Philadelphia's Adolescent Vaccine Self-Consent Regulation: Provider Perspectives, Implementation Barriers, and...

Area of Science:

• Public Health
• Adolescent Health
• Health Policy

Background:

• Philadelphia's 2007 adolescent self-consent regulation allows informed youth (11-18) to authorize immunizations.
• The regulation's visibility and utilization are not well understood, despite its potential for reducing barriers and advancing health equity.

Purpose of the Study:

• To explore healthcare provider perspectives on awareness, utility, and implementation challenges of Philadelphia's adolescent self-consent regulation.
• To identify barriers and facilitators to the effective implementation of adolescent self-consent for immunizations.

Main Methods:

• Semi-structured interviews were conducted with 13 Philadelphia-based clinicians.
• Interviews were thematically analyzed using Braun and Clarke's six-phase approach, ensuring trustworthiness through reflexive memoing and peer debriefing.

Main Results:

• Limited awareness of the regulation among providers, with discussions often hypothetical.
• Ethical tensions arose between supporting adolescent autonomy and maintaining parental trust.
• Institutional barriers (EHR templates, clinic policies) and communication challenges (lack of training) impeded implementation.
• Providers recognized the equity potential for marginalized youth but noted workflow limitations.

Conclusions:

• The adolescent self-consent regulation is under-recognized and under-implemented due to low awareness, ethical concerns, and misaligned systems.
• Implementation requires targeted dissemination, provider training, and adjustments to electronic health records and clinic workflows.
• Translating self-consent rights into equitable access and improved vaccine uptake necessitates systemic support and clear public health guidance.