Involving stakeholders in informing the development of a Knowledge Translation (KT) intervention to improve the vaccination experience at school

Abstract

Objective: Pain, fear, and fainting management during school-based vaccinations is suboptimal. The objective was to examine stakeholder perceptions of barriers and facilitators to better practices. Method: Six semi-structured focus groups were conducted in Niagara Region, Ontario: two parent groups (n=7); one grade 7 to 8 student group (n=9); two nurse groups (n=12); and one school staff group (n=6). Participants shared perceptions about school vaccination clinics and the implementation of specific strategies and tools. Focus groups were audio recorded and transcribed. The Consolidated Framework for Implementation Research (CFIR) was used as the framework for analysis. Results: Feedback from stakeholders was categorized into four domains of CFIR: intervention characteristics, inner setting, outer setting, and characteristics of individuals. Intervention characteristics included: vaccine educational materials, vaccination accommodations, distraction techniques, topical anaesthetics, and food. Inner setting factors included: school vaccination procedures, relationships between school staff and nurses, assessment and documentation of student fear, and factors that contribute to a chaotic vaccination clinic. Outer setting factors were: the social environment and addressing parent and student needs. Stakeholder roles were discussed in characteristics of individuals. Conclusion:This study identified elements that can facilitate and challenge pain and fear mitigation tools and strategies; these elements should be considered in the development of a Knowledge Translation (KT) intervention to improve the school vaccination experience.

The CARD™ System for improving the vaccination experience at school: Results of a small-scale implementation project on program delivery

“…In conclusion, CARD TM was successfully integrated within the vaccination process and aligned well with the roles and responsibilities of the different stakeholders. As a result of this study and other related work in this program of research (10)(11)(12)(13)(14), NRPH expanded implementation of CARD TM across the entire school vaccination program in the fall of 2018, including about 150 schools without commensurate changes to staffing levels. The addition of the school liaison nurses to clinics visit 2, however, was not adopted due to insufficient evidence of need.…”

“…At the end of the control school staff and parent interviews, participants were given a summary of CARD TM , shown the CARD TM pamphlets (10), and asked to provide their comments. These methods and tools were informed from our prior research (11)(12)(13), and incorporated aspects from the Consolidated Framework for Implementation Research (CFIR) (15).…”

“…Changes in practices were presented to school board administrators via meetings and executive summaries, and to the public via the organization's website. Ontario Ministry of Health and Long-Term Care; 10 Canadian Family Advisory Network; 11 AnxietyBC, Vancouver, British Columbia…”

“…We undertook a program of research to address this evidence-to-care gap (9). With input from all relevant stakeholders, we developed a multifaceted KT intervention called The CARD TM System (C-Comfort, A-Ask, R-Relax, D-Distract); herein called CARD TM (10)(11)(12)(13). CARD TM is an overarching approach to vaccination delivery that incorporates the CPG recommendations (8) into activities undertaken ahead of time and on the day of vaccination to promote student-centred care and coping during vaccination.…”

Student Feedback to Tailor the CARD™ System for Improving the Immunization Experience at School

“…In this study, we solicited the perspectives of grade 9 students about these educational materials. When we originally developed and evaluated the CARD™ educational materials, we included students in grades 6 to 8 [13][14][15][16]; however, across different geographical regions, immunizations are carried out in other grade levels, including grade 9 students. There are many transitions that students make in grade 9 that may impact on acceptability of CARD™.…”