Karafillakis E, Peretti-Watel P, Verger P, Chantler T, Larson H J
Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
UMR Vitrome, AMU, IHU Méditerrannée, IRD, Marseille, France; Southeastern Health Regional Observatory (ORS Paca), Marseille, France.
Vaccine. 2021 Sep 24;39(40):5741-5747. doi: 10.1016/j.vaccine.2021.08.096. Epub 2021 Sep 2.
Mothers are often responsible for vaccination decisions in the household. However, their confidence in certain vaccines such as Human Papillomavirus (HPV) vaccines is eroding in some countries. France is one of the countries with the lowest HPV vaccine uptake in Europe, with parents delaying or refusing the vaccine for their adolescent daughters due to safety- and effectiveness-related concerns. Although parental consent is required for vaccination, adolescents' involvement in HPV vaccination decision-making could improve vaccine uptake, with self-consent procedures already introduced in some countries. Adolescents' capacity to engage in decision-making is influenced by their maturity and autonomy in health. This study explored the role of maturity in decision-making around HPV vaccination in France through qualitative interviews with adolescent girls (n = 24) and their mothers (n = 21) and two focus groups with adolescent girls (n = 12). A codebook approach to thematic analysis revealed that adolescent girls' involvement in HPV decision-making is a process that evolved with maturity. As adolescents progressed towards maturity at different speeds, some expressed childlike traits such as impulsive decisions and others described more rational, reflective decision-making. Despite these differences, most adolescents in this study described a passive role in HPV vaccination decision-making, following their parents' lead. However, their expressed desire for information and involvement in discussions indicates that their lack of engagement may not only be due to a lack of maturity but also a result of mothers and doctors excluding them from getting involved. Furthermore, as health behaviours are shaped during adolescence, the influence of vaccine hesitant mothers on their daughters' own views and beliefs could be significant, together with exposure to regular controversies in the mainstream media. Individualised approaches to engage adolescents in decision-making around their own health are needed, for example through strengthening discussions and information around HPV vaccination with parents and doctors.
母亲通常负责家庭中的疫苗接种决策。然而，在一些国家，她们对某些疫苗（如人乳头瘤病毒（HPV）疫苗）的信心正在下降。法国是欧洲HPV疫苗接种率最低的国家之一，由于对安全性和有效性的担忧，家长们会推迟或拒绝为青春期女儿接种该疫苗。虽然疫苗接种需要家长同意，但青少年参与HPV疫苗接种决策可能会提高接种率，一些国家已经引入了自我同意程序。青少年参与决策的能力受到其健康方面成熟度和自主性的影响。本研究通过对青春期女孩（n = 24）及其母亲（n = 21）进行定性访谈，以及对青春期女孩（n = 12）进行两个焦点小组讨论，探讨了成熟度在法国HPV疫苗接种决策中的作用。一种主题分析的编码手册方法显示，青春期女孩参与HPV决策是一个随着成熟度而演变的过程。随着青少年以不同速度走向成熟，一些人表现出冲动决策等孩子气的特征，而另一些人则描述了更理性、反思性的决策。尽管存在这些差异，但本研究中的大多数青少年表示在HPV疫苗接种决策中处于被动角色，听从父母的安排。然而，她们表达的对信息的渴望以及参与讨论的意愿表明，她们缺乏参与可能不仅是因为不够成熟，也是母亲和医生将她们排除在外的结果。此外，由于健康行为在青春期形成，疫苗犹豫的母亲对女儿自身观点和信念的影响可能很大，同时主流媒体上经常出现相关争议。需要采取个性化方法让青少年参与围绕自身健康的决策，例如通过加强与家长和医生关于HPV疫苗接种的讨论和信息交流。
