Demographic Inequalities in Hospital Social Work Support Across Autism Care Pathways: A Mixed-Method Study in Vietnam

Abstract

Background: Autism spectrum disorder is a developmental disability that often requires coordinated diagnostic, treatment, rehabilitation, education, and social-support pathways. Hospital social work may help families understand a diagnosis, complete referrals, access intervention, and sustain follow-up, but these supports may not be experienced equally across demographic groups. This study examined education- and income-related differences in caregiver-reported hospital social work support and considered their implications for intellectual and developmental disability services. Methods: A mixed-methods analysis used cross-sectional data collected at Thai Binh Children's Hospital from November 2024 to July 2025. Quantitative data were obtained from 89 family caregivers. Qualitative material comprised 15 in-depth interviews, one five-participant focus group, one family case study, five expert consultations, and a document review. Service-domain differences were examined using Welch tests reconstructed from group summaries and Tamhane pairwise comparisons; qualitative field notes were used to interpret service barriers. Results: Caregivers generally reported frequent and effective psychosocial support, early-intervention guidance, resource mobilization, service coordination, community education, and follow-up. Education was associated with psychosocial support and other support, and income was associated with psychosocial support. Significant pairwise differences ranged from 0.351 to 0.479 points on four-point scales (Hedges g approximately 0.62-1.52). The most common barriers were low confidence or perseverance (73.0%), inadequate information (49.4%), limited family caregiving assistance (40.4%), and financial strain (33.7%). The five service domains were strongly intercorrelated (r = 0.687-0.916), suggesting a linked care pathway rather than isolated activities. Conclusion: Hospital social work may facilitate diagnostic understanding, access to treatment, and rehabilitation, and continuity of care, although child developmental outcomes and co-occurring intellectual disability were not measured. Proactive navigation, accessible communication, supported referral, and hospital-to-community follow-up should be evaluated in multi-center longitudinal studies.