Trial reportBMC public health2021
Feasibility of implementation of CARD™ for school-based immunizations in Calgary, Alberta: a cluster trial.
Trial report in BMC public health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03948633 (Improving the Vaccination Experience at School in Calgary), which is not on this map. Cited by 9 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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.
Improving the Vaccination Experience at School in Calgary
Who cites it
9 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- 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 Psychological Interventions for Reducing Distress During Vaccine Injections.The Clinical journal of pain · 2026Pooled it
- A Systematic Review and Meta-Analysis of the Effectiveness of Process Interventions for Reducing Distress During Vaccine Injections.The Clinical journal of pain · 2026Pooled it
- From Evidence to Practice: Implementing the 2026 Canadian Clinical Practice Guideline Update on Vaccination-Related Distress in the Dutch National Immunization Program.The Clinical journal of pain · 2026Article
- "It Could Become a Standard"-A Qualitative Study of the CARDChildren (Basel, Switzerland) · 2026Article
- Effect of CARD (Comfort-Ask-Relax-Distract) on acceptance of school-based vaccinations: A controlled before and after study.Human vaccines & immunotherapeutics · 2025Article
- A Comparative Study of the CARD™ System and Tell-show-do Technique in the Behavior Management of 6-10-year-old Children.International journal of clinical pediatric dentistry · 2025Article
- Opportunities for HPV vaccine education in school-based immunization programs in British Columbia, Canada: A qualitative study.Human vaccines & immunotherapeutics · 2024Article
- CARD (Comfort Ask Relax Distract) integration guide for community pharmacies administering vaccinations: How to playCanadian pharmacists journal : CPJ = Revue des pharmaciens du Canada : RPCArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors.
Funding
Abstract
backgroundNegative experiences with school-based immunizations can contribute to vaccine hesitancy in youth and adulthood. We developed an evidence-based, multifaceted and customizable intervention to improve the immunization experience at school called the CARD™ (C-Comfort, A-Ask, R-Relax, D-Distract) system. We evaluated the feasibility of CARD™ implementation for school-based immunizations in Calgary, Canada.
methodsIn a mixed methods study, two Community Health Centres providing immunization services, including 5 schools each with grade 9 students (aged approximately 14 years), were randomized to CARD™ or control (usual care). In the CARD™ group, public health staff and students were educated about coping strategies prior to immunization clinics. Clinics were organized to reduce fear and to support student's choices for coping strategies. Public health staff in the CARD™ group participated in a focus group discussion afterwards. We sought a recruitment rate of 80% for eligible schools, an external stakeholder focus group (e.g., school staff) with 6 or more individuals, 85% of individual injection-related data acquisition (student and immunizer surveys), and 80% absolute agreement between raters for a subset of data that were double-coded. Across focus groups, we examined perceptions of acceptability, appropriateness, feasibility and fidelity of CARD™.
resultsNine (90%) of eligible schools participated. Of 219 students immunized, injection-related student and immunizer data forms were acquired for 195 (89.0%) and 196 (89.5%), respectively. Reliability of data collection was high. Fifteen public health and 5 school staff participated in separate focus groups. Overall, attitudes towards CARD™ were positive and compliance with individual components of CARD™ was high. Public health staff expressed skepticism regarding the value of student participation in the CARD™ system. Suggestions were made regarding processes to refine implementation.
conclusionWhile most outcome criteria were satisfied and overall perceptions of implementation outcomes were positive, some important challenges and opportunities were identified. Feedback is being used to inform a large cluster trial that will evaluate the impact of CARD™ during school-based immunizations.
trial registrationThe trial is registered at ClinicalTrials.gov ( NCT03948633 ); Submitted April 24, 2019.
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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.