Abstract
Incentivising vaccine consent form return may improve vaccine uptake and be seen as less coercive than incentivising vaccination itself. We assessed the acceptability of financial incentives in this context among adolescent females and explored potential mechanisms by which incentives might change behaviour. Focus groups and analysis of free-text questionnaire responses. Study 1: 36 female secondary students in London (age 13-14) participated in six focus groups exploring the use of incentives in the context of vaccination. Data were analysed thematically. Study 2: was conducted to triangulate the findings of Study 1, by analysing free-text questionnaire responses from 181 female secondary students in London (age 12-13) reporting their opinion of incentivising consent form return. Data from Study 1 was also used to explore perceived potential mechanisms of action by which incentives might encourage consent form return. Focus group participants had positive attitudes towards incentives, with 61% of free-text responses also expressing this. Most focus group participants thought that incentives would encourage consent form return (18% of free-text respondents spontaneously also mentioned this). While incentivising consent form return was seen as ethical, focus group participants who incorrectly thought that vaccine receipt was being incentivised raised concerns about bribery, although only 4% of free text respondents reported these concerns. Frequently raised mechanisms of action included incentives increasing engagement with, and the perceived value of consent form return. Adolescents had positive views of financially incentivising consent form return to promote vaccine uptake, although care must be taken to reduce misconceptions regarding what is being incentivised. Incentivising vaccination was seen as coercive, but incentivising actions that increase the likelihood of vaccination (i.e. consent form return) were not. Incentives may encourage adolescents to return consent forms by helping them engage with this behaviour or increasing its' perceived value.
Highlights
In the UK, vaccines for school-aged children are mainly offered through school-based programmes, and similar approaches are used in Australasia, Europe and North America for some vaccines
While incentivising consent form return was seen as ethical, focus group participants who incorrectly thought that vaccine receipt was being incentivised raised concerns about bribery, only 4% of free text respondents reported these concerns
We explored the acceptability of financial incentives directed at adolescents via two studies that were conducted as part of a process evaluation of the cluster randomised controlled feasibility trial, described above, that incentivised human papillomavirus (HPV) vaccination consent form return as a means of improving vaccination uptake [1, 20]
Summary
In the UK, vaccines for school-aged children are mainly offered through school-based programmes, and similar approaches are used in Australasia, Europe and North America for some vaccines. In school-based vaccination programmes in the UK, consent for vaccination is sought, most commonly, using paper forms which students are required to get signed by a parent or guardian and return to school by hand. Parents are asked to indicate on the forms whether consent is being given or declined. Unpublished data from health authorities consistently show that a large proportion of consent forms are not returned; for example around 45% of child flu vaccine consent forms are unreturned (personal communication–Dr Heffernan, NHS England (London)). Evidence suggests that returned forms are more likely to provide consent than decline it [1], motivating consent form return may increase vaccination uptake [2]
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