Optimising informed consent in school-based adolescent vaccination programmes in England: A multiple methods analysis

Tracey Chantler*, Louise Letley, Pauline Paterson, Joanne Yarwood, Vanessa Saliba, Sandra Mounier-Jack

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)

Abstract

The process of obtaining informed consent for school-based adolescent immunisation provides an opportunity to engage families. However, the fact that parental consent needs to be obtained remotely adds complexity to the process and can have a detrimental effect on vaccine uptake. We conducted a multiple methods analysis to examine the practice of obtaining informed consent in adolescent immunisation programmes. This involved a thematic analysis of consent related data from 39 interviews with immunisation managers and providers collected as part of a 2017 service evaluation of the English adolescent girls’ HPV vaccine programme and a descriptive statistical analysis of data from questions related to consent included in a 2017 survey of parents’ and adolescents’ attitudes to adolescent vaccination. The findings indicated that the non-return of consent forms was a significant logistical challenge for immunisation teams, and some were piloting opt-out consent mechanisms, increasing the proportion of adolescents consenting for their own immunisations, and introducing electronic consent. Communicating vaccine related information to parents and schools and managing uncertainties about obtaining adolescent self-consent for vaccination were the main practical challenges encountered. Survey data showed that parents and adolescents generally agreed on vaccine decisions although only 32% of parents discussed vaccination with their teenager. Parental awareness about the option for adolescents to self-consent for vaccination was limited and adolescents favoured leaving the decision-making to parents. From the interviews and variability of consent forms it was evident that health professionals were not always clear about the best way to manage the consent process. Some were also unfamiliar with self-consent processes and lacked confidence in assessing for ‘Gillick competency’. Developing pathways and related interventions to improve the logistics and practice of consent in school-based adolescent immunisation programmes could help improve uptake.

Original languageEnglish
Pages (from-to)5218-5224
Number of pages7
JournalVaccine
Volume37
Issue number36
DOIs
Publication statusPublished - 23 Aug 2019

Bibliographical note

Funding Information:
The research was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Immunisation (Grant reference: HPRU-2012-10096 ) at the London School of Hygiene and Tropical Medicine in partnership with Public Health England (PHE) . The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England.

Funding Information:
Tracey Chantler, Sadie Bell, and Sandra Mounier-Jack report that they were in receipt of funding from the National Institute of Health Research while conducting this research. Vanessa Saliba, Louise Letley and Joanne Yarwood worked for Public Health England for the duration of this research.

Funding Information:
We are grateful for the information shared freely by interview and survey participant and for the support provided by Jo Ferrie and Patricia Stevens in the development of research tools for the qualitative evaluation. SMJ participated in the design of the study, supported data collection and analyses of the qualitative evaluation, and helped draft the manuscript. TC wrote the manuscript, led the design and analysis of the qualitative study. LL and JY led the design of the survey and the data analysis and wrote the relevant finding section. VS and PP conducted the review of consent forms and wrote the relevant findings section. All authors supported the development of the manuscript and approved the final version. The research was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Immunisation (Grant reference: HPRU-2012-10096) at the London School of Hygiene and Tropical Medicine in partnership with Public Health England (PHE). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England. Tracey Chantler, Sadie Bell, and Sandra Mounier-Jack report that they were in receipt of funding from the National Institute of Health Research while conducting this research. Vanessa Saliba, Louise Letley and Joanne Yarwood worked for Public Health England for the duration of this research.

Publisher Copyright:
© 2019 The Author(s)

Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.

Keywords

  • Adolescence
  • Communication
  • Immunisation
  • Informed consent
  • Multiple-methods research
  • Vaccination

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