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

Philadelphia's adolescent self-consent regulation, adopted in 2007, permits youth aged 11-18 who are capable of informed consent to authorize immunizations that prevent reportable diseases. Despite its potential to reduce barriers and advance equity, the regulation's visibility and use remain poorly understood. This study explores healthcare provider perspectives on the awareness of the regulation, utility, and implementation challenges.

We conducted semi-structured interviews with 13 Philadelphia-based clinicians (pediatrics, family medicine, nurse practitioners, medical director; September 2024-January 2025). Interviews (45-60 minutes) were recorded, transcribed, and thematically analyzed using Braun and Clarke's six-phase approach, with reflexive memoing, peer debriefing, and an audit trail to enhance trustworthiness.

Five themes emerged: (1) Limited awareness: most participants were unfamiliar with the regulation and discussed hypothetical "what if" scenarios; (2) Ethical tensions: support for adolescent autonomy was tempered by concerns about parental trust and ongoing relationships; (3) Institutional barriers: electronic health record templates, intake protocols, and standing clinic policies defaulted to parental involvement; (4) Communication challenges: providers feared conflict and lacked scripts/training to navigate disagreements; and (5) Equity potential: participants recognized benefits for youth facing parental absence, hesitancy, or structural barriers, yet noted that current workflows rarely enable independent access.

The regulation remains under-recognized and under-implemented due to low awareness, relational ethics concerns, and misaligned clinic systems. Actionable implementation supports, targeted dissemination, provider training, electronic health record/workflow adjustments, and clear public health guidance are needed to translate adolescent self-consent rights into equitable access and improved uptake.