Electronic consent for school-age vaccinations: a rapid review

Electronic consent for school-age vaccinations: a rapid review | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Electronic consent for school-age vaccinations: a rapid review Chukwudi Okolie , Golibe Ezenwugo , Mai Barry , Kerryann Richmond-Russell , Simon Cottrell doi: https://doi.org/10.1101/2025.05.15.25327678 Chukwudi Okolie 1 Public Health Wales Vaccine Preventable Disease Programme , Wales, United Kingdom Find this author on Google Scholar Find this author on PubMed Search for this author on this site For correspondence: chukwudi.okolie{at}wales.nhs.uk Golibe Ezenwugo 2 Public Health Wales Evidence Service , Wales, United Kingdom Find this author on Google Scholar Find this author on PubMed Search for this author on this site Mai Barry 1 Public Health Wales Vaccine Preventable Disease Programme , Wales, United Kingdom Find this author on Google Scholar Find this author on PubMed Search for this author on this site Kerryann Richmond-Russell 1 Public Health Wales Vaccine Preventable Disease Programme , Wales, United Kingdom Find this author on Google Scholar Find this author on PubMed Search for this author on this site Simon Cottrell 1 Public Health Wales Vaccine Preventable Disease Programme , Wales, United Kingdom Find this author on Google Scholar Find this author on PubMed Search for this author on this site Abstract Full Text Info/History Metrics Data/Code Preview PDF Abstract Background The use of digital or electronic processes for gathering consent to immunisation for school-age vaccinations (“e-consent”) has the potential to improve the efficiency of the process. However, little is known currently about the effectiveness of e-consenting or implications on vaccination uptake and equity. Methods MEDLINE, Embase, Cochrane Library, Scopus, PsycINFO, and Google Scholar were systematically searched for relevant publications from January 2000 until November 2024. Studies included in this review reported impact data on the use of digital or electronic processes as a means of obtaining informed consent for school-aged vaccinations. The quality of research included in the rapid review was assessed using the JBI critical appraisal tool for assessment of risk of bias for randomised controlled trials, the JBI checklist for quasi-experimental studies, and the mixed methods appraisal tool (MMAT). A narrative synthesis approach was used to analyse data and present findings. Results Four studies met the criteria for inclusion in the review. Included studies were conducted in the UK (n = 2) and USA (n = 2). Overall, the review findings appeared to suggest a preference by parents of school children for e-consent systems. Some parents found e-consent forms easy to use, however some others found the transition from traditional paper consent to e-consent difficult to adapt to. The use of e-consent did not appear to improve the timeliness of consenting or vaccination uptake. Language barriers, practical issues with transitioning to the new e-consent system, and concerns over lack of trust in electronic data, were among the reasons given for lack of engagement with the system. Conclusions There is currently growing interest on the use of e-consent as a means of obtaining informed consent for school-aged vaccinations. However, there is a paucity of high-quality evidence on the benefits and limitations of e-consent. None of the four studies included in this review identified that use of e-consent led to improved uptake, and none evaluated the impact of e-consent on vaccine equity. The impact of e-consent on overall level of consent/ non-consent return was variable. Transitioning from paper to e-consent systems has been difficult for some parents and adolescents to adapt to. Further evaluations of e-consent are required to inform its use in vaccination processes. Although utilisation of e-consent could yield efficiencies in gathering of consent, evidence that it leads to any benefit in vaccination outcomes is very limited. Introduction Immunisation programmes around the world are increasingly incorporating vaccines that target age groups beyond infancy and early childhood, into their national immunisation schedules ( World Health Organization, 2014 ). Educational settings play a vital role in the delivery of these programmes. Delivering immunisation programmes in schools makes vaccines more accessible to pupils, ensures timely protection and improved uptake ( Crocker et al., 2012 ), and is an important opportunity to check that children are up to date with all their routine immunisations ( UK Health Security Agency, 2024a ). In the UK, vaccines routinely offered to children and young people in school include seasonal influenza vaccine, Human papillomavirus (HPV) vaccine, MenACWY vaccine, Td/IPV (3 in 1 booster), and the MMR check and offer ( UK Health Security Agency, 2024b , Welsh Government, 2024 ). Consent to immunisation is a legal requirement before vaccines can be administered to school children. For consent to immunisation to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision ( Ramsay, 2021 ). This is usually done by the person themselves or someone with parental responsibilities. In high and middle-income countries, the most common method of collecting consent is by completion of a formal written consent form ( Footer and Foster, 2022 ). However, logistical challenges involved in getting paper forms to and from parents, and a desire to save time, resources, and increase vaccination uptake, has led to calls for a more streamlined consent process ( Chantler et al., 2019 , Footer and Foster, 2022 ). The use of digital tools and web-based technology for obtaining informed consent is not new and has become increasingly popular over the last decade. Digital or electronic consent (e-consent) systems have the potential to improve the efficiency of the consenting process and various vaccination-related outcomes. Recent studies on e-consent have shown promising results in various healthcare settings including, clinical care ( Chimonas et al., 2023 ), medical research ( Gesualdo et al., 2021 ), and neurosurgery ( Bethune et al., 2018 ). E-consent systems for school-age vaccinations are currently being trialled in several NHS trusts in the UK. At present, little is known about the effectiveness of these systems, whether they have any impact on vaccination-related outcomes, or any potential risks to digital equity. This rapid review therefore seeks to assess the evidence on the use of digital or electronic consent (e-consent) as a means of obtaining informed consent for school-aged vaccinations, in comparison to traditional paper-based consent processes. Objectives The objectives of this rapid review are to: Identify, review, and synthesise the findings from published articles describing e-consent systems for obtaining informed consent for school-aged vaccinations. Evaluate the effectiveness of e-consent over paper-consent processes in terms of timeliness and completeness of consent return, uptake and equity of vaccination. Methods This rapid review was based on abbreviated systematic review methods and conducted in compliance with PRISMA guidelines ( Page et al., 2021 ). Search strategy Six electronic databases – MEDLINE, Embase, Cochrane Library, Scopus, PsycINFO, and Google Scholar – were systematically searched on 27 November 2024 for relevant publications. A comprehensive search strategy ( Appendix 1 ), developed in MEDLINE and adapted for use in each of the other databases, was used for the searches. Database subject and keyword searches were conducted using a range of terms representing “school”, “child”, “electronic consent”, and “vaccination”. Searches were limited to literature from OECD countries (pre-1974 membership) published in English language from 2000 onwards. A 2000 date limit was agreed as this would be more likely to capture literature on digital or electronic consenting processes. The reference lists of included studies were also reviewed for relevant publications. All search results were exported into an EndNote library (version 20) and duplicates removed. The review protocol is available in the International Prospective Register of Systematic Reviews (registration number: CRD42025637787). Criteria for considering studies for the review Studies eligible for inclusion in this review reported effectiveness data on the use of digital or electronic consent as a means of obtaining informed consent for school-aged vaccinations. This included both secondary and primary research studies. The complete eligibility criteria for inclusion of studies in this review can be found in Table 1 . View this table: View inline View popup Download powerpoint Table 1: Eligibility criteria Selection of studies for inclusion in the review Following removal of duplicates in Endnote, all articles were imported into the systematic reviewing software Rayyan ( Ouzzani et al., 2016 ) for screening. A two-stage screening process was undertaken by four independent reviewers (CO, GE, MB, & KRR). First, all reviewers screened titles and abstracts against the eligibility criteria in Table 1 , to identify potentially eligible publications. In the second stage, all reviewers independently assessed full texts of eligible studies to identify studies to be included in the review. The reviewers also examined the reference lists of all included studies to identify other potentially eligible studies. Any disagreements at either stage were resolved by consensus. Critical appraisal The quality of included studies was assessed using three critical appraisal tools – the JBI critical appraisal tool for assessment of risk of bias for randomised controlled trials ( Barker et al., 2023 ), the JBI checklist for quasi-experimental studies ( Barker et al., 2024 ), and the mixed methods appraisal tool (MMAT) ( Hong et al., 2018 ). Two reviewers (CO & GE) independently assessed the methodological quality of all included studies. Any disagreements were resolved by consensus. Data extraction Two reviewers (CO & GE) independently extracted data from included studies using a data extraction table. For all included studies, data were extracted on general information (study reference, including title, authors, year of publication, country), study details (study design, aims, populations, sample size, setting, intervention details, outcome measures), and study findings. Study authors’ conclusions and any additional comments of note were also extracted. Both reviewers compared all extracted data and resolved any disagreements by discussion. Data analysis and synthesis A narrative synthesis approach was used for evidence synthesis. The use of meta-analysis to synthesise quantitative findings was considered, however, due to the small number of eligible studies, the limited data provided, and the different outcomes measured, it was not practical to conduct a valid meta-analysis. Results A total of 3756 citations were identified through electronic database searching. After deduplication, the initial number of citations decreased to 2878. Of these, 2865 citations were excluded after screening of titles and abstracts. Thirteen articles were assessed at full-text for eligibility, of which four articles met the criteria for inclusion in the review. The study selection process is shown in Figure 1 . Download figure Open in new tab Figure 1: PRISMA flow diagram Characteristics of included studies Of the four included studies, two were cluster randomised controlled trials (RCTs), one was a quasi-experimental study, while the remaining study was a mixed methods study. The included studies were conducted in the UK (n = 2) and USA (n = 2). Three of the four included studies were conducted in secondary schools and targeted adolescent school children, while one study was conducted in elementary schools. Two studies ( Szilagyi et al., 2016 , Szilagyi et al., 2018 ) focused on school-located influenza vaccinations, while the other two studies ( Chantler et al., 2020 , Footer and Foster, 2022 ) focused on HPV vaccination. Outcomes reported in included studies included consent form return rates ( Chantler et al., 2020 , Footer and Foster, 2022 ), vaccination uptake ( Chantler et al., 2020 , Footer and Foster, 2022 , Szilagyi et al., 2016 ), outcome of consent ( Chantler et al., 2020 ), and user satisfaction, preference, and acceptability ( Chantler et al., 2020 , Footer and Foster, 2022 , Szilagyi et al., 2016 , Szilagyi et al., 2018 ). Two related RCTs ( Szilagyi et al., 2016 , Szilagyi et al., 2018 ) investigated the impact of school-located influenza vaccinations, with an exploratory aim of assessing the use of web-based consent. The details of the individual studies can be found in Table 2 . View this table: View inline View popup Table 2: Characteristics of included studies Quality assessment Due to the variation in study designs of the individual studies, quality was assessed using three critical appraisal tools – the JBI critical appraisal tool for assessment of risk of bias for randomised controlled trials ( Barker et al., 2023 ), the JBI checklist for quasi-experimental studies ( Barker et al., 2024 ), and the mixed methods appraisal tool (MMAT) ( Hong et al., 2018 ). The two RCTs were judged to be of moderate quality, the mixed methods study was judged to be of good quality, while the quasi-experimental study was judged to be of very low quality, due to limited information on the study sample and statistical techniques used in the study. Critical appraisal details can be seen in Tables 3 , 4 , and 5 . View this table: View inline View popup Download powerpoint Table 3: Critical appraisal (RCTs) View this table: View inline View popup Download powerpoint Table 4: Critical appraisal (Quasi-experimental studies) View this table: View inline View popup Table 5: Critical appraisal (Mixed-methods) Study findings Impact of e-consent on consent form return Two studies assessed the impact of e-consent on consent form return ( Chantler et al., 2020 , Footer and Foster, 2022 ). Study findings were mixed. Chantler et al., (2020) conducted a mixed-methods study to evaluate the usability and acceptability of an electronic consent pilot intervention for school-based immunisations, and assessed its impact on consent form returns and HPV vaccine uptake. The study reported that timely return was lower in the e-consent schools (73.3% vs 91.6%, p=0.008) compared with schools issued paper consent forms. Reasons for lower consent form return in e-consent schools included difficulties encountered by some parents in accessing and using the intervention. Footer and Foster (2022) piloted an e-consent form with a cohort of 12–13-year-olds eligible for the HPV1 vaccine, and compared outcomes with children who had been issued with the traditional paper consent form. The study reported an average e-consent return rate of 80% which was significantly higher than the paper consent return rate. There was also a significantly quicker return rate for e-consent forms compared to paper returns. Impact of e-consent on vaccination uptake Three studies assessed the impact of e-consent on vaccination uptake ( Chantler et al., 2020 , Footer and Foster, 2022 , Szilagyi et al., 2016 ). Chantler et al., (2020) assessed the impact of an e-consent intervention on HPV vaccination uptake and found that there was no statistically significant difference in the proportion of pupils that were vaccinated at the scheduled vaccination session between the paper (n=14) and e-consent (n=14) schools (80.6% vs 81.3%, p=0.93). Footer and Foster (2022) reported that during the pilot phase of an e-consent form for the routine school aged immunisation programme, vaccine uptake remained stable - with similar consent rates as the previous year’s using paper forms; HPV1 uptake 2018-2019 (paper consent) = 89.6% vs. HPV1 uptake 2019-2020 (e-consent) = 89.9%. However, vaccine uptake dropped by 20% the following year, HPV1 uptake 2020-2021 (e-consent) = 70.2%. This decrease in consent was attributed to external factors like COVID-19 disruptions and misinformation about vaccines. Szilagyi et al., (2016) assessed the impact of offering school-located influenza vaccination (SLIV) clinics using both web-based and paper consent upon overall influenza vaccination rates among elementary school children. The study findings reported that type of consent (paper or web-based) did not appear to markedly affect the impact of SLIV (no data provided). Impact of e-consent on outcome of consent One study assessed the impact of the introduction of an e-consent intervention on outcome of consent ( Chantler et al., 2020 ). This study compared e-consent schools with paper consent schools in terms of outcome of consent, and reported no statistically significant difference in the proportion of pupils for whom a ‘yes’ consent was received between the paper (n=14) and e-consent (n=14) schools (85% in e-consent schools, 83% in paper consent schools, p = 0.89). User satisfaction, preference, and acceptability Four studies reported user satisfaction, preference, or acceptability outcomes ( Chantler et al., 2020 , Footer and Foster, 2022 , Szilagyi et al., 2016 , Szilagyi et al., 2018 ). Chantler et al., (2020) used qualitative methods to capture data on the usability and acceptability of e-consent and paper consent from school staff, parents, and adolescents. These methods included the use of school feedback forms and interviews. The parents interviewed found the e-consent system easy to use and usually completed the form as soon as they received it. According to feedback from nurses and schools, not all parents found the intervention easy to access or use. Language barriers and practical issues with the system, accounted for some of these difficulties. Some staff also found the transition from paper to e-consent difficult to adapt to, which they felt removed some level of control from schools. Footer and Foster (2022) reported that parents found it easier to engage with the programme electronically, which resulted in an improvement in the number of returned consent forms. However, it was found that some schools, immunisation team staff, and parents were resistant towards moving away from traditional paper consent forms, citing concerns over lack of trust in electronic data. Some parents also struggled with this new process particularly those whom English is not their first language. Szilagyi et al., (2016) reported that among parents who consented for school-located influenza vaccination (SLIV) clinics, nearly half (47%) of those notified by backpack fliers and four-fifths (89%) of those notified by e-mail consented online, indicating a preference for web-based consent. Szilagyi et al., (2018) assessed the use of a novel web-based vaccine consent process to offer parents the option of consenting online for adolescent school-located influenza vaccination (SLIV) clinics or printing forms for written consent. Study findings showed that of the 65 students enrolled in SLIV at the three schools exclusively using e-mail notifications, 37 (57%) consented online, whereas 28 (43%) parents printed out, signed, and returned completed paper consent forms to school. Among the 188 adolescents attending the five schools that sent both e-mail and paper notifications, 152 (81%) consented online (p < 0.001 compared with e-mail-only notifications) and 36 (19%) returned completed paper consent forms. Discussion Summary of key findings To the best of our knowledge, this is the first review to assess the available evidence on the use of electronic consent (e-consent) as a means of obtaining informed consent for school-age vaccinations. While there has been growing interest on the use of e-consent in healthcare and other research areas, there appears to be a paucity of evidence-based studies focused specifically on e-consent for school-aged vaccinations. The review findings appear to suggest a preference for e-consent systems over traditional paper-based consent by parents of school children. Parents interviewed found the system easy to use, which resulted in better engagement with school-based vaccination programmes. However, some parents and school staff found the transition from traditional paper consent to e-consent difficult to adapt to. Language barriers, practical issues with the new system, and concerns over lack of trust in electronic data, were among the reasons given for lack of engagement with the system. The review findings showed that e-consent did not improve the outcome of consent or vaccination uptake. Again, challenges encountered in transitioning from paper to electronic consent, was highlighted as a possible cause. According to Chantler et al., (2020) , issues with information technology functionality, and limited staff training and engagement of schools, hampered the transition process. The authors suggested that new technologies, like e-consent, would need to be used for more than a year before they can show any benefits and become incorporated into routine practice. Footer and Foster (2022) attributed external factors like the COVID-19 pandemic for lower vaccination uptake. The study authors theorised that a combination of government guidelines on isolation and lack of public trust in vaccines due to widespread misinformation about the COVID vaccine, was responsible for lower vaccination uptake. Mixed findings were reported on the impact of e-consent on consent form return. One study reported lower consent form returns in schools issued with e-consent forms compared to schools issued with paper forms, while the other study reported a significantly higher return rate for children issued with e-consent forms. As this outcome was reported by only two studies with varying results, firm conclusions cannot be made on the impact of e-consent on consent form return. Our review findings are in keeping with other evidence reviews on e-consent ( Chen et al., 2020 , Chimonas et al., 2023 , Obaidi et al., 2024 ). These studies found that the number of research publications on e-consent were relatively low but emergent, which confirms our finding of the paucity of high-quality published studies on this topic. When used in clinical care or healthcare settings, improvements were reported in efficiency and user preference ( Chimonas et al., 2023 , Obaidi et al., 2024 ). However, replacing paper consent with e-consent for research was met with concern over privacy breeches, data misuse, and anonymity ( Chen et al., 2020 ). Further research on the consequences of transitioning from paper to e-consent are therefore recommended. Strengths and limitations of this rapid review Due to time and resource constraints, an abbreviated systematic review methodology was utilised in this review. This included the use of a systematic approach to identify, review, and synthesise study findings in compliance with PRISMA guidelines. An extensive literature search using a wide range of search terms and databases was also conducted. Only studies with study designs incorporating a comparative element, as well as those whose findings are generalisable to the UK, were included. The quality of included studies was assessed using critical appraisal tools well suited for the study designs of included studies. This review is limited by the inclusion of only studies published in English language and the absence of grey literature searches. Whilst it is possible that additional eligible publications may have been missed, a thorough and transparent attempt was made to capture all relevant publications with minimal risk of bias. Strengths and limitations of the available evidence All included studies had clear aims, objectives and outcome measures. Studies were mostly quantitative, but also contained qualitative aspects for better understanding of the subject. Included studies were conducted in the UK and USA, therefore, aiding the generalisability of findings to the UK context. Except for one study that was focused on elementary school children, the majority of studies focused on adolescent children in secondary school. Only four studies were eligible for inclusion in this review, highlighting a paucity of research evidence on e-consent. Some outcomes were reported by so few studies - in some cases, one study, making it difficult to draw definitive conclusions. In some pilot studies, the e-consent intervention had not been implemented long enough for a meaningful impact assessment. Several evidence gaps were identified, notably an absence of studies assessing the impact of e-consent on vaccine equity and access. Similarly, none of the studies explored the cost-effectiveness and quantified time savings of e-consent systems or focused on DPT, MenACWY, and MMR vaccinations. Furthermore, none of the included studies explored the characteristics of parents who consented using the e-consent process or targeted children not in mainstream education. Implications for policy and practice This rapid review highlights the potential benefits of e-consent over traditional paper consent systems for school-age vaccinations. Research evidence on the effectiveness of e-consent processes is currently very much emergent. However, more high-quality research is needed to inform the use of these processes for obtaining informed consent for vaccinations. Further research focusing on the consequences of transitioning from paper to e-consent, such as digital exclusion, vaccine inequity, as well as language considerations is needed to inform policy and practice. Conclusion There is currently growing interest on the use of e-consent as a means of obtaining informed consent for school-aged vaccinations. However, there is limited published evidence from the small number of studies identified. When compared to paper consent, e-consent forms were found to be easier to use and quicker to complete but did not have any impact on vaccination uptake. Transitioning from paper to e-consent systems was found to be difficult for some parents and adolescents. Any change in process may take a while to embed and a decrease may be seen before its true impact is observed. Further evaluations of the benefits and consequences of e-consent are required to inform its use in vaccination processes. Data Availability All data produced in the present study are available upon reasonable request to the authors Appendix 1 Search strategy 1 (child* or school* or teen* or adolescen* or youth* or young person* or young people or girl* or boy*).ti,ab. 2 exp Schools/ 3 (school or schools).ti,ab. 4 1 or 2 or 3 5 (informed consent or informed decision or consent).ti,ab. 6 ((improv* or optimi*) adj2 consent).ti,ab. 7 (online consent or online informed consent or electronic consent or electronic informed consent or digital consent or digital informed consent or e-consent or econsent or consent by email).ti,ab. 8 ((computer or tablet or digital or electronic or electronic device or multimedia or smartphone or online systems or mobile applications or apps or internet) adj2 consent).ti,ab. 9 5 or 6 or 7 or 8 10 exp Vaccination/ or exp Immunization Programs/ or exp Immunization/ 11 (immunis* or immuniz* or vaccina*).ti,ab. 12 exp Diphtheria-Tetanus-Pertussis Vaccine/ 13 exp Papillomavirus Vaccines/ 14 exp Meningococcal Vaccines/ 15 exp Influenza Vaccines/ 16 (((cervical cancer or diphtheria or DtaP or DTP or HPV or measles or MenC or MenACWY or meningitis or Meningococcal or Neisseria meningitidis or papillomavirus or pertus* or rubella or rubeola or td?ipv or tetanus or wart virus or whoop*) adj2 immunis*) or immuniz* or vaccina*).ti,ab. 17 10 or 11 or 12 or 13 or 14 or 15 or 16 18 4 and 9 and 17 References ↵ Barker , T. H. , Habibi , N. , Aromataris , E. , Stone , J. C. , Leonardi-Bee , J. , Sears , K. , Hasanoff , S. , Klugar , M. , Tufanaru , C. , Moola , S. & Munn , Z . 2024 . The revised JBI critical appraisal tool for the assessment of risk of bias for quasi-experimental studies . JBI Evidence Synthesis , 22 , 378 – 388 . OpenUrl PubMed ↵ Barker , T. H. , Stone , J. C. , Sears , K. , Klugar , M. , Tufanaru , C. , Leonardi-Bee , J. , Aromataris , E. & Munn , Z . 2023 . The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials . JBI Evidence Synthesis , 21 , 494 – 506 . OpenUrl PubMed ↵ Bethune , A. , Davila-Foyo , M. , Valli , M. & Da Costa , L . 2018 . e-Consent: approaching surgical consent with mobile technology . Can J Surg , 61 , 339 – 344 . OpenUrl Abstract / FREE Full Text ↵ Chantler , T. , Letley , L. , Paterson , P. , Yarwood , J. , Saliba , V. & Mounier-Jack , S . 2019 . Optimising informed consent in school-based adolescent vaccination programmes in England: A multiple methods analysis . Vaccine , 37 , 5218 – 5224 . OpenUrl PubMed ↵ Chantler , T. , Pringle , E. , Bell , S. , Cooper , R. , Edmundson , E. , Nielsen , H. , Roberts , S. , Edelstein , M. & Mounier-Jack , S . 2020 . Does electronic consent improve the logistics and uptake of HPV vaccination in adolescent girls? A mixed-methods theory informed evaluation of a pilot intervention . BMJ Open , 10 , e038963 . OpenUrl Abstract / FREE Full Text ↵ Chen , C. , Lee , P. I. , Pain , K. J. , Delgado , D. , Cole , C. L. & Campion , T. R. , JR. 2020 . Replacing Paper Informed Consent with Electronic Informed Consent for Research in Academic Medical Centers: A Scoping Review . AMIA Jt Summits Transl Sci Proc , 2020 , 80 – 88 . OpenUrl PubMed ↵ Chimonas , S. , Lipitz-Snyderman , A. , Matsoukas , K. & Kuperman , G . 2023 . Electronic consent in clinical care: an international scoping review . BMJ Health Care Inform , 30 . ↵ Crocker , J. , Porter-Jones , G. , Mcgowan , A. , Roberts , R. J. & Cottrell , S . 2012 . Teenage booster vaccine: factors affecting uptake . Journal of Public Health , 34 , 498 – 504 . OpenUrl CrossRef PubMed ↵ Footer , R. & Foster , O . 2022 . The introduction of electronic consent for the school aged immunization program . Public Health Nursing , 39 , 320 – 325 . OpenUrl PubMed ↵ Gesualdo , F. , Daverio , M. , Palazzani , L. , Dimitriou , D. , Diez-Domingo , J. , Fons-Martinez , J. , Jackson , S. , Vignally , P. , Rizzo , C. & Tozzi , A. E . 2021 . Digital tools in the informed consent process: a systematic review . BMC Medical Ethics , 22 , 18 . OpenUrl PubMed ↵ Hong , Q. N. , Fàbregues , S. , Bartlett , G. , Boardman , F. , Cargo , M. , Dagenais , P. , Gagnon , M.-P. , Griffiths , F. , Nicolau , B. , O’cathain , A. , Rousseau , M.-C. , Vedel , I. & Pluye , P . 2018 . The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers . Education for Information , 34 , 285 – 291 . OpenUrl CrossRef ↵ Obaidi , H. , Elkhyatt , Y. , Alzubaidi , M. & Househ , M . 2024 . Use of E-Consent in Healthcare Settings: A Scoping Review . Digital Health and Informatics Innovations for Sustainable Health Care Systems , 1064 – 1068 . ↵ Ouzzani , M. , Hammady , H. , Fedorowicz , Z. & Elmagarmid , A . 2016 . Rayyan—a web and mobile app for systematic reviews . Systematic Reviews , 5 , 210 . OpenUrl PubMed ↵ Page , M. J. , Mckenzie , J. E. , Bossuyt , P. M. , Boutron , I. , Hoffmann , T. C. , Mulrow , C. D. , Shamseer , L. , Tetzlaff , J. M. , Akl , E. A. , Brennan , S. E. , Chou , R. , Glanville , J. , Grimshaw , J. M. , Hróbjartsson , A. , Lalu , M. M. , Li , T. , Loder , E. W. , Mayo-Wilson , E. , Mcdonald , S. , Mcguinness , L. A. , Stewart , L. A. , Thomas , J. , Tricco , A. C. , Welch , V. A. , Whiting , P. & Moher , D . 2021 . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews . Bmj , 372 , n71 . OpenUrl FREE Full Text ↵ Ramsay , M. 2021 . Immunisation against infectious disease [Online] . UK Health Security Agency . Available: https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book [Accessed]. ↵ Szilagyi , P. G. , Schaffer , S. , Rand , C. M. , Goldstein , N. P. N. , Vincelli , P. , Hightower , A. D. , Younge , M. , Eagan , A. , Blumkin , A. , Albertin , C. S. , Dibitetto , K. , Yoo , B.-K. & Humiston , S. G . 2018 . School-located Influenza Vaccinations for Adolescents: A Randomized Controlled Trial . Journal of Adolescent Health , 62 , 157 – 163 . OpenUrl CrossRef PubMed ↵ Szilagyi , P. G. , Schaffer , S. , Rand , C. M. , Vincelli , P. , Eagan , A. , Goldstein , N. P. N. , Hightower , A. D. , Younge , M. , Blumkin , A. , Albertin , C. S. , Yoo , B.-K. & Humiston , S. G . 2016 . School-Located Influenza Vaccinations: A Randomized Trial . Pediatrics , 138 . ↵ UK HEALTH SECURITY AGENCY . 2024a . Adolescent vaccination programme: briefing for secondary schools 2024 to 2025 [Online]. Available: https://www.gov.uk/government/publications/adolescent-vaccination-programme-in-secondary-schools/adolescent-vaccination-programme-briefing-for-secondary-schools [Accessed 13 November 2024 2024 ]. ↵ UK HEALTH SECURITY AGENCY . 2024b . Supporting immunisation programmes [Online] . Available: https://www.gov.uk/government/publications/health-protection-in-schools-and-other-childcare-facilities/supporting-immunisation-programmes [Accessed 13 November 2024 2024]. ↵ WELSH GOVERNMENT . 2024 . Healthy Child Wales Programme: for school aged children [Online] . Available: https://www.gov.wales/healthy-child-wales-programme-school-aged-children-summary-immunisation-schedule-html#:∼:text=The%20vaccination%20status%20of%20every,to%20obtain%20the%20outstanding%20vaccinations. [Accessed 10 March 2025 2025]. ↵ WORLD HEALTH ORGANIZATION 2014 . Considerations regarding consent in vaccinating children and adolescents between 6 and 17 years old . Geneva, Switzerland : World Health Organization . View the discussion thread. Back to top Previous Next Posted May 15, 2025. Download PDF Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. You are going to email the following Electronic consent for school-age vaccinations: a rapid review Message Subject (Your Name) has forwarded a page to you from medRxiv Message Body (Your Name) thought you would like to see this page from the medRxiv website. Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Share Electronic consent for school-age vaccinations: a rapid review Chukwudi Okolie , Golibe Ezenwugo , Mai Barry , Kerryann Richmond-Russell , Simon Cottrell medRxiv 2025.05.15.25327678; doi: https://doi.org/10.1101/2025.05.15.25327678 Share This Article: Copy Citation Tools Electronic consent for school-age vaccinations: a rapid review Chukwudi Okolie , Golibe Ezenwugo , Mai Barry , Kerryann Richmond-Russell , Simon Cottrell medRxiv 2025.05.15.25327678; doi: https://doi.org/10.1101/2025.05.15.25327678 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Tweet Widget Facebook Like Google Plus One Subject Area Public and Global Health Subject Areas All Articles Addiction Medicine (568) Allergy and Immunology (863) Anesthesia (300) Cardiovascular Medicine (4435) Dentistry and Oral Medicine (444) Dermatology (382) Emergency Medicine (608) Endocrinology (including Diabetes Mellitus and Metabolic Disease) (1509) Epidemiology (15228) Forensic Medicine (30) Gastroenterology (1124) Genetic and Genomic Medicine (6597) Geriatric Medicine (668) Health Economics (997) Health Informatics (4534) Health Policy (1368) Health Systems and Quality Improvement (1613) Hematology (540) HIV/AIDS (1264) Infectious Diseases (except HIV/AIDS) (15916) Intensive Care and Critical Care Medicine (1103) Medical Education (623) Medical Ethics (146) Nephrology (667) Neurology (6599) Nursing (346) Nutrition (998) Obstetrics and Gynecology (1144) Occupational and Environmental Health (957) Oncology (3332) Ophthalmology (974) Orthopedics (369) Otolaryngology (420) Pain Medicine (436) Palliative Medicine (130) Pathology (663) Pediatrics (1693) Pharmacology and Therapeutics (691) Primary Care Research (711) Psychiatry and Clinical Psychology (5447) Public and Global Health (9230) Radiology and Imaging (2198) Rehabilitation Medicine and Physical Therapy (1370) Respiratory Medicine (1196) Rheumatology (593) Sexual and Reproductive Health (712) Sports Medicine (530) Surgery (712) Toxicology (99) Transplantation (289) Urology (265) (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'a00476a17bbf58d3',t:'MTc3OTU0MzUzMQ=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();