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

Abstract Background Secondary prevention public health programmes, including paediatric preventive screening, enable the early identification of health concerns in asymptomatic children, thus reducing potential future risks. In paediatric contexts, decisions regarding participation are made by parents and may involve complex cognitive, emotional, and relational processes. While existing research has predominantly focused on participation and screening-related decisions, these may be understood within the broader construct of parental engagement, which encompasses but extends beyond participation in a specific healthcare decision. The present study therefore aims to synthesise the individual, relational, organisational, and contextual factors influencing parental participation in structured paediatric preventive screening programmes for physical conditions and to interpret them within a broader engagement perspective. Methods This review was pre-registered with PROSPERO (CRD420251058370). A comprehensive search was performed in PubMed, Scopus, PsycINFO, and Web of Science without temporal constraints, including studies published in English. Qualitative, quantitative, and mixed-methods studies investigating parental participation, intentions, and decision-making regarding paediatric preventive screening were considered. Screening and full-text assessment were performed independently by two reviewers. Identified determinants were organised according to Bronfenbrenner’s ecological framework and synthesised narratively. Results Sixty-two studies were included. At the microsystem level, perceived clinical benefits, disease severity, informational reassurance, and parental responsibility facilitated participation, while anxiety, fear of medicalisation, low perceived susceptibility, and misconceptions acted as barriers. At the mesosystem level, trust in healthcare professionals and family support facilitated participation, whereas ineffective communication, conflicting recommendations from healthcare professionals, and disagreement within families hindered it. At the exosystem level, accessibility, integration into routine care, public funding, and transparency facilitated participation, whereas logistical and financial barriers hindered it. At the macrosystem level, institutional trust and social norms facilitated participation, whereas cultural beliefs, privacy concerns, and stigma acted as barriers. Conclusions Parental participation in paediatric preventive screening is a multifaceted decision-making process shaped by determinants operating across individual, relational, organisational, and sociocultural levels. Organising these determinants within an ecological framework provides a basis for understanding participation as part of a broader parental engagement process that extends beyond the screening decision itself. These findings may inform future research on parental engagement and support the development of screening strategies based on clear information, emotional support, and effective communication.