Optimising informed consent in school-based adolescent vaccination programmes in England: A multiple methods analysis
Optimising informed consent in school-based adolescent vaccination programmes in England: A multiple methods analysis
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DOI：
10.1016/j.vaccine.2019.07.061
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发表时间：
2019-08-23
期刊：
影响因子：
5.5
通讯作者：
Mounier-Jack, Sandra
中科院分区：
文献类型：
--
作者：
Chantler, Tracey;Letley, Louise;Mounier-Jack, Sandra
为学校青少年免疫接种获得知情同意的过程为家庭参与提供了机会。然而，需要远程获得父母同意的事实增加了这一过程的复杂性，并可能对疫苗的吸收产生不利影响。我们进行了一项多方法分析，以检查在青少年免疫规划中获得知情同意的做法。这包括对2017年英国青春期女孩HPV疫苗计划服务评估中收集的39次免疫管理人员和提供者访谈中与同意相关的数据进行专题分析，以及对2017年父母和青少年对青少年疫苗接种态度调查中与同意相关问题的数据进行描述性统计分析。调查结果表明，不归还同意书对免疫接种团队来说是一个重大的后勤挑战，一些团队正在试点选择退出同意机制，增加同意自己接种疫苗的青少年比例，并引入电子同意。向家长和学校传达与疫苗有关的信息以及管理在获得青少年自我同意接种疫苗方面的不确定性是遇到的主要实际挑战。调查数据显示，尽管只有32%的父母与青少年讨论了疫苗接种问题，但父母和青少年对疫苗接种的决定总体上是一致的。父母对青少年自行同意接种疫苗的认识有限，青少年倾向于让父母做决定。从访谈和同意书的多变性可以明显看出，保健专业人员并不总是清楚管理同意程序的最佳方式。一些人还不熟悉自我同意过程，对评估“吉利克能力”缺乏信心。制定途径和相关干预措施，改善以学校为基础的青少年免疫规划的后勤和同意做法，可能有助于提高接种率。(C) 2019作者。Elsevier Ltd.出版。
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. (C) 2019 The Author(s). Published by Elsevier Ltd.