ArticleHuman vaccines & immunotherapeutics2022
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.
Article in Human vaccines & immunotherapeutics, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.
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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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it, 23 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 Process Interventions for Reducing Distress During Vaccine Injections.The Clinical journal of pain · 2026Pooled it
- CARD (Comfort Ask Relax Distract) and community pharmacy vaccinations: Evaluation of implementation outcomes from a cluster randomized trial.Human vaccines & immunotherapeutics · 2025Trial
- CARD (Comfort Ask Relax Distract) and community pharmacy vaccinations: Evaluation of effectiveness outcomes from a cluster randomized trial.Human vaccines & immunotherapeutics · 2025Trial
- A randomized double-blinded trial to assess recurrence of systemic allergic reactions following COVID-19 mRNA vaccination.The Journal of allergy and clinical immunology · 2024Trial
- "It Could Become a Standard"-A Qualitative Study of the CARDChildren (Basel, Switzerland) · 2026Article
- Coping with Pokes: Child, Caregiver, and Clinician Feedback on a Caregiver-Led Educational Resource for Managing Children's Needle Fear.Nursing reports (Pavia, Italy) · 2026Article
- Using the CARD system for university-based pop-up vaccination clinics: A two-stage hybrid effectiveness-implementation study.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
- 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
- Online environmental scan and content analysis of social stories about needle procedures.Journal of pediatric psychology · 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
- Omission of alcohol skin cleansing and risk of adverse events in long-term care residents undergoing COVID-19 vaccination: A cohort study.Human vaccines & immunotherapeutics · 2024Article
- How stressful was the COVID-19 vaccination procedure? Comparison between mass vaccination centers and general practices.Vaccine: X · 2024Article
- COVID-19 Vaccination Delivery in Long-Term-Care using the CARD (Comfort Ask Relax Distract) System: Mixed Methods study of Implementation Drivers.Canadian journal of pain = Revue canadienne de la douleur · 2022Article
- Experiences of community pharmacists administering COVID-19 vaccinations: A qualitative study.Canadian pharmacists journal : CPJ = Revue des pharmaciens du Canada : RPCArticle
- Integration of CARD (Comfort Ask Relax Distract) for COVID-19 community pharmacy vaccination in children: Effect on implementation outcomes.Canadian pharmacists journal : CPJ = Revue des pharmaciens du Canada : RPCArticle
- CARD (Comfort Ask Relax Distract) for community pharmacy vaccinations in children: Effect on immunization stress-related responses and satisfaction.Canadian pharmacists journal : CPJ = Revue des pharmaciens du Canada : RPCArticle
- CARD (Comfort Ask Relax Distract) integration guide for community pharmacies administering vaccinations: How to playCanadian pharmacists journal : CPJ = Revue des pharmaciens du Canada : RPCArticle
- Community pharmacists' perceptions of the CARD (Comfort Ask Relax Distract) system for use during vaccinations.Canadian 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
5 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Many people have negative experiences with vaccination due to stress-related reactions including fear and pain. We used a pre-post study design to evaluate the impact of implementing a modified version of the CARD (Comfort-Ask-Relax-Distract) system on stress-related reactions in individuals aged 12 y or older undergoing COVID-19 vaccinations in mass vaccination clinics. Vaccine recipients reported their level of pain, fear and dizziness during vaccination. Clinic staff reported their attitudes about CARD and use of CARD interventions. CARD improved client symptoms across genders and ages with an average reduction in needle pain, fear and dizziness of 75%, 40% and 44%, respectively. CARD was more effective in younger individuals. Clinic staff reported positive attitudes about CARD and uptake of selected CARD interventions. In summary, the modified CARD system reduced stress-related responses in a general population undergoing COVID-19 vaccinations in a mass vaccination clinic, was feasible and acceptable to staff. Future implementation efforts are recommended that include more diverse cultural contexts and incorporate education of individuals about CARD ahead of time.
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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.