thesis about first aid

• Open access
• Published: 08 November 2022

How to evaluate first aid skills after training: a systematic review

• Sihvo Minna 1 , 2 ,
• Hiltunen Leena 1 &
• Kärkkäinen Tommi 1  

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine volume  30 , Article number:  56 ( 2022 ) Cite this article

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To be able to help and save lives, laypersons are recommended to undergo first aid trainings. The aim of this review was to explore the variety of the elements of the measuring systems to assess the effects of first aid trainings on different aspects of first aid skills including practical skills, knowledge, and emotional perspectives.

This systematic literature review used Scopus and PubMed databases and searched for studies published between January, 2000, and December, 2020. Out of 2,162 studies meeting the search criteria, 15 studies with quantitative and repeatable evaluation methods to assess first aid skills after first aid training for adults were included in the final analysis.

Practical skills, especially on the ability to perform cardiopulmonary resuscitation (CPR) and to use an automated external defibrillator, were the most studied first aid skills after first aid training. This evaluation was based on several standardized measurements and assessed often with the help of a combination of resuscitation manikin and observer. Evaluation methods of performance in other emergency situations are not well standardized. Questionnaires used to assess knowledge of first aid, though seemingly based on guidelines, were also not standardized, either. Emotional aspects of first aid (willingness or self-confidence) were evaluated by highly simplified questionnaires, and answers were graded by five-point Likert scale.

According to our review, the focus of evaluation methods after first aid training has been on practical skills and especially on CPR. Though the evaluation of first-aid knowledge seems to be straightforward, it is not performed systematically. Evaluation methods for emotional aspects are highly simplified. Overall, standardized measurements and evaluation methods to assess all aspects of first aid skills are needed.

Introduction

Out-of-hospital cardiac arrest (OHCA) cause 350,000 deaths each year in Europe [ 1 ]. In Finland, the annual incidence of OHCA is typically 46–80/100,000 inhabitants [ 2 ]. In most circumstances, survival rates are low being just above 10% [ 2 ]. With the help of a layperson, these survival rates could, however, be doubled [ 3 ]. Indeed, the cardiopulmonary resuscitation (CPR) given by laypersons has likely increased the survival rate of patients who underwent OHCAs during the past decades [ 4 ]. The first person to witness an OHCA, therefore, plays a critical role in the survival of a person having a cardiac arrest [ 5 , 6 ]. Stroke, with an annual incidence the annual number of approximately 14,000 in Finland, is one of the leading causes of death and disability [ 7 ]. The early detection of stroke in the prehospital setting has the potential to decrease delays in treatment and, hence, improve stroke outcomes [ 8 , 9 ]. Therefore, awareness of stroke warning signs by a layperson is important.

In Europe (EU-27), 146,000 people died in over 4.5 million accidents (mortality rate, 3.2%) in 2016 [ 10 ]. The number of accidents in Finland with 5.5 million inhabitants caused by a physical injury at home or leisure time is more than a million [ 11 ]. The mortality of these accidents is higher in Finland (4.7%) than in other Nordic countries and this figure is approximately 1.5 times the EU average [ 10 ]. Overall, first aid skills enabling one to cope with all common emergency situations, in addition to OHCA, are needed [ 7 , 11 ].

According to European guidelines [ 12 ], the goals of first aid include preserving life, alleviating suffering, preventing further illness or injury, and promoting recovery. First aid, defined as the initial care provided by a layperson for an acute illness or injury, has been shown to save lives and to reduce morbidity [ 3 , 13 , 14 ]. To be able to act in any emergency situations, laypersons have undergone various kinds of first aid trainings [ 15 , 16 , 17 , 18 ]. A typical setting for a training course is a traditional on-site class-room training, an on-line course, or a combination of these two (blended learning). Modern technologies, such as virtual techniques, smartwatches, and mobile devices, can be used to enhance any of these training sessions [ 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. Although, millions of people have been trained each year with some evidence that these people have a greater tendency to perform CPR in a real-world situation [ 6 , 26 ], the overall efficacy of first aid training is not clear [ 27 , 28 ].

In first-aid trainings, knowledge and practical skills are easy to teach. In a sudden life-threatening situation, human factors as self-efficacy, willingness to help, and courage, are also meaningful [ 29 , 30 ]. Despite undergoing first aid training, people often have low confidence to help before professional assistance arrives [ 29 , 31 , 32 ]. The effect of first aid training on theses human factors is poorly studied [ 16 , 29 ]. Studies have concentrated especially on the practical skills of performing CPR and the use of an automated external defibrillator (AED) [ 3 , 13 , 16 , 18 ]. Other practical first aid skills, such as required in choking, hemorrhage, stroke, and trauma have been less focused on [ 33 ].

Measuring the knowledge and behavior of a helper for all aspects of first aid skills is challenging. Whether an optimal quality of CPR can be defined has even been questioned [ 3 ]. Despite the numerous studies of first aid trainings, the lack of standardized measurements to evaluate all aspects of first aid skills is evident. The aim of this review was to explore the variety of the elements of the measuring systems to evaluate different aspects of first aid skills including practical skills, knowledge, and emotional perspectives.

Materials and methods

This systematic review was following Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) 2009 guidelines [ 34 ]. Because the aim was to explore the variety of methods used in the evaluation of first aid training effect and not to analyze the study outcomes, some parts of the PRISMA 2009 checklist were not applicable (see Additional file 1). Studies with adult participants in the first aid training were included, which composed the population (P) in the Population, Intervention, Comparator, Outcome (PICO) question.

Eligibility criteria

To inspect the elements used to assess first aid training effect, we used the following inclusion criteria:

Participants were 18 years or older without health education background.

Studies were written in English and published between 2000 and 2020.

Studies followed the guidelines published either by the American Heart Association (AHA) [ 35 ] or European Resuscitation Council (ERC) [ 12 ].

The training effect on practical skills, knowledge and/or emotional aspects were evaluated with an explicitly specified evaluation method that is repeatable and provides a quantitative outcome.

We concentrated on the studies of first aid for acute illnesses and traumas. Therefore, studies of mental health first aid were excluded. Due the special feature of neonatal or infant first aid, these studies were also excluded. All studies from countries with limited access to quality health care and education were also excluded because first aid training system and the required skills can differ between these and those countries included.

Information sources and search strategy

All possible studies were retrieved either from Scopus or Pubmed. Database search started on September 2020 and ended on December 2020 and included studies published between January 1, 2000, and December 31, 2020. Used keywords first in Scopus and then in Pubmed were as follows: first aid AND layperson(s), first aid AND bystander(s), first aid AND helper(s), first aid AND learning, first aid AND teaching, first aid AND education, first aid skill(s). During the Pubmed search, duplicates were excluded. The number of studies, meeting the search criteria in this first step of the selection process was 2,163.

Study selection process

Those 2,163 studies meeting the search criteria were further screened by the first author. Because this review was not an outcome analysis, excluding studies due to quality issues was unnecessary. It was more important to able to identify all possible sources of the evaluation methods under study. The whole process is shown in the flow diagram in Fig.  1 . Based on the abstracts and titles of the studies, 299 studies were included in further evaluation. The references of these 299 studies were also checked, yielding 12 additional studies. After duplicates were removed, the number of studies was 272. After the evaluation of full-text articles and exclusion of those 141 studies not meeting the earlier described inclusion criteria, the number of included studies was 131.

Adapted from: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi: https://doi.org/10.1371/journal.pmed1000097

Flow diagram of included studies.

In the detailed evaluation, 61 additional studies were excluded based on the eligibility criteria (Fig.  1 ): (1) Participants in the study were health care students or professionals (n = 8) or < 18-year-old (n = 16), (2) study concentrated the first aid of children (n = 1), (3) the study setup or the elements to measure training outcomes were unclear (n = 3), lacking (n = 13), qualitative (n = 7) or did not follow guidelines (ERC or AHA) (n = 3), (4) the study was a part of a medical study (n = 2) and (5) evaluation method did not assess first aid skills after training (n = 8). All excluded studies are listed in Additional file 2.

Of the 70 studies that were found eligible, 58 studies on CPR and AED and 12 studies on other aspects of first aid remained to be evaluated in the qualitative synthesis. It became, however, soon evident that those 58 included CPR studies repeatedly applied the same evaluation methods to assess the training effects. Because the interest of the study was in the variety of elements to measure the first aid training effect, we started an additional evaluating process about CPR studies to simplify the description of the results in this synthesis. In this process, we compared the evaluation methods used in a single CPR study to the evaluation methods described in two very recent CPR reviews [ 13 , 16 ]. If these reviews already included the used elements of the evaluation systems, a study was excluded. All excluded CPR studies according to this additional evaluation are listed in Additional file 3. The total number of studies whose evaluation methods were included in the reviews, and therefore excluded, was 55. Therefore, of the 58 CPR studies, only these two reviews and a single study using virtual reality (VR) technology [ 19 ] were included in the final analysis. Overall, the number of studies that underwent final detailed evaluation and qualitative synthesis was 15. These studies are depicted in Table  1 .

Of the 15 analyzed studies, two reviews [ 13 , 16 ], and one randomized trial [ 19 ] provided the evaluation methods to assess resuscitation skills (Table  1 ). The randomized study not included in these two reviews used modern virtual technology both in training and in the evaluation process and was, therefore, relevant. Twelve studies provided those evaluation methods to assess first aid skills other than CPR [ 15 , 25 , 27 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ].

Those included studies were classified into three separate groups based on which aspect of first aid skills they deal with: knowledge, practical skills, or emotional aspects (self-confidence, courage, willingness). Studies measuring more than one aspect of first aid skills were included in all relevant categories (Table  2 ). Studies included in those two CPR reviews and the only separate randomized CPR study were classified accordingly but discussed in a separate section.

Practical skills of first aid

Of 12 non-CPR studies, 10 uncovered practical skills (Table  2 ). Practical skills in all these studies were evaluated in different experimental first-aid situations (Table  3 ).

Two studies [ 25 , 41 ] assessed first aid skills in an experimental choking situation. The data for the assessment were provided either by an application and an observer or only by a smart watch application. A smartwatch was worn by a participant while performing first aid for choking on a CPR manikin. The quality of back blow or abdominal thrust was evaluated by a quantitative accelerometer and gyroscope data provided by the smartwatch. According to these data, the BreathEZ application, in both studies, classified the quality of back blow or abdominal thrust as too soft, correct, or too hard. In back blows, observer also marked whether simulated 911 calling and the correct manikin position were done properly.

Tourniquet use

Of five bleeding control studies, the observer inspected the application of a tourniquet in four [ 36 , 37 , 39 , 40 ]. In two HapMed leg Tourniquet Trainers provided additional digital data [ 15 , 40 ]. In one study [ 15 ], the outcome was based only on the data provided by the recording manikin. The roles of the observer in these studies were (1) to confirm all successfully completed digital recordings, (2) to verify correct tourniquet application, and (3) to assess the participant`s performance during the application.

The assessment of tourniquet application included the evaluation of (1) positioning, (2) tightness using a thin instrument or a finger between the tourniquet and the mannequin, (3) the steps required to complete the application, and (4) the time of application with the aim being less than 7 min (Table  3 ). The recording manikin and HapMed leg Tourniquet Trainer also provided data on time scale and pressure status.

Hemostatic dressing

The only study of the use of hemostatic dressings in first aid relied on the subjective data provided by the observer and the digital data provided by a Z-medica simulator [ 38 ]. This simulator provided exact feedback only of the amount of pressure applied. The defined pressure limit for the correct application of the hemostatic dressing was 5 pounds per square inch, approximately 250 mmHg. The required time to apply the dressing was a maximum of 3 min. The technical performance was graded by the observer either success or failure based on the checklist modified from the existing AHA´s first aid/CPR/AED recommendations [ 38 ]. If the participant made a mistake in any step of the application, it was scored as a failure.

Multiple scenarios

In a choking scenario causing a cardiac arrest, both the first aid of choking and resuscitation were evaluated [ 27 ]. The evaluation process relied on the data provided by the observer and recording manikin. The observer assessed the correct order and proper execution of each step (scene safety, unconsciousness, clearing of airways with abdominal thrusts, calling emergency medical services, opening of airway, and taking care of breathing). The recording manikin measured the same parameters as in resuscitation studies: the rate, depth, and frequency of breathing and the rate, depth, and the location of chest compressions.

The other study evaluated practical first aid skills to control severe bleeding and to apply CPR [ 44 ]. The evaluation of the performance was based on a scoring tool—the Objective Structured Clinical Examination (OSCE). In OSCE, actors play planned scenarios. Specially trained examiners assessed the performance according to the pre-defined evaluation criteria. A maximum of 24 points could be achieved. In the first station, 13 different actions to control severe bleeding were scored; in the second, 11 required actions in the resuscitation were scored.

Knowledge on first aid

First aid knowledge in acute stroke has been evaluated in two studies [ 42 , 43 ]. A study by Handschu et al. explored whether a short 15 to 20 min session will increase the general knowledge of stroke and the recognition of stroke symptoms [ 42 ]. The other study [ 43 ] assessed how well warning signs and risk factors of stroke are identified 6 weeks and 5 months after intervention. In a both studies, data were collected by open-ended questions. Multiple-choice questions were used only in the study by Kleindorf et al. [ 43 ].

Scenario-based questions have been used to assess the level of first aid knowledge in case of massive bleeding [ 36 ]. Scenarios were based on pictures of extremity wounds to decide of the need of a tourniquet. One study tested first aid knowledge by a multiple choice first aid exam using questions from the Worker’s Compensation Board of British Columbia´s first aid exam [ 27 ].

Attitudes and emotional aspects of first aid

Emotional aspects have been included in studies of choking, bleeding control, and multiple first aid scenarios. These studies scaled the comfortableness and the willingness to help in given scenarios from 1 to 5. In a study by Ertl and Christ [ 44 ], attendants were interviewed to evaluate the most important causes of stress in an emergency situation and subjective requirements to eliminate this kind of stress factor. The answers were categorized as follows: no stressor, lack of skill, fear of being alone, fear of doing harm, strain after having help, revulsion, findings on patient´s status, being self-responsible, and pressed for time.

Measuring practical skills, knowledge, and emotional aspects of resuscitation

Resuscitation or basic life support-skill (CPR/AED) is the most studied area of the field first aid skills. In many of these trials, the setting is a randomized control study [ 13 , 16 ]. These studies have been conducted without intervention, before and after intervention, within a month after intervention, within 1–3 months after intervention, and more than 3 months after intervention.

Practical skills

The quality of BLS-skills (CPR/AED) have been measured by a recording manikin, a recording simulator manikin, a manikin with special software, and a recording defibrillator [ 13 , 16 ]. A combination of observer’s subjective evaluation, a recording video, and a recording manikin has also been used. Testing after new VR technology-based resuscitation training has relied on the data provided by the sensors inside the mannequin or on the wrists [ 19 ]. With the webcam (focused on the mannequin), it was possible to confirm the quality of CPR.

Despite of evaluation method, the quality of CPR was based on the compression rate (100–120/min), compression depth (50–60 mm), compression-ventilation ratio, duration of interruptions between chest compressions, full chest recoil, correct hand placement, the amount of correct compression, ventilation volume (500 ml), ventilation time (s), and overall performance. Overall performance was estimated by using a modified checklist filled by the observer. The checklist was adopted either from the AHA`s guidelines or from the ERC guidelines [ 13 , 16 ]. They include the following parameters: safety check, shoulder shaking, calling for help, head rotation, airway control, breath control, and using AED. AED performance were measured as follows: switching on the AED, removing clothing, time from the start of assessment to switching on the AED, electrodes attached correctly, location of wrongly placed electrodes, time from starting assessment to attaching electrodes, rescuer`s position during analysis, pushing the shock button as directed, shock safety, time from starting assessment to the first shock, and restarting CPR.

Knowledge, attitudes, and emotional aspects of resuscitation

One of the systematic reviews contained depiction on how the knowledge of resuscitation was measured [ 16 ]. Knowledge was measured by open-ended questions and multiple-choice question of clinical scenarios. Willingness, self-confidence, and changes in self-efficacy were measured using a five-point Likert-type scale.

According to our review, most studies assessing first aid skills after the corresponding training have focused on evaluating either practical skills or the knowledge of first aid or both (Table  2 ). In these studies, CPR is overrepresented. In recent years, emotional aspects, such as willingness to help and self-confidence, have gained interest as well [ 29 ]. Despite the large number of studies, the measurement systems used to evaluate first aid skills are not consistent. Only with congruent evaluation methods in all aspects of the first aid skills, we are able compare the outcomes of various first aid trainings held by different organizations including private, non-governmental or governmental organizations.

Measuring practical skills of first aid

First aid is often seen as a practical skill that can only be learned through practical exercises in created real-life scenarios. Emergency situations played by actors and based on OSCE are the most complex and the closest possible real-scenario where the first-aid skills can be evaluated. This kind of set-up is suitable for research purposes, but its’ role in everyday life after any kind of first-aid training is not a reality. Because the real-life performance in an emergency situation is difficult to measure, the effects of first aid training, especially CPR, are widely evaluated by the resuscitation training manikins. Other devices have also been used in first aid studies to provide real-time performance feedback. HapMed leg Tourniquet Trainer or Z-medica simulator provides measurable digital data of hemostatic effect of a tourniquet or hemostatic dressing [ 15 , 40 ]. A smartwatch application has been developed to evaluate the effectiveness of a back blow in a choking situation. [ 25 ]. Standard manikins have been developed to teach and to measure CPR skills. In some studies, these same manikins are utilized to enhance teaching and the evaluation process in other emergency situations, such as choking or major bleeding [ 15 , 25 ].

Digital devices give exact digital feedback to analyze the outcomes of learning or teaching [ 13 , 16 , 18 , 45 ]. Especially in the evaluation of CPR, a device provides highly specific and detailed and repeatable digital data on parameters, such as compression rate, hand placement, and compression depth [ 13 , 16 ]. For this evaluation process, such new and more expensive technology as VR have been used, as well [ 22 , 45 ]. In the implementation of any new and especially costly technology or devices, we have to keep the focus on the aim of first aid teaching. At this point, modern technologies, such as a CPR manikin with digital feedback, provide mostly just more exact data during the first aid training and in the evaluation of training effect. In the near future, modern technology can most likely be utilized widely in both teaching and evaluation of first aid.

Although digital devices provide measurable, repeatable, and comparable parameters of a specific practical skill, the importance in teaching and evaluation of the emergency situation as a whole should be pointed out. Therefore, in many studies included in this review, the evaluations were performed by both an observer and a device and more rarely only by any device (Table  3 ). For this kind of evaluation, especially for CPR and using AED, the international guidelines provide recommendations and standardized checklists [ 46 , 47 ]. Checklists have, however, been modified in many CPR studies from these standardized checklists [ 16 , 38 ]. Although the evidence of using a checklist during the evaluation is inadequate [ 48 , 49 ], the wide-scale use of a congruent checklist would provide researchers and first-aid instructors data to compare different types of interventions. These recommendations and checklists concentrate on CPR, and the need for those in other emergency situations is evident.

Measuring knowledge on first aid theory

After first aid training, questionnaires to evaluate knowledge have been used as the sole evaluation method to measure the level of first aid skills. The level of knowledge was evaluated by either multiple-choice, open-ended, or scenario-based questions. This kind of assessment is, however, most often combined to the evaluation of practical skills [ 13 , 16 , 36 ]. In this review, only two first aid training studies to enhance stroke awareness used solely either open-ended questions or multiple-choice questions to assess the improvement in the ability to recognize risk factors, warning signs, and symptoms of stroke [ 42 , 43 ]. The challenge is that the level of knowledge assessed by these questionnaires does not seem to indicate how well the layperson can perform first aid even in a simulated environment [ 50 ]. At the community, the theoretical knowledge on the basics in CPR is poor [ 51 ]. Overall, a certain level of first aid knowledge is a requirement to enable to provide optimal help in any emergency situation and to evaluate the level of knowledge after training we need these tests.

The assessment of knowledge between studies has not been congruent. In many studies, researchers have created their own questionnaires [ 6 , 50 , 52 ]. It would seem to be useful to create congruent ways to test theoretical knowledge in different aspects of first aid. With congruent testing, the outcome evaluation of various types of interventions would be comparable and would most likely provide more accurate information. This is especially important during the last years when online learning has increased rapidly.

Measuring the emotional aspects of first aid

The vital role of first aid is effective only if the layperson, in addition to practical skills and knowledge, has the willingness and confidence to help. Many barriers exist to prevent laypersons to start CPR [ 53 , 54 , 55 ] and, therefore, regardless of first-aid interventions the rate of performed CPR if needed in real-life situation remains too low [ 31 , 32 ]. Out-of-hospital cardiac arrest survival is influenced by human factors [ 56 ]. The number of studies evaluating the emotional aspects of first aid is, however, limited. In several studies of this review, willingness or self-confidence were evaluated by a simple questionnaire and answers graded by a five-point Likert scale before and after training [ 25 , 36 , 38 , 39 , 41 , 44 ]. The question is whether this kind of simple assessment is enough to scale the motivation, willingness, and self-confidence after training so that it correlates with the ability to act in a real-life situation.

The ERC [ 57 ] has emphasized the importance of emotional and behavioral aspect in teaching first aid. The evaluation of emotional changes after training should also be optimized to enhance this. The ultimate aim would be to improve laypersons’ response rate in any emergency situation.

Limitations

In this study, some limitations must be considered. First, this systematic review has followed Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) 2009 guidelines [ 34 ]. During the process of this study in 2021, an updated version of PRISMA guidelines were published [ 58 ]. The search process of this review had already been done before the updated PRISMA version, and, therefore, it was natural to continue according to the previous version. Second, only two databases were used, and only one person performed the database searches. This does not, however, limit the number of studies included and, therefore, to cause selection bias. Also, two other authors were involved in the study selection throughout the process checking and validating all potential articles. Third, in this review, we did not perform any qualitative analysis. It was, however, our aim to explore the variety of the evaluation methods used in the assessment of first aid skills after first aid interventions.

According to our review, the focus of first aid interventions and, especially, evaluation methods, has been on CPR. For CPR, the international guidelines provide clear recommendations and standardized checklists to unify the training and the outcome evaluation. The evaluation methods in practical skills other than CPR are not standardized and less used. Repeatable questionnaires are typically utilized to evaluate first aid knowledge. These questionnaires are, however, not congruent, either. Though first aid skills are composed of theoretical knowledge, practical skills, and a courage to help, emotional aspects have gained the least attention in the training and evaluation. We need more information of these emotional factors preventing laypersons to help in a life-threatening situation, and on how trainings can be improved so that a helper is able to overcome fear and anxiety.

A topical question is how the development of online learning and use of modern technology could improve the first-aid trainings [ 59 , 60 ]. Results from [ 61 ] showed that an online course before CPR did improve theoretical knowledge but did not affect practical skills or willingness to help, which was even not influenced by existing emergency experience [ 62 ]. However, in order to analyze and compare different modes of training, we need congruent, consistent and transparent methods to evaluate the learning outcomes. Analysis and empirical evaluation of the ability to act in real emergencies is challenging. Only through evidence of the changes in learner´s first aid knowledge, practical skills and self-confidence can we improve the effectiveness of first aid education keeping the ultimate aim in mind – to save more lives.

Data availability

Data in systematic reviews consists of original articles with copyright. Full articles that where analyzed during the systematic review process and are not open access can be requested from the co-author (MS).

Abbreviations

Cardiopulmonary resuscitation

Out-of-hospital cardiac arrest

Automated external defibrillator

Population, Intervention, Comparator, Outcome

American Heart Association

European Resuscitation Council

Virtual reality

Randomized control trial

Objective Structured Clinical Examination

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Minna, S., Leena, H. & Tommi, K. How to evaluate first aid skills after training: a systematic review. Scand J Trauma Resusc Emerg Med 30 , 56 (2022). https://doi.org/10.1186/s13049-022-01043-z

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The effect of psychological first aid training on knowledge and understanding about psychosocial support principles: a cluster-randomized controlled trial.

1. Introduction

2. materials and methods, 2.1. participants and procedures, 2.2. measures, 2.3. pfa training, 2.4. analyses, 3.1. participants, 3.2. main outcomes, 3.3. secondary outcomes: confidence, professional attitude and professional quality of life, 4. discussion, 5. conclusions, supplementary materials, author contributions, acknowledgments, conflicts of interest.

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Sijbrandij, M.; Horn, R.; Esliker, R.; O’May, F.; Reiffers, R.; Ruttenberg, L.; Stam, K.; de Jong, J.; Ager, A. The Effect of Psychological First Aid Training on Knowledge and Understanding about Psychosocial Support Principles: A Cluster-Randomized Controlled Trial. Int. J. Environ. Res. Public Health 2020 , 17 , 484. https://doi.org/10.3390/ijerph17020484

Sijbrandij M, Horn R, Esliker R, O’May F, Reiffers R, Ruttenberg L, Stam K, de Jong J, Ager A. The Effect of Psychological First Aid Training on Knowledge and Understanding about Psychosocial Support Principles: A Cluster-Randomized Controlled Trial. International Journal of Environmental Research and Public Health . 2020; 17(2):484. https://doi.org/10.3390/ijerph17020484

Sijbrandij, Marit, Rebecca Horn, Rebecca Esliker, Fiona O’May, Relinde Reiffers, Leontien Ruttenberg, Kimberly Stam, Joop de Jong, and Alastair Ager. 2020. "The Effect of Psychological First Aid Training on Knowledge and Understanding about Psychosocial Support Principles: A Cluster-Randomized Controlled Trial" International Journal of Environmental Research and Public Health 17, no. 2: 484. https://doi.org/10.3390/ijerph17020484

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Determinants of knowledge, attitude, and practice towards first aid among kindergarten and elementary school teachers in Gondar city, Northwest Ethiopia

• Belayneh Shetie Workneh 1 ,
• Enyew Getaneh Mekonen 2 &
• Mohammed Seid Ali 3  

BMC Emergency Medicine volume  21 , Article number:  73 ( 2021 ) Cite this article

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Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. School-age children are more likely to experience unintentional injuries in the school, while they are playing and teachers are the primarily responsible body for keeping the welfare of the students. Knowing the knowledge, attitude, and practice of kindergarten and elementary school teachers towards first aid will be used as an input for policymakers to intervene and provide training. Therefore, this study was aimed to assess knowledge, attitude, practice, and associated factors towards first aid among kindergarten and elementary school teachers in Gondar city, Northwest Ethiopia, 2021.

An institution-based cross-sectional study was conducted from January 01 to 20, 2021. A simple random sampling technique was employed to recruit 346 participants. A structured pretested self-administered questionnaire was used to collect data. Data were entered in Epi-info version 7, analyzed using SPSS version 21, and presented by frequencies, percentages, tables, and graphs. Bivariable relationships between the independent and outcome variable were investigated using a binary logistic regression model and a multivariable analysis was run to control potential confounding factors. Variables with a p -value < 0.05 were considered as factors significantly associated and the strength of association was determined using an odds ratio with a 95% CI.

Only 41.1% of the teachers had good knowledge of first aid. Nearly two-thirds (64.8%) of the teachers had a favorable attitude towards first aid. The majority (85.8%) of the teachers who faced a child in need of first aid in their school gave first aid. Factors like working experience [AOR: 2.45; 95% CI (1.26, 4.73)], school level [AOR: 4.72; 95% CI (1.96, 11.4)], school type [AOR: 4.23; 95% CI (2.07, 8.64)], and having information about first aid [AOR: 2.09; 95% CI (1.11, 3.92)] were significantly associated with knowledge. School-level [AOR = 5.4, 95% CI (2.18–11.67)], school type [AOR = 0.45, 95% CI (0.21–0.94)], and working experience [AOR = 0.33, 95% CI (0.13–0.86)] were the factors significantly associated with attitude.

Less than half and nearly two-thirds of the teachers had good knowledge and a favorable attitude towards first aid. The majority of the teachers who encountered a child in need of first aid gave first aid. Having higher working experience, working in elementary and private schools, and having previous information increases the odds of having good knowledge. Teachers who work in elementary and private schools and have the lower working experience had higher odds of favorable attitude towards first aid. It is better to give attention to the training of staff on first aid specifically for teachers working in kindergarten and governmental schools and new employees and consider integrating first aid in teachers’ training curriculum.

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First aid can be defined as the immediate care given to a person who has been injured or suddenly ill with materials available on hand to preserve life, alleviate suffering, prevent further illness or injury, and promote recovery [ 1 , 2 , 3 ]. It is one of the most important procedures to follow in case of a medical emergency or an accident. At least 39% of pre-hospital deaths are potentially preventable with better interventions [ 4 ]. An accident is something harmful and takes place suddenly and unexpectedly that may result in simple injuries or major complications like broken bones with heavy bleeding, failure to breathe, unconsciousness, or even death [ 5 ]. Many dangerous situations like fainting, falls, intoxications and road crashes that happen at home, school, or in the workplace affect victims and their relatives both physically and psychologically [ 3 ].

Unintentional injuries are the leading cause of morbidity and mortality for children [ 6 ]. Injuries continue to be an important cause of morbidity and mortality in the developed and developing world [ 7 ]. Globally more than 2000 families lost their child due to unintentional injury or accidents every day [ 5 ]. The most common causes of accidents and injuries in school children are bullying and assaults, slip and fall accidents, school bus, and playground accidents, food poisoning, and sports activities which result in a significant number of serious injuries [ 8 ]. Negligence in injuries or accidents at elementary and kindergarten schools causes the life-threatening condition [ 9 ]. The majority of injuries are occurred during free play and on the playground and are precipitated by child-related factors, like being pushed. Boys had significantly higher median injury rates than girls [ 10 ].

In Ethiopia, the annual mortality caused by injuries is projected to increase from 10,697 in 2015 to 11,989 by 2030 among children less than 5 years and the number of deaths among 0–14-year olds will be 30,364 [ 11 ]. School-age children are more likely to experience unintentional injuries in school, while they are playing. School teachers are the primarily responsible body for keeping the welfare of the students and oversee their activities. They are the first contact and responsible person when children faced injuries. However, studies showed that the level of knowledge and basic practice of first aid among school teachers were found to be poor [ 12 , 13 , 14 ].

A study conducted at Lideta sub-city, Addis Ababa and Jimma, Ethiopia among kindergarten teachers, showed that 79.9 and 50.4% of the teachers encountered a child in need of first aid, and 89.7 and 52.1% of teachers gave first aid respectively [ 13 , 14 ]. In the country, schools have not Emergency Medical Technician (EMT), paramedics, or other trained health professionals who will give first aid. However, pre-hospital school-based Emergency Medical Service (EMS) at school by school personnel is mandatory for saving the children from disability and death. Therefore, assessing the level of knowledge, attitude, and practice of kindergarten and elementary school teachers on first aid is important to intervene and provide training.

Methods and materials

Study design and period.

An institution-based cross-sectional study was conducted from January 01 to 20, 2021.

Study setting

The study was conducted at kindergarten and elementary schools found in Gondar city, Northwest Ethiopia. Gondar city is 727 Km far from Addis Ababa, the capital city of Ethiopia, and 180 km from Bahir Dar, the capital city of Amhara regional state. Gondar city has a total area of 192.3 sq. KM. The city has a total population of 338, 646 peoples with 256,041 people whose age is between 18 and 65 years old in 6 sub-cities and 27 Kebele with a total of 78,772 households. Under the Gondar city administration education office there are 11 secondary, 64 elementary, and 70 kindergarten schools with a total of 2649 teachers.

Study participants

All kindergarten and elementary school teachers working in Gondar city who were available during the data collection period were included in the study. Those teachers who are seriously ill and attending external training courses off-site during the study period were excluded from the study.

Sample size determination

The sample size was calculated using the single population proportion formula by taking the estimated proportion of knowledge, attitude, and practice among kindergarten and elementary school teachers: 44% [ 13 ], a confidence level of 95%, and a margin of error of 5%. The final sample size was 346 after using a correction formula and adding a 10% non-response rate.

Sampling technique and procedure

A simple random sampling technique was employed to recruit the required participants for the study. First, we stratified participants into elementary and kindergarten school teachers, and then we allocated the required sample for each stratum proportionally. Finally, study participants were selected from each stratum by simple random sampling.

Data collection instruments and procedures

Data were collected using a structured pre-tested self-administered questionnaire. The questionnaire contains 43 questions arranged into four sections; the first section contains eight questions regarding the socio-demographic characteristics of the participants, the second section contains 11 questions regarding first aid knowledge of kindergarten and elementary school teachers, the third section contains seven attitude related questions, and the last section contains 17 practice-related questions. The questionnaire was adapted from a similar study done at Addis Ababa, Ethiopia [ 14 ]. Data were collected with the help of four trained BSc nurse data collectors and two MSc nurse supervisors. A written guideline was given to the data collectors to assure that every participant received the same directions and information. The anonymity of the participant was kept by informing them not to write their name. The instruments were distributed among the study population, after guarantying their willingness to take part in the study, and then it was collected by the data collectors after completion. During data collection data collectors and supervisors followed the recommended precautions to prevent COVID-19.

Data processing and analysis

Data clean-up and cross-checking were done before analysis. Checked, cleaned, and coded data were entered into EPI info version 7 and exported to SPSS version 21 for analysis. Descriptive statistics like frequencies, percentages, mean and standard deviation, tables, and figures were used to present data. Bivariable relationships between each independent variable and outcome variable were investigated using a binary logistic regression model. Those independent variables with a p -value < 0.2 at the bivariable level were included in multivariable analysis to control potential confounding factors. After adjusting their effect on the outcome variable, those variables with a p -value < 0.05 with a 95% confidence interval were regarded as factors significantly associated.

Data quality assurance

The data collection tool was pretested before the actual data collection time at Bahir Dar city kindergarten and elementary schools, which were not included in the study using 5% of the total sample size. Amendments on the instrument, such as unclear questions and ambiguous words were made accordingly. The pretest was also used to estimate how much time it takes to administer the entire questionnaire. The tool was first developed in the English language and translated to the Amharic language with back translation to English for consistency. The one-day training was given to data collectors and supervisors on the objective of the study, instrument, and data collection procedures by the principal investigators. Supervision was conducted by the principal investigators and supervisors. To ensure data quality, each data collector checked the questionnaire from each study participant for completeness daily. The supervisors and principal investigators reviewed each questionnaire daily and checked for completeness.

Socio-demographic characteristics of the respondents

A total of 338 respondents have participated in the study with a 97.7% response rate. Among the total participants, 212 (62.7%) respondents were females. One-third (33.4%) of the respondents were in the age group of above 42 years. Of the total participants, 219 (64.8%) respondents were degree holders. Two hundred thirteen (67.5%) of the respondents were married. Among the total respondents, 103 (30.5%) respondents had greater than 10 years of work experience in teaching. The majority (84.9%) of the respondents were from primary schools and 266 (77.8%) of the respondents were from government schools. Most (71.6%) of the respondents did not take the training in first aid (Table  1 ).

Knowledge of kindergarten and elementary school teachers towards first aid

Of the total respondents, only 41.1% (with 95% CI (35.9, 45.7%)) of the respondents had good knowledge of first aid (Fig.  1 ). The majority (81.7%) of the participants had information about first aid. Of these, 10.9, 7.6, 21.0, and 60.5% were heard from family, books, media, and health professionals respectively. The majority (93.5%) of the respondents correctly respond to what first aid means. Nearly two-thirds (66.3%) of the participants were aware of giving nothing by mouth for fainting children. More than three fourth (79.6%) of the respondents understand the concept of immobilization for neck and back injuries (Table  2 ).

Knowledge and attitude of kindergarten and elementary schools teachers towards first aid in Gondar city, Northwest Ethiopia, 2021 ( n  = 338)

The attitude of kindergarten and elementary school teachers towards first aid

Among the total participants, nearly two-thirds (64.8%) with 95% CI (59.2–69.8%) of the respondents had a favorable attitude towards first aid (Fig.  1 ). About 200 (59.2%) of the respondents strongly agreed with the idea giving first aid at school is fair. One hundred three (30.5%) of the respondents were strongly disagreed with giving first aid at school is unpleasant. About half (49.4%) of the respondents were strongly disagreed with giving first aid is not good. About 207 (61.2%) of the respondents were strongly agreed with giving special care for injured children in academic work is appropriate (Table  3 ).

The practice of kindergarten and elementary school teachers towards first aid

More than three-fourths (76.9%) of the teachers faced a child in need of first aid in their school and 85.8% of them gave first aid for the child. Ninety-five (28.1%) of the participants faced a child with difficulty of breathing and nearly half (49.5%) of them encouraged the student to sit quietly. One hundred forty-six (43.2%) of the respondents faced a child with fainting and 75.3% of them kept the student in a flat position. Nearly three-fourths (74.9%) of the teachers faced a child with bleeding from his/her nose and more than half (51.0%) of them applied uninterrupted pressure by pressing nostrils together. Nearly half (50.6%) of the participants faced a child with bleeding on his/her body and 35.1% of them pressed firmly with a clean bandage to stop bleeding. One hundred forty-eight (43.8%) of the teachers faced a child with seizure/epilepsy and 41.2% of them moved surrounding objects to avoid injury. Nearly one-third of the respondents faced a child with choking and more than half (58.3%) of them stood behind the child encircling the child’s chest by hands and squeezed. Nearly one-fifth (19.5%) of the participants faced a child with an injured neck and back and more than half (54.6%) of them avoided head and neck movement and kept their body straight (Table  4 ).

Factors associated with knowledge of teachers towards first aid

Using bivariable logistic regression analysis age, experience, school level, school type, training, having information about first aid, and history of exposure with a child in need of first aid were found to be significantly associated with knowledge. In multivariable logistic regression analysis, working experience, school level, school type, and having information about first aid were significantly associated with the knowledge of teachers towards first aid.

Teachers who worked for 11–20 years were nearly three times higher to be knowledgeable compared with teachers who worked for less than 10 years [AOR: 2.45; 95% CI (1.26, 4.73)]. Those teachers working at elementary schools were nearly five times higher to have good knowledge compared with teachers working at kindergarten schools [AOR: 4.72; 95% CI (1.96, 11.4)]. Those study participants who work at private schools were nearly four times higher to have good knowledge about first aid compared with governmental school teachers [AOR: 4.23; 95% CI (2.07, 8.64)]. Those teachers who had information about first aid were two times higher to have good knowledge compared with their counterparts [AOR: 2.09; 95% CI (1.11, 3.92)] (Table  5 ).

Factors associated with the attitude of teachers towards first aid

Bivariable and multivariable logistic regression analyses were carried out. Age, training, school level, school type, and experience were eligible for multivariable analysis. In multivariable analysis, the factors significantly associated with the attitude of the participants were; school level, school type, and experience. Teachers who work in elementary schools were five times more likely to have a favorable attitude towards first aid than teachers who work in kindergarten [AOR = 5.4, 95% CI (2.18–11.67)]. Teachers who work in governmental schools were 55% times less likely to have a favorable attitude towards first aid than teachers who work in private schools [AOR = 0.45, 95% CI (0.21–0.94)]. Teachers who work for greater than equal to 21 years were 67% times less likely to have a favorable attitude towards first aid than teachers who work for ten and below 10 years [AOR = 0.33, 95% CI (0.13–0.86)] (Table  6 ).

The result of this study revealed that only 41.1% of the respondents have good knowledge of first aid. The finding of this study is in line with previous studies conducted in Addis Ababa, 40.0% [ 14 ], Debretabor, 45.8% [ 12 ], and Jimma, Ethiopia 44.4% [ 13 ]. According to the participant’s response, 85.8% of the respondents report as they give first aid for injuries and illness however less than half of the participants have good knowledge. It implies that some of the teachers exercise first aid interventions without basic knowledge. It shall be given attention and first aid training to equip school teachers with first aid knowledge to give evidence-based first aid for accidents.

The finding of this study was higher than a study conducted in Saudi Khamis mushyt city, 19.6% [ 15 ]. The difference might be due to variation in sample size and socio-demographic characteristics of the respondents. On the other hand, the result of this study was lower than the studies conducted in Malaysia 77.4% [ 16 ] and Iraq 95% [ 17 ]. The possible reason for this variation might be due to differences in a school setup, socio-demographic characteristics of the respondents, and variation in the measurement. The previous studies were conducted among elementary school teachers whereas the current study was conducted among both elementary and kindergarten school teachers.

This study revealed that 64.8% of kindergarten and elementary school teachers had a favorable attitude towards first aid. This finding was in line with a study conducted in Saud Arabia (67%) [ 18 ] and Riyadh (68.4%) [ 19 ]. This might be due to the similarities of teachers in academic activities in the school. However, this finding was lower than studies conducted in Debre tabor, Ethiopia (75%) [ 12 ], Addis Ababa, Ethiopia (75%) [ 14 ], and Jatinangor (71.5%) [ 20 ]. This discrepancy might be due to the variation of teacher’s academic performance, knowledge, training about first aid, and the school settings across those areas. The previous study conducted in Debre tabor was conducted only among elementary school teachers and the study in Addis Ababa, Ethiopia was conducted among kindergarten school teachers only. On the other hand, our study incorporates the attitude of both elementary and kindergarten school teachers.

In the current study, 85.8% of the teachers who encountered children in need of first aid gave first aid to the child. This finding was relatively consistent with a study conducted in Addis Ababa, Ethiopia (89.7%) [ 14 ]. However, it was higher than studies conducted in Debre Tabor, Ethiopia (64%), Jimma, Ethiopia (52.1%), Khamis Mushayt City, Saudi Arabia (54.9%), and Indonesia (78.8%) [ 12 , 13 , 15 , 20 ]. The possible justification for this difference might be due to the difference in data collection tool used in each study, study participants, and knowledge level. The current study was conducted among kindergarten and elementary school teachers whereas the previous studies were conducted among either kindergarten or elementary school teachers only.

Working experience, school level, school type, and having information about first aid were significantly associated with knowledge towards first aid. The odds of having good knowledge were nearly three times higher among teachers who had 11–20 years of experience compared with those teachers who had less than 10 years of experience. This finding was supported by studies conducted in Debre tabor, Ethiopia, Addis Ababa, Nigeria, Malaysia, Al-Qassim Saudi Arabia, and Khamis Mushyt city Saudi Arabia [ 12 , 14 , 15 , 16 , 21 , 22 ]. This might be due to learning from experience as they faced individuals in need of first aid, training on first aid, and pre-hospital service. The finding of this study revealed that special consideration should be given to the newly employed teachers. This might also be due to as teacher’s working experience increases their academic studies will be complemented by another way of learning from day-to-day exposure. In turn, previous exposure of a child in need of first aid also provides them with crucial knowledge, skills, and personal attributes through communication, team-working and problem-solving skills.

The odds of having good knowledge were five times higher among elementary school teachers compared with kindergarten school teachers. It might be due to the difference in the level of education. According to the result of this study, almost all of the elementary school teachers were diploma and degree holders while kindergarten school teachers were certificate. This implies that special attention should be given to kindergarten school teachers since they give care for kids who didn’t aware of their environment and susceptible to accidents. Private school teachers were four times higher to be knowledgeable compared with teachers who work at governmental schools. This might be due to the difference in a school setup. Most of the time private schools are business-oriented, competitive, and well equipped with infrastructures including first aid kits. To attract customers and to be competitive private schools might provide training for teachers about first aid and accident prevention which makes private school teachers more knowledgeable compared with governmental school teachers.

Similarly, Participants who had previous information about first aid were two times higher to be knowledgeable compared with their counterparts. This finding is supported by studies conducted in Addis Ababa [ 20 ] and Debretabor, Ethiopia [ 12 ]. This might be due to having previous information regarding first aid leads to a higher score of knowledge-related questions than respondents who didn’t have information about the issue. This implies that obtaining information about first aid and emergency medical care either from media, training, health professionals, or family increases the acquisition of knowledge towards first aid.

School-level, school type, and working experience were significantly associated with the attitude towards first aid. Teachers who work in elementary schools were five times more likely to have a favorable attitude towards first aid compared with teachers who work in kindergarten schools. This might be due to those teachers who work in primary schools were more knowledgeable about first aid since the school level determines the teacher’s competency. Governmental school teachers were 55% times less likely to have a favorable attitude towards first aid than teachers who work in private schools. This might be due to private schools might have good standards and structures of the school including first aid kits and their teachers also might have strict control since private schools are business-oriented. Similarly, the working experience was significantly associated with the attitude of teachers towards first aid. Teachers who had working experience of greater than or equal to 21 years were 67% times less likely to have a favorable attitude compared with teachers who had working experience of less than or equal to 10 years. This finding was supported by other studies [ 14 , 23 ], [ 24 ]. This might be due to those teachers with long time experience give less attention to first aid because mostly they are old age and their academic status is diploma whereas younger age groups of teachers were degree holders.

This study has some limitations

There might be a possibility of social desirability and recall bias. We were unable to identify factors associated with practice due to the variation in the type of cases requiring first aid. The generalizability of the findings to schools in other parts of the country might be compromised since the study was conducted in one city. We were also unable to make an adequate comparison with other studies due to the lack of similar studies.

Less than half and nearly two-thirds of the teachers had good knowledge and a favorable attitude towards first aid. The majority of the teachers who encountered a child in need of first aid gave first aid. Having higher working experience, working in elementary and private schools, and having previous information about first aid increases the odds of having good knowledge of first aid. Teachers who work in elementary and private schools and have the lower working experience had higher odds of favorable attitude towards first aid. It is better to give attention to the training of staff on first aid specifically for teachers working in kindergarten and governmental schools and new employees. Policymakers in education might use the finding of this study as an input to integrate first aid in teachers’ training curriculum.

Availability of data and materials

The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

Abbreviations

Adjusted odds ratio

Confidence interval

Emergency medical service

Emergency medical technician

Statistical package for social sciences

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Acknowledgments

The authors are grateful to the University of Gondar, Gondar city administration Education Office, data collectors, and study participants.

No funding has been received for the conduct of this study and/or preparation of this manuscript.

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Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

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Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

Enyew Getaneh Mekonen

Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

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BSW: participate in the conception and design; analysis and interpretation of data; drafting and revising the manuscript. EGM: took part in the acquisition, analysis, and interpretation of data; drafting the article or revising it critically for important intellectual content; drafting and revising the manuscript. MSA: participate in the analysis and interpretation of data, drafting the manuscript, and revising it. All authors agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

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Before conducting the study, ethical clearance was obtained from the institutional review board of the University of Gondar. A written permission letter was obtained from school directors. Participants were informed about the purpose of the study and written informed consent was obtained from them. Confidentiality was maintained by omitting direct personal identifiers on the questionnaire, by using code numbers, storing data locked with a password, and not misuse or wrongfully disclose their information. Participants were also informed that participation was voluntary and they can withdraw from the study participation at any stage if they are not comfortable with the investigation. The study protocol is performed per the relevant guidelines.

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Workneh, B.S., Mekonen, E.G. & Ali, M.S. Determinants of knowledge, attitude, and practice towards first aid among kindergarten and elementary school teachers in Gondar city, Northwest Ethiopia. BMC Emerg Med 21 , 73 (2021). https://doi.org/10.1186/s12873-021-00468-6

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DOI : https://doi.org/10.1186/s12873-021-00468-6

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A systematic literature review on first aid provided by laypeople to trauma victims

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• 1 Department of Anaesthesiology and Intensive Care, Hammerfest Hospital, Hammerfest, Norway. [email protected]
• PMID: 22897491
• PMCID: PMC3495299
• DOI: 10.1111/j.1399-6576.2012.02739.x

Death from trauma is a significant and international problem. Outcome for patients suffering out-of-hospital cardiac arrests is significantly improved by early cardiopulmonary resuscitation. The usefulness of first aid given by laypeople in trauma is less well established. The aim of this study was to review the existing literature on first aid provided by laypeople to trauma victims and to establish how often first aid is provided, if it is performed correctly, and its impact on outcome. A systematic review was carried out, according to preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines, of all studies involving first aid provided by laypeople to trauma victims. Cochrane, Embase, Medline, Pubmed, and Google Scholar databases were systematically searched. Ten eligible articles were identified involving a total of 5836 victims. Eight studies were related to patient outcome, while two studies were simulation based. The proportion of patients who received first aid ranged from 10.7% to 65%. Incorrect first aid was given in up to 83.7% of cases. Airway handling and haemorrhage control were particular areas of concern. One study from Iraq investigated survival and reported a 5.8% reduction in mortality. Two retrospective autopsy-based studies estimated that correct first aid could have reduced mortality by 1.8-4.5%. There is limited evidence regarding first aid provided by laypeople to trauma victims. Due to great heterogeneity in the studies, firm conclusions can not be drawn. However, the results show a potential mortality reduction if first aid is administered to trauma victims. Further research is necessary to establish this.

© 2012 The Authors. Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation.

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The First Aid: Types and Elements Research Paper

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First aid is a necessary skill for anybody to learn in order to be prepared for any emergency circumstance. It gives a foundational grasp of the abilities required to assist someone who has been hurt or may be in need of medical assistance. This research paper will evaluate the significance of first aid, the fundamental elements of first aid, and the various types of first aid that can be deployed.

First aid is a critical skill to possess, as it can benefit individuals in multiple scenarios. It is essential to be able to provide first aid in an emergency, as it can potentially save lives and lessen the intensity of injuries. Furthermore, first aid can also ameliorate the risk of infection and other adverse consequences that may arise in an emergency situation (Mills et al., 2020). The fundamental tenets of first aid are relatively straightforward. These principles include evaluating the environment and the individual, administering essential life support, and taking suitable action to address the individual’s condition (Furst, 2018). It is imperative to be aware of the indications and manifestations of different types of injuries and the measures that should be taken in each case.

Additionally, it is equally essential to be familiar with the various first aid practices that can be implemented. In an emergency, several sorts of first aid can be performed, ranging from simple wound care (such as wound cleansing and wrapping) to more advanced treatments such as cardiopulmonary resuscitation and other life-saving interventions (Furst, 2018). Other forms of first aid may include the immobilization of an injured person and providing emotional support to those in distress.

In conclusion, first aid is an invaluable skill for any individual to acquire in order to be adequately equipped for any emergency. It is paramount to be conscious of the fundamental principles of first aid, as well as the various types of first aid that can be engaged in an emergency. With a thorough understanding of the basics of first aid, it is feasible to be prepared to assist someone in need.

Furst, J. (2018). The complete first aid pocket guide: Step-by-Step treatment for all of your medical emergencies . Adams Media.

Mills, J., Rosenberg, J. P., Bollig, G., & Haberecht, J. (2020). Last aid and public health palliative care: Towards the development of personal skills and strengthened community action . Progress in Palliative Care , 28 (6), 343–345. Web.

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The willingness to perform first aid among high school students and associated factors in Hue, Vietnam

1 Health Personnel Training Institute, University of Medicine and Pharmacy, Hue University, Hue, Vietnam

2 School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan

Pham Thanh Tung

3 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America

4 Department of Physiology, Hanoi Medical University, Hanoi, Vietnam

5 Research Advancement Consortium in Health, Hanoi, Vietnam

Le Nguyen Quynh Nhu

6 Daklak Center for Diseases Control and Prevention, Daklak, Vietnam

Nguyen Tuan Linh

7 University of Medicine and Pharmacy, Hue University, Hue, Vietnam

Dinh Thanh Tra

Nguyen vu phuong thao, tran xuan tien, hoang huu hai.

8 Faculty of Public Health, Department of Epidemiology and Statistics, Danang University of Medical Technology and Pharmacy, Da Nang, Vietnam

Vo Van Khoa

9 Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, Hue University, Hue, Vietnam

Nguyen Thi Anh Phuong

10 Faculty of Nursing, University of Medicine and Pharmacy, Hue University, Hue, Vietnam

11 Faculty of International Education, University of Medicine and Pharmacy, Hue University, Hue, Vietnam

12 Office of Science-Technology and International Relations, University of Medicine and Pharmacy, Hue University, Hue, Vietnam

Hoang Bao Long

13 Institute of Gastroenterology and Hepatology, Hanoi, Vietnam

Bui Phuong Linh

14 Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America

Associated Data

According to our application to the Institutional Ethics Committee of Hue University of Medicine and Pharmacy, the data cannot be shared publicly because of ethical restrictions to protect the confidentiality of the participants. A deidentified dataset is available for researchers who meet the criteria for access to confidential data. Requests for data should be submitted to the Institutional Ethics Committee of Hue University of Medicine and Pharmacy (Email: nv.ude.vinu-demeuh@rits ; Add: 06 Ngo Quyen St., Hue 530000 – Vietnam; Tel: +84.234.3822873) and the corresponding author, Dr. Le Duc Huy (contact via nv.ude.inueuh@yuhcudel ).

Adolescents who are willing to perform first aid can help prevent injuries and ultimately death among themselves and others involved in accidents or injuries. This study aims to estimate the prevalence of students’ willingness to perform first aid procedures and additionally examine associated factors among high school students in Hue, Vietnam.

A cross-sectional study utilizing multi-stage stratified random sampling was conducted between April to July 2020 by investigating 798 high school students in Hue, Vietnam. Participants were invited to complete a self-reported questionnaire pertaining to individual demographic characteristics, personal perception of self-efficacy, and willingness to perform first aid. To better interpret these findings, both multivariable linear and Poisson regression models were fitted to evaluate the association between individual student characteristics and the willingness to perform first aid.

The prevalence of having willingness to perform first aid (defined as ≥4 points out of 5 to all three questions) was 49.9% (95%CI:28.6–71.2%). The major reported barriers in performing first aid were fear of making mistakes and hurting victims (34.4%, 95%CI:31.9–37.0%), no prior first aid training (29.8%, 95%CI:25.9–33.9%), and forgetting first aid steps (23.0%, 95%CI:15.8–32.2%). By employing the multivariable linear regression model, it was identified that students with high (β = 0.614, 95%CI:0.009–1.219) or very high (β = 1.64, 95%CI:0.857–2.422) levels of self-efficacy appeared to be more willing to perform first aid. Similarly, in the Poisson regression models, compared to neutral students, students who reported high (PR = 1.214, 95%CI:1.048–1.407) or very high (PR = 1.871, 95%CI:1.049–3.337) levels of self-efficacy were more willing to perform first aid.

Conclusions

The level of willingness to perform first aid among high school students in this study population was found to be moderate. Therefore, integrating activities to promote self-efficacy in first aid training could be considered a progressive step towards improving a student’s willingness to provide such life-saving procedures.

1. Introduction

Child and adolescent injuries are a significant cause of childhood mortality globally, leading to a large burden upon public health in low- and middle-income countries (LMICs) [ 1 , 2 ]. According to a study investigating the global burden of diseases in 2017, it was found that injuries are a major factor that is attributed to approximately 1900 child death cases per day worldwide [ 3 ]. Recent studies demonstrated that various first-aid interventions such as cardiopulmonary resuscitation (CPR), management of a suspected spinal/head injury or bleeding that is performed by untrained personnel (e.g., caregiver, bystander) or a trained provider could be crucial to mitigate mortality and the risk of disability caused by injuries [ 4 ]. Additionally, training children in first aid techniques has been considered a novel strategy to increase the rate of CPR within a community, thus resulting in higher survival rates [ 5 – 7 ]. A high level of willingness to perform first aid among adolescent bystanders can improve the timely access to quality care for victims, contributing to the reduction of morbidity and mortality caused by injuries [ 5 , 8 ]. Therefore, the World Health Organization has recommended the “Kids save lives” statement to emphasize the role of children in increasing the rate of CPR amongst lay people [ 8 , 9 ]. While studies of children receiving first aid training have been well documented in developed countries [ 10 , 11 ], the data in developing countries remains limited and presently illustrates a low rate of first aid training for children [ 12 , 13 ]. Regardless, even among children who received first-aid training, their willingness to perform first aid was influenced by various factors. Furthermore, several studies have indicated that the factors related to the lack of students’ willingness to perform first aid include insufficient knowledge [ 11 ], fear of hurting the victim [ 6 ], and the fact that the victim was a stranger [ 11 ].

In a lower-middle-income country such as Vietnam with 26.2 million children (i.e., 28.0% of the population in 2017) [ 14 ], data on the willingness to perform first aid across children remains poorly reported [ 15 , 16 ], despite the importance of willingness to perform first aid [ 6 , 11 , 17 – 19 ]. Vietnamese children have been suffering from a large burden attributed to injuries such as fall, motor vehicle accident, and being attacked or abused or fighting with someone [ 20 ]. In 2017, injuries led to 7400 excessive deaths in Vietnamese children aged 10–19 years old [ 21 ]. A recent Vietnamese national survey in 2013, which included high school students, indicated that 34.3% of boys and 25.1% of girls were injured at least once during the past year [ 20 ]. Though schools are encouraged to organize first aid training for teachers, staff, and students, there remains a lack of standardized formal curriculum at both regional and national levels in Vietnam [ 22 ].

To our knowledge, there are no published datasets that assess the willingness of students to perform first aid and associated factors in Vietnam. Therefore, it is essential to conduct studies reflecting the present efficacy of first aid training and recommend means to bolster training quality. Thus, this study aims to estimate the prevalence of willingness to perform first aid amongst high-school students in Hue and thus identify factors that may be associated with first aid interventions.

Study design and study population

A cross-sectional study on high school students in Hue was conducted from April to July 2020. Hue is a major education and healthcare center within Vietnam, with an estimated population of 652,572 in 2021 [ 23 ]. All high schools in Hue, in addition to other provinces in Vietnam, are required to follow a national framework provided by the Vietnamese Ministry of Education’s general education program [ 24 ]. General education comprises three levels: five years of primary education (elementary school), four years of lower secondary education (middle school), and three years of upper secondary education (high school) [ 25 ].

However, as most students in grade 12 tend to have busy schedules in order to prepare for the National High School Exam, we decided to select grades 10 and 11 students, who have more flexible schedules from high schools across Hue as the source population. There are presently 11 high schools in Hue [ 26 ], with 8328 high school students within grades 10 and 11 at the time of the study.

Sample and selection of participants

Data were collected during the baseline assessment phase of the first aid training project of Hue University of Medicine and Pharmacy. The required sample size for this study was calculated by utilizing a formula for cross-sectional studies [ 27 ] with 95% confidence level and 5% precision and accounted for the proportion of participants who have demonstrated sufficient first aid knowledge p = 0.491, as assessed in a previous study [ 28 ]. Due to the use of a multistage stratified random sampling design, the design effect was multiplied by a factor of 2. To account for participants refusing to complete or returning incomplete questionnaires, an additional 10% of the sample population was added. Overall, 844 students were included in the study population.

A multistage stratified random sampling technique was utilized to produce a representative sample of high school students from Hue. 11 public high schools within Hue were stratified into two groups, north or south schools that are separated by the Huong River. At the first stage, we randomly selected four high schools (two schools in the north and two schools in the south of the city) ( Fig 1 ). At the second stage, among 4 selected representative high schools, all classes in grades 10 and 11 were selected. Approximately 8–10 students were randomly selected in each class. We collaborated with the schools to meet and obtain agreement from the selected students and their parents. Students were asked to complete a self-reported electronic-based questionnaire on smartphones, tablets, or laptops under the research staffs’ in-person instructions. In the case of students who did not own an electronic device to get access to the questionnaire, we would provide our tablets.

The inclusion criteria for participants included being in grade 10 or grade 11 at selected high schools during recruitment, receiving permission to participate in the study from parents or legal guardians, and having both physical and mental capacity to answer the questionnaire of the study.

Instrument development

After conducting the literature review, we developed a questionnaire to investigate the prior acquisition of first aid training, current levels of self-efficacy, and willingness to perform first aid ( S3 Table ). All selected questions were translated into Vietnamese and back-translated to English using the approach of Back-Translation for Cross-Cultural Research [ 29 ]. The translation process includes the following steps: forward translation, back-translation, back translation review and discussion by the expert panel, and finalization. A language expert, a senior lecturer in the nursing department, translated all English questions into Vietnamese. Another independent senior emergency physician back-translated those questions into the English version. The consensus panel was then carried out to ensure the two English versions were comparable. The questions had modest adjustments to fit Vietnamese culture and language throughout the translation procedure. According to Bandura (1997), “Perceived self-efficacy is concerned with people’s beliefs in their capabilities to produce given attainments” [ 30 ]. From this definition, we defined self-efficacy as the participant’s belief in their capabilities to perform first aid and save human lives. According to Bandura’s Self-Efficacy Theory, we constructed the self-efficacy scale for first aid [ 30 ]. Based on a previous study by Wei et al. in 2013 [ 31 ] which discussed the common types of injury among Vietnamese high school students [ 32 ], we decided to use a self-efficacy score calculated on the basis of six questions. The participants were then asked to rank personal levels of self-efficacy to perform each of the six essential first aid skills (including calling emergency, cardiopulmonary resuscitation, chest compression, mouth-to-mouth ventilation, immobilization of fracture, and stopping bleeding). Point for each skill could range from 1 point as “Not confidence at all” to 5 points as “Very confident.” The maximum possible score which denotes the highest level of self-efficacy for all six first aid skills was 30, a minimum score of 5 illustrates the lowest level of self-efficacy. Apart from the continuous scale, we classified the student’s self-efficacy into 5 categories as very low (<10 points), low (10–14 points), neutral (15–19 points), high (20–24 points), and very high (≥25 points).

Willingness to perform first aid by students was calculated based on three questions in a similar ranking system which was previously described [ 33 ]. Questions inquiring about self-reported levels of participant willingness to perform first aid was divided into three different circumstances: (1) a victim is a stranger, (2) the student is the only person who can help in the accident, and (3) other people are also present in the accident were used. For each of the three questions, participants were asked to rank their level of willingness to perform first aid as “fully disagree” (1 point) to “fully agree” (5 points). The maximum score of willingness is 15, and the minimum score is 3. We defined persons as being willing to perform first aid if their willingness mean score was higher than the mean score of the study population; otherwise, they would be classified as not willing to perform first aid. Also, we presented results using another definition of being willing to perform first aid which required a person to respond “agree” or “fully agree” (≥ 4 points, i.e., only positive responses) in all three willingness questions; otherwise, they would be categorized as not willing to perform first aid.

To evaluate the content and face validity of the presented questions, a panel of experts on nursing and specialists in emergency medicine at the Emergency Department at Hue University of Medicine and Pharmacy was established. The expert panel commented and approved the first draft of the survey which included questions on general characteristics (sex, age, school, class), history of injuries (number of injuries, types of most serious injury, causes of the injury), any experience with first aid training, self-efficacy, and willingness to provide first aid. Each individual item in the draft questionnaire was evaluated for readability, appropriateness, concreteness, and significance. After that, two researchers discussed the questionnaire with six high school students from Hue to collect their feedback on the readability and adequacy of the questionnaire. A quantitative pilot survey was also implemented on 50 students from the source population to create an exhaustive list of choices for the final multiple-choice questions. The time estimated to complete the questionnaire is about 20 minutes. Ultimately, the expert panel finalized the revised questionnaire which was then employed for this study.

Data analyses

In terms of construct validity, Exploratory Factor Analysis (EFA) was carried out to identify the possible latent variables that uncover the structure of items in questionnaire. First, we established the model using principal component analysis, followed by a scree plot [ 34 ] and parallel analysis [ 35 ] to determine the number of factors. The following criteria were used to identify the number of factors: a) eigenvalues larger or equal to the eigenvalue at the scree plot’s "elbow", and (b) explain more than 80% of the total variation.

After the number of factors was defined, we carried out the iterative principal factor analysis with an oblique Promax rotation method to extract factors. The items with the highest loading factor <0.4, or uniqueness >0.5 would be removed. The procedure was repeated until no more objects in the model were removed. The results of Bartlett’s test of sphericity [ 36 ] and the Kaiser-Meyer-Olkin (KMO) measure of sample adequacy [ 37 ] were used to evaluate the applicability of EFA. The Cronbach’s Alpha was also used to measure internal consistency.

All statistical analyses accounted for the multiple-stage sampling strategy with the “svy” options in Stata version 15.1 [ 38 ]. Sampling weights were employed to obtain representative estimates of the whole population of high school students in Hue, Vietnam and to adjust for non-response bias and over or under-sampling.

Weighted proportions and confidence intervals were calculated for categorical variables, the weighted mean and confidence intervals were computed for continuous variables. Univariate comparisons on participant demographics, prior first aid training, self-efficacy, and willingness were assessed using Pearson Chi-Squared, Fisher’s exact tests, or independent t-test.

To identify associated factors, we conducted a literature review and created a simple causal diagram (DAG—directed acyclic graph) to illustrate the relationship between variables [ 39 – 41 ]. VanderWeele et al. and Hernán et al. suggested that this approach would provide more valid estimates as compared to traditional biostatistical approaches, such as backward and forward selection [ 39 – 41 ].

For the continuous score of willingness, we fitted a multivariable linear regression model to explore the association between the willingness to perform first aid and the student’s personal characteristics such as their level of self-efficacy, prior first aid training (Yes/No), class, sex, and injury experience in the past 12 months (Yes/No) which required participants to be absent from school for at least one day. We also examined the associated factors with willingness to perform first aid categorized by average mean score or positive responses as described in section 2.3 using Poisson regression models with binary outcomes. As the prevalence of students who lack the willingness to perform first aid among the study population was greater than 10%, the association between these binary outcomes and independent variables would be overestimated using logistic regression. Therefore, using log-binomial regression models to directly approximate Prevalence Ratios (PRs) would be an alternative solution; however, this model often fails to converge [ 42 ]. To tackle these statistical issues, previous studies calculated PRs by employing a modified Poisson regression model with a robust error variance for binary outcome data [ 43 , 44 ]. With such a model, Chen et al. demonstrated that the results were comparable to log-binomial regression models [ 45 ].

After data analysis in Stata 15.1, R statistical software version 3.4.0 and the packages ggplot2 and ggpubr [ 46 , 47 ] were used to visualize the study’s findings.

Ethical considerations

Our research proposal was approved by the Institutional Review Board (IRB) of Hue University of Medicine and Pharmacy with the registration number: H2020/057. We also obtained permission from the executive boards of all four selected high schools. All participants and their parents were informed of the purpose of the study and explained the minimal risks involved with the participation and the confidentiality of their data. All participation was voluntary, and the respondents could quit the study whenever they wanted. All written consent forms were collected before students participated in the study. According to the Vietnamese law of children, children are defined as under 16 years old [ 48 ]. As all eligible participants in this study were 16 years old and above, they are not considered children or minors. Therefore, consent from parents or guardians was not required by the local IRB at Hue University of Medicine and Pharmacy. However, the research team did get verbal consent from the guardians of eligible students. After completing the questionnaire, every student received a reusable water bottle as a small gift as compensation for their time.

In total, 844 students were randomly invited to the study; among this group, only 798 students (94.5%) agreed to participate and completed the questionnaire ( Fig 1 ).

Study population characteristics

Table 1 shows the weighted characteristics of study participants by sex. Approximately half of the study participants were in grade 10. With regards to first aid training, only 9.1% (95%CI: 1.5–38.7%) of female students had ever attended a first aid training course, while this proportion in male counterparts was 13.6% (95%CI: 5.6–29.4%); however, this difference was not statistically significant (p = 0.159). Among those trained in first aid, only about ⅓ of participants were trained within the past year across both sexes. Participants mainly received information detailing first aid procedures from the internet (84.8%, 95%CI: 60.5–95.3%) and their teachers (63.5%, 95%CI: 35.4–84.6%). Over 15% of students (95%CI: 7.4–29.4%) experienced an injury at least once during the past 12 months.

a Weighted N = 5065.

b Weighted N = 3263.

c Weighted N = 8328.

Fig 2 presents the weighted proportions of responses for each question regarding levels of self-efficacy and the willingness to perform first aid. Among the six first aid skills asked, participants reported low confidence for the administration of most first aid skills, except for calling for emergency services. However, with regards to willingness in the three first aid circumstances, participants mostly agreed to provide first aid, especially when they were the only person who could help victims (84.6%, 95%CI: 70.2–92.7%), as well as when the victim was a stranger (74.8%, 95%CI: 53.6–88.4%). Approximately half of the participants were willing to engage in emergency scenarios when other bystanders were also present (56%, 95%CI: 30.7–78.5%).

Self-efficacy of students regarding first aid

In terms of self-efficacy of students regarding first aid, the preliminary EFA model revealed that three components were sufficient ( S1 Fig ). The refined model appeared to have three factors ( S4 Table ).

The pattern of factor loading and correlation matrix among the factors of an oblique rotation are presented in S4 and S5 Tables, respectively. The content of the items indicates that these three factors focus on the quick response (Emergency call), basic life support (Cardiopulmonary resuscitation, chest compression, mouth-to-mouth ventilation), and first aid for injury (Immobilization of fracture, stopping bleeding). The results of Barlett’s test and the KMO statistic show that the EFA model was appropriate. The Kaiser-Mayer-Olkin MSA was high (0.816 > 0.5) [ 49 ]. Bartlett’s test suggested that the correlation matrix was not random (p < 0.001) [ 50 ]. Therefore, our data were suitable for factor analysis.

The Cronbach’s alpha coefficient of self-efficacy scale was 0.8321. This suggests the scale has good internal consistency [ 51 ].

Table 2 presents the weighted prevalence of different levels of self-efficacy of first aid. Most students (about 70%) showed a neutral, low, or very low level of first aid self-efficacy. Male students have a significantly higher self-efficacy mean score (17.1, 95%CI: 15.5–18.8) than female students (p-value = 0.006 from t-test). Consistently, the male group tended to have a greater proportion of high (29.3% (95%CI: 22.0–38.0%)) and a very high level of efficacy (6.4% (95%CI: 0.9–34.0%)) in comparison to female students. About 46% of students with prior first aid training reported a high or very high level of self-efficacy, whereas this proportion in those without previous training was only 26%. There was not a statistically significant difference between the levels of self-efficacy between the students who were trained in the past year and those who received training more than one year ago.

Abbreviations: CI, confidence interval; N/A, not applicable as there was no participant in this category.

a The level of self-efficacy was classified based on the sum of scores from six Likert self-efficacy questions.

b p-value from an unpaired t-test.

c p-value from Chi-squared test.

d p-value from an unpaired t-test, the group who answered “do not know” was not included in statistical tests.

e p-value from Chi-squared test, the group who answered “do not know” was not included in statistical tests.

Willingness of students to perform first aid

Similar to the Self-efficacy scale, we developed the EFA model for items measuring willingness. However, because the willingness scale includes three items, we can define only 1 factor. In addition, the rotation approach is not applied to a single factor. Factor loading of items measuring willingness is shown in the S6 Table .

The results of Bartlett’s test (p < 0.001) and Kaiser-Mayer-Olkin MSA (0.687) indicate that the factor analysis can be useful.

The Cronbach’s alpha coefficient for willingness scale was 0.7649. This indicates that the internal consistency of the self-efficacy items is acceptable [ 51 ].

Table 3 indicates that half of all surveyed high school students of both sexes reported that they would be willing to perform first aid skills in all three aforementioned circumstances. The estimated prevalence utilizes two definitions that are similar in each characteristic. Students in grade 10 had a slightly higher mean willingness score as well as a higher prevalence of willingness, but this was found to be not statistically significant (p-value: 0.286, t-test). Interestingly, students without prior first aid training had a slightly higher mean score (12.2 (95%CI: 10.9–13.5)) and higher mean-based prevalence of willingness (54%, 95%CI: 33.9–73.0%), as well as positive response-based prevalence (50.9%, 95%CI: 33.7–68.0) in comparison to students who reported having received first aid training before. However, these differences were not statistically significant. Furthermore, students with a higher level of self-efficacy to perform first aid appeared more willing to administer first aid to the victim. There were no noticeable differences in the mean score or prevalence of willingness across strata of sources of first aid information received.

Abbreviations: CI, confidence interval.

a Having willingness to perform first aid was defined as having the willingness score larger than the mean of willingness score of the study population (from 12.2 points and above).

b Having willingness to perform first aid was defined as having positive responses (i.e., responded “agree” or “fully agree”) in all three Likert willingness questions.

c p-value from an unpaired t-test.

d p-value from Chi-squared test.

e p-value from an unpaired t-test, the group who answered “do not know” was not included in statistical tests.

f p-value from Chi-squared test, the group who answered “do not know” was not included in statistical tests.

Barriers and facilitating factors associated with students’ willingness to perform first aid

We asked students to rank the top three barriers which may prevent them from providing first aids. The proportion of students choosing each barrier as the first, second, and third barrier by sex was presented in Fig 3 . The three barriers that surfaced in all first, second, and third rank were fear of making mistakes and hurting victims (34.1%, 95%CI: 31.3–37.1), not yet been trained to do first aid (30.3%, 95%CI: 28.3–32.4), and forgetting first aid steps (22.9%, 95%CI: 15.5–32.3) ( Fig 3 ). Fear of making mistakes and hurting victims was more common in female students (38.2%, 95%CI: 37.6–38.8) as compared to male students (27.8%, 95%CI: 21.2–35.6) ( S1 Table ).

Fig 4 shows the proportions of students who responded “Yes” to facilitating factors listed in the questionnaire. The most common factor that motivated high school students to perform first aid was being the only bystander in accident circumstances (83.9%, 95%CI: 74.1–90.5%), followed by “being trained to do first aids” (57.6%, 95%CI: 27.7–82.8%). The proportions of facilitating factors were not different between males and females (p = 0.683, Chi-square test) ( S2 Table ).

Factors associated with students’ willingness to perform first aid

Based on the multivariable models from Table 4 , we found that the level of self-efficacy and prior first aid training was significantly associated with students’ willingness to perform first aid.

Abbreviations: PR, prevalence ratio calculated from Poisson regression model; CI, Confidence interval.

Bold numbers indicated statistically significant results with p figure <0.05.

a Model 1: Multivariable linear regression model with the continuous willingness score (ranging from 3 to 15 points) as the outcome.

b Model 2: Multivariable Poisson regression model with the binary willingness variable as the outcome. Having willingness to perform first aid was defined as having the willingness score greater than the mean of willingness score of the study population (from 12.2 points and above).

c Model 3: Multivariable Poisson regression model with the binary willingness variable as the outcome. Having willingness to perform first aid was defined as having positive responses (i.e., responded “agree” or “fully agree”) in all three Likert willingness questions.

In the multivariable linear regression model, compared to neutral students, students with a very low level of self-efficacy were less willing to perform first aid (β = -1.706, 95%CI: (-3.023)—(-0.39)); whereas, those with a high or very high levels of self-efficacy were significantly more willing to do such techniques (β = 0.614, 95%CI: 0.009–1.219; β = 1.64, 95%CI: 0.857–2.422, respectively). Additionally, any prior first aid training experience had a significant negative association with students’ willingness (β = -0.518, 95%CI: (-0.899)–(-0.136)).

In the multivariable Poisson regression models, only high and very high levels of self-efficacy were associated with having willingness to perform first aid, as compared to students with neutral self-efficacy. The factor of previously receiving first aid training was not statistically significantly associated with willingness in these two models.

In the present study, the willingness to perform first aid among high school students within a Vietnamese city was approximately 50%; this is lower than studies conducted across high school students in China (73%) [ 13 ], Hong Kong (83.3%) [ 52 ], New Zealand (63%) [ 53 ], and Japan (50–68.2%) [ 11 ]. However, the finding of this study is slightly higher than the results reported in Malaysia with 45.1% [ 54 ]. Overall, these differences could be due to variation in specific questionnaires and definition of willingness to perform first aid between studies. For example, one Japanese study utilized dichotomous questions on five hypothetical scenarios of cardiopulmonary arrest to estimate the prevalence of willingness to perform first aid among students [ 11 ]. Furthermore, other studies in New Zealand and China employed Likert questions which primarily focus on two scenarios, such as if the victim was a stranger or family member [ 13 , 53 ].

This study also investigated the leading factors which act as barriers or facilitators in influencing the willingness of students to perform first aid. The presented study further illustrates that the fear of making mistakes and hurting victims (38.2%, 95%CI: 37.6–38.8%) remains the most prevalent reason which prevents students from offering first aid. This finding is in line with studies conducted in other countries. For example, in Japan, the reason for unwillingness to perform CPR was the fear of inadequate performance in first aid [ 11 ]. Similarly, in Hong Kong, nearly 30% of students reported that being afraid of making mistakes and hurting victims could be a major barrier to performing first aid [ 52 ]. A similar finding was found in Malaysian students [ 54 ]. Another significant barrier for performing first aid was not receiving first aid training yet (30.4%, 95%CI: 27.6–33.2%). This result was similar to a previous study on Hong Kong high school students who reported that not being trained in first aid was the second most common reason for the reluctance to perform first aid [ 52 ].

In our study, only 9.1% of students had experienced first aid training. This prevalence was slightly lower than Hong Kong (12.3%) [ 52 ], Malaysia (17%) [ 54 ], and far below some highly developed countries such as Japan (59%) [ 11 ], New Zealand (70%) [ 53 ] where first aid training courses have been formally provided in the education system. In Norway, first aid training has become a compulsory part of the national high school curriculum, with 90% of the Norwegian population receiving at least one first aid training course within ten years [ 10 ]. On the other hand, the most prominent motivating factor to perform the first aid was the realization that one is the only one available to provide the help. This study finding was also found in another study conducted in Malaysia [ 54 ].

Apart from knowledge of first aid, self-efficacy plays an important role in initiating, maintaining, and changing first-aid behavior [ 33 ]. For example, individuals who lack self-efficacy were less likely to adopt first aid knowledge in a real situation. Recent evidence has also indicated that self-efficacy is a significant factor which influences willingness to perform first aid [ 19 , 33 ]. In this study, a low prevalence of students (11.2%) with a high or very high level of self-efficacy in performing first aid is reported ( Table 2 ). This result is slightly higher than results observed within the Japanese public (9%) [ 19 ]. However, it is lower than another study in Norway, where this percentage accounts for 57% [ 33 ].

After adjusting for school grade, sex, injury experience, first aid training experience, and self-efficacy, it was found that student willingness to perform first aid is associated with levels of self-efficacy in all three regression models. Student groups with a very high level of self-efficacy were more willing to perform first aid, whereas those with low levels tend to be more reluctant to perform the first aid. Self-efficacy is typically utilized to indicate the ability to perform specific actions. In a previous Norwegian study, self-efficacy was the strongest predictor of intended behavior to demonstrate first aid skills [ 33 ]. Several studies on the public population of Taiwan and Japan also found a similar finding [ 19 , 55 ]. Although having not received first aid training has been reported as a common barrier to performing first aid, the role of this factor is not clear when analyzing multivariable models. In the linear regression model, we found that students who received first aid training were negatively associated with willingness to perform the first aid; however, this association was not significant in the Poisson regression models. This finding should be interpreted with caution as few studies have evaluated the relationship between self-efficacy and the willingness of students to perform first aid. The results derived from the linear regression model utilized in this study were inconsistent with previous studies where first aid training was found as a significantly positive factor related to the willingness of the public to perform some first aid skills such as CPR [ 19 , 56 ]. However, another study identified that students who received the first aid training showed a lower score of attitudes toward first aid behavior than untrained ones [ 55 ], and one study reported that half of the students trained once in first aid were more likely to be afraid of attempting CPR [ 57 ]. Furthermore, having prior first aid training was modestly showed to decrease the willingness score by 0.518. While this is statistically significant in the linear regression model, it was not showed to have any association in the Poisson models. Moreover, although we acquired information of experience in first aid training, we did not collect other important factors that may influence the attempt of first aid including the type of training, quality of training, and the frequency of training. Therefore, further investigation is needed to answer these questions.

There are some strengths in this study. First, we employed the multi-stage stratified random sampling approach to select the study participants. Therefore, the presented results are likely representative of the whole high school student population in Hue. Second, to our knowledge, this is the first and largest study on student’s willingness to perform first aid skills in Southeast Asia. Third, apart from CPR skills, our survey covered other first-aid skills including stopping bleeding, immobilizing fractures, and calling emergency services, which have not been well reported in the literature.

This study also has some limitations which need to be considered. First, the study was a cross-sectional study that was unable to establish a causal relationship. Second, the study population included students who are primarily living in urban areas. Therefore, the interpretation of these results upon students living in rural areas needs to be taken with caution. Third, there were a few classes that were under or oversampled as compared to our initial target. Though we applied post-stratification weights in all surveyed analyses to partly adjust for this issue, there would still be residual bias due to sampling. Finally, as there are no international standard questionnaires which have been developed to evaluate the willingness to perform first aid at the time of this study, utilization of the self-developed instrument in this study could have led to challenges to compare the levels of willingness between countries. Moreover, our questionnaire may not have covered all aspects of this issue and potentially overlooked some key factors which influence the willingness of respondents, thus leading to potential biases in our model.

The willingness of high school students to perform first aid in Hue, Vietnam, was moderate. The most prominent factor for the willingness of students to perform first aid as an intervention remains as individual self-efficacy. The essential integration of boosting self-efficacy in first aid training can be an important aspect to reform first aid training in Vietnam. Further studies are required to explore approaches to improve both willingness, self-efficacy, and knowledge of first aid approaches in Vietnamese children.

Supporting information

Acknowledgments.

We would love to thank Dr. Nguyen Khanh Huy, Ms. Tran Thi Nguyet, and Ms. Tran Thi Hang for their valuable feedback to improve the questionnaire. We also thank the student union secretaries in the selected high schools who helped us contact the teachers, students, and students’ parents. Also, we deeply thank our collaborators, supervisors, and study participants for their effective cooperation during the data collection procedure. Lastly, we thank Jonathan Josephs-Spaulding for his language editing of the manuscript.

Funding Statement

The study received funding (for study design and data acquisition) from the Research Advancement Consortium in Health (REACH) - a non-profit entity in Vietnam, of which Linh Bui and Tung Pham are co-managers. Linh Bui and Tung Pham did not receive any payment or compensation from this position at REACH. On behalf of REACH, they provided consultancy on study design, data collection and analysis, and preparation of the manuscript. However, Linh Bui and Tung Pham had no role in the decision to publish this study, and this final decision belongs to the funded research team.

Data Availability

Essay on First Aid

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• Open access
• Published: 09 July 2024

A cross-sectional survey of first-aid kit equipment in a family in Sichuan, China

• Dan Wen 1   na1 ,
• Li Wan 2   na1 ,
• Haiyan He 1 ,
• Qianmei Zhong 2 ,
• Qingli Jiang 1 ,
• Xiuru Yang 1 ,
• Dan Zhang 1 &
• Yuqi Shen 1  

BMC Public Health volume  24 , Article number:  1829 ( 2024 ) Cite this article

18 Accesses

Metrics details

To examine residents’ first-aid kit preparation and its influencing factors.

Cross-sectional survey.

A questionnaire survey was conducted among 449 permanent residents in Sichuan Province using convenience sampling. We examined participants’ demographic characteristics, self-efficacy, health literacy, and personality.

Of the participants, 111 (24.7%) stocked a home first-aid kit. The most frequent supplies were disinfection supplies (91.9%), common medicines (86.5%), and dressing supplies (76.6%). Family per capita monthly income, medical expenses payment method, chronic diseases, general self-efficacy, and health literacy were influencing factors of family first-aid kit preparedness.

A multilevel and interactive emergency literacy education system should be established to improve residents’ abilities to prevent emergencies.

Peer Review reports

Introduction

Globally, 45 million people are disabled and 5.8 million die each year due to sudden trauma [ 1 ], the fourth leading cause of death. Injury-related death and disability impose a massive burden on low- and middle-income countries, comprising nearly 90% of the global injury toll [ 2 ]. The home first-aid kit is a comprehensive first-aid kit for accidents, such as knife wounds or earthquakes. They guarantee the safety of residents and play an important role when family members are injured [ 3 ]. In recent years, living standards have improved, and health awareness has been promoted. Home first-aid kits have been receiving increasing attention. In particular, owing to the impact of the COVID-19 pandemic, people’s attention and demand for medical and protective products have increased rapidly.

According to cognitive theory, self-efficacy is the strongest factor affecting public emergency preparedness behavior and a successful sustainer of health promoting behavior. A study [ 4 ] has found that individuals’ emergency preparedness behaviors are related to emergency knowledge, attitude, and self-efficacy. Findings from a study investigating the relationship between personality traits and hoarding behaviors in patients with novel coronavirus pneumonia, has found that, in emergency situations, agreeableness, neuroticism, and openness tend to lead to emergency supplies hoarding [ 5 ]. Health literacy refers to the ability of individuals to obtain and understand basic health information and make correct decisions to promote their health. There is a positive correlation between health literacy and health behaviors, including preventive measures and emergency service utilization [ 6 ].

American public health agencies work to help people respond to disasters and emergencies. In 2003, the U.S. Federal Emergency Management Agency launched a national emergency preparedness campaign to encourage the public to prepare emergency supplies [ 7 ]. In Australia, approximately one-fifth of households have mobile phones, first-aid kits, batteries, and other first-aid items [ 8 ]. Facing frequent extreme weather events and natural disasters, in 2015, China established its Ministry of Emergency Management, and issued the Emergency Management Standards. These standards encouraged households to stock first-aid kits and masks and aimed to improve the public’s awareness of disaster prevention and mitigation, as well as their ability to rescue themselves and others [ 9 ].

According to cognitive theory, self-efficacy is a pivotal factor influencing public emergency preparedness and health-promoting actions. However, the specific determinants motivating or impeding families in Sichuan to prepare and utilize first-aid kits remain unclear. This study aims to bridge the knowledge gap by exploring the relationship between emergency preparedness behaviors, personality traits, health literacy, and household first-aid kit preparedness/utilization in Sichuan, China, thereby offering insights for optimizing family emergency preparedness and first-aid kit utilization.

Materials and methods

Participants.

Families with reading comprehension and expression skills who had lived in a city in Sichuan Province, China, for more than six months within the previous 12 months were included in this study. Participants with mental disorders and those who provided incomplete information were excluded. After receiving a detailed explanation of the study, each participant provided verbal informed consent.

Questionnaire

The questionnaire comprised three parts. The first was the sociodemographic characteristics of the research participants, including gender, age, education level, per capita monthly income of the family, whether family members suffer from chronic diseases, and how medical expenses are paid. The second part of our study comprehensively evaluated the availability and completeness of home first-aid kits among participants’ households. Initially, we investigated the possession of a home first-aid kit, gaining insights into the percentage of households that have prepared a kit for emergencies. Subsequently, for households that confirmed the presence of a kit, we assessed its completeness by inquiring about the specific types of items within. The definition of a home first-aid kit is a collection of essential, well-stocked medical supplies, including bandages, analgesics, and antiseptic cream, readily accessible for self-care in minor household injuries or illnesses. The third component was the standard scale, which included the New General Self-Efficacy Scale (NGSES), Short-Form Health Literacy Instrument (HLS-SF12), and the 10-item short version of the Big Five Inventory (BFI-10).

The new general self-efficacy scale

The NGSES was used to evaluate residents’ self-efficacy [ 10 ]. There are 10 items in the scale. A 4-point Likert scale was used, with overall scores ranging from 10 to 40. Higher scores indicate a higher sense of self-efficacy. The Cronbach’s α coefficient of this scale was 0.87, and the retest reliability in this study was 0.87.

The short-form health literacy instrument

The HLS-SF12 was used to assess residents’ health literacy [ 11 ]. The scale includes 12 items regarding three aspects: medical care, disease prevention, and health promotion. Each item is rated on a 4-point scale (1 = very hard, 2 = hard, 3 = easy, and 4 = very easy). The higher the score, the higher the health literacy level. The Cronbach’s α coefficient of the scale was 0.87, and the retest reliability in this study was 0.86.

The 10-item short version of the big five inventory

The 10-item short version of the BFI-10 was used to evaluate residents’ personality characteristics [ 12 ]. The scale includes ten items and five dimensions: neuroticism, extraversion, openness, agreeableness, and conscientiousness. The scale uses a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree); the higher the score, the more significant the personality traits. The internal consistency coefficients of the five dimensions of the scale ranged from 0.443 to 0.708, and the retest reliability ranged from 0.819 to 0.901.

Data collection

The study was conducted from March 1 to May 1, 2023, using convenient sampling methods. To obtain a representative sample, we initially applied cluster sampling to identify distinct clusters in the community, selected based on geographical criteria. Subsequently, within these clusters, we utilized convenient sampling to individually administer questionnaires to residents. Through the assistance of community workers, the researchers entered the community and distributed questionnaires to the residents individually. Data were collected using an online questionnaire platform called Wenjuanxing, the most popular survey software in China ( https://www.wjx.cn/ ).

Data analysis

Data were analyzed using SPSS (version 25.0; IBM, Chicago, IL, USA) with a significance threshold of p  < 0.05. Measurement data conforming to normal distribution are described as mean ± standard deviation. Measurement data with non-normal distribution are described as the median and quartile. The count data are described and analyzed based on frequency and component ratios. Demographics, self-efficacy, health literacy, and personality characteristics were independent variables in this study. The availability of a home first-aid kit was the dependent variable. The chi-square test and rank-sum test were used for single-factor analysis. Multivariate binary stepwise logistic regression was used for the multivariate analysis.

Ethical considerations

The study was conducted in accordance with the principles of the Declaration of Helsinki. The first page of the questionnaire introduced the purpose and content of the study. The respondents were asked if they agreed to participate in the study. The participants had to click the “Agree” button to enter the questionnaire filling interface. Only those who agreed to participate completed the questionnaire. The study procedure was approved by the Ethics Committee of the Mianyang Central Hospital (S202303110-01).

Quality control

To ensure the reliability and validity of our study, we implemented rigorous quality control measures. Prior to the survey, we conducted two pre-investigations to identify and resolve questionnaire design issues. Expert consultation was sought twice to refine our methods and mitigate bias. During data collection, trained investigators administered questionnaires face-to-face to clarify doubts and ensure response accuracy. Post-collection, a double-check process verified logical consistency and data accuracy. If singular or outlier values were identified, the original questionnaire was retrieved and verified with the investigator. These measures strengthened the reliability of our findings.

Basic information of respondents and preparation of home first-aid kit

A total of 458 questionnaires were collected, of which 449 were valid, with an effective recovery of 98.0%. A total of 111 households (24.7%) were equipped with first-aid kits. The chi-square test showed that there were statistically significant differences in first aid kit equipment among people with different education levels, per capita monthly family income, medical expenses payment methods, and whether they suffered from chronic diseases ( p  < 0.05, Table  1 ).

Type of items stored by responders with a home first-aid kit

The most commonly stocked item was “sterilized items (such as iodine),” with 102 households (91.9%) having such items stocked. The least stocked items were “special drugs (such as quick-acting heart-saving pills and emergency angina medication),” accounting for 37 households (33.3%). The 40 respondents who chose “other items” filled in other items stored in their home first-aid kit, including masks, plasters, and eye drops (Table  2 ).

Self-efficacy, health literacy, and big five personality scores of respondents

The NGSES, HLS-SF12, and BFI-10 scores are shown in Table  3 . The rank sum test showed that self-efficacy, health literacy, health promotion, Big Five personality traits, openness, and agreeableness had significant effects on whether a participant stocked a home first-aid kit ( p  < 0.05).

Factors affecting home first-aid kit preparation

Statistically significant variables in the univariate analysis of general information, self-efficacy, health literacy, and the Big Five personality traits were included in the binary logistic regression analysis. The assignment method for the independent variables is shown in Supplementary Material 1 . The results show that per capita monthly household income, medical expenses payment method, chronic disease, general self-efficacy, and health literacy were factors influencing the availability of first-aid kits in family households. These differences were statistically significant ( p  < 0.05; Table  4 ).

This study shows that 24.7% of included participants’ households in Sichuan Province were equipped with first-aid kits. Household per capita monthly income, medical expenses payment method, chronic disease, self-efficacy, and health literacy are factors that influence family first-aid kit preparedness. A survey of emergency preparedness knowledge, attitudes, and behaviors of community residents in Heilongjiang Province [ 6 ] has shown that less than 5% (133/2686) of the respondents prepared basic emergency supplies. A study on the emergency preparedness behaviors of Japanese residents has shown that only 11% of households stocked a home first-aid kit [ 13 ]. In China and many other regions abroad, people must consider the preparation of first-aid kits and other household emergency supplies.

In 2020, the Ministry of Emergency Management of China issued a list of recommended household emergency supplies. The emergency medicine list includes commonly used medicines (over-the-counter drugs such as anti-infection, anti-cold, and anti-diarrhea drugs), medical materials (wound dressings such as bandages, band-aids, and gauze), betadine, and cotton swabs (for wound treatment and disinfection). Among the participants who had prepared a home first-aid kit, the most stocked item was disinfection supplies (91.9%). Among the surveyed households, 86.5% had stocks of commonly administered drugs. This was mainly possibly related to the policy of epidemic containment and control in the early stages and an increase in residents’ health awareness. Residents reserve drugs, mainly anti-inflammatory, anti-diarrheal, and other daily treatment drugs. However, s drugs such as rescue pills, traditional Chinese medicine, angina pectoris, and other emergency medicines are limited. This may be related to factors, such as whether a family member has a chronic disease. In addition, masks have become an important tool for preventing the spread of respiratory viruses, and many home first-aid kits (36%) are equipped with masks. Government departments should strengthen publicity and training, improve community residents’ preparedness for emergencies, and increase the public’s awareness of first aid.

The per capita monthly household income, the medical expenses payment method, and the presence or absence of chronic diseases are factors that were found to influence the availability of first-aid kits in households. Respondents with higher per capita household income were more likely to have a home first-aid kit. Similarly, a previous study has found that monthly household income was a factor affecting the behavior of residents in preparing emergency supplies [ 3 ]. The higher the monthly household income, the more conscious residents were regarding protecting their lives and property. Respondents who had health insurance were more likely to have a home first-aid kit than those who paid for their own medical expenses. It has been found that differences in medical expenses payment methods reflect differences in the medical care level received [ 14 ]. Respondents without health insurance were likely to be financially disadvantaged and have relatively low incomes, therefore being less likely to have a home first-aid kit. Respondents with chronic diseases are more active and self-manage their health [ 15 ]. Those with proactive access to health-related information and who make appropriate health decisions are more likely to stock a home first-aid kit; therefore, the Chinese government should implement measures to develop effective medical insurance policies, increase compensation, and gradually expand the scope and proportion of medical insurance reimbursement. The treatment of chronic diseases in outpatient clinics should be improved to reduce the cost burden on residents’ families. Furthermore, basic medical insurance, serious disease insurance, and medical assistance services should be provided to low-income rural residents.

Self-efficacy is an individual’s confidence in their ability to complete a specific task. It is closely related to an individual’s diet, physical exercise, smoking habits, and other health behaviors and is an important factor in promoting health [ 16 ]. Studies have shown that when self-efficacy is high, responses to emergencies show more positive attitudes [ 17 ]; therefore, higher self-efficacy is a protective factor for the public against emergencies. In our study, self-efficacy was one of the factors associated with the preparation of a home first-aid kits. People with higher self-efficacy were more likely to have a home first-aid kit than those with lower self-efficacy. Residents with high self-efficacy can remain calm when facing problems, form positive beliefs and attitudes, and stimulate their behavior. Improving self-efficacy is helpful in improving the level of health literacy and promoting the adoption of healthy behaviors and lifestyles.

Health literacy refers to an individual’s ability to obtain, understand, evaluate, and use information to make decisions and take actions that affect health conditions [ 9 ]. Health literacy is an important mediating variable that affects health outcomes, health behaviors, and access to and the utilization of medical services [ 18 ]. In this study, we found that respondents who scored higher on the health promotion dimension were more likely to have a home first aid kit than those who scored lower. This may be because the higher the degree of health promotion of the respondents, the more likely they are influenced by social or environmental factors to take positive health actions. People are increasingly using the Internet to obtain health information. This includes diverse sources, such as health professionals, the media, and social organizations. While providing quality medical information, the Internet and social media also increase the possibility of obtaining inaccurate, misleading, or commercially motivated medical information [ 19 ]. Researchers [ 20 ] have reviewed online health information and found that online health information quality is a major problem. They recommended improving the quality and accessibility of online information systems to help people effectively navigate to reliable health information sources.

This study has several limitations. First, we used convenience sampling, which may have introduced a selection bias. Second, our sample size was small and cannot represent the level of Sichuan Province or the whole country. Finally, we used a self-report questionnaire, which did not objectively reflect the authenticity of the participants’ relevant behaviors.

Less than a quarter of families in Sichuan Province have first-aid kits stocked at home. Household per capita monthly income, medical expenses payment method, chronic diseases, general self-efficacy, and health literacy are factors that influence the availability of first-aid kits in households. Educational efforts should establish multilevel emergency literacy training and comprehensive public education programs, while policy initiatives should target income improvement, health insurance expansion, and financial incentives for first-aid kit purchases. Furthermore, community-based initiatives, collaborating with local stakeholders, should promote emergency preparedness and first-aid kit ownership. It is imperative to improve the public’s self-efficacy and health literacy; draw attention to the importance of emergency supplies, such as home first-aid kits; and increase residents’ abilities to prevent medical emergencies. Ultimately, a strengthened regulatory framework with minimum standards for first-aid kit availability, particularly for households with vulnerable members, is essential to ensure universal access.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

New General Self Efficacy Scale

SF12 Short-Form Health Literacy Instrument

10 10-item short version of the Big Five Inventory

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Acknowledgements

The authors thank the community residents of Mianyang City, Sichuan Province for their support and the community staff for their assistance.

This research did not have any funding.

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Dan Wen, Li Wan contributed equally to this work.

Authors and Affiliations

Intensive Care Unit, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan Province, China

Dan Wen, Haiyan He, Qingli Jiang, Xiuru Yang, Dan Zhang & Yuqi Shen

Department of Nursing, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan Province, China

Li Wan & Qianmei Zhong

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DAN WEN, HAIYAN HE, and LI WAN designed the study. QIANMEI ZHONG and QINGLI JIANG collected and interpreted the data. XIURU YANG, Dan Zhang, and Dan Wen analyzed the data. HAIYAN HE and LI WAN drafted the manuscript. Dan Wen, and XIURU Yang critically revised the paper. YUQI SHEN assists in completing the modification.

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Correspondence to Dan Zhang .

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Wen, D., Wan, L., He, H. et al. A cross-sectional survey of first-aid kit equipment in a family in Sichuan, China. BMC Public Health 24 , 1829 (2024). https://doi.org/10.1186/s12889-024-19376-y

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DOI : https://doi.org/10.1186/s12889-024-19376-y

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10 Things I Hate About You

July 11, 2024, melissa ruiz.

Returning to Princeton after a semester abroad, I was looking forward to conducting my senior thesis research over the summer. Princeton, where everything feels familiar. But I quickly realized that, like people, places frequently change over time. In honor of one of my favorite romantic comedies of all time, I decided to write my own version of 10 Things I Hate About You: Princeton Edition. 

I hate the hill. (There is steady incline from Yeh College to Nassau Hall) It's simple: going up this hill every time I want a cup of coffee or have a work shift on campus is an absolute pain.

I hate the weather. As a New Jersey native, you'd think I'd be used to it by now but I live farther north where we don't have this kind of humidity. The heat wave hitting Princeton this summer, with temperatures in the high 90s, is something I'm not particularly happy about.

I hate leaving Rocky, my residential college. For my summer research, I'm staying in the newer residential colleges, NCW and Yeh. I miss the charm of Rocky, the greenery and the peacefulness. Seeing people walk around or taking photoshoots, it's a distinct environment I've grown accustomed to. NCW and Yeh feel like I'm in a small isolated world.

I hate that my friends aren't here. Most of them are off in different parts of the world or the country working on amazing projects. I miss having people I'm close to nearby, especially after being apart for so long.

I hate all the new construction sites; every day, there's literally a new roadblock. But with each detour, I'm led to a new path I've never taken. I see a new side of Princeton that I wouldn't have seen before because I stick to the same routine. So, while it can be frustrating each day, I'm learning to be grateful for each new place I discover. 

I hate how much I love my lab. We have so many new people over the summer but that comes with the quick reminder that their presence is only temporary. So with each moment I grow closer to them, I know how much harder it's going to be to say goodbye.

I hate how much I love crocheting. I've picked up a hobby I've wanted to pursue for years but never had the time for. Crocheting is such a great, mindless activity and I know that soon I won't have countless hours to spend on my different projects.

I hate how much I love working on my thesis. These two months simultaneously feel like I've gotten so much and nothing done. Running a longitudinal study across different institutions takes a lot of preparation and organization. While I'm close to being where I want to be, I know I still have a lot to do. But I enjoy it because it's work I'm passionate about—work I feel is important.

I hate how time flies so fast here. I only have a few weeks left before the summer session ends and I'll be going home. I'm trying to soak in every moment, every time my lab comes up with a new topic to debate, like grapes vs. cherries or what constitutes a cake. These are the moments I won't forget.

So, in the wise words of Kat Stratford, “But mostly I hate the way I don’t hate you. Not even close. Not even a little bit. Not even at all.” Just like with growing pains, I come to see everything from a new perspective. I see how change can be good and bad, but most of all, how I'm changing with it.

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