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Brohman I, Blank G, Mitchell H, Dubé E, Bettinger JA. Opportunities for HPV vaccine education in school-based immunization programs in British Columbia, Canada: A qualitative study. Hum Vaccin Immunother 2024; 20:2326779. [PMID: 38517252 PMCID: PMC10962613 DOI: 10.1080/21645515.2024.2326779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/01/2024] [Indexed: 03/23/2024] Open
Abstract
Despite the availability of school-based immunization programs (SBIPs) in Canada, human papillomavirus (HPV) vaccine uptake remains suboptimal. Vaccine education may improve vaccine uptake among adolescents. The objective of this qualitative study was to identify opportunities for HPV vaccine education in British Columbia, Canada, by exploring the perspectives of students, parents, school staff, and public health nurses on the current SBIP. Individual semi-structured interviews were conducted with adult participants and focus groups were conducted with grade 6 students between November 2019 and May 2020. The interviews and focus groups were transcribed and then analyzed using reflexive thematic analysis. Opportunities for HPV vaccine education were identified in three themes: 1) making SBIPs student-centered; 2) adopting a collaborative and interdisciplinary approach to vaccine education; and 3) actualizing parent education opportunities. Broad support existed for a formal, collaborative HPV grade 6 vaccine curriculum delivered by teachers and public health nurses to provide evidence-based health information. Participants voiced that the curriculum should integrate students' perspectives on topics of interest and address needle associated pain and anxiety. Parents were identified as the primary vaccine decisionmakers, therefore, participants stated it was crucial to also provide parent-directed vaccine education as part of SBIP. Our findings support the development of a collaborative HPV vaccine curriculum directed to and informed by students and parents to buttress current SBIPs in British Columbia.
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Affiliation(s)
- Isabella Brohman
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Gabriel Blank
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Hana Mitchell
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Eve Dubé
- Department of Anthropology, Laval University, Laval, QC, Canada
| | - Julie A. Bettinger
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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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] [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] [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, 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] [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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