AquOTic: protocol for a type 1 hybrid effectiveness-implementation trial of an occupational therapy-based water competency intervention for children on the autism spectrum.

Abstract

Drowning is a leading cause of unintentional death among children on the autism spectrum, emphasising the need for tailored water competency interventions. Autism-related factors such as wandering, sensory differences and limited danger awareness increase drowning risk. Evidence suggests structured aquatic programmes improve water safety, yet guidance on effective components and implementation fidelity in community settings remains limited. This type 1 hybrid effectiveness-implementation randomised controlled trial will evaluate AquOTic, an occupational therapy-based water competency intervention for children on the autism spectrum aged 5-9 years. A total of 108 participants will be randomised into three arms: (1) AquOTic delivered by professional student swim buddies, (2) AquOTic delivered by community swim buddies and (3) usual water exposure control. Primary outcomes include water competency and swim skills measured by standardised performance-based and caregiver-report measures. Secondary aims assess implementation determinants (fidelity, engagement, attitudes) using mixed methods, while exploratory analyses calculate costs and resources. Ethical approval has been obtained from The Ohio State University Institutional Review Board (protocol number: STUDY20250101). Written informed consent will be obtained from parents or legal guardians and assent from children when appropriate. Findings will be disseminated through peer-reviewed publications, conference presentations and partnerships with community organisations involved in autism and water safety. NCT07076264.