Aspect of implementation | Specific suggestions regarding preparation of staff for future cluster trial |
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Leadership roles | Foster a positive implementation climate by undertaking the following activities: • Frequent communication between formally appointed implementation leaders and project leaders regarding progress and issues related to implementation |
• Checklist for vaccine coordinator (manager overseeing school immunization program at CHC level) articulating supervisory role in staff training and CARD™ implementation | |
• Process for regular data transfer (e.g., weekly) to researchers for ongoing data entry and feedback to support ongoing debriefs and planning future clinics | |
• Ensure adequate staff to carry out CARD™ (plan for activities to take longer due to learning curve and additional time involved in immunization planning activities) | |
• Manage staff anxiety from CARD™ and concurrent practice changes (e.g., direct data entry) | |
• Regular communication (newsletter, infographic, Q&A) regarding study progress and results to engage and inform staff | |
• Solicit structured feedback from external stakeholders (e.g., school staff) | |
• Prepare and oversee additional training and resources with project leaders to support staff with CARD™ implementation, as specified further below | |
Booster traininga for staff | Provide additional training and support (overseen by the vaccine coordinator and supported by the formally appointed implementation leaders) to improve staff understanding, buy-in and self-efficacy, including: |
• Rationale and overarching goal of CARD™ and alignment with organizational mission/values | |
• Re-review of educational materials (e.g., training videos) | |
• Revised and expanded resources for use (e.g., invitations to principals for participation, scripts for interactions with students, class introductions, reminder prompts on data forms) | |
• Detailed instructions regarding data collection procedures (e.g., use of pre-numbered data collection forms, and other checklists) | |
• Role of staff feedback to inform revisions and refinement to implementation processes and documentation, as specified further below | |
Specific instructions in implementation processes and checklists | Provide more instruction (including sample pictures/illustrations) regarding how to tailor some components of CARD™ to the local context, including: |
• Bundling needed materials and supplies (e.g., table posters, door signs, distraction kits, extra data forms) ahead of time, in a grab and go bag, for easy retrieval | |
• Leveraging existing meetings with school staff to include information about CARD™ (e.g., annual anaphylaxis training) | |
• Keeping the number of students in pre-immunization waiting area to a reasonable amount (about double the number of immunizing nurses) | |
• Addressing student anxiety in the pre-immunization waiting area. Suggestions: distraction kits, adult supervision | |
• Providing seating in pre-immunization waiting area to increase student comfort | |
• Adding more instruction about effective separation of workstations, obscuring equipment from view, and positioning students so that they cannot see one another during immunization | |
• Diversifying distraction items in the distraction toolkit so they are suitable to different students | |
• Including information about injecting two vaccines in the same arm | |
• Using regular staff meetings to continue conversations about CARD™ implementation with all team members go inform additional revisions and refinement to implementation | |
Revision of data collection forms | Revise the nurse feedback form to maintain fidelity and accuracy in documentation, including: |
• Adding reminder prompts for several core components of CARD™ performed at the time of immunization (i.e., asking about fear prior to injection, inviting students to play their CARDs, injecting 2 vaccines in one arm) | |
• Clarifying operational definitions of coping strategies (e.g., verbal distraction, deep breathing, and muscle tension) to reduce potential error and bias in their interpretation by immunizing staff recording data | |
Revision of student education | Revise student education, including: |
• Instructing students that 2 vaccines will be injected in the same arm unless they choose otherwise | |
• Adding pictures of the immunizing space and waiting area that will be used in the specific school to help prepare them | |
• Sending reminder to students about immunization day close to the actual date to prevent them forgetting | |
• Ensuring educational videos play ahead of time (e.g., download videos onto computer, obtain necessary computer adapters, IT support) | |
• Reducing teaching time around the videos, including removal of cases, to reduce redundancy/overlap with videos; use time to answer student questions | |
• Encouraging students to bring their own distraction items to ensure they are suitable | |
• Including a topical anesthetic information form | |
• Pinning up CARD™ posters around school (e.g., main area, classroom) as a reminder of CARD™ | |
• Providing access to students of their completed CARD™ pamphlets so that they can be reviewed prior to immunization |