Regional Disparities in the Use and Demand for Digital Health Services for Autism Spectrum Disorder in China: Cross-Sectional Survey of Stakeholder Perspectives.

Abstract

Background: Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition, the prevalence of which is increasing in China and worldwide. Digital health technologies offer promising solutions for improving screening, diagnosis, and rehabilitation of children with ASD, particularly in resource-limited settings. However, digital health technologies for ASD have not been adopted in China. Understanding utilization patterns, influencing factors, and user needs is essential to inform equitable, effective digital health strategies.

Objective: This study aimed to assess the current use, influencing factors, and perceived needs of digital health services among parents of children with ASD and rehabilitation therapists in 2 distinct provinces in China.

Methods: A cross-sectional survey was carried out between November 2023 and February 2024 in Heilongjiang and Fujian provinces. Purposive sampling recruited a total of 780 parents and 745 rehabilitation therapists to complete a structured questionnaire. Data were analyzed using descriptive statistics, stepwise multivariable logistic regression, and multiple response analysis.

Results: The use of digital health services was low among parents (46/780, 5.9%) and rehabilitation therapists (161/745, 21.6%), although the demand was substantially higher (621/780, 79.6% and 671/745, 90.0%, respectively). Among parents, higher use was positively associated with younger age (20-29 years), employment, lower income (≤CNY 3000/month [US $421.247/month]), and delayed ASD diagnosis (7-12 years old). Among rehabilitation therapists, male, special education background, and autism-specific training experience predicted higher use (all P<.05). Demand was significantly greater in Fujian than in Heilongjiang and was positively associated with higher education levels in parents and rehabilitation therapists (P<.05). Parents and rehabilitation therapists valued a greater understanding of ASD behaviors and development and easier access to resources as primary benefits. Common barriers to the use of digital health services included high cost, need for additional equipment, and usability challenges. The smartphone-WeChat mini-program was the preferred device and platform, respectively. Parents prioritized access to rehabilitation courses, remote guidance, and policy information, while rehabilitation therapists favored personalized plans and professional skills training.

Conclusions: Despite a strong demand, digital health services are underused in ASD care across China, with adoption of digital health services influenced by regional disparities and sociodemographic factors. This study, as the first comparative analysis of parents and rehabilitation therapists in 2 Chinese provinces, provides stakeholder-specific insights to guide targeted, locally relevant interventions. Bridging the digital divide through inclusive policies, training, and cross-sector collaboration will be essential for equitable integration into ASD care pathways.