ArticleHuman vaccines & immunotherapeutics2025
Development and refinement of an online CARD (Comfort Ask Relax Distract) course for organizations and providers delivering vaccinations and other needle procedures.
Article in Human vaccines & immunotherapeutics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 2 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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
9 citing papers in PubMed, 2 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 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 effectiveness outcomes from a cluster randomized trial.Human vaccines & immunotherapeutics · 2025Trial
- CARD (Comfort Ask Relax Distract) and community pharmacy vaccinations: Evaluation of implementation outcomes from a cluster randomized trial.Human vaccines & immunotherapeutics · 2025Trial
- 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
- Effect of CARD (Comfort-Ask-Relax-Distract) on acceptance of school-based vaccinations: A controlled before and after study.Human vaccines & immunotherapeutics · 2025Article
- Using the CARD system for university-based pop-up vaccination clinics: A two-stage hybrid effectiveness-implementation study.Human vaccines & immunotherapeutics · 2025Article
- Commentary: Improving the vaccination experience for children and adults.Human vaccines & immunotherapeutics · 2025Article
- Playing CARD (Comfort Ask Relax Distract): Upping our game on the quality of vaccine delivery.Human vaccines & immunotherapeutics · 2025Article
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
No grant is acknowledged in the PubMed record.
Abstract
The CARD system (Comfort-Ask-Relax-Distract) is an evidence-based protocol for mitigating vaccine injection-related reactions, such as pain, fear and fainting. We developed a new online CARD training course to educate organizations and providers about CARD and evaluated usability and impact on conceptual knowledge and attitudes. After an initial development phase, three iterative phases of user testing were conducted in individuals with different levels of familiarity with CARD. In the first two phases, experts and non-experts provided feedback using surveys and semi-structured interviews. In the third phase, new learners answered a knowledge test and attitudes survey. Revisions occurred throughout based on qualitative and quantitative analyses, guided by the Universal Design for Learning (UDL) framework. Thirty-one healthcare providers and trainees from 8 disciplines participated across study phases. They held positive attitudes in all components of the UDL, including engagement (e.g. perceptions of relevance and value), representation (e.g. multiple ways included to perceive information, common language), and action and expression (e.g. access to materials, interactivity). Modifications addressed feedback regarding content development, organization and expression of information, and course navigation. Phase 3 participants demonstrated knowledge and positive attitudes about CARD, including confidence and intention to use CARD. In summary, this study developed and refined an online CARD course to educate organizations and providers about CARD in a feasible way and to improve readiness for implementation. The course has the potential to improve efficiency and effectiveness of CARD implementation.
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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.