Service use disparities within the autism spectrum disorder (ASD) field are particularly relevant for parent-mediated interventions, and may suggest a lack of fit between these interventions and the needs of underserved community settings. The present project attempted to understand and address these disparities through two studies. In the first study, Rogers' Diffusion of Innovations theory was used to guide a research-community partnership aimed at understanding the perceived compatibility, complexity, and relative advantage, as well as the structural barriers to using an evidence-based, parent-mediated intervention for ASD (i.e. Project ImPACT) within a Medicaid system. Three focus groups were conducted with 16 Medicaid-eligible parents, and 3 focus groups were conducted with 16 ASD providers working within a Medicaid system. Across all groups, parents and providers reported general interest in using Project ImPACT but emphasized the need to: 1) reduce the complexity of written materials; 2) better support families in practicing the intervention within their pre-existing routines; 3) allow for a more flexible program delivery; 4) involve the extended family; and 5) ensure a strong parent-therapist alliance. These findings were used to propose an adapted delivery model for Project ImPACT in collaboration with the same community partner. After doing so, the primary aim of the second study was to determine whether these adaptations influenced parents' and providers' perception of program attributes specific to Roger's theory and their intent to use the program. Eighty-two parents and eighty providers from a variety of socioeconomic backgrounds participated in the second study. Participants were randomized so that they watched a presentation of either the original or adapted Project ImPACT program. After watching the presentation, participants rated the following: 1) demographic information; 2) Project ImPACT attributes (i.e. compatibility, complexity, and relative advantage); 3) perceived structural barriers; and 4) intent to use the program. Two-way, between-subjects ANOVAs were run to examine the impact of program type (original vs. adapted), participant SES (i.e. Medicaid vs. non-Medicaid), and their interaction on perceptions of program attributes, perceived structural barriers, and intent to use the program. Results showed a significant main effect of SES and a marginal main effect of program type on parents' report of perceived structural barriers to using Project ImPACT. There was no main effect of program type or SES on parents' ratings of program attributes or intent to use. However, there was a significant interaction between SES and program type such that Medicaid-eligible parents rated the adapted program more favorably. Although Medicaid-eligible parents also tended to report greater intent to use the adapted program, this interaction was marginally significant. For providers, there was no main effect of program type, caseload SES, or their interaction on ratings of program attributes or intent to use. However, qualitative follow-up for both parents and providers demonstrated important differences in how participants discussed the strengths and weaknesses of the original versus adapted program. Results from the present study suggest that research-community partnerships may be beneficial in increasing the fit and relevance of parent-mediated interventions for ASD within low SES settings. Importantly, Roger's Diffusion of Innovations theory may be a framework that can be used by researchers to guide and test adaptations to parent-mediated interventions for use within a variety of community settings.
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