Participatory Systems Mapping to Explore Underserved Autistic People's Journey through Primary Healthcare

Autistic people experience poorer health outcomes and significant barriers to healthcare. Research has historically excluded autistic people from underserved backgrounds, such as those from racially minoritised communities, low-income households, individuals with co-occurring learning disabilities, or those who are non- or minimally speaking. Consequently, there is limited evidence on how healthcare systems can meet the needs of the most disadvantaged. This paper evaluates an innovative practice in autism research, combining co-production with Participatory Systems Mapping and creative methods to explore the healthcare experiences of underserved autistic adults. We co-designed workshops with a steering group of autistic adults from underserved groups (n= 6) using persona development, user journey mapping, and stakeholder prioritisation to evaluate and interrogate causal relationships in healthcare access. Thirty-one participants took part across four workshops from underserved community groups in South Yorkshire. The sample included representation from Somali and Black African communities (35.5%) and participants from areas of high deprivation according to the Index of Multiple Deprivation (Mdn= 2, Range= 1–9). There was also some involvement of autistic people with co-occurring learning disabilities and those who were non- or minimally speaking. Feedback from the workshops demonstrated that participants felt able to share ideas and experiences. A validated causal loop diagram was produced with the steering group ("Misalignment-Invalidation Cycle"), illustrating how communication barriers and clinician invalidation generate reinforcing loops of misalignment in understanding and disengagement from healthcare. Ultimately, this approach provides a practical blueprint for engaging underserved autistic people and generating actionable insights to inform more inclusive healthcare interventions.