Exploring caregivers’ perspectives on utilising public healthcare services in Malta for individuals with autism

Abstract

Background: Autistic individuals may experience barriers when accessing healthcare, including communication difficulties, sensory challenges, inflexible service processes and limited autism understanding among healthcare staff. Caregivers often play an important role in navigating healthcare services, advocating for adjustments and supporting autistic individuals during healthcare encounters. Although these issues are documented internationally, no published Maltese research identified in the present review specifically examined caregivers’ experiences of Malta’s public healthcare for autistic individuals. Aims: This study aimed to explore caregivers’ perspectives on utilising public healthcare services in Malta for autistic individuals. It sought to identify barriers and challenges, their perceived consequences, positive healthcare experiences and potential facilitators that could improve healthcare access and experiences. Method: A qualitative design was adopted. Participants were recruited purposively through the Autism Parents Association. Six semi-structured online interviews were conducted and analysed using thematic analysis following Braun and Clarke’s six-phase approach. Findings: Five overarching themes were identified: barriers to accessing public healthcare; consequences for autistic individuals and caregivers; environmental and sensory challenges; positive experiences within public healthcare; and caregiver-identified facilitators. Participants described limited autism understanding, prolonged waiting, administrative barriers, sensory overload and organisational unpredictability. These experiences contributed to child distress, caregiver emotional labour and, in some cases, avoidance of public healthcare or reliance on private services. Positive encounters were associated with supportive and flexible staff responses. Suggested facilitators included autism training, reduced waiting and environmental, preparatory and visual supports. Discussion: Findings broadly reflected international literature while providing context-specific evidence from Malta. They highlight the importance of autism-responsive, flexible healthcare provision and the potential contribution of occupational therapy through environmental adaptation, education, consultation and advocacy. Further research should include autistic individuals and healthcare professionals and evaluate autism-responsive practices within Maltese healthcare settings.