Using the CARD system for university-based pop-up vaccination clinics: A two-stage hybrid effectiveness-implementation study

Mass vaccination clinics efficiently vaccinate large numbers of people. The CARD system (Comfort, Ask, Relax, Distract) is a vaccination delivery framework that can improve the experiences of vaccine recipients and providers. This two-stage hybrid effectiveness-implementation study implemented and sustained CARD in university-based vaccination clinics involving pharmacy student vaccinators. Stage 1 was a before-and-after study conducted across four COVID-19 vaccination clinics in November-December, 2022. Stage 2 was a single cohort study whereby CARD was sustained across four COVID-19/influenza vaccination clinics in November, 2023. In both stages, vaccine recipients rated experiences relative to last vaccination (primary outcome) and symptoms (pain, fear, dizziness) using surveys. Pharmacy student vaccinators completed attitudes and behaviors surveys; a subsample participated in focus groups. In Stage 1, more vaccine recipients in the after period (vs. before) reported a better vaccination experience relative to their last vaccination (64.0% vs 33.6%; p n = 181). Fear and pain were lower (1.1 vs. 1.7, p = .03; and 1.6 vs. 2.1, p = .02, respectively). In Stage 2, 57.4% (95% CI: 53.1%-61.6%; n = 542) of vaccine recipients reported a better experience. Across stages, pharmacy students had positive attitudes about acceptability, feasibility, and sustainability of CARD and reported high fidelity with CARD-recommended interventions. CARD is recommended for university-based vaccination clinics to improve vaccine recipient and provider experiences.