The CARD™ System for Improving the Vaccination Experience at School: Results of a Small-scale Implementation Project on Student Symptoms

Background: Many students fear vaccinations. We implemented a novel, multifaceted knowledge translation intervention in the school vaccination setting incorporating evidence-based coping strategies—The CARD™ System (C-Comfort, A-Ask, R-Relax, D-Distract)—and evaluated impact on knowledge, symptoms, coping strategies, and fidelity. Methods: Five experimental schools (ES) and five control schools (CS) in a controlled clinical trial. ES students completed a knowledge/attitudes survey during a CARD™ educational session and selected coping strategies before vaccinations. CS students received the usual vaccine lesson. Nurses recorded strategies used and students rated symptoms. Fidelity to CARD™ was evaluated. Results: CARD™ increased knowledge and coping strategy use. Distraction, deep breathing, support and privacy were most selected. CARD™ (vs. control) was associated with less high fear and high dizziness; pain and vaccination rate did not differ. High fidelity to CARD™ components was observed. Discussion: CARD™ improves student symptoms during school-based vaccinations. Research in different settings is recommended to confirm results.M.Sc