title: Ethical Challenges in School-Based Immunization Programs for Adolescents: A Qualitative Study.
abstract: OBJECTIVE
  We investigated ethical issues in school-based immunization programs for adolescents and how they are addressed.
  
  
  METHODS
  We used qualitative methods and an ethnographic approach to observe 9 secondary schools on immunization days in South Australia in 2011; concurrently, we conducted 9 focus groups with female secondary school students, 6 semistructured interviews with parents, and 10 interviews with nurses and teachers. We explored ethical challenges from the perspective of these groups.
  
  
  RESULTS
  We identified ethical challenges for the delivery of adolescent immunization in a school-based setting in 3 main areas: informed consent, restrictions on privacy, and harm to students in the form of fear and anxiety.
  
  
  CONCLUSIONS
  We found areas in which the design and delivery of school-based immunization programs can be improved. Information about immunization should be provided in ways that are appropriate to young people and their parents, and privacy protections should be enhanced when possible. Involving young people in the design and delivery of programs would assist with making these improvements.
authors.affiliation: Annette Braunack-Mayer, Joanne Collins, Rebecca Tooher, Claudia Proeve, and Teresa Burgess are with the School of Population Health, University of Adelaide, South Australia, Australia. Helen Marshall is with the School of Paediatric and Reproductive Health, University of Adelaide, South Australia. S. Rachel Skinner is with the Discipline of Paediatrics and Child Health, University of Sydney, New South Wales, Australia. Maree O'Keefe is with the Faculty of Health Sciences, University of Adelaide, South Australia. Maureen Watson is with the Communicable Disease Control Branch, South Australia Health, South Australia.
authors.forename: Annette
authors.initials: A
authors.lastname: Braunack-Mayer
authors.forename: S Rachel
authors.initials: SR
authors.lastname: Skinner
authors.forename: Joanne
authors.initials: J
authors.lastname: Collins
authors.forename: Rebecca
authors.initials: R
authors.lastname: Tooher
authors.forename: Claudia
authors.initials: C
authors.lastname: Proeve
authors.forename: Maree
authors.initials: M
authors.lastname: O'Keefe
authors.forename: Teresa
authors.initials: T
authors.lastname: Burgess
authors.forename: Maureen
authors.initials: M
authors.lastname: Watson
authors.forename: Helen
authors.initials: H
authors.lastname: Marshall
mesh_terms: D000293:Adolescent; D002648:Child; D003219:Confidentiality; D005178:Faculty; D005260:Female; D017144:Focus Groups; D006801:Humans; D017589:Immunization Programs / Q000941:ethics*; D007258:Informed Consent; D007407:Interviews as Topic; D010290:Parents / Q000523:psychology; D036301:Qualitative Research; D012572:School Health Services / Q000941:ethics*; D013021:South Australia; D013334:Students / Q000523:psychology