Freedman Tamlyn, Taddio Anna, Alderman Leslie, McDowall Tori, deVlaming-Kot Christene, McMurtry C Meghan, MacDonald Noni, Alfieri-Maiolo Angela, Stephens Derek, Wong Horace, Boon Heather
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario.
Niagara Region Public Health & Emergency Services, Thorold, Ontario.
Paediatr Child Health. 2019 Apr;24(Suppl 1):S42-S53. doi: 10.1093/pch/pxz020. Epub 2019 Mar 29.
Many students are afraid of receiving vaccinations at school. We implemented a novel, multifaceted knowledge translation intervention incorporating evidence-based vaccination coping strategies-The CARD™ System (C-Comfort, A-Ask, R-Relax, D-Distract)-and evaluated impact on student attitudes, knowledge, coping strategies used, and symptoms during school-based vaccinations.
Mixed methods. Ten schools participated in a controlled clinical trial: five experimental and five control. Experimental School (ES) students completed a knowledge and attitudes survey during an in-class CARD™ educational session prior to school vaccinations and selected coping strategies for upcoming vaccinations. Control School (CS) students received the usual vaccine education lesson, which did not include information about or selection of coping strategies. At all schools and during both vaccination clinic visits (fall and spring), injecting nurses recorded specific coping strategies used, and students independently rated their fear, pain, and dizziness during vaccinations. Focus groups were conducted at five schools after all clinics were completed (three ES, two CS).
ES students had higher knowledge (P<0.001), less fear (P=0.03), and greater willingness to be vaccinated (P=0.001) after the in-class education session. Students rated the education as understandable, sufficient, useful, and that it prepared them for vaccinations. During school vaccination clinics, ES students selected more coping interventions than CS students. There were fewer students with high levels of fear (P=0.008) and dizziness (P=0.04) in the ES group. In round 2, fewer students (P=0.02) in the ES group returned to the clinic postvaccination because they were feeling unwell. ES students participating in focus groups scored higher on their knowledge test (P<0.001) compared with CS students and reported learning and benefitting from CARD™.
This small-scale implementation study provides preliminary evidence of the effectiveness of CARD™ in improving vaccination experiences for students at school. Future research is recommended that examines CARD™ in different settings to confirm these results.
许多学生害怕在学校接种疫苗。我们实施了一种新颖的、多方面的知识转化干预措施，纳入了基于证据的疫苗接种应对策略——CARD™系统（C-安慰、A-询问、R-放松、D-分散注意力），并评估了其对学生态度、知识、所采用的应对策略以及在校接种疫苗期间症状的影响。
混合方法。十所学校参与了一项对照临床试验：五所实验学校和五所对照学校。实验学校（ES）的学生在学校接种疫苗前的课堂CARD™教育课程中完成了一项知识和态度调查，并为即将到来的疫苗接种选择应对策略。对照学校（CS）的学生接受常规的疫苗教育课程，其中不包括应对策略的信息或选择。在所有学校以及两次疫苗接种门诊（秋季和春季）期间，注射护士记录所采用的具体应对策略，学生在接种疫苗期间独立对自己的恐惧、疼痛和头晕程度进行评分。在所有门诊结束后，在五所学校（三所ES学校、两所CS学校）进行了焦点小组讨论。
在课堂教育课程后，ES学校的学生知识水平更高（P<0.001），恐惧程度更低（P=0.03），接种疫苗意愿更强（P=0.001）。学生们认为该教育易于理解、内容充分、有用，并使他们为接种疫苗做好了准备。在校内疫苗接种门诊期间，ES学校的学生选择的应对干预措施比CS学校的学生更多。ES组中恐惧程度高（P=0.0那么08）和头晕（P=0.04）的学生较少。在第二轮中，ES组中因感觉不适而在接种疫苗后返回门诊的学生较少（P=0.02）。与CS学校的学生相比，参与焦点小组讨论 的ES学校学生在知识测试中的得分更高（P<0.001），并报告从CARD™中学习并受益。
这项小规模的实施研究为CARD™在改善学校学生疫苗接种体验方面的有效性提供了初步证据。建议未来的研究在不同环境中对CARD™进行检验以证实这些结果。
