Autonomy and Parental Consent Decisions for Public Health Interventions: a Qualitative Meta-synthesis of School Age Vaccination

Background: The issue of consent for vaccine programmes has been highlighted recently by global pandemic caused by COVID – 19 and the need for rapid uptake of vaccinations. ‘Vaccine hesitancy’ is now an ordinary part of the conversation when discussing population-based programmes aimed at reducing the spread of disease. To provide, refuse or delay consent is has often seen as tangible expression of the acceptability of public health intervention, but debate has started to include the consent process itself, particularly where one person is making the decision for another e.g parent for child. In developed countries parental consent is required prior to vaccination of children. Health professionals are trained to provide medical facts to parent to help them make a choice but not to interfere in personal decisions. However, deciding whether to consent to or refuse vaccination on behalf of a child can be a difficult task for some parents and there is little understanding of the influences that facilitate or impede parents’ decision making.The following question was posed: What influences parents’ decisions to provide or refuse their consent for inclusion into public health programmes aimed at their school age children (4-18 years) in developed national healthcare systems? Methods: This is a systematic review that uses qualitative meta-synthesis. PsychINFO, PsycARTICLES, MEDLINE and the International Bibliography of the Social Sciences were searched for papers. After screening abstracts and full texts, 14 papers were subject to quality standards review and ultimately nine papers were included in the final review. First, second, and third order constructs were identified. First order constructs were taken as participant views, interpretations put forward by the papers’ authors were deemed second order constructs, before any commonalities were identified and grouped into third order constructs that were subsequently arranged into seven major analytical themes. Findings: Parents’ provide or refuse consent based on more than the factual, evidence-based information supplied by health professionals. Personal information from a trusted source often has more influence, with parents valuing this ‘evidence’ as much as traditional scientific information. Consent decisions reflect the fact that people are inherently social beings that are politically and economically located in society. Parents’ consent decisions are influenced by a complex web of circumstances. Conclusion: We should not think of consent for public health interventions in simplistic terms i.e. where medically factual information is provided by health professionals on with no other input and on which we expect parents to make a decision. This is an outdated mode of operating based on medical model of health.