What do adolescents think about vaccines? Systematic review of qualitative studies

Abstract

Adolescence presents a key opportunity to build vaccine-related health literacy and promote vaccine confidence and uptake. Although adolescents are central to vaccination programs, their views around vaccines are frequently underrepresented in qualitative literature. We reviewed qualitative studies to systematically identify and summarize existing evidence on adolescents’ own understanding of vaccines and experiences with vaccine decision-making, including self-consent when applicable. CINAHL; Embase; Ovid Medline; and Psych Info database searches were last updated on May 28, 2022. Data pertaining to general study characteristics, participant demographics, and qualitative content were extracted independently by two reviewers and analyzed using textual narrative synthesis. Out of 3559 individual records, 59 studies were included. The majority of the studies were conducted in high-income countries and 75% focused on human papilloma virus vaccines, with the remaining studies looking at COVID-19, meningococcal, hepatitis B and influenza vaccines or adolescent experiences with vaccines in general. Adolescent self-consent was explored in 7 studies. Perspectives from sexual and gender minorities were lacking across studies. Adolescents often had limited understanding of different vaccines and commonly perceived vaccine information to be directed towards their parents rather than themselves. Many adolescents felt school-based vaccine education and information available through healthcare providers were insufficient to make informed decisions about vaccines. While adolescents described obtaining vaccine information from traditional and online media, face-to-face interactions and opinions from trusted adults remained important. Adolescents generally relied on their parents for vaccine-decision making, even when self-consent was an option. A notable exception to this included marginalized adolescents who could not rely on parents for health-related advice. Qualitative literature about adolescent vaccines would be enriched by studies examining vaccines other than the HPV vaccine, studies examining adolescent vaccine programs in low and middle-income countries, and by deliberately eliciting vaccine experiences of adolescent with diverse sexual orientation and gender identities.

Opportunities for HPV vaccine education in school-based immunization programs in British Columbia, Canada: A qualitative study

“…In the qualitative literature, adolescent perspectives on vaccines have often been missing, overlooking a critical stakeholder group. 13 , 17 Several studies conducted among adolescents have found adolescents are interested in learning more about the HPV vaccine and being involved in the decision-making process. 26–30 In our study, participating students identified several different topics of interest about vaccines, such as managing vaccine-related anxiety, and the benefits of vaccination – all of which could be leveraged to design an effective vaccine educational intervention in SBIPs.…”

“…Focus group and interview guides were based on the sensitizing concepts of the study and review of literature examining experiences with SBIPs and HPV vaccination. 13 , 15 , 17 Background information was obtained from consultations with regional health authority medical health officers and nurses responsible for planning grade six vaccine programs, review of relevant documents (SBIP consent forms, vaccine information sheets) and observations of SBIPs days at several nonparticipating schools. We explored the attitudes and perceptions about vaccines in general and HPV vaccination specifically, SBIP, and potential opportunities to increase HPV vaccine uptake.…”

“…Importantly, the current literature on HPV SBIPs and vaccine education lacks the perspectives of students. 13 The objective of this qualitative study was to identify opportunities for HPV vaccine education in BC SBIPs by exploring the perspectives of students, parents, school staff, and public health nurses on current SBIPs.…”

Acceptability of HPV Vaccines: A Qualitative Systematic Review and Meta-Summary

“…The second strength is that, to the best of our knowledge, no publications have synthesized qualitative research that addresses the issue of the acceptability of HPV vaccines. The selected reviews in this study address barriers [ 47 ], decision-making processes [ 48 , 49 ], interventions [ 50 ], and messages in social networks [ 51 ], among others. Notably, a review was published in 2020 [ 52 ] that analyzed the social aspects related to the acceptance of the vaccine.…”

From Qualitative Research to Quantitative Preference Elicitation: An Example in Invasive Meningococcal Disease

“…For example, if people prefer fewer injections, this suggests that the availability of MenABCWY (pentavalent) vaccines may increase vaccine uptake, since they provide the same coverage with two injections instead of three. Qualitative research on this topic is required, particularly to understand the preferences of adolescents who are central to vaccination programs but are frequently underrepresented in qualitative literature [ 10 ]. One previous qualitative study has explored MenACWY vaccine-related knowledge, attitudes, and decision making.…”