency reliability and convergent validity. Providers showed low confidence in all aspects of providing care to autistic adults. Training needs may be highest in the areas of communicating with patients and identifying and making necessary accommodations. Future research is needed to validate this scale further and to understand how to meet providers’ training needs most effectively.