A qualitative study to assess school nurses' views on vaccinating 12-13 year old school girls against human papillomavirus without parental consent.
BACKGROUND
In the UK, parental consent for the routine vaccination of 12-13 year olds schoolgirls against human papillomavirus (HPV) is recommended, although legally girls may be able to consent themselves. As part of a vaccine study conducted ahead of the National HPV Vaccine Programme we sought the views of school nurses on vaccinating girls who did not have parental consent.


METHODS
HPV vaccination was offered to all 12 year old girls attending schools in two Primary Care Trusts in Greater Manchester. At the end of the study semi-structured, tape-recorded interviews were conducted with school nurses who had delivered the vaccine (Cervarix). The interview template was based on concepts derived from the Theory of Planned Behaviour. Transcripts were analysed thematically in order to understand school nurses' intentions to implement vaccination based on an assessment of Gillick competency.


RESULTS
School nurses knew how to assess the competency of under-16s but were still unwilling to vaccinate if parents had refused permission. If parents had not returned the consent form, school nurses were willing to contact parents, and also to negotiate with parents who had refused consent. They seemed unaware that parental involvement required the child's consent to avoid breaking confidentiality. Nurses' attitudes were influenced by the young appearance and age of the school year group rather than an individual's level of maturity. They were also confused about the legal guidelines governing consent. School nurses acknowledged the child's right to vaccination and strongly supported prevention of HPV infection but ultimately believed that it was the parents' right to give consent. Most were themselves parents and shared other parents' concerns about the vaccine's novelty and unknown long-term side effects. Rather than vaccinate without parental consent, school nurses would defer vaccination.


CONCLUSIONS
Health providers have a duty of care to girls for whom no parental consent for HPV vaccination has been given, and in the UK, this includes conducting, and acting upon, an assessment of the maturity and competence of an adolescent minor. To facilitate this, policies, training and support structures for health providers should be implemented.
Stretch
Rebecca
R
Academic Unit of Obstetrics and Gynaecology, University of Manchester, St. Mary's Hospital Research Floor (5th), Oxford Road, Manchester M139WL, UK. rebecca.stretch@hpa.org.uk
McCann
Rosemary
R
Roberts
Stephen A
SA
Elton
Peter
P
Baxter
David
D
Brabin
Loretta
L
D000293:Adolescent; D052685:Alphapapillomavirus / Q000276:immunology; D001291:Attitude of Health Personnel; D002648:Child; D005260:Female; D006801:Humans; D009723:Nurse-Patient Relations; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D033282:Parental Consent; D012573:School Nursing; D020377:Self Efficacy; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*
D053918:Papillomavirus Vaccines; C510352:human papillomavirus vaccine, L1 type 16, 18