Brazil’s Pharmacists Pass the Autism Knowledge Test in First National Survey

Pharmacists are often the most accessible health professionals in any community. In Brazil, where a large share of the population walks into a pharmacy before ever booking a medical appointment, the person behind the counter may be the first point of contact for a family worried about a child’s development. That makes what pharmacists know about autism spectrum disorder, or ASD, far more than an academic question. A new nationwide survey, published in BMC Health Services Research, has now provided the first comprehensive picture of how well Brazilian pharmacists understand the condition, and the results are strikingly positive.

The study, led by Larissa Couto-Rosa and colleagues at the Federal University of Espírito Santo, set out to fill a conspicuous gap. International research had repeatedly suggested that pharmacists in many countries hold unsatisfactory knowledge about ASD, which can interfere with the quality of care they deliver. Yet until now, no nationwide study had ever assessed the knowledge of Brazilian pharmacists about the disorder. Given that Brazil has one of the largest pharmacy workforces in the world and a universal health system that relies heavily on pharmaceutical services, the absence of such data was a genuine blind spot in health services research.

To close that gap, the team conducted a cross-sectional survey running from June 2021 to August 2022. Pharmacists from all five regions of Brazil were selected by convenience sampling and answered an online questionnaire, open from June 2021 to February 2022, that collected sociodemographic information and measured both knowledge and stigma related to ASD. The instrument at the heart of the study was the Brazilian version of the Autism Stigma and Knowledge Questionnaire, known as the ASK-Q, a validated tool that breaks understanding of autism into distinct domains: diagnosis, etiology, and treatment, alongside items probing stigmatizing attitudes.

The technical thresholds of the ASK-Q are worth understanding, because they set a demanding bar. To be classified as having adequate knowledge, respondents needed to score at least 92.3 percent on the diagnosis domain, 88.7 percent on etiology, and 92.9 percent on treatment. On the stigma scale, the expectation is even stricter: respondents should not endorse stigma at all, with the cut-off set at 99.01 percent. These are not lenient benchmarks. They require near-complete mastery of facts about how autism is identified, what causes it, and how it is treated, as well as the complete absence of misconceptions that have historically surrounded the condition.

Against those demanding standards, the 413 participating pharmacists performed remarkably well. Almost all respondents demonstrated adequate knowledge in every clinical domain: 99.0 percent reached the threshold for etiology, 99.0 percent for diagnosis, and 98.8 percent for treatment. Perhaps most striking of all, every single participant, 100.0 percent, declined to endorse stigma toward people with autism. In a field where international studies have often painted a more troubling picture of gaps and misconceptions among frontline health workers, the Brazilian results stand out as an unusually strong foundational understanding of the disorder.

The survey also revealed a clear pattern in where that knowledge came from. Pharmacists who had a family member with ASD achieved the highest rates of correct answers in the diagnosis domain, a difference that was statistically significant with a p-value below 0.001. Similarly, pharmacists who had direct contact with a person with autism scored highest on the etiology and diagnosis domains, with p-values of 0.004 and 0.002 respectively. In other words, personal exposure to autism, whether through family ties or professional and social contact, was the strongest predictor of deeper understanding. Knowledge, it seems, travels through lived experience more powerfully than through formal training alone.

The demographic profile of the sample adds important context. The majority of participants, 81.1 percent, were women, which mirrors the composition of the pharmacy profession in Brazil and much of the world. The researchers emphasize that the sample was comprehensive, spanning different age groups and socioeconomic backgrounds across the country’s five regions, which strengthens the generalizability of the findings. At the same time, they are candid about a key limitation: because convenience sampling was used, individuals with greater awareness of or interest in autism may have been more likely to agree to participate. That means the true national average could plausibly be lower than the near-perfect scores reported, a caveat that any interpretation of the results must carry.

The study was conducted with rigorous ethical oversight. It was approved by the Human Research Ethics Committee under registration CAAE 39222520.6.0000.8151, carried out in accordance with the Declaration of Helsinki, and all participants provided informed consent and agreed to confidentiality and privacy statements. The statistical analysis was appropriately matched to the data: descriptive statistics summarized the sample, the Mann-Whitney test compared unpaired samples, and the chi-square test assessed associations with categorical variables. The research received no external financial support and was conducted by a team affiliated with the Federal University of Espírito Santo and the Federal University of Catalão.

Why does pharmacist knowledge about autism matter so much in practice? Pharmacists occupy a unique position in the medication-use system. They counsel families starting new therapies, monitor for adverse effects and drug interactions, and increasingly participate in pharmaceutical care programs within Brazil’s unified health system, the SUS. For autistic patients, who may take psychotropic medications or manage co-occurring conditions, a pharmacist who understands the disorder can communicate more effectively, adapt counseling to sensory and communication needs, and flag inappropriate prescriptions. Conversely, a pharmacist who misunderstands autism may reinforce myths, dismiss family concerns, or fail to recognize when a referral is needed. The near-universal absence of stigmatizing attitudes found in this survey is particularly encouraging, because stigma is often the hardest barrier to dismantle.

The authors argue that their findings should feed directly into policy and education. The results, they write, may contribute to strategies to improve knowledge about ASD, such as continuing education programs, integrating autism training into pharmacy curricula, and public health campaigns. They may also influence public policies, clinical practices, and future research in pharmacy and autism care. Given the strong baseline documented here, the priority shifts from remediation to refinement: embedding structured ASD content into professional education so that understanding does not depend on personal contact with an autistic person. For a profession that sees millions of Brazilians every day, even incremental gains in knowledge could translate into earlier recognition of developmental concerns and better support for autistic individuals and their families, long before they reach a specialist’s office.

Subject of Research: Pharmacists' knowledge and stigma regarding autism spectrum disorder in Brazil

Article Title: Pharmacists’ knowledge about Autism Spectrum Disorder – a national survey

Article References: Couto-Rosa, L., Schultz, P. V., Brambila-Manso, B., Rocha, K. S., Ayres, L., Araújo, D. C., & Santos-Júnior, G. A. D. (2026). Pharmacists’ knowledge about Autism Spectrum Disorder – a national survey. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15564-1

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15564-1

Keywords: autism spectrum disorder, pharmacists, Brazil, national survey, health services research, ASK-Q questionnaire, stigma, pharmaceutical care, continuing education, cross-sectional study, public health, diagnosis knowledge