A comprehensive systematic review has mapped the complex web of determinants governing whether parents choose to enrol their children in preventive health checks, framing these decisions within an overarching parental engagement perspective. Published in BMC Health Services Research by researchers Anita Werner, Mariarosaria Savarese, and Guendalina Graffigna, the synthesis evaluates sixty-two studies examining structured paediatric preventive screening programmes for physical conditions. Rather than treating screening participation as an isolated, transactional choice, the research situates parental decision-making inside a multifaceted ecological structure, demonstrating how individual psychology, relational dynamics, healthcare delivery systems, and broader cultural environments collectively guide family health actions and screening choices.

Paediatric preventive screening operates as a central cornerstone of secondary prevention public health initiatives, which are designed to achieve early identification of emergent health concerns in asymptomatic children and subsequently reduce potential future risks. In paediatric healthcare contexts, critical choices concerning screening attendance and clinical uptake rest squarely upon parents, involving complex cognitive, emotional, and interpersonal decision-making processes. While earlier investigations have predominantly concentrated on immediate screening participation and isolated screening-related decisions, the authors emphasize that such actions can be understood within the broader construct of parental engagement. This encompassing conceptual paradigm recognises that authentic engagement incorporates specific healthcare decisions while simultaneously extending far beyond any single screening event.

To systematically capture these diverse influences, the investigative team established a comprehensive methodological protocol pre-registered in the international prospective register of systematic reviews, PROSPERO, under registration number CRD420251058370. The researchers executed an extensive literature search across four major electronic databases—PubMed, Scopus, PsycINFO, and Web of Science—applying no temporal constraints to ensure full coverage of published English-language studies. Eligible research encompassed qualitative, quantitative, and mixed-methods investigations exploring parental participation, parental intentions, and decision-making processes tied directly to paediatric preventive screening. To safeguard methodological rigor throughout the process, two independent reviewers carried out study screening and full-text assessments, categorising the extracted determinants narratively according to Bronfenbrenner’s ecological framework.

At the foundational microsystem level, which encompasses individual and personal factors, parental decisions were steered by a delicate balance of cognitive beliefs and emotional responses. The synthesis revealed that perceived clinical benefits, awareness of disease severity, informational reassurance, and an internalized sense of parental responsibility served as primary facilitators encouraging active screening participation. Conversely, significant personal barriers frequently deterred parents from enrolling their children in recommended programmes. These hindering factors included heightened parental anxiety, fear of medicalisation, misconceptions surrounding health conditions, and low perceived susceptibility, wherein caregivers felt their asymptomatic children faced negligible health risks and therefore required no preventive evaluation.

Moving outward to the mesosystem tier, the review delineated the powerful influence of immediate interpersonal relationships and interactions with clinical providers. Trust in healthcare professionals and strong family support emerged as essential mesosystem facilitators, validating decisions and easing procedural hesitation for caregivers. In contrast, relational breakdowns and inconsistent interactions significantly impeded participation. Parents encountered major obstacles when healthcare professionals engaged in ineffective communication or delivered conflicting recommendations, generating confusion during clinical consultations. Furthermore, internal disagreement among family members regarding the necessity, safety, or appropriateness of paediatric screening frequently undermined parental consensus, halting progress toward participation.

At the exosystem level, which reflects broader organisational structures, health service delivery, and systemic infrastructure, administrative design directly dictated programme accessibility and parental follow-through. Facilitating factors included the direct physical and procedural accessibility of screening services, the seamless integration of screening protocols into routine paediatric care, transparent administrative procedures, and the provision of public funding to offset clinical expenses. On the other hand, systemic friction consistently discouraged engagement. Prominent exosystem barriers comprised tangible logistical hurdles, such as inconvenient scheduling or travel demands, alongside direct or indirect financial barriers that placed preventive health checks beyond the practical reach of families.

Finally, at the macrosystem level, encompassing overarching societal norms, institutional systems, and cultural values, widespread public attitudes shaped parental inclinations toward preventive care. Broad-based institutional trust and supportive social norms functioned as key facilitators, establishing paediatric screening participation as an accepted civic and community standard. Nevertheless, powerful sociocultural barriers often counteracted these positive influences. The systematic review identified privacy concerns regarding sensitive personal health data, cultural beliefs that conflict with screening practices, and social stigma attached to potential diagnoses as substantial macrosystem forces dissuading parents from participating.

In their concluding synthesis, the authors underline that parental participation in paediatric preventive screening represents a multifaceted decision-making continuum shaped concurrently across individual, relational, organisational, and sociocultural domains. Structuring these determinants within Bronfenbrenner’s ecological framework demonstrates that participation constitutes one key dimension of a wider, continuous parental engagement pathway extending beyond momentary screening choices. The researchers note that these synthesized findings provide an evidence-based foundation for future parental engagement research and can directly support healthcare systems in developing effective screening strategies grounded in clear information, responsive emotional support, and effective clinical communication.

Subject of Research: Determinants of parental participation and engagement in paediatric preventive screening programmes

Article Title: Multilevel determinants of parental participation in paediatric screening: a systematic review from an engagement perspective

Article References: Werner, A., Savarese, M., & Graffigna, G. (2026). Multilevel determinants of parental participation in paediatric screening: a systematic review from an engagement perspective. BMC Health Services Research. https://doi.org/10.1186/s12913-026-16082-w

Image Credits: AI Generated

DOI: 10.1186/s12913-026-16082-w

Keywords: paediatric preventive screening, parental engagement, parental decision-making, secondary prevention, Bronfenbrenner ecological framework, systematic review, asymptomatic children, perceived clinical benefits, fear of medicalisation, healthcare professional trust, routine care integration, public funding, institutional trust, social norms, informational reassurance, conflicting recommendations, PROSPERO pre-registration