Mental Health Professionals’ Attitudes towards Evidence-Based Practice and usage of Evidence-Based Practices for Children with Autism Spectrum Disorder in Bangladesh and Germany
by Mst. Maleka Pervin
Date of Examination:2022-12-06
Date of issue:2023-02-24
Advisor:Prof. Dr. York Hagmayer
Referee:Prof. Dr. York Hagmayer
Referee:Prof. Dr. Timo Brockmeyer
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Name:PhD Thesis_Mst. Maleka Pervin_21804666.pdf
EnglishAutism spectrum disorder (ASD) is recognized as the leading mental health-related cause of the global burden of disease with lifelong effects on affected children and adolescents (Baxter et al., 2015; Li et al., 2022; Lord et al., 2020). Although a lot of research has been conducted on ASD and available treatments, almost everything we know about effective interventions comes from rich, mostly Western high-income countries (HIC; National Autism Center, 2015; National Research Council, 2001; Odom et al., 2010, 2012; Wong et al., 2014, 2015) with elaborate and highly specialized health care systems. Very little is known about ASD and its treatment in low and lower-middle-income countries (LMIC), which often have developing healthcare systems and provide little or even no services to children and adolescents with developmental disorders. To improve treatment and care in HIC, professional mental health care organizations have moved toward a widespread use of evidence-based practices (EBPs) that have their roots in different theoretical viewpoints and have clear evidence of efficacy. The situation in LMIC is rather different due to financial constraints, which limits the services and the level of care that can be provided, lower levels of education, which entails that even professional may not be trained in a broad spectrum of EBPs, and cultural differences, which may make the adoption of some practices more difficult. Moreover, cultural misperceptions and social practices may impede the implementation of EBPs. For this dissertation, I first researched what is known about EBPs in LMIC and whether treatments, for which evidence from HIC exists are also effective and can be considered evidence-based in LMIC. Then I selected two countries, Germany as a HIC and Bangladesh as a LMIC, to investigate differences in attitudes towards evidence-based practice, the variety of EBPs used, and how these relate to socio-demographic factors. The dissertation consists of three manuscripts based on three projects. The first two manuscripts have been published in 2022, the third is under revision. Each research paper investigates a different and specific set of research questions. The aim of the first project of this dissertation was to find out whether there are differences in the effectiveness of interventions in HIC vs. LMIC and which types of treatments can be considered evidence-based in LMIC. To find out, I conducted a meta- review analyzing systematic reviews on the effectiveness of treatments and interventions for target outcomes in children and adolescents with ASD, which consider research studies from HIC and LMIC. In addition, individual research papers from LMIC were reviewed to find out whether they provide enough evidence to consider at least some of the studied interventions evidence-based. The aim of the second project was to examine mental health professionals’ and special teachers’ attitudes towards evidence-based practice (EBP) and their usage of EBPs for children and adolescents with ASD and to explore how providers’ demographic factors are related to the attitudes and the adoption of EBPs in Bangladesh. To this aim, I conducted a cross-sectional study to examine the attitudes of professionals that work with towards EBP for children and adolescents with ASD and explored providers’ demographic factors related to attitudes to and adoption of EBPs in Bangladesh. The aim of the third project was to directly investigate potential differences in attitudes towards EBP, the usage of different EBPs, and their relation to sociodemographic variables in Bangladesh and Germany. To the best of my knowledge, this is the first time such a comparative study has been conducted. To allow for a meaningful comparison of findings on attitudes from the two countries, it is important to establish measurement invariance of the instrument used to assess attitudes. In addition, the study focused on professionals that work in a clinical setting with children and adolescents with ASD to ensure that all were supposed to provide treatment and care. The dissertation consists of five chapters. Chapter 1 is a general introduction and gives some background information on ASD and its epidemiology in selected HIC and LMIC. The healthcare systems of Bangladesh and Germany are described as well as the organizations that provide services for children and adolescents with ASD. The terms “Evidence-based practice (EBP)” and “Evidence-based practices (EBPs)” are defined. Then, attitudes towards EBP and EBPs as well as what are the barriers and facilitators to the implementation and usage of EBP and EBPs are described. Respective theoretical models are presented. Next, goals, research questions, and basic structure of this dissertation are presented in this chapter. Finally, short summary of the three studies of this dissertation are presented. Chapter 2 presents Paper 1— Pervin, M., Ahmed, H. U., & Hagmayer, Y. (2022). Effectiveness of interventions for children and adolescents with autism spectrum disorder in high-income vs. lower-middle-income countries: An overview of systematic reviews and research papers from LMIC. Frontiers in Psychiatry, 13. Chapter 3 consists of Paper 2— Pervin, M., & Hagmayer, Y. (2022). Attitudes towards evidence-based practice of professionals working with children and adolescents with autism spectrum disorder in Bangladesh. Administration and Policy in Mental Health and Mental Health Services Research, 49(5), 861-880. Chapter 4 is Manuscript 3— Pervin, M., Hansmann, N. M., & Hagmayer, Y. (submitted). Attitudes towards evidence-based practice and usage of evidence-based practices for children and adolescents with autism spectrum disorder: A comparison of mental health professionals in Bangladesh and Germany. Journal of Autism and Developmental Disorders. Chapter 5 is the general discussion. It begins with a section summarizing and discussing findings from three papers. Part one discusses the evidence-based practices in HIC and LMIC (Paper 1), professional attitudes towards EBP and the usage of EBPs for children with ASD in Bangladesh (Paper 2), and differences in professionals’ attitudes toward EBP, EBPs used and their relationship between Germany and Bangladesh (Manuscript 3). After that, the strengths and limitations of this dissertation are discussed. The implications are presented in light of the overall findings and the chapter ends with recommendations for future research. Finally, the concluding remarks wrap up the entire purpose of this dissertation. Appendices and general references are included in this dissertation.
Keywords: Mental Health Professionals. Attitudes. Evidence-based practice. Evidence-based practices. Autism spectrum disorder. High-income countries. Lower middle-income countries.