Bridging the Gap in Early Cerebral Palsy Detection: Primary Care Providers' and Specialists' Perspectives on Implementing PROMPTs for Referral

BACKGROUND: Cerebral palsy (CP) is the most common childhood-onset physical disability. Although diagnosis can be made within the first year of life, many children, particularly those with milder presentations, are diagnosed well after their second birthday. Delayed recognition limits access to early interventions and increases caregiver stress. The Early Detection and Intervention Toolkit for CP (EDIT-CP) was developed to bridge this gap, including PROMPTs for referral (Primary-care Referral of Motor-impaired children: Physician Tools) to guide early identification in primary care. OBJECTIVES: This study aimed to explore how PROMPTs can be optimized and implemented across Canadian healthcare contexts. Specifically, we explored (1) primary care providers' perspectives on PROMPTs' feasibility, usability and integration into well-baby visits and surveillance tools; and (2) paediatric specialists' perspectives on referral patterns, age of diagnosis, barriers to early detection and system-level dissemination strategies. METHODS: In a qualitative study design, participants were first provided access to EDIT-CP and PROMPTs for referral for review prior to data collection. Semi-structured interviews were then conducted with primary care providers (n = 11), and a focus group (n = 7) and interviews with paediatric specialists (n = 2) to explore their perspectives on feasibility, usability, referral patterns and system-level implementation. Data were analysed using a hybrid inductive-deductive approach. RESULTS: Primary care providers highlighted the importance of clearer referral thresholds and pathways, with PROMPTs perceived as a useful facilitator. Specialists highlighted progress in earlier diagnosis for infants with high probability of CP, ongoing hesitancy to diagnose before age two and inequities in access. Both groups valued embedding PROMPTs for referral into existing workflows, emphasized the need for training and dissemination strategies and underscored the importance of communication with families. CONTRIBUTION: Findings show strong alignment among providers on the need for structured, practical and scalable early detection pathways. PROMPTs for referral extend early detection into frontline practice, offering a strategy to reduce diagnostic delays and promote equitable access to early intervention for children with CP.