Tele-delivered caregiver coaching for autism in South Africa – A mixed-methods study of acceptability, appropriateness and feasibility

Objective Tele-delivered interventions can benefit autistic children and families in low-resource settings, but the digital divide may worsen existing disparities. To address this, we adapted a Naturalistic Developmental Behavioural Intervention (NDBI)-based caregiver coaching program for tele-delivery to enhance fit for low-resource families in Cape Town, South Africa. This manuscript examines the contextual fit (acceptability, appropriateness, feasibility) and implementation facilitators/barriers of the adapted intervention. Methods A mixed-method design was used to assess implementation outcomes in a pilot study of 16 participants (caregivers and practitioners), with quantitative (Acceptability of Intervention Measure, AIM; Intervention Appropriateness Measure, IAM; Feasibility of Intervention Measure, FIM) and qualitative data. Quantitative data were analysed using descriptive statistics and qualitative interview data using framework analysis. Results Quantitative data showed high scores for acceptability, appropriateness and feasibility (AIM intervention materials = 4.5/5; AIM session structure = 4.4/5; IAM intervention materials = 4.6/5; IAM session structure = 4.5/5; FIM session structure = 4.4/5), supported by qualitative findings. Barriers included small text size on intervention materials and internet connectivity. Facilitators included minimal text in intervention materials, an accessible delivery platform (WhatsApp), collaborative caregiver-practitioner relationships, data and technical support, protected practitioner time, and school leadership support. Conclusion This is one of the first studies in a LMIC to assess implementation of an asynchronous autism caregiver coaching program delivered entirely via a low-cost instant messaging platform (WhatsApp). Findings suggest the tele-delivered intervention fit well in this low-resource South African setting. Results are promising, and evaluating caregiver and child outcomes is a key next step.