Stakeholder Perspectives on the Feasibility, Acceptability, and Implementation Strategies for Adapted Autism Spectrum Disorder Screening Tools in Community Settings in Kilimanjaro, Tanzania

Abstract

Background: Early identification of Autism Spectrum Disorder (ASD) is critical for optimizing developmental outcomes, yet community-based screening remains underutilized in Tanzania due to systemic, cultural, and logistical barriers. Purpose: This study explores stakeholder perceptions of the acceptability, feasibility, and potential implementation strategies for culturally adapted autism screening tools in community-based early childhood settings in the Kilimanjaro region, Tanzania. Methods: A phenomenological qualitative study guided by the Socioecological Model (SEM) was conducted across preschools, daycare centers, and rehabilitation facilities in Moshi Municipality and Hai District. Multi-stakeholder participants included daycare center directors, kindergarten teachers, healthcare providers, and parents and guardians of children with ASD and policymakers (10 in-depth interviews, 3 focus group discussions). Data were collected through usability assessments, cognitive debriefing, and semi-structured discussions, and were thematically analyzed using NVivo 15 aligned with SEM domains. Results: Participants reported high perceived acceptability of utilizing the tools, driven by the tools Swahili adaptation, perceived clinical usefulness, and cultural relevance. Key anticipated feasibility enablers included private administration of the tools to mitigate stigma, trained non-specialist screeners, and structured caregiver psychoeducation. Primary barriers included questionnaire length, caregiver stress, and initial resistance. Multi-level implementation strategies emerged: standardized training, consistent home school communication, multidisciplinary care coordination, task-shifting to Community Health Workers, engagement of local and faith leaders, and integration into digital and policy frameworks. Conclusion: Culturally adapted ASD screening tools are feasible and acceptable in Tanzanian community settings when deployed with attention to linguistic accessibility, confidentiality, staff capacity, and cross-sectoral partnerships. Embedding screening within existing early childhood and community health infrastructure, supported by policy alignment and digital outreach, offers a scalable model for improving early ASD identification in low-resource contexts