Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom.
Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom.
Vaccine. 2019 Jan 14;37(3):417-429. doi: 10.1016/j.vaccine.2018.12.007. Epub 2018 Dec 17.
The recent global expansion of routine adolescent vaccination programmes has the potential to protect young people against infectious diseases and improve their health. Although the legal framework in many countries permits young people to consent for vaccinations if competent, lack of written parental consent can still prevent uptake. We aimed to review systematically the associated barriers and enablers to implementation of adolescent self-consent procedures.
A comprehensive search strategy of ten databases from inception to June 2018 was undertaken to identify relevant qualitative and quantitative studies. Titles, abstracts and full texts were assessed for eligibility, and the methodological quality of eligible primary studies evaluated. Thematic synthesis methods were used to interpret and combine qualitative data, and to identify overarching themes as well as similarities and differences within themes. Quantitative data were summarised and, because the data were sufficiently similar in focus, were integrated within the qualitative framework.
Twenty-five publications related to 23 studies were included. Three themes were identified which related to the policy framework, protection, and self-determination. Despite supportive national policy frameworks, implementation of adolescent self-consent procedures can be prevented by local policies, professionals' misunderstandings of the legal framework and the context in which the vaccination programme is delivered. Motivation to protect young people's health increased acceptability of adolescent self-consent, but implementation might be prevented to protect the reputation of professionals or relationships with parents. Further, maintaining the role of parents as decision-makers for their child's healthcare was frequently prioritised over enabling young people's autonomy to consent.
Barriers to the implementation of adolescent self-consent procedures have implications for young people's health and uptake of vaccination programmes. There is a need to clarify the policy framework and challenge the primacy of parental consent.
PROSPERO CRD42017084509.
最近，常规青少年疫苗接种计划在全球范围内的扩展，有可能保护年轻人免受传染病的侵害，改善他们的健康状况。尽管许多国家的法律框架允许年轻人在有能力的情况下对疫苗接种进行同意，如果没有书面的父母同意，仍然可以阻止接种。我们旨在系统地审查实施青少年自我同意程序的相关障碍和促进因素。
从开始到 2018 年 6 月，我们进行了全面的数据库搜索策略，以确定相关的定性和定量研究。评估标题、摘要和全文的资格，并评估合格的主要研究的方法质量。使用主题综合方法解释和综合定性数据，并确定总体主题以及主题内的相似点和差异点。对定量数据进行总结，由于数据在重点上足够相似，因此将其纳入定性框架内进行整合。
有 25 篇出版物与 23 项研究相关，确定了三个与政策框架、保护和自我决定相关的主题。尽管有支持性的国家政策框架，但地方政策、专业人员对法律框架的误解以及疫苗接种计划实施的背景都可能阻止青少年自我同意程序的实施。保护年轻人健康的动机提高了对青少年自我同意的可接受性，但为了保护专业人员的声誉或与父母的关系，可能会阻止实施。此外，将父母作为其子女医疗保健决策人的角色经常优先于年轻人自主同意的权利。
实施青少年自我同意程序的障碍对年轻人的健康和疫苗接种计划的接种率有影响。有必要澄清政策框架，挑战父母同意的首要地位。
PROSPERO CRD42017084509。
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