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 (<i>primary outcome</i>) 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%; <i>p</i> &lt; .001; <i>n</i> = 181). Fear and pain were lower (1.1 vs. 1.7, <i>p</i> = .03; and 1.6 vs. 2.1, <i>p</i> = .02, respectively). In Stage 2, 57.4% (95% CI: 53.1%-61.6%; <i>n</i> = 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.