ArticleHuman vaccines & immunotherapeutics2025
Effect of CARD (Comfort-Ask-Relax-Distract) on acceptance of school-based vaccinations: A controlled before and after study.
Article in Human vaccines & immunotherapeutics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
9 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Reducing distress during vaccine injections: 2026 clinical practice guideline update.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026Guideline
- A Systematic Review and Meta-Analysis of the Effectiveness of Process Interventions for Reducing Distress During Vaccine Injections.The Clinical journal of pain · 2026Pooled it
- CARD (Comfort Ask Relax Distract) and community pharmacy vaccinations: Evaluation of effectiveness outcomes from a cluster randomized trial.Human vaccines & immunotherapeutics · 2025Trial
- CARD (Comfort Ask Relax Distract) and community pharmacy vaccinations: Evaluation of implementation outcomes from a cluster randomized trial.Human vaccines & immunotherapeutics · 2025Trial
- Improving Vaccine Knowledge Among Adolescents Aged 11-14 Years: A Pre-Post School-Based Educational Intervention.Vaccines · 2026Article
- Playing CARD (Comfort Ask Relax Distract): Upping our game on the quality of vaccine delivery.Human vaccines & immunotherapeutics · 2025Article
- Development and refinement of an online CARD (Comfort Ask Relax Distract) course for organizations and providers delivering vaccinations and other needle procedures.Human vaccines & immunotherapeutics · 2025Article
- Using the CARD system for university-based pop-up vaccination clinics: A two-stage hybrid effectiveness-implementation study.Human vaccines & immunotherapeutics · 2025Article
- Commentary: Improving the vaccination experience for children and adults.Human vaccines & immunotherapeutics · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Injection-related pain and fear are common in children undergoing school-based vaccinations and contribute to vaccine refusal. The CARD system (Comfort Ask Relax Distract) includes interventions that reduce pain and fear. This pragmatic study evaluated CARD's impact on school program-related vaccine uptake using a controlled before and after study design. Altogether, 67 Public and Catholic schools receiving vaccination services from a public health unit in Ontario, Canada, were included. Schools were ranked by vaccination uptake in grade 7 students in 2022-2023. The bottom 29 schools were allocated to CARD (intervention) and the remainder to control for 2023-2024 school vaccinations. In CARD schools, nurses educated students at school and information about CARD was added to vaccine correspondence for parents. On vaccination day, nurses applied interventions designed to improve coping. Vaccination coverage outcomes were assessed for 3 targeted vaccines - human papillomavirus (HPV), hepatitis B (HB), and meningococcal conjugate-ACYW (MCV). Baseline (2022-2023) vaccine coverage was lower (
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.