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Taddio A, Coldham J, Logeman C, McMurtry CM, Bucci LM, Gudzak V, MacDonald NE, Little C, Samborn T, Moineddin R. CARD (Comfort Ask Relax Distract) for school-based immunizations in Calgary, Canada: a pragmatic cluster trial. Pain 2024; 165:644-656. [PMID: 37824173 PMCID: PMC10859848 DOI: 10.1097/j.pain.0000000000003050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/10/2023] [Accepted: 07/27/2023] [Indexed: 10/13/2023]
Abstract
ABSTRACT School-based immunizations are fear-inducing events for many students and contribute to vaccine hesitancy. We developed an immunization delivery framework called the CARD (Comfort Ask Relax Distract) system that incorporates evidence-based interventions to improve the experience (eg, reduce fear, pain, dizziness). We evaluated CARD in grades 6 and 9 students in Calgary, Canada. In this pragmatic, hybrid, effectiveness-implementation, cluster trial, we randomized 8 Community Health Centres providing regional immunization services to CARD or control (usual care). In the CARD group, public health staff educated students about CARD and planned processes to reduce fear cues and support student coping choices during immunization. Students self-reported fear, pain, and dizziness during immunization using a 0-10 numerical rating scale; staff recorded procedure details, including vaccines administered, fainting episodes, and coping strategies used. Staff participated in focus groups afterward. Altogether, 8839 children from 105 schools in the 2019 to 2020 school calendar year were included. Fear was lower for CARD (mean = 3.6 [SD = 3.1] vs control 4.1 [3.2]; mean difference = -0.5; 95% confidence interval = -0.74 to -0.21; P < 0.001). Effectiveness persisted after stratification by student gender (male and female) and grade level (grade 6 and grade 9). Other symptoms did not differ. Compared with control, CARD students used peers, privacy, muscle tension, and topical anesthetics more; verbal distraction, deep breathing, and adult support were used less frequently ( P < 0.05, all analyses). Immunization rate did not differ. Staff reported positive to neutral attitudes about CARD. In summary, this pragmatic trial demonstrated that CARD improved the immunization experiences of students at school.
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Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Charlotte Logeman
- Child Health Evaluative Services, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Lucie M. Bucci
- Bucci-Hepworth Health Services Inc., Pincourt, QC, Canada
| | - Victoria Gudzak
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Noni E. MacDonald
- Faculty of Medicine, Dalhousie University, IWK Health Centre, Halifax, NS, Canada
| | | | - Tracy Samborn
- Cochrane Community Health Centre, Alberta Health Services, Cochrane, AL, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Taddio A, Rocchi M, Bucci LM, McMurtry CM, LeDrew E, Shea C, Morrison J, Yang M, Gudzak V, Logeman C, MacDonald NE. CARD (Comfort Ask Relax Distract) integration guide for community pharmacies administering vaccinations: How to play your best hand. Can Pharm J (Ott) 2022; 156:56S-61S. [PMID: 36756628 PMCID: PMC9899972 DOI: 10.1177/17151635221139193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/22/2022] [Indexed: 12/23/2022]
Affiliation(s)
| | - Marie Rocchi
- the Leslie Dan Faculty of Pharmacy, University
of Toronto
| | | | - C. Meghan McMurtry
- the Department of Psychology, University of
Guelph,Pediatric Chronic Pain Program, McMaster
Children’s Hospital, Hamilton,Children’s Health Research Institute,
Guelph
| | - Erin LeDrew
- TIDES & Community Education, Centre for
Addiction and Mental Health, Toronto
| | - Christine Shea
- the Institute of Health Policy, Management and
Evaluation, University of Toronto,Institute of Health Policy, Management and
Evaluation, University of Toronto
| | | | - Molly Yang
- Wholehealth Pharmacy Partners, Markham,
Ontario
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Taddio A. Introducing CARD (Comfort Ask Relax Distract) as a vaccine delivery program for community pharmacy-based vaccinations. Can Pharm J (Ott) 2022; 156:2S-5S. [PMID: 36756629 PMCID: PMC9899970 DOI: 10.1177/17151635221136489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 09/28/2022] [Indexed: 12/15/2022]
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Taddio A, Morrison J, Gudzak V, Logeman C, McMurtry CM, Bucci LM, Shea C, MacDonald NE, Yang M. Integration of CARD (Comfort Ask Relax Distract) for COVID-19 community pharmacy vaccination in children: Effect on implementation outcomes. Can Pharm J (Ott) 2022; 156:36S-47S. [PMID: 36748084 PMCID: PMC9755037 DOI: 10.1177/17151635221139783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/21/2022] [Indexed: 12/15/2022]
Abstract
Introduction Community pharmacists report that providing vaccinations can be challenging, particularly if the vaccine recipient is a child, because of heightened levels of fear. The objective of this study was to determine acceptability and feasibility of the CARD (Comfort Ask Relax Distract) system as a vaccination delivery framework for children receiving COVID-19 vaccinations in a community pharmacy setting. CARD incorporates evidence-based interventions that reduce fear and immunization stress-related responses in vaccine recipients and was demonstrated to be effective and feasible in other vaccination settings providing vaccinations to children and adults. Methods This mixed-methods study involved 5 independent pharmacies (with 6 vaccinators) offering COVID-19 vaccinations to children between 5 and 11 years of age. Vaccinating staff and implementation leads from the pharmacy organization participated in a small-scale CARD implementation project (before-and-after design). Afterwards, they filled in quantitative surveys and provided qualitative feedback about their perceptions and experiences in focus group discussions. Qualitative data were analyzed deductively, using the Consolidated Framework for Implementation Research (CFIR). Results The study was conducted between January 16 and March 20, 2022. Across both quantitative and qualitative measures, vaccinating staff reported positive attitudes about CARD and alignment with their professional roles. They reported that CARD reduced children's fear and improved the vaccination experiences in children and parents and for themselves. Vaccinators reported increased confidence due to CARD. They reported compatibility of CARD interventions within their practice and that it was time neutral. They maintained use of some interventions after the study. They also provided suggestions and shared concerns about fidelity and future feasibility of continuing various components of the program. Conclusion CARD was demonstrated to be acceptable and feasible by vaccinators performing vaccinations in children in community pharmacies.
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Affiliation(s)
| | | | - Victoria Gudzak
- Leslie Dan Faculty of Pharmacy, University of
Toronto, Ontario
| | | | - C. Meghan McMurtry
- Department of Psychology, University of Guelph,
Ontario,Pediatric Chronic Pain Program, McMaster
Children’s Hospital, Hamilton, Ontario,Children’s Health Research Institute, Guelph,
Ontario
| | - Lucie M. Bucci
- Immunize Canada, Canadian Public Health
Association, Ottawa, Ontario
| | - Christine Shea
- Institute of Health Policy, Management and
Evaluation, University of Toronto, Ontario
| | | | - Molly Yang
- Wholehealth Pharmacy Partners, Markham,
Ontario
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Taddio A, McMurtry CM, Logeman C, Gudzak V, de Boer A, Constantin K, Lee S, Moline R, Uleryk E, Chera T, MacDonald NE, Pham B. Prevalence of pain and fear as barriers to vaccination in children - Systematic review and meta-analysis. Vaccine 2022; 40:7526-7537. [PMID: 36283899 DOI: 10.1016/j.vaccine.2022.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/30/2022] [Accepted: 10/08/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Injection-related pain and fear are common adverse reactions in children undergoing vaccination and influence vaccine acceptance. Despite the large body of literature on sources of vaccine non-compliance, there is no estimate of the prevalence of pain and fear as contributing factors. The objective was to estimate the prevalence of injection pain or fear of needles as barriers to childhood (i.e., 0-18 years) vaccination. METHODS Four databases were searched from inception for relevant English and French articles until August 2021. In addition, the references of recent systematic reviews and all articles included in the review were hand searched. Article screening and data extractions were performed in duplicate. Studies were included if they reported on injection-related pain or fear of needles in children (0-18 years) using a checklist/closed-ended question(s). Results were stratified by respondent (parents or children), type of pediatric population (general or under-vaccinated), and relative importance of barrier (pain or needle fear as primary reason or any reason for under-vaccination). Prevalence rates of pain or needle fear were combined using a random effects model. Quality of included studies was assessed using the Joanna Briggs Institute critical appraisal checklist for prevalence data. Quality across studies was assessed using GRADE. RESULTS There were 26 studies with 45 prevalence estimates published between 1995 and 2021. For parent reports (of children) and children self-reported reasons for non-compliance, prevalence rates of pain or needle fear ranged from 5 to 13% in a general population and 8 to 28% in an under-vaccinated population, with a substantial variation in the prevalence estimates. There was no difference between category of respondent or relative importance on pain or needle fear prevalence rate. A regression model demonstrated an overall prevalence rate of pain or needle fear as an obstacle to vaccination of 8% in the general population and 18.3% in the under-vaccinated population. All evidence was very low in quality. CONCLUSION This is the first review to systematically quantify the prevalence and therefore, importance, of pain and needle fear as obstacles to vaccination in children around the world. Pain from injection or fear of needles were demonstrated to be sufficiently prevalent as barriers to vaccination in children to warrant attention. Addressing pain and fear has the potential to significantly improve vaccination acceptance.
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Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, and Child Health Evaluative Sciences, The Hospital for Sick Children (SickKids), Toronto, Canada.
| | | | | | - Victoria Gudzak
- Clinical Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Adrian de Boer
- Clinical Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | | | - Soeun Lee
- Department of Psychology, University of Guelph, Guelph, Canada
| | - Rachel Moline
- Department of Psychology, University of Guelph, Guelph, Canada
| | | | | | | | - Ba' Pham
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
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Taddio A, Gerges S, Rocchi M, Gudzak V, Ilersich AL. Perceptions of pharmacy technician students of the CARD (Comfort Ask Relax Distract) e-module introduced as part of vaccine injection training. Can Pharm J (Ott) 2022; 156:48S-55S. [PMID: 36756625 PMCID: PMC9899967 DOI: 10.1177/17151635221139827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/21/2022] [Indexed: 12/13/2022]
Abstract
Introduction The scope of practice for pharmacy technicians is expanding to include vaccine administration in some provinces. Vaccine training courses and programs currently do not include education about mitigating immunization stress-related responses (ISRR) and improving the vaccination experience. We obtained feedback from pharmacy technician students about a new e-module that addresses this identified knowledge gap, whereby learners are educated about CARD (Comfort Ask Relax Distract), a vaccine delivery framework that reduces ISRR and improves the vaccination experience. Methods Mixed-methods design including second-year pharmacy technician students who elected to take an accredited vaccine injection training program. Students were given access to the CARD e-module after completing mandatory vaccine education components. Eight students answered a quantitative survey and 4 (50%) additionally participated in a focus group. Qualitative data were analyzed deductively using the Consolidated Framework for Implementation Research (CFIR). Results The study was conducted between April 28 and June 12, 2022. Students reported positive attitudes about the CARD e-module across quantitative and qualitative measures. Qualitative feedback spanned 4 CFIR constructs: intervention characteristics, outer setting, inner setting and individual characteristics. Students reported the e-module was well designed and that the content was relevant. They believed CARD facilitated provision of vaccinations using a person-centred approach that promotes vaccination. They felt that CARD could potentially add time to the vaccination appointment and that it would need to be acceptable to pharmacy leaders because of implications for training and vaccination delivery. They suggested that CARD education should be mandatory. CARD improved their confidence in delivering vaccinations, and they planned to integrate CARD into their practice. Conclusion The CARD e-module was well received by pharmacy technician students when coupled with usual vaccine injection training.
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Affiliation(s)
| | - Sandra Gerges
- Faculty of Health Sciences and Wellness,
Pharmacy Technician Program, Humber College, Toronto
| | | | | | - Angelo L. Ilersich
- Faculty of Applied Health Sciences, Brock
University, St. Catharines, Ontario
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Taddio A, Morrison J, Gudzak V, Logeman C, McMurtry CM, Bucci LM, Shea C, MacDonald NE, Yang M. CARD (Comfort Ask Relax Distract) for community pharmacy vaccinations in children: Effect on immunization stress-related responses and satisfaction. Can Pharm J (Ott) 2022; 156:27S-35S. [PMID: 36756630 PMCID: PMC9899969 DOI: 10.1177/17151635221137682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction CARD (Comfort Ask Relax Distract) is a vaccine delivery program demonstrated to reduce pain, fear and associated immunization stress-related responses (ISRR) in children undergoing vaccinations at school. This study evaluated CARD's clinical impact when integrated into community pharmacy-based pediatric vaccinations. Methods This was a before-and-after CARD implementation study in 5 independent pharmacies offering COVID-19 vaccinations to children aged 5-11 years. No changes were made to practices in the "before" phase. CARD interventions were integrated in the "after" phase (e.g., children prepared a coping plan using a checklist, distraction toolkits were placed in waiting and vaccination spaces, vaccinations were performed with privacy, needles were obscured). Children self-reported ISRR, including fear, pain and dizziness during vaccination, and both children and parents/caregivers (herein, parents) compared the child's experience to their last needle (better, same, worse). In the "after" phase, parents and children reported how much CARD helped (not at all, a little bit, a moderate amount, a lot). Results The study was conducted between January 16 and March 20, 2022. Altogether, 152 children participated (71 before and 81 after CARD); demographic characteristics did not differ. Children's self-reported fear was lower after CARD, when assessed continuously (2.5 vs 3.7 out of 10; p = 0.02) or dichotomously, using a cut-off of 0 vs >0 (58% vs 80%; p = 0.01). Pain was lower when assessed dichotomously (<2 vs ≥2; p = 0.03). There was no difference in dizziness. After CARD, children and parents reported more positive experiences compared to the child's last needle (p = 0.01, both analyses) and more children and parents reported that distraction and child participation in the process were helpful (p < 0.001, both analyses). Overall, 92% of children and 91% of parents said CARD helped. Conclusion CARD reduced children's fear and improved vaccination experiences for children and parents when integrated in community pharmacy-based vaccinations.
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Affiliation(s)
| | | | | | | | - C. Meghan McMurtry
- Department of Psychology, University of
Guelph,Pediatric Chronic Pain Program, McMaster
Children’s Hospital, Hamilton,Children’s Health Research Institute, Guelph,
Ontario
| | | | - Christine Shea
- Institute of Health Policy, Management and
Evaluation, University of Toronto,Institute of Health Policy, Management and
Evaluation, University of Toronto, Ontario
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Taddio A, McGilton KS, Zheng N, Yeung L, Lafleur B, Fung JS, MacDonald NE, Andrew MK, Verschoor CP. COVID-19 Vaccination Delivery in Long-Term-Care using the CARD (Comfort Ask Relax Distract) System: Mixed Methods study of Implementation Drivers. Can J Pain 2022; 6:173-184. [PMID: 36278249 PMCID: PMC9586631 DOI: 10.1080/24740527.2022.2115880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives Methods Results Discussion
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Affiliation(s)
- Anna Taddio
- MSc, PhD, Professor, Leslie Dan Faculty of Pharmacy, University of Toronto (UofT); and Senior Associate Scientist, The Hospital for Sick Children, Toronto, ON
| | - Katherine S. McGilton
- PhD, KITE, Toronto Rehabilitation Institute, University Health Network (UHN); Professor, Lawrence S Bloomberg, Faculty of Nursing, UofT, Toronto, ON
| | - Nancy Zheng
- BScN, KITE, Toronto Rehabilitation Institute, UHN, Toronto, ON
| | - Lydia Yeung
- BSc, KITE, Toronto Rehabilitation Institute, UHN, Toronto, ON
| | - Benoit Lafleur
- MD, Northern Ontario School of Medicine (NOSM), Sudbury, ON
| | | | - Noni E. MacDonald
- MD, MSc FRCP Professor, Faculty of Medicine, Dalhousie University (DU), Halifax, NS
| | - Melissa K. Andrew
- MD, PhD, Professor, Faculty of Medicine, DU; Canadian Center for Vaccinology, Halifax, NS
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9
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Taddio A, Gudzak V, Jantzi M, Logeman C, Bucci LM, MacDonald NE, Moineddin R. Impact of the CARD (Comfort Ask Relax Distract) system on school-based vaccinations: A cluster randomized trial. Vaccine 2022; 40:2802-2809. [PMID: 35365344 DOI: 10.1016/j.vaccine.2022.02.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/17/2022] [Accepted: 02/20/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND The CARD (Comfort Ask Relax Distract) system is a vaccine delivery framework that integrates evidence-based interventions to reduce stress-related responses and improve the vaccination experience for children undergoing vaccinations at school. In preliminary studies, CARD was acceptable and effective. The objective was to evaluate CARD in a large, pragmatic trial to confirm its effectiveness in real-world settings. METHODS Hybrid effectiveness-implementation cluster randomized trial in schools receiving vaccination services from Wellington-Dufferin-Guelph Public Health. Forty schools with grade 7 students (12 years old) were randomized to CARD and control (n = 20/group). Nurses in CARD schools planned clinics with principals and educated students about CARD ahead of time. Principals disseminated information to staff and parents and sent reminders. Vaccination day processes minimized fear and facilitated student self-selected coping strategies. Nurses in control schools followed usual practices, which excluded principal meetings, education, reminders, and systematic integration of fear-reducing or child-selected coping strategies. Outcomes included stress-related symptoms (fear - primary outcome, pain, dizziness, fainting, post-vaccination reactions), use of coping interventions, vaccination uptake, attitudes and implementation outcomes (acceptability, appropriateness, feasibility, fidelity). RESULTS Altogether, 1919 students were included. Fear and pain were lower in CARD schools: OR 0.65 (95% CI 0.47-0.90) and OR 0.62 (95% CI 0.50-0.77), respectively. No students fainted in CARD schools compared to 0.8% in control (p = 0.02). Dizziness and post-vaccination reactions did not differ. Student-led coping interventions were used more frequently in CARD schools. Vaccination uptake was 76.1% in CARD schools and 72.5% in control schools (OR 1.13 (95% CI 0.85-1.50)). Staff and students had positive attitudes about CARD and implementation outcomes; however, recommendations were made to improve fidelity. DISCUSSION CARD reduced stress-related responses in students undergoing vaccinations at school and was positively received by students and public health staff. CARD is recommended to improve the quality of vaccination delivery services. TRIAL REGISTRATION NCT03966300.
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Affiliation(s)
- Anna Taddio
- Clinical Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, and Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.
| | - Victoria Gudzak
- Clinical, Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Marlene Jantzi
- Vaccine Preventable Disease Program, Wellington-Dufferin-Guelph Health Unit, Guelph, Canada
| | - Charlotte Logeman
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Lucie M Bucci
- Immunize Canada, Canadian Public Health Association, Ottawa, Canada
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Segers EW, Ketelaar M, Taddio A, de Man MACP, Schoonhoven L, van de Putte EM, van den Hoogen A. Exploring key elements of approaches that support childrens' preferences during painful and stressful medical procedures: A scoping review. J Pediatr Nurs 2022; 62:e16-e24. [PMID: 34266719 DOI: 10.1016/j.pedn.2021.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 11/17/2022]
Abstract
PROBLEM Children undergoing medical procedures can experience pain and distress. While numerous interventions exist to mitigate pain and distress, the ability to individualize the intervention to suit the needs and preferences of individual children is emerging as an important aspect of providing family-centered care and shared decision making. To date, the approaches for supporting children to express their preferences have not been systematically identified and described. A scoping review was conducted to identify such approaches and to describe the elements that are included in them. ELIGIBILITY CRITERIA Studies that (a) described approaches with the aim to support children to express their coping preferences during medical procedures; (b) included the option for children to choose coping interventions; (c) included a child (1--18 years). SAMPLE Searches were conducted in December 2019 and November 2020 in the following databases: Cinahl, Embase, PubMed and Psycinfo. RESULTS Thirteen studies were identified that included six distinct approaches. Four important key elements were identified: 1) Aid to express preferences or choice, 2) Information Provision, 3) Assessment of feelings/emotions, 4) Feedback/Reflection and Reward. CONCLUSIONS Identified approaches incorporate components of shared decision-making to support children in expressing their preferences during medical procedures and treatments. IMPLICATIONS Children undergoing medical procedures can be supported in expressing their coping needs and preferences by using components of shared decision-making.
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Affiliation(s)
- Elisabeth W Segers
- Department of Children, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands.
| | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation Medicin, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario M5S 3M2, Canada
| | - Marjorie A C P de Man
- Department of Children, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands
| | - Lisette Schoonhoven
- Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, UK
| | - Elise M van de Putte
- Department of Children, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands
| | - Agnes van den Hoogen
- Department of Children, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands; Utrecht University, Utrecht, the Netherlands
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Cull K, Bowles SK, MacDonald N, McNeil S, Taylor B, Slayter K, Steenbeek A, Taddio A, Bucci LM, Isenor JE. Patient perspectives of pain mitigation strategies for adult vaccine injections. Can J Pain 2021. [DOI: 10.1080/24740527.2021.1967113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Kathryn Cull
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Susan K. Bowles
- Department of Pharmacy, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Noni MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shelly McNeil
- Division of Infectious Diseases, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Beth Taylor
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kathryn Slayter
- Department of Pharmacy, IWK Health, Halifax, Nova Scotia, Canada
| | - Audrey Steenbeek
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Lucie M. Bucci
- Immunize Canada, Canadian Public Health Association, Ottawa, Ontario, Canada
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12
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Jordan A, Carter B, Vasileiou K. “Pain talk”: A triadic collaboration in which nurses promote opportunities for engaging children and their parents about managing children’s pain. Paediatric and Neonatal Pain 2021; 3:123-133. [PMID: 35547948 PMCID: PMC8975224 DOI: 10.1002/pne2.12061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/23/2021] [Accepted: 07/26/2021] [Indexed: 11/10/2022]
Abstract
Effective communication with children about pain is important and has the potential to mediate the short‐ and longer‐term effects of pain on children. Most communication studies relating to children's pain have focused on language children use to describe everyday pain experiences. However, little is known regarding how health professionals, particularly nurses, communicate with children in healthcare settings about pain. This study aimed to explore how nurses talk to children and their parents about pain and what factors influence nurses’ use of language and non‐verbal communication. A cross‐sectional mixed‐methods (predominantly qualitative) survey (“pain talk”) was conducted, comprising qualitative items about pain communication and four vignettes portraying hypothetical cases of children representing typical child pain scenarios. Participants were recruited via email, social media, newsletters, established networks, and personal contacts. A total of 141 registered (68.1%) or in‐training nurses across 11 countries with experience of managing children's pain completed the survey. Textual survey responses were analyzed using conventional qualitative content analysis. Qualitative content analysis generated a meta‐theme “Being confident and knowing how to do ‘pain talk’” and four main themes that described the functions, purpose, and delivery of “pain talk”: (a) “contextualizing and assessing,” (b) “empowering, explaining, and educating,” (c) “supporting, affirming, and confirming,” and (d) “protecting, distracting, and restoring.” “Pain talk” was a triadic collaborative communication process that required nurses to feel confident about their role and skills. This process involved nurses talking to children and parents about pain and creating engagement opportunities for children and parents. “Pain talk” aimed to promote the agency of the child and parent and their engagement in discussions and decision‐making, using information, support, and comfort. Nurses shaped their “pain talk” to the specific context of the child's pain, previous experiences, and current concerns to minimize potential distress and adverse effects and to promote optimal pain management.
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Affiliation(s)
- Abbie Jordan
- Centre for Pain Research and Department of Psychology University of Bath Bath UK
| | - Bernie Carter
- Faculty of Health, Social Care and Medicine Edge Hill University Ormskirk UK
| | - Konstantina Vasileiou
- Department of Psychology University of Bath Bath UK
- University of West Attica Athens Greece
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Taddio A, Coldham J, Logeman C, McMurtry CM, Little C, Samborn T, Bucci LM, MacDonald NE, Shah V, Dribnenki C, Snider J, Stephens D. Feasibility of implementation of CARD™ for school-based immunizations in Calgary, Alberta: a cluster trial. BMC Public Health 2021; 21:260. [PMID: 33526030 PMCID: PMC7849968 DOI: 10.1186/s12889-021-10247-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 01/14/2021] [Indexed: 01/23/2023] Open
Abstract
Background Negative experiences with school-based immunizations can contribute to vaccine hesitancy in youth and adulthood. We developed an evidence-based, multifaceted and customizable intervention to improve the immunization experience at school called the CARD™ (C-Comfort, A-Ask, R-Relax, D-Distract) system. We evaluated the feasibility of CARD™ implementation for school-based immunizations in Calgary, Canada. Methods In a mixed methods study, two Community Health Centres providing immunization services, including 5 schools each with grade 9 students (aged approximately 14 years), were randomized to CARD™ or control (usual care). In the CARD™ group, public health staff and students were educated about coping strategies prior to immunization clinics. Clinics were organized to reduce fear and to support student’s choices for coping strategies. Public health staff in the CARD™ group participated in a focus group discussion afterwards. We sought a recruitment rate of 80% for eligible schools, an external stakeholder focus group (e.g., school staff) with 6 or more individuals, 85% of individual injection-related data acquisition (student and immunizer surveys), and 80% absolute agreement between raters for a subset of data that were double-coded. Across focus groups, we examined perceptions of acceptability, appropriateness, feasibility and fidelity of CARD™. Results Nine (90%) of eligible schools participated. Of 219 students immunized, injection-related student and immunizer data forms were acquired for 195 (89.0%) and 196 (89.5%), respectively. Reliability of data collection was high. Fifteen public health and 5 school staff participated in separate focus groups. Overall, attitudes towards CARD™ were positive and compliance with individual components of CARD™ was high. Public health staff expressed skepticism regarding the value of student participation in the CARD™ system. Suggestions were made regarding processes to refine implementation. Conclusion While most outcome criteria were satisfied and overall perceptions of implementation outcomes were positive, some important challenges and opportunities were identified. Feedback is being used to inform a large cluster trial that will evaluate the impact of CARD™ during school-based immunizations. Trial registration The trial is registered at ClinicalTrials.gov (NCT03948633); Submitted April 24, 2019.
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Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario, M5S 3M2, Canada.
| | - Joanne Coldham
- Alberta Health Services, 10101 Southport Road SW, Calgary, Alberta, T2W 3N2, Canada
| | - Charlotte Logeman
- The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, 4003 Mackinnon Building (Mackinnon Extension), Guelph, Ontario, N1G 2W1, Canada
| | - Cheri Little
- Alberta Health Services, 10101 Southport Road SW, Calgary, Alberta, T2W 3N2, Canada
| | - Tracy Samborn
- Cochrane Community Health Centre, Alberta Health Services, 60 Grande Blvd, Cochrane, Alberta, T4C 0S4, Canada
| | - Lucie M Bucci
- Immunize Canada, 404-1525 Carling Avenue, Ottawa, Ontario, K1Z 8R9, Canada
| | - Noni E MacDonald
- IWK Health Centre, Dalhousie University, 5850/5980 University Avenue, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Vibhuti Shah
- Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada
| | - Cindy Dribnenki
- Alberta Health Services, Suite 104 Main Floor West Tower, 14310-111 Avenue, Edmonton, Alberta, T5M 3Z7, Canada
| | - Joanne Snider
- Alberta Health Services, Suite 104 Main Floor West Tower, 14310-111 Avenue, Edmonton, Alberta, T5M 3Z7, Canada
| | - Derek Stephens
- The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
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Bucci LM, MacDonald NE, Freedman T, Taddio A. Benchmarking public health pain management practices during school immunizations. ACTA ACUST UNITED AC 2020; 45:367-72. [PMID: 33315983 DOI: 10.14745/ccdr.v46i10a10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background Pain and fear during immunizations can affect children and their future behaviour toward immunization. These negative experiences can be amplified when children receive vaccines as part of school-based immunization programs, where parental or tutor supports are missing. In 2015, HELPinKIDS&ADULTS, a Canadian network of experts, published a clinical practice guideline (CPG) on the management of pain and fear during immunization. This guideline has been endorsed by international, national and provincial organizations. However, the level of integration and implementation of the CPG into local and community immunization programs such as school-based immunization clinics is unclear. Methods An investigation whether public health units in Ontario integrated and implemented the pain and fear interventions recommended by the CPG into school-based immunization policies and practices was concluded. Results The study shows that the majority of public health units do have pain and fear policies and procedures in place, but interventions are not integrated in a consistent and formal manner, leading to suboptimal uptake of interventions during immunizations at school. Conclusion For pain interventions to be applied with sufficient fidelity and in enough individuals to have a meaningful effect, organizational leaders need to create directives and procedures that support implementation in a systematic and accountable manner.
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15
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Logeman C, Taddio A, McMurtry CM, Bucci L, MacDonald N, Chalmers G, Gudzak V, Shah V, Coldham J, Little C, Samborn T, Dribnenki C, Snider J. Student Feedback to Tailor the CARD™ System for Improving the Immunization Experience at School. Children (Basel) 2020; 7:E126. [PMID: 32899632 PMCID: PMC7552616 DOI: 10.3390/children7090126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 02/07/2023]
Abstract
Increasing the comfort of vaccine delivery at school is needed to improve the immunization experience for students. We created the CARD™ (C-Comfort, A-Ask, R-Relax and D-Distract) system to address this clinical care gap. Originally designed for grade 7 students, this study examined the perceptions of grade 9 students of CARD™. Grade 9 students who had experience with school-based immunizations, either as recipients or onlookers (n = 7; 100% females 14 years old) participated. Students answered pre-post surveys, reviewed CARD™ educational materials and participated in a semi-structured focus group discussion. The Consolidated Framework for Implementation Research (CFIR) was used as the framework for analysis of qualitative data. Participants reported positive perceptions of CARD™ educational materials and that CARD™ could fit into the school immunization process. CARD™ improved knowledge about effective coping interventions and was recommended for education of both nurses and students. The results provide preliminary evidence that CARD™ is acceptable and appropriate for implementation in grade 9 school-based immunizations.
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Affiliation(s)
- Charlotte Logeman
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada; (C.L.); (V.G.)
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada; (C.L.); (V.G.)
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - C. Meghan McMurtry
- Department of Psychology, The University of Guelph, Guelph, ON N1G 2W1, Canada;
- McMaster Children’s Hospital, Hamilton, ON L8N 3Z5, Canada
| | - Lucie Bucci
- Immunize Canada, Canadian Public Health Association, Ottawa, ON K1Z 8R9, Canada;
| | - Noni MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, NS B3K 6R8, Canada;
| | - Garth Chalmers
- University of Toronto Schools, Toronto, ON M5S 2R7, Canada;
| | - Victoria Gudzak
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada; (C.L.); (V.G.)
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Vibhuti Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada;
| | - Joanne Coldham
- Alberta Health Services, Calgary, AB T2W 3N2, Canada; (J.C.); (C.L.); (T.S.); (C.D.); (J.S.)
| | - Cheri Little
- Alberta Health Services, Calgary, AB T2W 3N2, Canada; (J.C.); (C.L.); (T.S.); (C.D.); (J.S.)
| | - Tracy Samborn
- Alberta Health Services, Calgary, AB T2W 3N2, Canada; (J.C.); (C.L.); (T.S.); (C.D.); (J.S.)
| | - Cindy Dribnenki
- Alberta Health Services, Calgary, AB T2W 3N2, Canada; (J.C.); (C.L.); (T.S.); (C.D.); (J.S.)
| | - Joanne Snider
- Alberta Health Services, Calgary, AB T2W 3N2, Canada; (J.C.); (C.L.); (T.S.); (C.D.); (J.S.)
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16
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Dubé E, Wilson S, Gagnon D, Deeks SL, Dubey V. " It takes time to build trust": a survey Ontario's school-based HPV immunization program ten years post-implementation. Hum Vaccin Immunother 2020; 17:451-456. [PMID: 32643527 DOI: 10.1080/21645515.2020.1775456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Describe Ontario's school-based human papillomavirus (HPV) vaccination program from the perspective of local public health units (PHUs). METHODS In 2018, Vaccine Preventable Diseases (VPD) managers at each of Ontario's 35 PHUs were invited to participate in an online survey regarding the organization and delivery of their HPV vaccination program. Questions were asked on the school-based program, training and support of vaccine providers, communication and promotion, assessing coverage rates and perceptions of the program's strengths and challenges. Descriptive statistics were generated for close-ended items. A thematic content analysis was performed for open-ended items. RESULTS Eighteen PHUs (54%, n = 19/35) responded. All responding PHUs provided the HPV vaccine in publicly funded schools but only 6 reported being permitted to provide HPV vaccine in private schools. Fact sheets, Q&As or other written information locally developed by the PHUs were the main tools used to communicate with parents (n = 17), students (n = 13), school personnel (n = 13) and school board officials (n = 9). The most frequently reported barriers were: limited program resources, negative perceptions held by parents and/or school staff regarding the HPV vaccine, logistical issues (e.g., getting the consents forms returned, collaboration with schools for vaccine delivery) and the fact that HPV vaccination is not mandatory under Ontario legislation. CONCLUSION Local public health units that implement HPV vaccine programs in schools identified logistical barriers, public perceptions about the HPV vaccine and the voluntary nature of the program as the main barriers.
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Affiliation(s)
- Eve Dubé
- Département des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec (INSPQ) , Québec, Canada.,Axe Maladies infectieuses et immunitaires, Centre de Recherche du CHU de Québec-Université Laval , Québec, Canada.,Université Laval , Québec, Canada
| | - Sarah Wilson
- Department of Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario , Ontario, Canada.,Department of Clinical Public Health, Dalla Lana School of Public Health , Ontario, Canada.,ICES , Ontario, Canada
| | - Dominique Gagnon
- Département des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec (INSPQ) , Québec, Canada
| | - Shelley L Deeks
- Department of Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario , Ontario, Canada.,Department of Clinical Public Health, Dalla Lana School of Public Health , Ontario, Canada
| | - Vinita Dubey
- Department of Clinical Public Health, Dalla Lana School of Public Health , Ontario, Canada.,Toronto Public Health and the Canadian Immunization Research Network , Ontario, Canada
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17
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McMurtry CM. Managing immunization stress-related response: A contributor to sustaining trust in vaccines. Can Commun Dis Rep 2020; 46:210-218. [PMID: 32673376 DOI: 10.4745/ccdr.v46i06a10] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Adverse events following immunizations (AEFI) are important to identify and manage effectively so as to sustain trust in vaccines and optimize health. The AEFI category related to "anxiety about the immunization" was considered problematic as it did not adequately capture the range of stress responses that can occur. The currently used term for this category, immunization stress-related responses (ISRR), is broader, including the full spectrum of signs and symptoms that can arise in response to stress. ISRR can include vasovagal reactions (fainting), hyperventilation and functional neurological symptoms (e.g. weakness, nonepileptic seizures). It is based on a biopsychosocial framework in which biological (e.g. age, sex), psychological (e.g. preparedness, previous experiences, anxiety) and social factors (e.g. response by others, social media) interact to create an individual's stress response to the immunization process. New guidance is available on prevention, early detection and management of ISRRs which is summarized in the article.
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Affiliation(s)
- C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph, ON.,Pediatric Chronic Pain Program, McMaster University, Hamilton, ON.,Adjunct Research Professor, Department of Paediatrics, Western University, London, ON.,Associate Scientist, Children's Health Research Institute, London, ON
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18
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Gold MS, MacDonald NE, McMurtry CM, Balakrishnan MR, Heininger U, Menning L, Benes O, Pless R, Zuber PLF. Immunization stress-related response - Redefining immunization anxiety-related reaction as an adverse event following immunization. Vaccine 2020; 38:3015-3020. [PMID: 32131975 DOI: 10.1016/j.vaccine.2020.02.046] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/11/2020] [Accepted: 02/16/2020] [Indexed: 12/13/2022]
Abstract
The Council for the International Organizations of Medical Sciences (CIOMS) and WHO working group on pharmacovigilance defines five cause specific AEFI which includes an immunization anxiety-related reaction. Historically this term has been used to describe a range of symptoms and signs that may arise after immunization that are related to "anxiety" about the immunization. However, the term "anxiety" does not adequately capture all the elements of this cause specific AEFI. In 2015, the Global Advisory Committee for Vaccine Safety convened an expert working group with the purpose of redefining, preventing and managing this particular AEFI. The term "Immunization Stress-Related Response" is proposed to replace the former terminology. We present a manual that redefines this AEFI and present a framework for prevention, diagnosis and management in both an individual and also when such events occur as clusters and affect multiple individuals. Since such mass events can result in cessation of immunization programmes and/or a loss of public confidence, a communication response is essential.
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Affiliation(s)
- Michael S Gold
- Discipline of Paediatrics, School of Medicine, University of Adelaide, Australia.
| | - Noni E MacDonald
- Department of Paediatrics, Dalhousie University, IWK Health Centre, Halifax, Canada
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph and Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Madhava Ram Balakrishnan
- Department of Essential Medicines and Health Products (EMP), World Health Organization, Genève, Switzerland
| | - Ulrich Heininger
- Division of Pediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Lisa Menning
- Expanded Programme on Immunization, World Health Organisation, Geneva, Switzerland
| | - Oleg Benes
- Regional Office Europe, World Health Organisation, Denmark
| | - Robert Pless
- Clinical Evaluation Division, Vaccines/Blood Biologics and Genetic Therapies Directorate, Health Canada, Canada
| | - Patrick L F Zuber
- Department of Essential Medicines and Health Products (EMP), World Health Organization, Genève, Switzerland
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19
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Taddio A, Alderman L, Freedman T, McDowall T, McMurtry CM, MacDonald N, deVlaming-Kot C, Alfieri-Maiolo A. The CARD™ System for improving the vaccination experience at school: Results of a small-scale implementation project on program delivery. Paediatr Child Health 2019; 24:S54-S67. [PMID: 30948923 PMCID: PMC6438865 DOI: 10.1093/pch/pxz021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 12/28/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE We conducted a small-scale implementation study that integrated The CARD™ System (C-Comfort, A-Ask, R-Relax, D-Distract)-a multifaceted knowledge translation intervention designed to improve the vaccination experience at school-within the school vaccination program. METHODS Mixed methods design, including a controlled clinical trial and focus group interviews. The experimental group included five schools whereby CARD™ was implemented. The control group included five schools whereby no changes were made. Focus groups were held at the end of the school year. For nurses trained in CARD™, additional focus groups were held at CARD™ training and after the first round of vaccine clinic visits. Outcomes included vaccination rate at school and adult stakeholder perceptions. RESULTS Altogether, 323 students attended study schools. Fifty-five nurses, school staff, and parents participated in 15 focus groups. The school vaccination rate did not differ (P>0.05) between groups for round 1 clinics (76% versus 77%) or round 2 clinics (68% versus 70%). Participants reported acceptability, appropriateness, feasibility, and satisfaction with CARD™. Experimental group nurses were able to integrate CARD™ within usual activities, including clinic planning, student education, and clinic-day set-up and student vaccinations. Students in experimental schools were described by nurses and school staff as more prepared and less fearful during vaccinations. Nurses reported that CARD™ built on their practice; they had higher confidence in their ability to assess pain and fear and higher satisfaction with their ability to manage it. Nurses also reported improved collaboration with students and with each other. All stakeholder groups recommended continuing CARD™. Some additional time was required, primarily related to clinic planning activities and data collection for study purposes. CONCLUSION CARD™ is a promising new approach for improving the delivery of vaccinations at school. Exploration of approaches to increase parental reach and monitoring of vaccination uptake rate over time are recommended.
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Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Leslie Alderman
- Niagara Region Public Health & Emergency Services, Thorold, Ontario
| | - Tamlyn Freedman
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Tori McDowall
- Niagara Region Public Health & Emergency Services, Thorold, Ontario
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20
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Taddio A. Pain Pain Go Away: Improving the vaccination experience at school. Paediatr Child Health 2019; 24:S1-S2. [PMID: 30948917 PMCID: PMC6438864 DOI: 10.1093/pch/pxz016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 01/04/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
- The Hospital for Sick Children, Toronto, Ontario
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21
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Taddio A, Freedman T, Wong H, McMurtry CM, MacDonald N, Ilersich ANT, Ilersich ALT, McDowall T. Stakeholder feedback on The CARD™ System to improve the vaccination experience at school. Paediatr Child Health 2019; 24:S29-S34. [PMID: 30948920 PMCID: PMC6438868 DOI: 10.1093/pch/pxz018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 12/28/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE School-based vaccination programs can be a source of distress for many students due to the pain from the needle injection and related fears. We created a multifaceted Knowledge Translation (KT) intervention to address vaccination and pain, fear, and fainting called The CARD™ System. The objectives were to document acceptability of key tools included in the multifaceted KT intervention and their effectiveness in improving knowledge and attitudes about vaccination pain and fear. METHODS Quantitative and qualitative methods were used. Students, school staff, public health nurses, and parents participated in separate focus groups whereby they independently completed a knowledge and attitudes survey and provided structured and qualitative feedback on key KT tools of the multifaceted KT intervention. They then repeated the knowledge and attitudes survey. RESULTS Altogether, 22 students (grade 6 and 7), 16 school staff (principals, grade 7 and 8 teachers, resource teachers, secretaries), 10 nurses (injecting, charge, and school nurses), and 3 parents participated. Knowledge test scores increased post-KT tool review: 8.5 (2.1) versus 7.3 (1.9); P<0.001. Attitudes were more positive about the individual nature of pain and fear experience during vaccination. Student fear scores were lower post-tool review: 5.1 (2.9) versus 4.6 (3.0); P<0.001. The majority of the participants reported they understood all the information, the amount was just right and that the information was useful. DISCUSSION The KT tools were demonstrated to be acceptable and to improve knowledge. Future research is warranted to determine their impact on student experience during school vaccinations.
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Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
- The Hospital for Sick Children, Toronto, Ontario
| | - Tamlyn Freedman
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Horace Wong
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | | | | | | | | | - Tori McDowall
- Niagara Region Public Health & Emergency Services, Thorold, Ontario
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Freedman T, Taddio A, McMurtry CM, Wong H, MacDonald N, McDowall T, deVlaming-Kot C, Alderman L. Involving stakeholders in informing the development of a Knowledge Translation (KT) intervention to improve the vaccination experience at school. Paediatr Child Health 2019; 24:S19-S28. [PMID: 30948919 PMCID: PMC6438867 DOI: 10.1093/pch/pxz017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 12/28/2018] [Indexed: 12/20/2022] Open
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.
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Affiliation(s)
- Tamlyn Freedman
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | | | - Horace Wong
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | | | - Tori McDowall
- Niagara Region Public Health & Emergency Services, Thorold, Ontario
| | | | - Leslie Alderman
- Niagara Region Public Health & Emergency Services, Thorold, Ontario
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Taddio A, Ilersich ANT, Ilersich ALT, Schmidt C, Chalmers G, Wilson E, McMurtry CM, MacDonald N, Bucci LM, Freedman T, Wong H. Piloting The CARD™ System for education of students about vaccination: Does it improve the vaccination experience at school? Paediatr Child Health 2019; 24:S35-S41. [PMID: 30948921 PMCID: PMC6438862 DOI: 10.1093/pch/pxz019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 12/28/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Many students are fearful of vaccine injection-associated pain. In prior research, we created Knowledge Translation (KT) tools to address school vaccinations and associated pain, fear, and fainting. The objectives of this pilot implementation project were to determine the acceptability and impact of these KT tools on student knowledge, attitudes, and perceptions of their vaccination experience. METHODS Pre-post mixed methods design. Students in an independent school in the Greater Toronto Area, Ontario, participated in two separate focus groups before and after school vaccinations. In both sessions, they independently completed a knowledge and attitudes survey, reviewed three KT tools (two videos and one pamphlet) and then repeated the knowledge and attitudes survey. They provided structured and qualitative feedback about the KT tools and described the impact of the education on the vaccination experience. RESULTS Altogether, 11 grade 7 students participated. Knowledge scores were higher post-tool review compared to baseline in the first focus group. There was no significant difference in fear scores and attitudes about getting vaccinated. Qualitative feedback was categorized into two themes: intervention characteristics and characteristics of the school environment. Students reported the KT tools helped them to prepare for vaccination. They used the information on vaccination day to reduce their own fear and pain and to assist peers. They believed all students should view the KT tools. Students reported that teachers and nurses did not do enough to make vaccinations a positive experience. For example, they did not provide a private setting as an option for vaccination and prevented them from using some coping strategies recommended in the KT tools. DISCUSSION This study provides preliminary evidence of the acceptability and positive impact of the KT tools on students' vaccination experiences. Future research is recommended that involves inclusion of all students and adults in the KT intervention.
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Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
- The Hospital for Sick Children, Toronto, Ontario
| | | | | | | | | | - Evelyn Wilson
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario
| | | | | | | | - Tamlyn Freedman
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Horace Wong
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
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Taddio A, McMurtry CM, Bucci LM, MacDonald N, Ilersich ANT, Ilersich ALT, Alfieri-Maiolo A, deVlaming-Kot C, Alderman L. Overview of a Knowledge Translation (KT) Project to improve the vaccination experience at school: The CARD™ System. Paediatr Child Health 2019; 24:S3-S18. [PMID: 30948918 PMCID: PMC6438869 DOI: 10.1093/pch/pxz025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 02/20/2019] [Indexed: 12/25/2022] Open
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.
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Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario.,The Hospital for Sick Children, Toronto, Ontario
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- Niagara Region Public Health & Emergency Services, Thorold, Ontario
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