Health Care Analysis

, Volume 23, Issue 1, pp 50–62 | Cite as

Informed Consent for HPV Vaccination: A Relational Approach

  • Maria Gottvall
  • Tanja Tydén
  • Margareta Larsson
  • Christina Stenhammar
  • Anna T. Höglund
Original Article


The aim of this study was to explore the relational aspects of the consent process for HPV vaccination as experienced by school nurses, based on the assumption that individuals have interests related to persons close to them, which is not necessarily to be apprehended as a restriction of autonomy; rather as a voluntary and emotionally preferred involvement of their close ones. Thirty Swedish school nurses were interviewed in five focus groups, before the school based vaccination program had started in Sweden. The empirical results were discussed in light of theories on relational autonomy. The school nurses were convinced that parental consent was needed for HPV vaccination of 11-year-old girls, but problems identified were the difficulty to judge when a young person is to be regarded as autonomous and what to do when children and parents do not agree on the decision. A solution suggested was that obtaining informed consent in school nursing is to be seen as a deliberative process, including the child, the parents and the nurse. The nurses described how they were willing strive for a dialogue with the parents and negotiate with them in the consent process. Seeing autonomy as relational might allow for a more dialogical approach towards how consent is obtained in school based vaccination programs. Through such an approach, conflicts of interests can be made visible and become possible to deal with in a negotiating dialogue. If the school nurses do not focus exclusively on accepting the individual parent’s choice, but strive to engage in a process of communication and deliberation, the autonomy of the child might increase and power inequalities might be reduced.


HPV vaccination Informed consent Relational autonomy School nursing Sweden 



This study was funded by the Swedish Cancer Society and the Solsticke Foundation. We are most grateful to the school nurses who participated in the investigation. Thanks also to the Ethics of Family in Health and Social Care Research Consortium as well as to the anonymous reviewers of HCAN for helpful comments on earlier versions of the manuscript.


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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Maria Gottvall
    • 1
  • Tanja Tydén
    • 1
  • Margareta Larsson
    • 2
  • Christina Stenhammar
    • 1
  • Anna T. Höglund
    • 1
  1. 1.Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
  2. 2.Department of Women’s and Children’s HealthUppsala University HospitalUppsalaSweden

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