International Journal of Healthcare Management

ISSN: 2047-9700 (Print) 2047-9719 (Online) Journal homepage: https://www.tandfonline.com/loi/yjhm20

Developing a community-based autism spectrum

disorder management model: Results after 1-year
pilot experience

Hua Thanh Thuy, Nguyen Thai Quynh Chi, Nguyen Thi Nga, Dinh Thu Ha,
Nguyen Thi Huong Giang & Nguyen Thanh Huong

To cite this article: Hua Thanh Thuy, Nguyen Thai Quynh Chi, Nguyen Thi Nga, Dinh Thu Ha,
Nguyen Thi Huong Giang & Nguyen Thanh Huong (2020): Developing a community-based autism
spectrum disorder management model: Results after 1-year pilot experience, International Journal
of Healthcare Management, DOI: 10.1080/20479700.2020.1755809

To link to this article: https://doi.org/10.1080/20479700.2020.1755809

Published online: 30 Apr 2020.

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INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT
https://doi.org/10.1080/20479700.2020.1755809

Developing a community-based autism spectrum disorder management

model: Results after 1-year pilot experience
Hua Thanh Thuya, Nguyen Thai Quynh Chi b
, Nguyen Thi Ngac, Dinh Thu Hab, Nguyen Thi Huong Giangd
and Nguyen Thanh Huong c
a
Department of Health Policy and Integrate, Management Training Institute, Hanoi University of Public Health, Hanoi, Vietnam;
b
Department of Health Sociology, Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, Hanoi,
Vietnam; cDepartment of Health Education, Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health,
Hanoi, Vietnam; dDepartment of Rehabilitation, National Pediatric Hospital, Hanoi, Vietnam

ABSTRACT ARTICLE HISTORY

Background: To develop an official comprehensive management of Autism spectrum disorders Received 8 February 2020
(ASD) system nationwide, we conducted a pilot community-based ASD management model, Accepted 5 April 2020
developed based on participatory approach to empower parents, preschool teachers and
KEYWORDS
health staff by conducting communication campaign, training and health system support in Autism spectrum disorders;
two Northern provinces of Vietnam in 2018. management; community;
Objective: To explore the appropriateness and feasibility of this model in terms of cultural appropriateness; feasibility;
context, ease of operation, existing health system structure, human resources, infrastructure Vietnam
and finance after one-year piloting.
Methods: A phenomenological qualitative study design was employed with 15 in-depth
interviews including piloting coordinator and local policymakers, 14 focus group discussions
with health staff and community, and 1 workshop with central stakeholders.
Results: Our findings demonstrated that the model is appropriate and feasible with cultural
context and existing resources. However, to replicate the model in other provinces, stigma
towards families having children with ASD in the community, lack of electronic connection
system between levels, and difficulties related to health insurance implementation at
provincial level should be solved.
Conclusion: Integrating ASD management into existing community mental health program;
developing ASD intervention package that covered by health insurance; and continuing
training for community and health staff should be implemented.

Background
According to the World Health Organization (WHO),
autism spectrum disorders (ASD) are a group of com-
plex brain development disorders characterized by
difficulties in social interaction and communication
and a restricted and repetitive repertoire of interests
and activities [1]. Recent epidemiological studies esti-
mated that median global prevalence of children with
ASD is 0.62% [2]. In addition, the rate of children
with ASD has been increased. In the United States of
America (USA), the rate in the 1962–1967 periods is
0.07–0.31%, amounted to 1.1% in the 1987–1999
periods [3], and according to the latest report, the
prevalence rate of children aged over 8 was 1.68% in
2014 [4]. Similarly, in Asian countries, the prevalence
of ASD reported in studies before 1980 was 1.9/
10,000 and reached over 14.8/10,000 in later studies
[5]. In Vietnam, a few studies, conducted at hospitals
or residential communities on a small scale, showed
that the prevalence of ASD ranged from 0.4% to
0.7%, boys had 2.1–7.7 times higher rate than girls;
children in cities had higher rate than those in rural
areas [6–10]. The latest study on a larger scale (at
three Northern provinces: Hanoi, Hoa Binh and Thai
Binh) showed that the ASD prevalence of children
aged from 18 to 30 months was 0.75% [11].
ASD inflicts enormous economic burdens which
results mainly from costs for supporting daily life
activities, special education or caregivers’ working pro-
ductivity reduction, whereas small improvements in
intervention for children with ASD can reduce these
costs remarkably [12,13]. ASD management helps to
detect and diagnose children with ASD early, thereby
improving efficiency of interventions for children
with ASD, preventing secondary defects, making sure
that children can live independently, work and inte-
grate into the society, reducing the burdens for their
families and the society in the future. WHO has
made strategic frameworks and emphasized on multi-
sectoral and empowerment approaches on managing
ASD comprehensively [2]. Meanwhile, in Vietnam,
such ASD management has not been developed.

CONTACT Nguyen Thai Quynh Chi nqc@huph.edu.vn Department of Health Sociology, Faculty of Social Sciences, Behavior and Health Education,
Hanoi University of Public Health, 1A Duc Thang Road, Duc Thang Ward, North Tu Liem district, Hanoi, Vietnam
© 2020 Informa UK Limited, trading as Taylor & Francis Group
2 H. T. Thuy et al.
Figure 1. The pilot community-based ASD management model in Vietnam.
Detecting, diagnosing, treating, and supporting chil-
dren with ASD are conducted separately, mainly orig-
inating from efforts of families themselves with minor
support from healthcare, rehabilitation institutions
and some nongovernmental organizations [10]. In
addition, community, even healthcare workers, lack
information and have limited knowledge about ASD
[14,15]. Therapeutic services for children with ASD
still lack in terms of quantity [10,16] and have limited
quality [17]. This has led to late detection and diagnosis
of children with ASD [6,18]; or even grown-up chil-
dren with ASD are not diagnosed and treated, hence,
unable to integrate into the social environment and
have to depend on their relatives’ support [10].
One of our government’s efforts to tackle the pro-
blem is this first, community-based ASD management
model (Figure 1), adapted to Vietnam’s economic,
cultural and social characteristics and piloted in two
Northern provinces (Hoa Binh and Thai Binh) from
January 2018 to January 2019. The development of
Figure 2. Process of developing community-based ASD management model.
the model process was described in Figure 2. As a
part of the piloting process, improving community
awareness of autism and strengthening healthcare
system capacity were also implemented. Communi-
cation to improve community awareness focus on
three target groups: caregivers, preschool teachers,
and community health staff. Health promotion
approaches and strategies for each group were
described in Table 1. The healthcare system capacity
was enhanced by developing and establishing pro-
cedures of early ASD identification, diagnosis and
intervention, guidelines and document forms for
ASD management; capacity building for health staff
at various levels; and equipped provincial Pediatrics
Hospitals with appropriate treatment facilities. This
study was conducted in order to provide scientific
evidences regarding the model’s appropriateness and
feasibility, which enables policymakers and stake-
holders to scale up ASD management model in
Vietnam.
 INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 3

Table 1. Health promotion approaches and strategies for the finance, existing health system structure, and supports
target audiences. of stakeholders [19].
Strategies
Preschool teachers and
Approaches Caregivers community health staff Data collection
Health education Health education workshop Qualitative data were collected from semi-structured
(in 2 days) to improve interviews/discussions. IDIs and FGDs were conducted
knowledge on ASD and
communication skill
between February and May 2019 and audiotaped with
Provide communication the approval of participants and then transcribed,
kit (banners, leaflets, whereas the workshop was conducted in August 2019
videos, posters and
development delays and written recorded by a note-taker.
screening tool (ASQ-VN))
to facilitate productive
dialogue with caregivers Data processing and analysis
Behavior change Hanging banners (at schools and healthcare Themes and sub-themes were developed based on the
communication institutions)
Hanging posters (at schools, healthcare institutions aims of the study and IDIs/FGDs guidelines by two
and public places) key researchers. There were five themes: cultural con-
Broadcasting on local loudspeakers
Delivering leaflets to each audience text, ease of operation, existing health system structure,
Empowerment Community health Becoming a core group to human resources, and infrastructure. The sub-themes
staff guide carry out communication
caregivers to use activities in the were elaborating accordingly to the themes, for
ASQ-VN toolkit community example: theme ‘Ease of operation’ was followed by
‘Operation of the ASD management model from com-
munity to provincial level; The cooperation between
Methods levels; Advantages and limitations of operating the
model in the area; etc.’; ‘Existing health system struc-
Study design
ture’ was elaborated by these sub-themes: ‘Roles of
This study applied phenomenological qualitative each level in the existing health system when adapting
research methodology. the ASD management model; The appropriateness of
the model to the existing health system; Advantages
and difficulties when integrating the model into the
Participant selection existing health system; etc.’. Transcripts and work-
Two northern provinces, Hoa Binh and Thai Binh, shop’s minute were critically processed and analyzed
were selected for the piloting. Participants in two dis- using a theoretical approach to conduct thematic
tricts represented for urban and coastal areas in Thai analysis [20]. Each key researcher independently
Binh and two districts represented for urban and coded the qualitative data into a system of themes
mountainous area in Hoa Binh were recruited. Purpo- and sub-themes and documented common or diver-
sive sampling was employed. People directly partici- gent perspectives. Interpretation of the data and emer-
pated in piloting ASD management model (including gent themes was discussed until consensus was reached
piloting coordinator, child-caregivers, preschool tea- among the research team. There was no cross-checking
chers and health staffs at commune, district, provincial, of data as these are indepth interviews and group dis-
and central levels), local policymakers and stakeholders cussions, not a survey questionnaire. The data were
at central level (ASD specialists; representatives from coded manually into each theme and sub-theme.
civil society organizations; policymakers of health,
social welfare, and education sectors) were selected Research ethics
for indepth interviews (IDI), focus group discussions The research was approved by the Ethics Committee of
(FGD), and expert workshop. There were 15 IDIs Hanoi University of Public Health (No. 319/2016/
(with piloting coordinator and local policymakers), YTCC-HD3). Informed consent was obtained from
14 FGDs (with child-caregivers, preschool teachers, participants prior to interviews/discussions.
and health staff) and 1 workshop with central stake-
holders with a total of 108 participants.
Results
Appropriateness
Tools for data collection
Guidelines for interviews/discussions for each partici- Although there were still some difficulties in the
pant group were developed based on research implementation process, the majority of participants
themes/sub-themes. The appropriateness was evalu- responded that the piloting model was relevant to cur-
ated to meet cultural context relevance and ease of rent cultural context in Vietnam and easy to deploy in
operation, whereas the feasibility was evaluated in reality, which provide strong evidences of the pilot
aspects of human resources, infrastructure/equipment, model’s appropriateness.
4 H. T. Thuy et al.
Relevant to cultural context
In Vietnam, information of ASD is in the state of ‘distor-
tion’: appearing disorderly in mass media but inaccur-
ately. However, information sources from health sector
always earn the highest trust from people. Therefore,
according to local policymakers, the pilot model was
initially established based on health sector that was eval-
uated as meet the trust of community belief:
Information on ASD in mass media is abundant but
not all is true. Therefore, there should be official infor-
mation source actually trusted by people in the com-
munity. Those are information from health system.
In my opinion, the pilot model with health staff as
its core is appropriate. (IDI, leader of Hoa Binh Pro-
vince People’s Committee)
In addition, most participants directly involved in
piloting the model expressed the opinion that the
model started by relationship between family, commu-
nity health staff and preschool teachers fitted well with
existing closed connection in Vietnamese community
and supported for the enabled for screening and diag-
nosing phases of the model.
Community health workers and preschool teachers
are very close and have a strong voice in the commu-
nity, thus starting the process by this relationship will
enable the foundation for the next steps of screening,
diagnosing and further. (IDI, piloting coordinator)
Interventions activities, especially communication
campaign, were also perceived by many participants
as relevant to indigenous worldviews:
Certainly, communication materials can be applied for
people from a variety of contexts because the images,
terminologies and concepts are culturally appropriate.
(FGD, child-caregivers, Hoa Binh).
However, the existence of the community discrimi-
nation against children with ASD and their families as
well as self-discrimination by the families having chil-
dren with ASD was argued as a significant obstacle in
conducting the pilot model. Grassroots health staffs
were difficult to access and mobilize families to allow
their children to receive intervention because they
want to hide information on their children:
The families having children with ASD are discrimi-
nated by neighbours who think that children with
ASD are the retribution caused by evils done by
their parents/grandparents. Therefore, many families
want to conceal information and lock their children
with ASD at home, refuse to see health staff or provide
wrong telephone number. It is quite difficult to access
and mobilize the families having children with ASD to
receive intervention and monitoring process. (FGD,
district health staff, Thai Binh).
Easy to operate
Most of the research participants, especially direct par-
ticipants in piloting phase, agreed that the model had
established clear functions, tasks, and operation mech-
anism, especially did not create big changes in the pre-
sent policy environment, thus the pilot
implementation was fairly favorable.
The role of components in the model accords with
current governmental documents, thus there are no
negative reactions during implementation. (IDI, pilot-
ing coordinator)
The only difficulty recognized from interviews was
the implementation of health insurance policy at grass-
roots level:
When we transferred children having positive testing
result with MCHAT-23 from communal level to pro-
vincial level, not via district level, health insurance
agency didn’t pay for these circumstances. This also
caused difficulty to the families having children with
ASD and grassroots health staffs as well. (FGD, com-
mune health staff, Hoa Binh)
Besides, the participants also placed emphasis on the
role and appropriateness of intervention activities
including communication campaign and activities
impacting health system in facilitating the favorable
environment and smooth operation of the pilot model.
As mentioned by the respondents, participatory and
empowerment approaches in the development and
implementation of communication strategies and
materials design were appropriate. Applying these
approaches was proved to be helpful in improving
awareness and reducing the community discrimination
against ASD, making community more interested in
and capable of assuming their role in the model.
Target audiences are involved in designing communi-
cation materials. Therefore, when they access these
products, they are quite satisfied. Besides, building a
core group to replicate the communication program
is a good way to minimize program implementation
costs. (IDI, piloting coordinator).
Communication activities are very significant. Images
in the materials are quite stunning with green as main
color. I find it quite easy to understand. Thanks to it, I
understand more clearly about autism and monitor
my children’s development milestones and also
remind other families. (FGD, child-caregivers, Thai
Binh)
However, to achieve better outcome, some partici-
pants recommended that there should be separate com-
munication activities for the parents and families
having children with ASD or developmental delays so
that they could see that not only their children have
problems but other families face the same situation.
By this way, the efforts made by the parents having
children with ASD were increased and thus discrimi-
nation would be reduced remarkably.
It is advised to organize sessions only for parents hav-
ing children with ASD. When they exchange their
thoughts with each other, they will feel less self-pity.

They will see that their children are not the only case
and they will be motivated to allow their children to
attend intervention. (FGD, provincial health staff,
Hoa Binh)
For the activities affecting health system, research
findings also indicated that the provision of pro-
fessional procedures, instructions and forms had
enabled the model to operate unanimously. However,
the absence of an electronic connection system
between various levels (communal – district – provin-
cial – central levels) had caused difficulty to managing
information on children with ASD:
At present, our department has a common email and
we share general activities in the department only. We
don’t connect with other units. Reports are still paper
based. If it is possible to connect information from
lower levels to higher level, information management
will be easier. (FGD, provincial health staff, Hoa Binh).
Feasibility
Most participants agreed that the pilot model was
applicable to a wider scale in the future as it based on
existing resources (human resources, infrastructure/
equipment, finance and health system structure) and
had strong support from stakeholders.
Human resources
Research participants agreed that the model develop-
ment and implementation based on available human
resources in the community and healthcare system, in
which establishing the role of components in accord-
ance with their existing capacity, functions and tasks,
was a quite suitable approach, serving as a core factor
that enabled the model to be replicated widely in the
future.
Human resources for model deploying, from commu-
nity to central level, are used the existing those in the
localities/facilities without recruiting new employers.
At community level, the model has mobilized the
involvement of parents/child-caregivers, preschool
teachers, village health workers, etc. those who have
great attention to children, thus they are very willing
to participate once they have been provided with
necessary knowledge and skills. (IDI, piloting
coordinator)
In addition, research findings also pointed out the
need of continuously training for community as well
as health staff for more effective empowerment in the
future due to the complexity of ASD and short period
of piloting:
After attending ASD screening training sessions, I pay
more attention to checking my kindergarten student’s
development milestones. However, I still know very
little about this issue. The training needs to be
expanded and repeated. (FGD, preschool teacher,
Hoa Binh)
INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 5
ASD is quite challenging. Surely, we or later colleagues
must be quite determined if we want to pursue this
field. We expect further training to be more confident
in using M-CHAT toolkit as well as providing inter-
vention services for children with ASD. (FGD, provin-
cial health staff, Hoa Binh)
Infrastructure and equipment
Similar to human resources, the pilot model was estab-
lished and developed based on existing infrastructure
system at healthcare facilities at all levels. For commu-
nal and district levels, there were hardly any changes.
For provincial level, such changes were limited to reno-
vating existing rooms/buildings and supplementing
some necessary equipment for intervention. According
to the participants, such changes were acceptable and
could be included in the annual procurement financing
plan of the hospitals.
I think that necessary equipment for intervention
room can be included in the annual procurement
plan made by provincial hospitals. This is quite feas-
ible. (IDI, leader of Hoa Binh Province Department
of Health)
According to stakeholders, especially policymakers,
it was quite important to refrain from causing curial
changes in infrastructure and equipment upon adopt-
ing the model, which enabled the model to be applied
easily in the context of limited resources in Vietnam:
In the context of limited resources, any big changes in
infrastructure and money will lead to difficulties in
implementation. However, with autism management
model based on existing resources, integrated in the
ongoing activities or programs, it will be very appro-
priate and feasible for implementation. (IDI, leader
of Thai Binh Province Department of Health)
Finance
From the perspective of services providers, the model
was feasible in terms of financing for further replica-
tion because the model operation could be integrated
in the existing programs or services at all levels without
budged additions.
At community and district levels, training activities
for caregivers, preschool teachers and community
health staff can be integrated into the children health-
care (such as vaccination, nutrition of school health
programs); the detecting and screening activities
might integrate into the mother and children health-
care and community-based metal health program;
and the intervention activities can be consolidated
into the community-based rehabilitation program.
This program can be integrated in the mental health
program or the mother and child healthcare program.
This can be done free of charge because it is associated
with current work of heath staff. (FGD, communal
health staff, Hoa Binh)
6 H. T. Thuy et al.
At provincial level, ASD diagnosing and interven-
tion could be implemented with trained doctors and
nurses at provincial hospitals. Training would be pro-
vided by trainers from the National Pediatrics Hospital
within their field as a program of building capacity.
Finance for intervention facilities might be integrated
in the annual plan of the hospital and could be
equipped year by year.
I have thought of an intervention unit for ASD. Here
we have vacant room, we just need some facilitates. I
have sent the request to the Director. It is not a big
sum of money and we can equip the intervention
unit year by year, start with basic things. The impor-
tant thing is we want to do it. (FGD, provincial health
staff, Hoa Binh)
However, our qualitative findings revealed several
financial challenges and burdens for families having
children with ASD due to unclearly health insurance
regulations. Policy advocacy solution, especially pol-
icies related to health insurance, therefore, was deemed
very important to solve financial problem in the future:
Autism intervention requires family patience and
huge money. In spite of statutory payment from health
insurance, regulations are very complicated and dis-
persed. The implementation of regulations is various
and depends on each provincial social insurance
agency. Policy advocacy should be done to make
health insurance payment packages for autism inter-
vention. (IDI, leader of Hoa Binh Province Depart-
ment of Health)
Healthcare system structure
The pilot model was operated based on the coordi-
nation and connection between the levels established
in the healthcare system (community, communal, dis-
trict, provincial and central levels). This was viewed as
a big advantage of healthcare sector compared with
other sectors:
Healthcare sector has advantage of an existing health-
care system from communal to central levels. There-
fore, the establishment of ASD management model
in healthcare sector is more favorable than that in edu-
cation or social labor sectors. (Workshop, expert on
special education)
Stakeholder support
In the workshop, all stakeholders, especially policy-
makers, expressed their interests and support to ASD
management model. They also stated their commit-
ment to introduce, scale-up the model and develop
regulations related to ASD in the future:
From the view of the mother and child healthcare
management authority agency, we pay special atten-
tion to and commit our support to this program.
We will start our commitment by developing health
insurance package for this syndrome and establishing
ASD screening as a routine activity in health insurance
payment at grassroots levels. (Workshop, central
health policymaker).
Discussion
This is the first study in Vietnam that provided evi-
dences of appropriateness and feasibility of a commu-
nity-based ASD management model in Vietnam. This
model was established based on empowerment and
contextual adaptation approaches which are important
approaches recommended by WHO for ASD manage-
ment [2]. Community (child caregivers, preschool tea-
chers and community heath staff) were empowered by
being involved in the development as well as
implementation of the model. They also had their
capacity improved to take initiative in performing
their role in the model and become a core group to
carry out and scale-up communication activities in
the community. In addition, the pilot model was for-
mulated and operated based on existing human
resources and infrastructure of healthcare system, in
accordance with cultural context and community belief
and trust. Our findings demonstrated that these
approaches were core factors that helped the pilot
model to be appropriate, feasible, and possible to be
replicated in wider scale. These approaches were also
used for chronic disease management and have been
proved to be cost-effective [21]. Since ASD is a lifelong
developmental disability and considering ASD as a
chronic health conditions requiring regular follow-up
and routine screening and treatment of medical and
psychiatric issues was recommended [22], it one
again could be affirmed that the empowerment and
contextual adaptation was appropriate approaches of
the development and implementation of the model.
One other approach emphasized by WHO [2] as
well as applied by the ASD management models in
other countries such as the USA [3], North Ireland
[23], and Malaysia [24] is multisectoral approach
including coordination among health, education, and
social welfare sectors. However, it was not showed
very clearly in the pilot model that put focus on health
sector (due to contextual factors as analyzed above).
Therefore, there should be continued efforts from
health, education, and social welfare sectors to further
develop the community-based ASD management
model more comprehensively in the future. Partner-
ship in community intervention projects plays an
important role in contributing to the success of the
interventions [25].
To deploy the pilot model, two intervention com-
ponents have been set up and implemented, including:
(i) communication campaign to improve the commu-
nity knowledge of ASD and (ii) activities impacting
on the healthcare system. Research findings indicated
the importance and appropriateness of these two com-
ponents in making the model operation easy.

However, our findings also showed that in the pro-
cess of piloting model, there remained some obstacles
to be taken into account to improve the model feasi-
bility in the scale-up phase. The most significant chal-
lenge was the persistence of community discrimination
against families having children with ASD and ‘self-
discrimination’ by those families themselves. The
reason for this situation was wrong knowledge of Viet-
namese community on the cause of ASD. They sup-
posed that the reason for children having ASD was
that their parents did not pay attention to and did
not care for their children. They even thought that
ASD was the consequence of evils done by such parents
[26,27]. These thoughts existed in the community as a
part of culture – social norms. Therefore, the 1-year
intervention with different kinds of communication
could not easily remove this stigma and discrimination.
This finding was also mentioned in the study of Senitan
et al. [28]. Accordingly, in order to overcome this
difficulty, it was necessary to fortify the communication
program to improve the community awareness and
reduce their discrimination against ASD. The second
barrier was that heath staff at commune healthcare
facilities remained unconfident in using ASD screening
tool (MCHAT-23). Another obstacle was the absence
of an electronic connection system between levels to
manage information on children with ASD and trans-
fer favorably. This was a common difficulty encoun-
tered in developing or undeveloped countries [29].
Last but not least, there were difficulties regarding
health insurance policy implementation at provincial
level. The reason for this situation was that current
regulations on ASD have not been included as a clear
section in the Law on Health Insurance for uniform
implementation among provinces. With the strong
commitment of policymakers in revising health insur-
ance regulations as suggested in national workshop,
this issue is likely to be solved in the near future [16].
Limitations of the study
There are several limitations in this study. First, the
study settings of two Northern provinces should not
ensure to be representative for six ecological regions
of Vietnam. Therefore, as recommendation of stake-
holders, the piloting phase needs to be expanded to
other ecological regions and the appropriateness and
feasibility should continue to be evaluated before
applying the model on a national scale. Second, due
to the short period of piloting, the findings only pre-
sented the initial exploration of the appropriateness
and feasibility of 1-year piloting model. Further
research is required to evaluate the long-term indi-
cators such as the impact, sustainability, and scalability
of the model. Finally, since the research team was
involved in the development of the piloting model,
the positive bias could have occurred in the interpret-
ation of the study finding.
INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 7
Implication for international healthcare
management
The community-based ASD management model devel-
opment and pilot implementation in Vietnam could be
considered to other developing countries with the limited
resources or ASD discrimination existence: (i) Applying
empowerment approach could be helpful in reducing
the community stigma against ASD as well as saving
resources; (ii) Formulating and operating the ASD man-
agement model based on existing system and resources;
and (iii) Integrating ASD activities into the appropriate
ongoing programs/services at community/facilities.
Conclusion
The community-based ASD management model devel-
oped based on empowerment approach and focused on
health sector was demonstrated to be appropriate and
feasible with cultural context and existing resources
after 1 year of piloting. However, there were still
some difficulties that need to be solved in order to
improve the feasibility of the model once it is replicated
in Vietnam, such as stigma towards families having
children with ASD in the community, lack of electronic
connection system between levels to facilitate the refer-
ral, and barriers related to health insurance implemen-
tation at provincial level. Integrating ASD management
into existing community mental health program;
developing ASD intervention package that covered by
health insurance; and continuing training for commu-
nity and health staff should be implemented.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Funding
This work was supported by Ministry of Science and Tech-
nology: [Grant Number ĐTĐL.CN-26/16].
Notes on contributors
Hua Thanh Thuy, with a background in pharmacy, started
her career in Health Policy and Integration Department,
Hanoi University of Public Health in 2008. Working in a
multi-disciplinary environment, she participated in teaching
and research activities of Health Policy, Medical Ethics, and
Pharmaceutical Management. Her research expertise and
interests include health systems, access to medicines, and
community feedback.
Nguyen Thai Quynh Chi has been working at the Hanoi
University of Public Health as a lecturer and researcher for
nearly 15 years. She involves in teaching courses on Health
Psychology, Health Sociology, Ethics, Social Marketing,
and Hospital Marketing. Her research interests included
mental health, reproductive health, HIV/AIDS and social
determinants of health. She has participated in several
research projects and international publications.
8 H. T. Thuy et al.
Nguyen Thi Nga obtained the Bachelor of Public Health
(2010), Master of Public Health in Kingdom of Thailand
(2015). Nga has been working at Hanoi University of Public
Health for 9 years. Nga is teaching subjects on Health Com-
munication, Health Promotion, Social Marketing. Her
research interests are included but not limit to health lit-
eracy, adolescents and youth health, child health, mental
health, mother care, and HIV/AIDS.
Dinh Thu Ha has been working as a lecturer and researcher for
the Faculty of Social Sciences, Behavior and Health Education,
at Hanoi University of Public Health for 8 years. In 2016, she
obtained her Master degree in Public Health at the Institute
of Tropical Medicine Antwerp, Belgium, with an outstanding
thesis. Ha is interested in women’s health, mental health, and
cancer, with a more focus on qualitative research method.
Nguyen Thi Huong Giang has been a medical doctor special-
ized in child health with focus on rehabilitation for children
with autism spectrum disorders (ASD) and other disabilities
at the National Pediatric hospital for nearly 25 years. Giang
is also a researcher of the Research Institute of Child Health
and one of the first researchers on ASD in Vietnam.
Nguyen Thanh Huong is the Vice Rector of the Hanoi Univer-
sity of Public Health, while also being the Vice editorial director
of Journal of Health and Development Studies. With more than
20 years’ experience in health professional and academic activi-
ties, Prof. Huong has published in a range of high-quality jour-
nals in the areas of her expertise such as health system and
policy, mental health, child, adolescent, and women health.
ORCID
Nguyen Thai Quynh Chi http://orcid.org/0000-0002-
3112-8707
Nguyen Thanh Huong http://orcid.org/0000-0002-9493-
9590
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