Understanding the Determinants of Use of the Australian Guide to Diagnosis of Fetal Alcohol Spectrum Disorder: Informing the Review, Development and Dissemination of New National Clinical Practice Guidelines.

Abstract

Introduction: The Australian Guide to the Diagnosis of fetal alcohol spectrum disorder (FASD), developed in 2016, is currently under review. This study aimed to understand how the Guide is used in practice and identify factors influencing its implementation.

Methods: A cross-sectional online survey was conducted with Australian health practitioners involved in the assessment and diagnosis of FASD. The Clinician Guideline Determinants Questionnaire was used. Quantitative data were summarised descriptively and content analysis was applied to open-ended questions.

Results: Of 333 survey sessions, 232 participants consented and 136 completed the survey. Most respondents were paediatricians (n = 54, 37%) or psychologists (n = 49, 33%). Although most clinicians felt confident using the Guide, only 44.1% agreed it clearly described the underlying evidence, and just 21% felt it adequately reflected patient preferences. Key enablers included clear, easy-to-follow guidance (n = 45, 36.3%); ease of access (n = 18, 14.5%) and familiarity with the Guide (n = 14, 11.3%). Common barriers were lack of access to appropriate clinicians, time and cost constraints (n = 25, 24.8%); concerns about the evidence base (n = 16, 15.8%); and lack of familiarity or skills (n = 8, 7.9%).

Discussion and conclusions: Findings highlight strong clinician engagement with the 2016 Guide but also identify areas for improvement, particularly around evidence transparency and alignment with person-centred care. By engaging with stakeholders and improving guidelines based on clinician feedback, we can improve the quality of care and support for individuals with FASD and their families.