Design, Implementation, and Evaluation of an Online Educational Training Program for Nurses on Autism Spectrum Disorder (ASD) in Kazakhstan

Abstract

Introduction: Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental condition that represents an important global health challenge due to its early onset, lifelong impact, and significant contribution to non-fatal disease burden. Despite increasing international recognition, substantial inequalities remain in the identification, diagnosis, and management of ASD, particularly in low- and middle-income countries. Nurses represent the largest and most accessible segment of the healthcare workforce and play a crucial role in early recognition, referral, and support for autistic individuals and their families. However, many nurses lack sufficient knowledge, training, and confidence related to ASD, which may contribute to delayed identification and fragmented care pathways. Aim: The aim of this study is to assess nurses’ knowledge, beliefs, practice challenges, and training needs related to Autism Spectrum Disorder and by developing, implementing, and evaluating a culturally adapted, evidence-based online training program for nurses. Methods: This research employed a multi-phase mixed-methods design guided by the Intervention Mapping (IM) framework and adult learning theory. Phase I involved a nationwide needs assessment to examine nurses’ knowledge, beliefs, and training needs. Phase II focused on the development of an online training program informed by the needs assessment findings and relevant literature. The program consisted of structured modules incorporating case-based learning, multimedia materials, and short knowledge assessments. Phase III involved the implementation of the training program through two online rollouts using the GetCourse platform among nurses from the National Center for Children’s Rehabilitation in Kazakhstan. Phase IV evaluated program effectiveness using pre- and post-training surveys, engagement data, and participant feedback. Results: The needs assessment involving 201 nurses revealed significant gaps in ASD knowledge, widespread misconceptions, inconsistent awareness of referral pathways, and limited prior training exposure, despite frequent clinical contact with autistic children. Over half of the nurses reported difficulties recognizing ASD, nearly half had never attended ASD-related training, and more than 90% expressed strong interest in structured education. A 14-hour, seven-session online training program was developed and received excellent expert evaluations (9.7-10/10) for relevance and clinical applicability. Implementation across two pilot rollouts demonstrated feasibility, acceptable engagement, and strong completion. Evaluation results showed statistically significant improvements in nurses’ self-reported confidence across ASD knowledge domains and key self-efficacy skills (Mann-Whitney U tests, p < 0.05), with medium to large effect sizes. Conclusion: This thesis provides empirical evidence from Kazakhstan on the feasibility and effectiveness of a culturally adapted online ASD training program for nurses. The findings demonstrate the potential of scalable digital education to strengthen nursing workforce capacity and improve preparedness for autism care in resource-constrained healthcare systems.