Table 2.

Relevant Child/Youth Consent Study Findings

Author	Challenges and barriers to informed consent	Considerations for obtaining consent	Key Findings/Wise Practices
Stiffman et al.	- Some providers required parental permission to offer services, even if youth were in danger. - The consent form was not deemed suitable despite community consultation.	- Families could consent via signing and mailing a pre-stamped postcard or in-person pre-interview.	- Interviewers used home visits to explain the study, obtain parent/guardian and youth consent, and conduct the interview.
Panagiotopoulos et al.	- Child welfare is the Elder’s responsibility, and obtaining informed assent directly from children was foreign. - The authors noted many sociological, ethical, and practical challenges.	- Community members required sufficient information (letters, preliminary clinic visits) before participating. - Confidence/trust were key facilitators. - Pre-intervention trips ensured “appropriate dialogue, care, respect and planning"3.	- Timing must be flexible and on the community’s terms. - Multi-lateral support is required (Elders, hereditary and elected Chiefs, band council, school, and health leaders). - Senior investigators met with community Elders and hosted a joint community feast.
Baydala et al.	- Differences in prioritizing individual vs. collective rights. - “Individualistic” research values disrupted traditional roles. - Children’s assent was considered unnecessary after obtaining community and parental consent. - Children were placed “in conflict with some of their kinship responsibilities”1 when asked to challenge parents’ decisions. - “Trust remains an issue when using written forms of agreement with Western institutions.”1	- Community researchers advised that home visits were ideal to obtain parental consent. - Visits were carried out by researchers who, in most cases, were also family members. - Children’s right to refuse was essential.	- Child assent should be conducted in culturally appropriate settings and reflect community values.
Rose et al.	- The consent rate was lower for students with lower socioeconomic backgrounds.	- The burden of obtaining parental consent should not be placed on students. - Tech (website, texting) and incentives (voucher, badge, prize draw) can be used to encourage the return of consent forms. - Home visits can be used for families who have not returned their consent forms.	- Information was provided through face-to-face meetings and in local languages.
Fletcher et al.	- Western REB processes presented logistical and process challenges. Insufficient money and time were allocated to consent processes. - Wording, document length and use of medical/ research terms in consent forms were all challenges. The term “risk” brought up past research injustices. - Written consent caused discomfort, and relationship-based oral consent was preferred. - “The current process is not meeting the stated objectives of safety and informed consent as typically envisioned by REBs.“5	- Local researchers recommended respectful and informational home visits by a community-based team member. - Information sheets should be left with parents. - Involving community members in the research process fostered partnership and trust. - Consenting hinged on multiple home visits lasting 1–2 h each. - Issues of guardianship and family structure had to be considered sensitively.	- After observing that written consent made parents and community researchers uncomfortable, oral consent was recommended. Ideally, this would be land-based. - Consenting should “reinforce culturally based ethical norms and consent practices rather than negotiated as an add-on to academic institutional practices.”5 - Early involvement of Elders and community leaders fostered spiritual, political, and psychological protection. - Relational consent processes reaffirmed kinship with community researchers, including offering tobacco to leaders and Elders.
Jardine & James	- Written consent contradicts Aboriginal approaches to research in many Northern communities. - Determining who should consent on behalf of minors is challenging in communities where guardianship may not be formally recognized.	- Although parental/guardian permission was obtained, researchers obtained oral assent from students.	- Youth/student researchers were trained to obtain consent and interview other students.
Yao et al.	- Community members raised privacy and confidentiality concerns.	- A waiver allowed teens aged 15–18 to participate without parental consent. - Teens who had already subscribed to the study’s texting service were invited/consented via text.	- Text messaging was used to reach teens effectively.
Chadwick et al.	NR	- Using a video allowed consent to be standardized across multiple research sites.	- Community leaders identified culturally appropriate ways to facilitate the trial’s implementation. - The tribal REB was designated the board of record.
Wagner et al.	- Since recruitment was school-based, vulnerable children could be denied participation opportunities due to school absences. - Low school attendance was due to funerals, medical appointments, and cultural events.	- Community researchers verbally translated study materials into appropriate languages, as required.	- Research assistants and community researchers conducted joint home visits to seek parental consent.
Anderson et al.	- Ensuring robust processes for informed consent, withdrawal and debriefing in an online environment	- Consent via email or audio-recorded verbal consent at Online Yarning Circle	NR
Siller et al.	NR	- Researchers incentivized returning consent forms regardless of consent or participation.	- Multiple ways to return consent forms (email, text or in-person)

NR = Not reported