“Know Your Children, Who They Are, Their Weakness, and Their Strongest Point”: A Qualitative Study on Diné Parent Experiences Accessing Autism Services for Their Children

Background and Objective: Marked inequities in access to autism services and related health outcomes persist for U.S. children, undermining broader initiatives to advance the population&rsquo:s health. At the intersection of culture, poverty, and ruralness little remains known about autism in many Indigenous communities. This qualitative study on the lived experiences of Navajo (Din&eacute:) parents raising a child with autism sought to identify factors affecting access to services. Methods: A Din&eacute: researcher conducted in-depth interviews with 15 Din&eacute: parents of children with autism living in or around the Navajo Nation. A directed content analysis approach was used to identify themes, subthemes, and connections between themes. Results: Twelve overarching themes emerged on Din&eacute: parents&rsquo: experiences accessing autism diagnostic and treatment services, as well as ways access to autism services can be improved. The following themes were related to diagnosis: the diagnostic process was often emotionally fraught: long wait times of up to years for diagnostic services were commonplace: limited clinician training and cultural humility impeded access to diagnostic services: and adequate health insurance, Indian Health Service referrals, care coordination, financial aid for travel, and efficient evaluation facilitated diagnosis. Themes on treatment access were as follows: parent perceptions of the extent to which an autism service helped their child affected access: social support helped parents to access treatment: obtaining referrals and care coordination influenced treatment access: treatment costs affected access: and service availability and geographic proximity impacted treatment access. Themes on ways to improve access to autism services were as follows: greater autism awareness is needed: autism-focused support groups may be helpful: and increased availability and quality of autism services across and around the Navajo Nation is paramount. Conclusions: Din&eacute: parents&rsquo: access to autism services was dynamically affected by sociocultural factors that must be addressed in future health equity-oriented initiatives.