Improving Autism-Friendly Practices among Pediatric Hospital Personnel: Protocol for a Randomized Controlled Trial

Introduction: Autistic children may experience avoidable distress and barriers during hospital care when sensory, communication, and predictability needs are not adequately accommodated. Pediatric hospital personnel frequently report limited autism-related knowledge and preparedness. This trial aims to evaluate whether a structured educational program improves personnel knowledge, attitudes, and perceived implementation of autism-friendly practices.

Methods: A single-center, parallel-group randomized controlled trial with repeated measurements will be conducted among clinical and non-clinical personnel with at least six months of experience at “P. & A. Kyriakou” Children’s Hospital, Athens, Greece. After baseline assessment and written informed consent, participants will be randomly allocated to an intervention or delayed-intervention control group. The intervention comprises two three-hour face-to-face sessions combining theoretical instruction, case-based discussion, role-playing, and simulation, supported by recorded materials and a two-hour booster webinar at six months. Controls will initially receive a brief educational guide. Outcomes will be evaluated using the 19-item Knowledge about Childhood Autism among Health Workers questionnaire, the 16-item Societal Attitudes Toward Autism scale, and the newly developed 24-item Autism-Friendly Hospital Assessment Tool. The latter will undergo content and face validation, construct-validity assessment, internal-consistency testing, and test–retest reliability evaluation. Outcomes will be measured at baseline and during follow-up to 12 months, and group-by-time changes will be analyzed using repeated-measures models. Sample size will be determined by a priori power analysis (f = 0.25, α = 0.05, power = 80%), allowing for 15–20% attrition. Ethics approvals have been obtained from the National and Kapodistrian University of Athens and the participating hospital.

Results: The primary hypothesis is that multimodal education will produce greater short-term and sustained improvements in knowledge, attitudes, and perceived autism-friendly practices than written information alone. Exploratory analyses will assess whether effects differ by professional role, experience, previous autism training, and contact with autistic children. Recruitment, attendance, completion, and attrition will inform feasibility and scalability. The AFHAT evaluation will additionally examine content, face, and construct validity, internal consistency, and test–retest reliability.

Conclusions: This trial will test a scalable, hospital-wide educational approach and inform the development of structured, family-centered, autism-responsive pediatric care.