Abstract
<title>Abstract</title> <p> <bold>Background:</bold> Early detection, early diagnosis, and early intervention are critical for rehabilitation of children with intellectual disability (ID). However, little is known concerning the delays within this service continuum in low-resource, multi-ethnic regions of China. <bold>Objective:</bold> This study aimed to investigate the current pathway of such service continuum among children with ID in Hainan Province, China, and to identify the associate factors of the service delays. <bold>Methods:</bold> A mixed-methods design was used. Quantitatively, we surveyed 198 parents of children with ID across 11 institutions in Hainan and conducted descriptive, univariate, and multivariate analysis. Qualitatively, we interviewed 11 parents of children with autism spectrum disorder from the same 11 institutions using a CFIR-based semi-structured protocol and analyzed the data using template analysis. Finally, the quantitative and qualitative findings were integrated. <bold>Results:</bold> Symptoms were first identified by family members in the majority of children with ID (71.2%). The average ages at detection, diagnosis, and intervention initiation were (2.24±1.12), (2.72±1.27) and (3.09±1.37) years, respectively, indicating a mean interval of 0.48 years (approx. 5.8 months) from detection to diagnosis, and 0.37 years (approx. 4.4 months) from diagnosis to the start of intervention. Family-, health system-, and social-level factors jointly influenced the time of detection, diagnosis and intervention initiation. Low primary healthcare capacity and negative family interactions were barriers to seeking early detection. In contrast, a higher education level of caregivers served as a facilitator. Although health screening offered diagnostic cues, diagnostic delays were still common. Beyond socioeconomic disadvantage of culturally entrenched belief, the insufficient provider expertise, parental misconceptions and psychological resistance also hindered timely diagnosis. Besides, multidimensional, socioculturally specific family challenges resulted in intervention delay, including male authority, deeply ingrained belief, ethnic minority status, and psychological resistance. <bold>Conclusions:</bold> Timely accessing the ID service in low-resource, multi-ethnic regions of China remain sub-optimal. Enhancing primary healthcare capacity, improving parents’ health literacy, empowering socioeconomically disadvantaged families are essential strategies to ensure children with ID access timely detection, diagnosis and intervention. <bold>Trial registration:</bold> No registration required. </p>