Taddio Anna, McMurtry C Meghan, Bucci Lucie M, MacDonald Noni, Ilersich Anthony N T, Ilersich Angelo L T, Alfieri-Maiolo Angela, deVlaming-Kot Christene, Alderman Leslie
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario.
The Hospital for Sick Children, Toronto, Ontario.
Paediatr Child Health. 2019 Apr;24(Suppl 1):S3-S18. doi: 10.1093/pch/pxz025. Epub 2019 Mar 29.
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.
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.
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.
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.
学生在学校接种疫苗时会经历恐惧、疼痛和昏厥。虽然存在基于证据的干预措施，但尚未开发出知识转化（KT）干预措施来减轻这些症状。一个多学科团队——“疼痛走开团队”成立，以解决这一知识与护理之间的差距。本手稿概述了为改善学校疫苗接种体验而开发和实施的基于证据的KT项目的方法、知识产品和影响。
我们通过与参与学校疫苗接种的关键利益相关者群体（学生、护士、学校工作人员和家长）进行焦点小组访谈，改编知识并评估知识使用的障碍。接下来，我们制定了项目特定目标和数据收集工具，并收集了基线数据。然后我们创建了一个名为CARD™系统（C-舒适、A-询问、R-放松、D-分散注意力）的多方面KT干预措施，以提供一个使用以学生为中心的方法来规划和实施疫苗接种的框架。在所有利益相关者群体举行的额外焦点小组中，对该框架中选定的KT工具进行了审查。然后，多方面KT干预措施最终确定并分阶段在两个项目中实施，包括七年级学生接受学校疫苗接种，并评估其对学生结果（如恐惧、疼痛、头晕症状）和过程结果（如减少学生症状的干预措施的使用、疫苗接种率）的影响。
参与者报告说改善疫苗接种体验很重要。根据参与者的反馈，开发了一种名为CARD™系统的基于证据的多方面KT干预措施，该措施满足了用户的需求和偏好。该干预措施中选定的KT工具被证明是可接受的，并改善了利益相关者群体对疫苗接种的知识和态度。在两个单独的实施项目中，CARD™帮助七年级学生为疫苗接种做好准备，并对他们的疫苗接种体验产生了积极影响。CARD™也改善了其他利益相关者群体的疫苗接种体验。没有证据表明对学校疫苗接种率有影响。
我们开发并实施了一种名为CARD™系统的有前景的多方面KT干预措施，以解决与疫苗接种相关的疼痛、恐惧和昏厥问题。建议未来进行研究，以确定其在不同年龄、不同地理区域和临床环境的学生中的影响。
