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Implementing new consent procedures for schools-based human papillomavirus vaccination: a qualitative study

02 April 2021
22 min read
Volume 2 · Issue 2



The requirement for written parental consent for school-based human papillomavirus vaccination programme in England can act as a barrier to uptake for some young women, with the potential to exacerbate health inequities.


To consider the practicalities and implications of implementing new consent procedures, including parental telephone consent and adolescent self-consent, in two local authority areas in the southwest of England.


Digitally recorded, semi-structured interviews were conducted with 53 participants, including immunisation nurses, school staff, young people, and parents. All interviews were fully transcribed and thematic analysis was undertaken.


Parental telephone consent was welcomed by the immunisation nurses, parents, and young women in the study. Adolescent self-consent was rare. Greater understanding of the barriers to uptake outside of mainstream school-based sessions is needed to further address inequalities in uptake.


The new procedures generally worked well but some important barriers to vaccination uptake remain.

The English schools-based human papillomavirus (HPV) vaccination programme began for young women in September 2008 and was not extended to young men in England until the 2019/2020 academic school year (Public Health England et al, 2019). High coverage in the programme for young women was achieved, but variations across local authorities were apparent (Public Health England, 2019). In southwest England, lower uptake by geographical area, ethnicity and educational setting has been shown (Fisher et al, 2013).

The World Health Organization (2014) defines ‘young people’ as those aged 10–24 years old. In the UK, the legal framework allows young people to be vaccinated without parental consent provided they demonstrate sufficient understanding of the nature and implications of treatment, often referred to as ‘Gillick competence’ (Gillick v West Norfolk and Wisbech Area Health Authority and Department of Health and Social Security, 1985). However, local policies tend to require parental consent for the HPV vaccine in the school setting, though this is a matter of preference, rather than a legal requirement, and this may act as a barrier to receipt of the vaccination for some young people (Batista-Ferrer et al, 2016; Fisher et al, 2019).

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