From Evidence to Practice: Implementing the 2026 Canadian Clinical Practice Guideline Update on Vaccination-Related Distress in the Dutch National Immunization Program.

Vaccination-related distress (VRD) encompasses a range of stress reactions associated with vaccination, including pain, needle fear, and stress. VRD is a significant barrier to immunization, contributing to up to 8% of vaccination refusals in children and even higher rates in under-vaccinated populations. Beyond immediate discomfort, VRD can lead to long-term psychological and physical consequences, underscoring the need for effective VRD-mitigation strategies. The updated knowledge synthesis and clinical practice guideline by the HELPinKids&Adults team provides evidence-based recommendations organized using the 5P framework: process, procedural, physical, pharmacological, and psychological interventions. These interventions target different user groups, including children, their support persons, and health care professionals. Multicomponent (complex) interventions, such as the Canadian CARD system (Comfort-Ask-Relax-Distract), integrate education with multiple VRD-reducing strategies. These multicomponent (complex) interventions have been shown to be effective in reducing VRD and promoted the adoption of other VRD-reducing interventions. However, the efficacy of a multicomponent (complex) intervention in the Canadian context does not guarantee its applicability in the Dutch setting. Consequently, the adaptation of such an intervention for the Dutch National Immunization Program necessitates a systematic implementation approach. Using the EPIS framework (Exploration-Preparation-Implementation-Sustainment), we explain our experiences to date with the cultural adaptation of the CARD system, the engagement of user groups, and the preparation of a Dutch version of the CARD system for pilot testing within the Dutch vaccination context.