Facilitators, barriers, and strategies in implementing early intervention for children with autism spectrum disorder aged 0–6 years: A multicenter qualitative study using the consolidated framework for implementation research

Autism spectrum disorder poses a growing global health challenge due to rising prevalence and significant disability burdens. Early intervention during the 0- to 6-year developmental window is critical to reduce individual, familial, and societal impacts. However, implementation gaps persist in China, particularly in resource-limited settings, where context-specific barriers and facilitators remain understudied. This multicenter qualitative study (July 12 to October 28, 2024.) across 11 cities in Hainan Province involved 47 stakeholders (4 policymakers, 13 managers, 13 practitioners, and 17 family caregivers of children with autism spectrum disorder aged 0–6 years). Semi-structured interviews guided by the Consolidated Framework for Implementation Research were complemented by document review and field observations, with data analyzed via template analysis. Key facilitators included government funding, stratified training, caregivers’ positive attitudes, and clear implementation standards. Barriers mainly included low social acceptance, regional resource disparities, workforce shortages, caregiver challenges, and limited evidence-based practice adoption. Four key strategies were identified: strengthening external support, optimizing internal resources, empowering stakeholders, and refining implementation through technology and evidence-based practices. This first China-based study uses a stakeholder-driven approach to co-design contextualized strategies, offering a model for improving autism spectrum disorder care delivery in similar resource settings globally. Lay abstract This study explored how to improve early support services for young children aged 0 to 6 years with autism spectrum disorder in resource-limited areas. We interviewed 47 stakeholders, including policymakers, service managers, healthcare professionals, and parents of autistic children across 11 cities to identify factors that support or limit effective early support services. Key helpful factors were government funding, practical staff training, and parents’ proactive attitudes. Major challenges included low public understanding of autism, unequal resources between regions, too few trained professionals, and difficulties families face accessing care. To address these, we suggest four solutions: increasing funding and community awareness, sharing resources more fairly, training more staff and supporting parents, and using technology and proven therapies. As the first study in China to design solutions with families and professionals, these strategies could help similar communities globally deliver better early autism care.