Background:
CARD (Comfort Ask Relax Distract) is an evidence-based vaccination delivery framework that promotes person-centred care. No studies have evaluated its implementation in mass influenza vaccination clinics. The objective was to integrate CARD in university-based influenza vaccination pop-up clinics and evaluate client and staff experiences.

Methods:
Mixed methods before-and-after quality improvement study. A baseline (control – usual care) phase preceded CARD implementation in one popup clinic. Then CARD was implemented incrementally in two subsequent clinics. Changes to the environment (delineating waiting and aftercare areas, providing privacy, obscuring needles from view), education (clients given CARD coping checklist at check-in), and interactions (defining discrete clinic roles and processes, using coping-promoting behaviours, removing alcohol skin antisepsis prior to vaccine injection) were made. Clients provided feedback using standardized surveys. Staff, including pharmacy student vaccinators, participated in clinic debriefs. Feedback informed real-time process changes during and between clinics.

Results:
Clinics were held Nov 17 (control), Nov 22 and Nov 24 (both CARD). Feedback from 298 adult vaccine clients, including university students and staff (representing >98% of all vaccinated individuals) demonstrated an incremental increase in the percent of clients with an improved experience compared to the last vaccination (34% baseline, vs. 49% and 57% in CARD clinics, respectively; p=0.003). Ten percent reported CARD influenced their decision to attend by a moderate amount to a lot. Staff liked the changes. Sample quotes after the final clinic included: “_very organized” and “best clinic ever.”

Conclusion:
This study demonstrated improvement in vaccination delivery after CARD implementation as reported by vaccine clients and staff.