ArticlePaediatrics & child health2019
The CARD™ System for improving the vaccination experience at school: Results of a small-scale implementation project on program delivery.
Article in Paediatrics & child health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 2 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 2 syntheses or guidelines pooled it, 34 citations in OpenAlex.
- Reducing distress during vaccine injections: 2026 clinical practice guideline update.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026Guideline
- A Systematic Review and Meta-Analysis of the Effectiveness of Procedural Interventions for Reducing Distress During Vaccine Injections.The Clinical journal of pain · 2026Pooled it
- Feasibility of implementation of CARD™ for school-based immunizations in Calgary, Alberta: a cluster trial.BMC public health · 2021Trial
- Neurobiological Effects of Non-Invasive Behavioural Management Strategies in Paediatric Dentistry: A Scoping Review.Clinics and practice · 2026Review
- "It Could Become a Standard"-A Qualitative Study of the CARDChildren (Basel, Switzerland) · 2026Article
- Development and refinement of an online CARD (Comfort Ask Relax Distract) course for organizations and providers delivering vaccinations and other needle procedures.Human vaccines & immunotherapeutics · 2025Article
- Playing CARD (Comfort Ask Relax Distract): Upping our game on the quality of vaccine delivery.Human vaccines & immunotherapeutics · 2025Article
- Effect of CARD (Comfort-Ask-Relax-Distract) on acceptance of school-based vaccinations: A controlled before and after study.Human vaccines & immunotherapeutics · 2025Article
- Online environmental scan and content analysis of social stories about needle procedures.Journal of pediatric psychology · 2025Article
- Integrating the CARD (Comfort Ask Relax Distract) system in a mass vaccination clinic to improve the experience of individuals during COVID-19 vaccination: a pre-post implementation study.Human vaccines & immunotherapeutics · 2022Article
- Children's Perceptions of Dental Experiences and Ways to Improve Them.Children (Basel, Switzerland) · 2022Article
- Preparing for a School-Located COVID-19 Vaccination Clinic.NASN school nurse (Print) · 2021Article
- Managing pain and fear: Playing your CARDs to improve the vaccination experience.Canada communicable disease report = Releve des maladies transmissibles au Canada · 2021Article
- Benchmarking public health pain management practices during school immunizations.Canada communicable disease report = Releve des maladies transmissibles au Canada · 2020Article
- Student Feedback to Tailor the CARD™ System for Improving the Immunization Experience at School.Children (Basel, Switzerland) · 2020Article
- Managing immunization stress-related response: A contributor to sustaining trust in vaccines.Canada communicable disease report = Releve des maladies transmissibles au Canada · 2020Article
- Involving stakeholders in informing the development of a Knowledge Translation (KT) intervention to improve the vaccination experience at school.Paediatrics & child health · 2019Article
- Pain Pain Go Away: Improving the vaccination experience at school.Paediatrics & child health · 2019Article
- Piloting The CARD™ System for education of students about vaccination: Does it improve the vaccination experience at school?Paediatrics & child health · 2019Article
- Stakeholder feedback on The CARD™ System to improve the vaccination experience at school.Paediatrics & child health · 2019Article
Corrections and comments
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Authors and funding
9 authors at 8 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveWe conducted a small-scale implementation study that integrated The CARD™ 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.
methodsMixed methods design, including a controlled clinical trial and focus group interviews. The experimental group included five schools whereby CARD™ 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 CARD™, additional focus groups were held at CARD™ training and after the first round of vaccine clinic visits. Outcomes included vaccination rate at school and adult stakeholder perceptions.
resultsAltogether, 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 CARD™. Experimental group nurses were able to integrate CARD™ 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 CARD™ 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 CARD™. Some additional time was required, primarily related to clinic planning activities and data collection for study purposes.
conclusionCARD™ 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.