City Research Online

Abstract

Introduction. Dental caries among primary school-age children in the UK is widespread (Davies et al., 2014). The Health and Social Care Information Centre states that dental caries is the most common reason children aged between five and nine were admitted to hospital accident and emergency units (HSCIC, 2013). Dental public health programmes are delivered via schools, including the application of fluoride varnish (FV) to children’s teeth. For children to take part parents must provide their consent. A large number of parents do not respond to the consent request (Davies et al., 2014) and this results in their children being excluded.

Research question. What barriers or enablers, or both, do parents experience when they are asked for consent for their child to participate in a school-based dental public health programme?

Methods. An initial exploration of the evolution of autonomy and consent practices was conducted. A literature review of international research revealed little information on consent from a parent’s perspective. Qualitative methods were used to explore parents’ views of consent, including four focus groups with 21 parents and 18 semi structured interviews across eight different schools in North London. Interactions with parents were transcribed verbatim and data from these were manually coded before being analysed thematically.

Findings. Six themes emerged from the qualitative data including; parents acting as their children’s protector, their own confidence levels to provide or refuse consent, the influence of social networks on decisions, the expectation to share some responsibility for children’s health with the State, the dislike of a consent process involving letters and the usefulness of information provided. A typology of parent decision makers was developed from these themes.

Discussion. The current approach to consent for FV programmes is problematic. It does not enable independent decision making by parents. Parents experience barriers the lack of face to face information and the way that consent requests are made. Parents navigate this process by drawing on their social network, including teachers to provide guidance. Health professionals’ practice of neutrality is experienced as a barrier and parents expect a level of paternalism towards their children.

Conclusion. The current approach to consent for FV programmes is flawed. Changes are needed to facilitate more informed decision making by parents that ultimately enables more active decisions.

Key words: consent, autonomy, parents experiences, dental public health.

Publication Type:	Thesis (Doctoral)
Subjects:	R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Departments:	Doctoral Theses School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses School of Health & Psychological Sciences > Healthcare Services Research & Management

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