The CARD™ System for improving the vaccination experience at school: Results of a small-scale implementation project on program delivery
Paediatrics and Child Health (Canada)
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Objective: We conducted a small-scale implementation study that integrated The CARDTM System (C-Comfort, A-Ask, R-Relax, D-Distract)-a multifaceted knowledge translation intervention designed to improve the vaccination experience at school-within the school vaccination program. Methods: Mixed methods design, including a controlled clinical trial and focus group interviews. The experimental group included five schools whereby CARDTM was implemented. The control group included five schools whereby no changes were made. Focus groups were held at the end of the school year. For nurses trained in CARDTM, additional focus groups were held at CARDTM training and after the first round of vaccine clinic visits. Outcomes included vaccination rate at school and adult stakeholder perceptions. Results: Altogether, 323 students attended study schools. Fifty-five nurses, school staff, and parents participated in 15 focus groups. The school vaccination rate did not differ (P>0.05) between groups for round 1 clinics (76% versus 77%) or round 2 clinics (68% versus 70%). Participants reported acceptability, appropriateness, feasibility, and satisfaction with CARDTM. Experimental group nurses were able to integrate CARDTM within usual activities, including clinic planning, student education, and clinic-day set-up and student vaccinations. Students in experimental schools were described by nurses and school staff as more prepared and less fearful during vaccinations. Nurses reported that CARDTM built on their practice; they had higher confidence in their ability to assess pain and fear and higher satisfaction with their ability to manage it. Nurses also reported improved collaboration with students and with each other. All stakeholder groups recommended continuing CARDTM. Some additional time was required, primarily related to clinic planning activities and data collection for study purposes. Conclusion: CARDTM is a promising new approach for improving the delivery of vaccinations at school. Exploration of approaches to increase parental reach and monitoring of vaccination uptake rate over time are recommended.