The evidence informing Patient Preview

Predictability and visual preparation

Visiting an unfamiliar healthcare environment can be stressful for anyone. For people on the autism spectrum, uncertainty, sensory sensitivities and communication difficulties can create significant barriers to accessing care.

Research highlights the serious consequences of these barriers, alongside the value of predictability, visual communication and preparation in helping people navigate unfamiliar experiences.

Patient Preview draws on these established approaches to help make healthcare environments more familiar, understandable and accessible.

Serious barriers, serious consequences

Research published in BMJ Open in 2022 found that adults on the autism spectrum experienced substantially greater difficulties accessing primary healthcare than adults without autism.¹

An international survey involving 507 adults on the autism spectrum and 157 adults without autism found the following:

Local research involving almost 36,000 Australians on the autism spectrum found a mortality rate more than twice that of the general population.

The science behind visual communication

The importance of predictability

Predictability is an important consideration in creating autism-friendly healthcare environments.

In 2023, researchers published the Autistic SPACE framework, identifying five key considerations for improving healthcare accessibility for people on the autism spectrum: Sensory needs, Predictability, Acceptance, Communication and Empathy.²

The framework specifically recommends providing clear information in advance, including photographs or videos of healthcare environments and staff, to help patients know what to expect.

Australian autism organisations, including Autism Association of Western Australia and Autism Spectrum Australia (Aspect), also provide guidance on structured supports, visual schedules and advance information to help people understand routines, anticipate transitions and prepare for changes.³ ⁴

Knowing what to expect can help make unfamiliar experiences more manageable, particularly for people who experience anxiety or difficulty with uncertainty.

How visual aids can help

Visual resources such as photographs, diagrams, schedules and step-by-step instructions can make information more accessible and unfamiliar situations easier to understand.

This may be particularly beneficial for some people on the autism spectrum who demonstrate strengths in visual processing, including recognising patterns and identifying fine details. Research has also identified differences in brain activity associated with visual processing, although these differences do not necessarily indicate superior visual abilities in every individual or task.⁵

Unlike spoken explanations, visual resources can be revisited as often as needed, allowing people to process information at their own pace.

A peer-reviewed review of visual supports published in Autism identified their potential to increase predictability, support communication, encourage participation and reduce anxiety. However, the authors also noted limitations in the available evidence, particularly for visual supports used outside educational settings.⁶

Research and professional guidance suggest that visual schedules and related supports can help some people follow routines, understand sequences of activities and participate more independently.³ ⁴ ⁶ ⁷

The effectiveness of these approaches varies according to individual needs, the type of visual support and how it is used.

Why real images matter

Photographs can provide a particularly useful way to communicate information about real people, objects and environments.

A study published in the Journal of Autism and Developmental Disorders found that children on the autism spectrum remembered newly learnt object names more accurately when presented with colour photographs rather than black-and-white cartoons.⁸

Although this research examined word learning rather than healthcare preparation, it suggests that realistic photographs may offer advantages over simplified illustrations for certain learning tasks.

Importantly, the Autistic SPACE framework also specifically recommends providing photographs or videos of healthcare environments and staff to help patients prepare for visits.²

Patient Preview is informed by research and established professional guidance on accessibility and visual supports. Its individual resources have not yet been independently evaluated for their effects on patient anxiety or healthcare outcomes. We welcome any feedback, suggestions or research opportunities.

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