Electronic consent for school-age vaccinations: a rapid review

BackgroundThe use of digital or electronic processes for gathering consent to immunisation for school-age vaccinations ("e-consent") has the potential to improve the efficiency of the process. However, little is known currently about the effectiveness of e-consenting or implications on vaccination uptake and equity. MethodsMEDLINE, Embase, Cochrane Library, Scopus, PsycINFO, and Google Scholar were systematically searched for relevant publications from January 2000 until November 2024. Studies included in this review reported impact data on the use of digital or electronic processes as a means of obtaining informed consent for school-aged vaccinations. The quality of research included in the rapid review was assessed using the JBI critical appraisal tool for assessment of risk of bias for randomised controlled trials, the JBI checklist for quasi-experimental studies, and the mixed methods appraisal tool (MMAT). A narrative synthesis approach was used to analyse data and present findings. ResultsFour studies met the criteria for inclusion in the review. Included studies were conducted in the UK (n = 2) and USA (n = 2). Overall, the review findings appeared to suggest a preference by parents of school children for e-consent systems. Some parents found e-consent forms easy to use, however some others found the transition from traditional paper consent to e-consent difficult to adapt to. The use of e-consent did not appear to improve the timeliness of consenting or vaccination uptake. Language barriers, practical issues with transitioning to the new e-consent system, and concerns over lack of trust in electronic data, were among the reasons given for lack of engagement with the system. ConclusionsThere is currently growing interest on the use of e-consent as a means of obtaining informed consent for school-aged vaccinations. However, there is a paucity of high-quality evidence on the benefits and limitations of e-consent. None of the four studies included in this review identified that use of e-consent led to improved uptake, and none evaluated the impact of e-consent on vaccine equity. The impact of e-consent on overall level of consent/ non-consent return was variable. Transitioning from paper to e-consent systems has been difficult for some parents and adolescents to adapt to. Further evaluations of e-consent are required to inform its use in vaccination processes. Although utilisation of e-consent could yield efficiencies in gathering of consent, evidence that it leads to any benefit in vaccination outcomes is very limited.