Background:

Despite American AAP guidelines recommending autism-specific pre-visit screening, a recent survey of pediatricians in Delaware and Maryland found only 8% screening for autism spectrum disorders. A web-based system (CHADIS) facilitates screening for autism by allowing parents to complete the screen online from home and provides results, decision support and documentation for QI to the pediatrician. This study explores the potential to offer CHADIS in the waiting room for those with limited access to the Internet or experience with technology.

Objective:

To compare alternative waiting room modalities: paper, laptop, touch screen tablet, and Interactive Voice Response (IVR) phone to determine relative efficiencies and preferences for completion of a standard autism screen (MCHAT) by parents in a sample of pediatric offices with diverse demographics.

Design/Methods:

162 parents of children age 16 to 38 months were recruited from the waiting room in 5 demographically dissimilar practices. The sample comprised 50% white; 41% African American; 9% other with 43% Medicaid. After being observed completing the full MCHAT using one randomly assigned modality (laptop, paper, kiosk, IVR) each parent completed a satisfaction survey. The parent then completed the first 4 items of the MCHAT again using each of the remaining 3 questionnaire-delivery modalities presented in random order and was surveyed about preferences.

Results:

Parents tended to be very satisfied with the modality presented to them initially, regardless of type. Few parents said that they would not complete the questionnaire before their visit in the future. Most parents preferred touch screen (35%), followed by paper (30.6%); keyboard (28%); and telephone (6.4%). Administration time for paper was significantly faster than the others; however, time requirements for office staff were greater for the paper modality. Compared to whites, African Americans were less likely to prefer paper in the waiting room, and Medicaid and Latino parents were more likely to list paper as their least preferred modality. There were no demographic differences in choosing either touch screen or computer. Medicaid participants were more likely to prefer screening in the waiting room rather than before the visit.

Conclusions:

Technological alternatives for pre-visit screening are acceptable and even preferred by parents across the racial and income spectrum.