CARD (Comfort Ask Relax Distract) and community pharmacy vaccinations: Evaluation of implementation outcomes from a cluster randomized trial
Bibliographic record
Abstract
The CARD system (Comfort Ask Relax Distract) is a protocol for vaccine delivery that includes interventions that facilitate vaccine recipient coping and improve the vaccination experience. CARD was compared to control (usual care) in a pragmatic hybrid effectiveness-implementation cluster randomized trial. Of 25 participating community pharmacies, 12 were randomized to CARD and 13 to control for all vaccines administered between November 2023 and January 2024. Implementation strategies planned to support CARD integration included an educational webinar, customized implementation recommendations, change equipment, online chat group, and audit and feedback. Educational outreach was added to improve intervention fidelity. This paper reports on implementation outcomes of the trial. Provider surveys and focus groups revealed acceptability and feasibility of CARD and implementation strategies. Vaccinators in CARD pharmacies (vs. control) reported higher satisfaction with vaccine recipient interactions and that overall, CARD was time neutral. They also reported higher utilization of some CARD-recommended injection techniques. Administrative data verified utilization of the CARD coping checklist, which solicits vaccine recipient coping preferences, in 96% of vaccine recipients that participated. Post-vaccination feedback surveys were available for 90% of vaccine recipients that participated. Implementation results were aligned with trial effectiveness outcomes, and support routine use of CARD in community pharmacies.Trial registration : NCT06098703
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.017 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".