Chapter 3: Research Methodology
Research Design and Approach
This quantitative study will be based on a non-comparative descriptive survey design to investigate the reasons why physicians from minority backgrounds or those trained outside do not commonly screen for autism spectrum disorder during well-child visits. Surveys provide a viable quantitative approach to collecting numerical information from the groups and samples that can be projected to other populations. Since this study aims to collect parental views on physician practice concerning ASD screening, the survey-based methodology facilitates the quantification and analysis of participant responses can be done. Particularly, an online self-administered survey will be used to assess the parent’s knowledge, perceptions and reported screening outcomes for ASD. A survey design offers an economical process of collecting the data involving a larger area at one time (Eapen et al., 2014). Compared to qualitative approaches, close-ended survey questions provide a much smoother path for the inferential statistics of trend discovery and also relationships between the variables of interest. Although qualitative methods such as open-ended questions or interviews could provide richer descriptive data on personal views, a survey design allows for greater sampling and standardized measurement based on the validated instruments.
The methodology of quantitative and a non-experimental survey approach is chosen for various reasons as they parallel with the research aims and questions. To begin with, descriptive analysis will be possible through analyzing the numerical data collected which entails the sample’s demographic variables and their experience. This can show the nature and regions where deficiencies are present in a physician’s ASD screening practices. Second, statistical analysis of the survey data will assess potential connections between independent variables (e.g., physician training background, child age, parent education level) and dependent variables related to ASD screening experiences and attitudes (e.g., screening practices, awareness of symptoms). This can shed light on why disparities in screening occur.
Additionally, utilizing validated survey measures supports collecting reliable data that minimizes bias or subjective interpretation. The survey includes established instruments measuring quality of life impact and symptom severity. Incorporating sound psychometric instruments strengthens quantitative rigour (Rahman, 2020). Furthermore, a non-experimental survey approach is appropriate and ethical for addressing the research questions. As this initial study aims to examine reported experiences rather than evaluate outcomes of an intervention, manipulating or controlling variables through an experimental design is not applicable (Taherdoost, 2022). Survey research also avoids potential ethical concerns with implementing a trial or imposing an intervention. Participants can anonymously share experiences without researcher influence. This quantitative non-experimental study using a survey methodology aligns with the research purpose, questions, and variables of interest while supporting ethical standards. The survey design enables efficient data collection using standardized measures for statistical analysis that can be generalized to the target population. Using validated instruments also minimizes bias and subjective interpretation. As this initial research aims to gather parent perspectives on physician ASD screening practices rather than measure outcomes of an intervention, a survey is well-suited for the investigative nature of the research questions.
Research Philosophy
This study employs an objective, positivist research philosophy focused on quantitative data collection and analysis. Positivism relies on the hypothetical deductive approach to test theories and hypotheses using empirical observations and statistical analysis (Taherdoost, 2022).
The current study aims to develop and validate a new Quality of Life (QoL) scale specifically for parents of children with autism spectrum disorder (ASD). The study utilizes the scientific methods of conceptualization, pilot testing and analyzing the psychometric properties of the Quality Of Life In Autism Questionnaire (QoLA). Parents completed the standardized survey measures with data being analyzed using various statistical methods such as tests of internal consistency, known-groups validity, and also convergent validity.
The qualitative methodology matches a positivist philosophy that is structured on the statistical analysis of empirical data to measure the reliability and validity of QoLA’s instrument. The research however does not include the subjective interpretations of quality or life perceptions and individual experiences. The study used an empirical approach that involved numerical participant ratings, quantitative comparisons between the groups and psychometric evaluations to support the validation of their scale (Rahman 2021). This positivist approach will enable the researchers to develop and validate QoLA using deductive reasoning and data analysis. Healthcare and research settings that centre on the quality of life for parents with ASD may benefit from refinement based on the results, including use as a tool. The methodology also enables future hypothesis testing on factors impacting parent quality of life using the QoLA measure.
Research Approach
This study will utilize a quantitative survey research approach to investigate why physicians, specifically those from minority backgrounds or trained overseas, do not routinely screen for autism spectrum disorder (ASD) in infants and young children. As outlined by Rahman (2020), survey research employs scientific questionnaires to systematically collect numerical data from a sample that can be used to describe and analyze characteristics of a broader population. The self-administered survey methodology aligns with the main research objective to explore physician practices, awareness, and rationale regarding screening for ASD across a target population. The survey approach will enable quantification and statistical analysis of physician experiences and viewpoints on screening practices for early ASD detection. Collecting numerical survey data will allow for descriptive analysis of sample demographics as well as examination of potential connections between variables that may influence screening behaviours using inferential statistical tests (Taherdoost, 2022). Additionally, incorporating validated instruments measuring theoretical constructs relevant to screening practices and attitudes will help minimize subjective bias and support the reliability of results.
Participants
The target population is parents of young children who see physicians from minority backgrounds or those trained overseas for well-child visits. A convenience sample will be recruited through social media platforms frequented by new parents. To participate, individuals must be 18 years or older and a parent of a child under age 5 who receives pediatric care from a minority or internationally trained physician. The planned sample size is 100 participants. This should provide sufficient data for statistical analysis while being a feasible recruitment number given time and resource constraints.
Instrumentation
Participants will complete a survey with three sections:
- Demographic questionnaire: Collects information on parent age, gender, race/ethnicity, education level, child age and gender.
- Quality of Life in Autism Questionnaire (QoLA): A 48-item measure with two subscales assessing overall parent quality of life and impact of a child’s ASD symptoms (Eapen et al., 2014). The full scale has demonstrated excellent reliability and validity. For this study, only the quality of life subscale will be used.
- Study questionnaire: Developed by the researcher to address the specific research questions. Includes 10-15 questions on parents’ experiences with having their child screened for ASD and their perspectives on physician practices.
Procedures
This study will utilize an online self-administered survey to collect quantitative data from parents on their experiences and perspectives related to having their young children screened for autism spectrum disorder (ASD). The use of a web-based survey platform allows for the efficient distribution to an extended area sample while also preserving participant anonymity through anonymous data collection procedures (Broder Fingert et al., 2018). This research will be coded using Qualtrics, and it should take about fifteen minutes. This period was defined based on the experts’ recommendations and pilot testing done to reduce respondent burden without compromising necessary detail for addressing the research questions. Respondents will be allowed to save their progress, pause the questionnaire and then they can continue with it.
Survey Development
The survey was constructed by the researcher based on the purpose of the study, previous literature review, expert inputs and also results of pilot testing. This procedure focused on establishing the highest evidence of content validity for the new instrument (Broder Fingert et al., 2018) which is very important. Each part had about twenty-five items in a preliminary survey:
- Demographic questions on parent/child characteristics
- Experiences with having child screened for ASD
- Perspectives on physician ASD screening practices
Content experts, including healthcare providers and researchers, experienced with ASD screening, reviewed the draft for relevance and coverage of the research objectives. Pilot testing was then conducted with 10 parents of young children who provided feedback on question clarity, response options, and survey length through structured phone interviews. Minor revisions were made accordingly, resulting in the finalized 15-item survey.
Recruitment
Participants will be recruited nationally through social media platforms frequented by parents of young children, particularly Facebook parent support groups. Recruiting through existing online communities facilitates access to the target population while allowing participants to maintain anonymity in survey responses (Lord et al., 2020). A study invitation will be posted in various parenting forums that provide a brief overview of the research goals, participation criteria, time commitment, and a link to begin the consent process. Eligibility criteria include being a parent/primary caregiver over age 18 with a child under age 5 who receives well-child care from a minority race/ethnicity physician or one trained overseas. Interested individuals who meet the criteria and provide informed consent electronically will access the survey link. Users who do not meet eligibility criteria will receive a message redirecting them from the survey.
Participant Anonymity
No identifying information is collected in survey responses. However, respondents can voluntarily provide an email address to be entered into a random drawing for one of five $20 gift cards as an incentive for participation (Lord et al., 2020). Email addresses for the drawing will be stored in a separate database from survey data to maintain anonymity. Secure data encryption and restricted file access will also be utilized to protect confidentiality.
Survey Translation
To facilitate participation across diverse cultural backgrounds, the survey will be translated from English into the four most common languages spoken by minority physician groups nationally – Vietnamese, Chinese, Korean and Japanese. This encompasses the languages of major Asian populations who experience healthcare disparities (Rahman, 2020). Professional translators native to each language will conduct the translations using forward-translation and blind back-translation procedures to establish accuracy. Content experts will review the translated versions to confirm the equivalence of meaning with the English source content. The translated surveys will be programmed into the Qualtrics software to enable participants to select their preferred language upon opening the survey link.
Data Analysis
Quantitative and qualitative techniques will be utilized to analyze the survey data collected. Quantitative analysis will include descriptive and inferential statistics using SPSS statistical software on the closed-ended survey responses (Rahman, 2020). Qualitative conventional content analysis methods will categorize and extract key themes from open-ended questions.
Quantitative Data Analysis
Frequencies and measures of central tendency (mean, median, mode) will summarize sample characteristics on demographic variables, including parent age, gender, race/ethnicity, child age and gender. This descriptive statistical profiling of the sample will determine diversity and representation. Further descriptive analysis will calculate measures of central tendency, variability (range, standard deviation) and data distribution (skewness, kurtosis) for each survey item. Within the screening experiences and perspectives sections, determining normality and extreme scores will help guide subsequent analysis decisions (Rahman, 2020). Bivariate inferential analyses will compare survey responses between demographic groups. Independent samples t-tests and ANOVA procedures will analyze mean differences based on parent gender, race/ethnicity, education level and child gender. Non-parametric Mann-Whitney U and Kruskal-Wallis tests will be applied for non-normal data. Identifying disparities in screening practices or awareness of social factors is a key study objective.
Multivariate analysis will involve multiple linear regression modelling to predict screening outcomes while controlling for selected covariates. Logistic regression will model the likelihood of a screening occurrence based on parent and physician characteristics. Structural equation modelling may evaluate mediation effects between study variables if sample size permits. Throughout the analysis, checking assumptions, transforming non-normal variables, and interpreting effect sizes will promote statistical conclusion validity (Taherdoost, 2022). Significance will be determined at the p < .05 level based on two-tailed tests. However, exact p-values and effect sizes will be reported where possible rather than relying solely on threshold indicators.
Qualitative Data Analysis
Open-ended questions will undergo conventional content analysis, an inductive coding process to describe themes within textual data. After data immersion through close reading, meaning units will be identified in responses and then categorized by emergent codes. Code frequency quantification and co-occurrence mapping will determine connections between codes. Analytic memos will track code decisions and category relationships. Trustworthiness techniques are essential for methodological rigour (Lord et al., 2020). Credibility will involve member-checking preliminary themes with select participants. Confirmability requires recognizing researcher biases that may influence interpretation. An audit trail of memos and documentation will enhance transparency. Lastly, a thick description with participant quotes will enable transferability judgments. Integrating the qualitative themes with quantitative findings will facilitate a comprehensive mixed-methods understanding of parental perspectives on physician ASD screening practices.
Ethical Data Management
Data cleaning will screen for errors or missing values possibly requiring exclusion. All analyses will involve de-identified datasets with confidential storage. Data will be retained for 3 years post-study conclusion before permanent deletion per ethical guidelines (Broder Fingert et al., 2018). Quantitative descriptive, comparative and predictive analysis harmonized with qualitative thematic coding will provide a strong methodological basis to address the purpose of studying factors that affect physician ASD screening practices as well as dedicate research questions.
Ethical Considerations
Several ethical assurances were enforced across all the phases of the study protocol to comply with the code on research integrity and protect human subjects. The protocol for this research was approved by the Human Research Ethics Committees of both the local health district and university before the participant recruitment as well as the data collection process. This review also assured the study methodology and informed consent potential benefits, as well as the risks for participants. Participation was completely voluntary as well (Broder, Fingert et al., 2018). The decision to participate in the research after understanding its objectives and modalities was an individual choice that each respondent made independently. Participants were informed both verbally and through the electronic consent process that they had the right to withdraw from the study at any time without penalty. Parents independently elected whether to provide consent after researchers discussed what participation would involve.
Confidentiality of participants’ identities and responses was strictly maintained to avoid potential social or psychological risks of releasing personal information. No names or directly identifying details were included in study documents or survey responses. Throughout the analysis and reporting, the data remained anonymous. The forms of contact details collected for the gift card draw were stored apart from the survey responses to protect anonymity (Eapen et al., 2014). Minimal risk was also associated with the survey, but participants were informed about this purpose and procedures before their perception as well. Support is available if any psychological distress occurs while sharing experiences. Standard care policies may require counselling services when needed. During the process of consent and data collection, researchers constantly watched out for any traces of emotional danger.
Ethical checks extended far beyond institutional oversight, as the study showed further rigour in instrument design and also expert validation. Survey questions were written by the results of the literature review and feedback from consumers, clinicians as well as researchers who are familiar with quality-of-life consequences and autism screening principles. This contributed to the development of balanced outlooks that corresponded with the target audience (Broder Fingert et al., 2018). Pilot testing facilitated the revision of questions to ensure proper articulation and also helped in the avoidance of sensitive issues. By informing the parents about the confidentiality protections, risks of mild emotional discomfort and benefits to themselves and society they made an informed decision on whether selling blood was worth it or not. While administering the surveys, parents could inquire and also leave if they were required to do so. Ethical adherence was sustained from the recruitment through to data management by the researchers’ open communication and procedural consistency.
After the study was completed, the participants could ask for the results. Debriefing provided an opportunity to express any doubts and, if the process produced distress, it also enabled contact with support services. This sustained the ethical standard of not harming social science research. Lastly, secure data retention and destruction policies will be adopted to ensure that the private information is not accessed by unauthorised persons.
Finally, this research utilized several ethical safeguards in the study design, and informed consent processes for the data collection and analysis. It was also very transparent with the participants (Rahman 2020). Oversight by institutional review boards, expert content validation, voluntary participation, confidentiality protections, communication of risks and benefits, available support services, and secure data retention enabled the conducting of the research ethically with beneficence. All procedures are aligned with standards outlined in the Helsinki Declaration and university policies to protect human subjects.
Summary
This quantitative survey study will examine parents’ experiences and perspectives on having their young children screened for autism spectrum disorder (ASD) by minority race/ethnicity and internationally trained physicians during well-child visits. The non-experimental methodology aligns with investigating the research question through numerical data collection from a sample that can indicate broader trends. An online self-administered survey was designed using validated instruments to enable efficient distribution to a national sample while maintaining anonymity. Participants will be parents aged 18+ years of children under 5 years receiving pediatric care from minority physicians. A target sample size of 100 was set to allow for sufficient statistical power and recruitment feasibility.
The survey comprises three sections: 1) Demographic questions on parent/child traits, 2) The Quality of Life in Autism Questionnaire assessing impacts of ASD symptoms, and 3) 10-15 study-specific questions on screening experiences with physicians and perspectives on their practices. Established measures were included such as the Quality of Life in Autism Questionnaire demonstrated to have strong psychometric properties, strengthening methodological rigor. Participants will be recruited through social media parenting forums frequented by the target population. The study information will be posted with a link to begin consent procedures and access the anonymous survey. Data encryption and confidential storage will maintain privacy. The estimated 15-20 minute survey will be offered in five languages to facilitate participation across diverse backgrounds.
Quantitative data analysis will focus on descriptive statistics to summarize sample and variable distributions, comparative analyses between demographic groups, and predictive modelling to determine factors associated with ASD screening rates. Qualitative data from open-ended questions will undergo content analysis of patterns in participant perspectives.
Ethical standards for human subjects research will be upheld through university IRB approval, informed consent, voluntary participation, anonymity protections, communicating risks like emotional discomfort and benefits of informing improved ASD screening practices, and secure data retention protocols.
References
Broder Fingert, S., Carter, A., Pierce, K., Stone, W. L., Wetherby, A., Scheldrick, C., Smith, C., Bacon, E., James, S. N., Ibañez, L., & Feinberg, E. (2018). Implementing systems-based innovations to improve access to early screening, diagnosis, and treatment services for children with autism spectrum disorder: An Autism Spectrum Disorder Pediatric, Early Detection, Engagement, and Services network study. Autism, 23(3), 653–664. https://doi.org/10.1177/1362361318766238
Eapen, V., Črnčec, R., Walter, A., & Tay, K. P. (2014). Conceptualisation and Development of a Quality of Life Measure for Parents of Children with Autism Spectrum Disorder. Autism Research and Treatment, 2014, 1–11. https://doi.org/10.1155/2014/160783
Lord, C., Brugha, T. S., Charman, T., Cusack, J., Dumas, G., Frazier, T., Jones, E. J. H., Jones, R. M., Pickles, A., State, M. W., Taylor, J. L., & Veenstra-VanderWeele, J. (2020). Autism spectrum disorder. Nature Reviews Disease Primers, 6(1), 1–23.
Rahman, S. (2020). The Advantages and Disadvantages of Using Qualitative and Quantitative Approaches and Methods in Language “Testing and Assessment” Research: a Literature Review. Journal of Education and Learning, 6(1), 102–112. https://files.eric.ed.gov/fulltext/EJ1120221.pdf
Taherdoost, H. (2022). What are different research approaches? Comprehensive review of qualitative, quantitative, and mixed method research, their applications, types, and limitations. Journal of Management Science & Engineering Research, 5(1), 53–63. https://doi.org/10.30564/jmser.v5i1.4538
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