Overview of a Knowledge Translation (KT) Project to improve the vaccination experience at school: The CARD™ System

Abstract

Background Students experience fear, pain, and fainting during vaccinations at school. While evidence-based interventions exist, no Knowledge Translation (KT) interventions have been developed to mitigate these symptoms. A multidisciplinary team—the Pain Pain Go Away Team—was assembled to address this knowledge-to-care gap. This manuscript provides an overview of the methodology, knowledge products, and impact of an evidence-based KT program developed and implemented to improve the vaccination experience at school. Methods We adapted knowledge and assessed the barriers to knowledge use via focus group interviews with key stakeholder groups involved in school-based vaccinations: students, nurses, school staff, and parents. Next, we developed project-specific goals and data collection tools and collected baseline data. We then created a multifaceted KT intervention called The CARD™ System (C-Comfort, A-Ask, R-Relax, D-Distract) to provide a framework for planning and delivering vaccinations using a student-centred approach. Selected KT tools from this framework were reviewed in additional focus groups held in all stakeholder groups. The multifaceted KT intervention was then finalized and implemented in stages in two projects including grade 7 students undergoing school vaccinations and impact on student outcomes (e.g., symptoms of fear, pain, dizziness) and process outcomes (e.g., utilization of interventions that reduce student symptoms, vaccination rate) were assessed. Results Participants reported that improving the vaccination experience is important. Based on participant feedback, an evidence-based multifaceted KT intervention called The CARD™ System was developed that addresses user needs and preferences. Selected KT tools of this intervention were demonstrated to be acceptable and to improve knowledge and attitudes about vaccination in the stakeholder groups. In two separate implementation projects, CARD™ helped grade 7 students prepare for vaccinations and positively impacted on their vaccination experiences. CARD™ improved vaccination experiences for other stakeholder groups as well. There was no evidence of an impact on school vaccination rates. Conclusion We developed and implemented a promising multifaceted KT intervention called The CARD™ System to address vaccination-associated pain, fear, and fainting. Future research is recommended to determine impact in students of different ages and in different geographical regions and clinical contexts.

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

“…Students viewed two videos (one general video about vaccination: https://youtu.be/z57vTpb19wQ; and one video about coping with fear, pain, and fainting: https://youtu.be/ c41HvgEKQSk) and then filled out their own preferences for coping strategies they wanted to use during vaccination on a student CARD TM pamphlet (available in ref. 10). Students also filled in knowledge and attitudes surveys, and, time permitting, reviewed selected written scenarios.…”

“…Liaison nurses in both groups disseminated vaccination consent forms to students with instructions to take them home, sign them with their parents, and then return them back to the school. In the experimental group, an extra pamphlet about CARD TM directed to parents (10) was included in the takehome package. Experimental group liaison nurses also disseminated a pamphlet about CARD TM directed to school staff (10) in the mailboxes of all school staff.…”

“…In the experimental group, an extra pamphlet about CARD TM directed to parents (10) was included in the takehome package. Experimental group liaison nurses also disseminated a pamphlet about CARD TM directed to school staff (10) in the mailboxes of all school staff.…”

“…Liaison school nurses and injecting clinic and charge nurses delivering services to the experimental schools were educated about CARD TM during a half-day workshop (with lunch provided) where they reviewed all of the resources and accompanying policy and process changes made to accommodate implementation (see also overview manuscript in this series for list of topics and resources) (10). Nurses were given a resource binder with key resources and supplies (e.g., fidget spinner, bubble pen).…”

“…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.…”