assessing the links between first aid training and community resilience

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ASSESSING THELINKS BETWEEN

FIRST AID TRAINING AND COMMUNITY

RESILIENCEResearch report l Research, Evaluation & Impact


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Assessing the links between first aid training and community resilience 1

ASSESSING THELINKS BETWEEN

FIRST AID TRAINING AND COMMUNITY

RESILIENCEJoanna White, Researcher, British Red Cross

Alison McNulty, Senior Researcher, British Red Cross


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2 Assessing the links between first aid training and community resilience


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AcknowledgementsResearch, Evaluation & Impact are very grateful for the support of theFirst Aid Education team. We are also grateful to all of the wonderfulparticipants, and the rst aid training coordinators and members of the

community and workplaces who helped us contact them.


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Copyright 2011

Any part of this publication may becited, translated into other languages oradapted to meet local needs without priorpermission of the British Red Cross,provided that the source is clearly stated.

This publication does not necessarilyrepresent the decisions or stated policyof the British Red Cross.

ISBN 978-0-900228-09-4


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Executive summary 7

1 Introduction 13 1.1 Dening community 13 1.2 Understanding community resilience 14 1.3 Identifying the outcomes of rst aid training at the British Red Cross 15

2 Method 17 2.1 Focus groups 17 2.2 Survey 18 2.3 Measuring our concepts 18

3 Results 21 3.1 Response rate 21 3.2 Respondents 21 3.3 Indicators of community resilience 22

3.4 Individual resilience 28 3.5 Elaborating on the outcomes of rst aid training 30 3.6 Interrelationships between community and individual resilience 31

4 Conclusions 35

5 Recommendations 39

6 References 43

c o n t e n t s


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1. The Context

1.1 From July 2010 to January 2011 theResearch, Evaluation and Impact teamundertook a study to assess the links betweenrst aid training and community resilience.

1. 2 As a starting point, we dened three primaryconcepts or features of concepts used in thisstudy community, community resilience,and rst aid outcomes.

1.3 Focus groups and a survey were the primarytools used for data collection. The survey wasadministered to both a control as well as anintervention (experimental) group.

1.4 Five main indicators of community resiliencewere identied as:> Social connectedness feel part of the

community, people in the communityknow the respondent, watch out for eachother, and are willing to help each other.

> Community efcacy people in the

community are willing to provide rstaid to each other, can be relied upon toprovide rst aid, and are likely to takeaction in a scenario in which noemergency services are available.

Executive Summary


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> Learning this refers to the acquisitionof information, where people in thecommunity know the respondent hashad rst aid training, know rst aidthemselves, and the respondent knowssomeone in the community to go tofor help if ever they need rst aid.

> Readiness to respond have preparationsin place to respond to a rst aidemergency, and reason for attendingrst aid training.

> Facilitating economic wellbeing andequality of access to rst aid training attending rst aid training for employmentpurposes, and removing nancial barriersto rst aid training (nancial barriers torst aid training were identied from the

qualitative data and were not askedabout in the survey itself).

2. Our ndings

2.1 Outcomes of rst aid training

2.1.1 Condence> This study supports condence as an outcome

of rst aid training, with attendance at rst aidtraining, especially multiple training, helping

to increase peoples condence to provide rstaid. However this condence was found todissipate over time when comparing those withrecent training to those who had previouslyreceived training.

2.1.2 Willingness> Willingness to provide rst aid as a rst aid

training outcome, in contrast, is not found tobe related to having been trained in rst aid,and is thus not supported as an outcome ofrst aid training. However, willingness wasfound to be related to some community

resilience indicators specically, socialconnectedness, community efcacy, andknowing someone who can be turned to forhelp (learning). As such, willingness may beable to be inuenced through a greaterunderstanding of these indicators.

2.2 Community resilience indicators

Taking each indicator of community resilienceseparately, a fuller picture of the relationshipswith rst aid training can be illustrated:

2.2.1 Social connectedness> Being socially connected is related to an

individuals willingness to act, with thosestating a willingness to act also reportingthey feel part of a community, the communitywatch out for each other, and that people inthe community are willing to help each other.Communities trained together showed greater

social connectedness in terms of the respondentfeeling more strongly a part of the communitythan those that were not (94% vs. 91%), andthose individuals trained more than once morestrongly agreed that people in their communitywatch out for each other (85% vs. 75%).


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2.2.2 Community efcacy > Similar to social connectedness, community

efcacy did not appear to be a direct result ofrst aid training, however aspects were relatedto willingness and condence to provide rstaid. Community efcacy is heightened in thosewho are trained together as a community,compared to those who are not. In addition,those who are trained more than once morestrongly agreed that people in their communityare willing to provide rst aid to each other inan emergency, compared to those trained onlyonce (76% vs. 65%).

> Analysis of qualitative data also suggests abenet to community efcacy if communitymembers are trained together. In the words

of one participant:

I feel that if you are learning with peopleyou know you are more likely to undertakethe challenge together and be morecomfortable with touching people initiallythat you know than a complete stranger.Once people are trained they are more willingto go into the outside world knowing they

are qualied and capable of doing rst aidto a stranger.

>

In terms of rst aid outcomes, the willingnessof a respondent to provide rst aid wassignicantly positively related to all aspectsof community efcacy, where people who arewilling to provide rst aid are also likely toagree that their community has each of thecommunity efcacy measures.

2.2.3 Learning> People who agreed that they know someone in

their community to go to for rst aid help wereboth more willing and condent to give rstaid than those who did not agree.

> It is encouraging that Trained respondents(intervention/experimental group) more sothan the Control respondents know who toturn to for rst aid help (35% vs. 25%).However, this is likely to be driven, at leastin part, by having attended that training withother members of their community, since thosein the Control group had similar levels ofagreement to those in the Trained group whohad not been trained with other members oftheir community (25% and 26% respectively).

In addition, given the positive relationshipbetween the number of training sessions andincreased knowledge, and those individuallytrained reporting lesser knowledge of who in

their community has rst aid skills, it seemsthat learning may be further enhanced bytraining people as a community.

2.2.4 Spread of knowledge> Levels of both willingness and condence

were higher for people who had shared rstaid skills or knowledge or had recommendedtraining to someone else, than those whohad not.

> Nearly all (95%) of the Trained respondentshad told someone they had received rst aidtraining, and around two thirds had sharedrst aid skills or knowledge (63%) orrecommended rst aid training to someoneelse (67%). This knowledge was most oftenspread to family and friends. However, thesegures appear to be at odds with the lowerreports of knowing who to turn to for rst aidhelp (71%) and knowing people who can giverst aid (28%). This perhaps suggests that thespread of knowledge may occur beyond theidentied communities or families/friends into other arenas of peoples lives.

2.2.5 Readiness to respond> Communities which have undertaken

preparations in order to be ready to respondto a rst aid emergency are likely to be thosein which other community members were

trained alongside the respondent. Indeed,communities in which the respondent wastrained as an individual were three times morelikely to report they had no preparations in


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place than communities in which othermembers were also trained (9% vs. 3%).

> People tended to view rst aid trainingitself as being an important step towardsbeing ready to respond. For example, one

respondent noted that rst aid trainingwould help communities by enabling people to take steps to protect themselvesand others from further injury .

2.2.6 Facilitating economic wellbeing andequality of access to rst aid training> The study found rst aid training had a

potential to impact upon economic wellbeing(that is, rst aid as an employment facilitator).Where the reason for attendance at a rst aidsession was employment related, respondentswere signicantly more willing and condentto give rst aid than those who attendedbecause it was part of a course they were on(for example academic or vocational) andtherefore a requirement.

2.3 Effects of community type oncommunity resilience

> Communities based, at least in part, on wherea respondent lives geographically scored loweron nearly all measures of community resilience

as compared to other types of communities,such as those based on social groups. Thisreinforces the need to consider many differenttypes of communities when targeting training.

2.4 Individual resilience

> First aid training appears to be positivelyrelated to individual resilience. The majorityof Trained respondents thought they weremore capable as a person (84%), and reliablein an emergency (73%), as a result of theirrst aid training.

> Willingness and condence to give rst aidwere both positively related to individualresilience, where those who were willing andcondent were likely to exhibit resilience traits.

> However, the relationship between rst aidtraining and individual resilience differedbetween respondents respondents who had

received workplace training tended to exhibitoverall higher levels of individual resiliencetraits.

> There are links between individual andcommunity resilience, for example peoplewho more strongly agreed that they couldusually nd their way out of difcult situationsrated their communities higher in socialconnectedness in terms of people watchingout for, and being willing to help each other.Similarly, those who more strongly agreed

that they are someone others can generally relyon in an emergency also more strongly agreedthat people in their community know that they(the respondent) have had rst aid training.

> Not all aspects of individual resilience relateto community resilience. It seems that theresilience of individuals may contribute tocertain features of community resilience, butfor the community to be resilient as a wholeother conditions must also be present.

2.5 The effect of age

> The age of the respondent was also animportant factor in both community andindividual resilience, as younger respondentsoften exhibited lower resilience than olderrespondents. Respondents aged 19 years andunder were also the least willing and condentto give rst aid. To get greater clarity on whatwas driving these relationships, we examinedthe data on young people who had attendedrst aid training in a group and/or who had

attended training repeatedly compared tothose who had not. The age effect did notdiminish in any signicant way. It does appearthat younger people are less likely to exhibit


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strong resilience features. British Red Crossfocus on young people/schools, therefore,is an important strategy to facilitate thegrowth of young peoples resilience usingrst aid as a vehicle.

3. Conclusions

3.1 This study has identied linkages betweenfeatures of community resilience and rst aidtraining. While it is not possible to establish acausal relationship, we do identify signicantrelationships between features such aswillingness and condence to administerrst aid and constituent elements of resiliencesuch as social connectedness, community

efcacy, learning and the spread of learning/ knowledge/skills.

3.2 We have also identied that the context andfrequency of training are signicant factorswhere community resilience features arepresent. In other words, in those peopletrained together and repeatedly we ndheightened measures of the resilienceelements tested for.

3.3 We have found signicant evidence to suggest

that willingness is not an outcome of rst aidtraining. Put another way, rst aid trainingper se will not increase our willingness toadminister rst aid in an emergency.However, condence to administer rst aid isan outcome of rst aid training, although thiswanes with the passing of time.

3.4 Age appears to be an important factor young people (19 and under) exhibited lowerlevels of the resilience features measured inthe study than those over 19, suggesting thisage group may be a one for greater focus.

3.5 The study suggests that the current rstaid approach in particular CBFA hassignicant potential to support thedevelopment of resilience, especially whenadministered within the context of socialgroupings and repeated training. The ndingsalso support the current CBFA approach asa means to reduce inequality (of access), andpromote a beneciary-led/tailored approachto delivering the service.

3.6 One way forward for the rst aiddepartment, therefore, is to ensure thattraining increasingly happens within the

types of environment that the study suggestsare conducive to growing resilience features.

4. Recommendations/WaysForward4.1 Disseminate the ndings of this survey in

accessible and creative ways and to a rangeof audiences both internal and external tothe British Red Cross.

4.2 Explore the targeting of training to existingcommunities. Qualitative data suggest thatthose who attend as a group feel morecomfortable together and thus learn more,and there is a sense that they could work

together in an emergency. Additionally, thetraining should be targeted at social groupsrather than groups dened solely bygeography, as this is where we see mostimpact. 1

4.3 Offer repeat training to rst aid trainees in

light of the benets raised herein, and giventhe fact that condence is known to dissipateafter a time.

4.4 A further examination by the rst aid and

Research, Evaluation and Impact teams ofthose resilience features that appear toinuence willingness (in particular) andcondence that is, social connectednessand community efcacy.

4.5 Continue to focus on rst aid training

through youth and schools as a way oftargeting young people and creating anenvironment in which they can grow theirown resilience.

4.6 Apply caution when labelling/deningcommunities as vulnerable. Many of thecommunities dened as vulnerable in thisstudy did not see themselves in this way.

4.7 Explore how the messages of positivebenets can be best communicated topotential beneciaries with the aim ofencouraging a greater uptake of rst aidtraining.

1 As of November 2011, the Research, Evaluation & Impact and First AidEducation teams are carrying out a second research study to furtherexamine the relationship between being trained together as a communityand the links between rst aid training and community resilience. Thisresearch will examine additional factors such as type of course, type ofcommunity, and proportion of community members trained.


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Akey aim of the British Red Cross SavingLives, Changing Lives strategy 2010 2015 is to facilitate the building ofresilience in communities to help them

prepare for and withstand disasters. Anunderlying assumption at the British Red Crossis that rst aid training helps to build communityresilience, through communities being better ableto rely on their own skills to save lives (ICRC,2010, p11 ). In March 2010 the SeniorManagement Team agreed to commissioninternal research into the outcomes and impactsof rst aid training in communities and the linkswith community resilience, to ensure that thisBritish Red Cross strategic priority is underpinnedby evidence.

The aim of this research, therefore, is to examinewhether there is evidence of community resilienceas a result of receiving British Red Cross rst aidtraining.

1.1 Dening community

The majority of community resilienceliterature views communities in geographicterms, for example groups of people living in

1 Introduction


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the same neighbourhood, town or city, whoare likely to be vulnerable to the same risks.As pointed out by Twigg (2007), this does nottake into account other conceptual types ofcommunities, such as those based around a

shared culture or interest. In addition, peoplecan be members of more than one communityat the same time, and large communities cancontain smaller ones (Twigg, 2007) .

The current research, therefore, considersa community to be a group of people whointeract with each other on a regular basisand share common characteristics, interests,or activities.

1.2 Understanding communityresilienceThe Civil Contingencies Secretariat (CCS),on behalf of the UK government, denescommunity resilience as communities andindividuals harnessing local resources andexpertise to help themselves in an emergency,in a way that complements the response of theemergency services (Cabinet Ofce, 2011, p4) .Accordingly, resilient communities recogniseand value the resources they have, and activelyengage with their vulnerabilities to cope with

and adapt to the situation (Nzegwu, 2010) .

The resilience of a community differs dependingon the scenario (Forgette & Van Boening, 2009) ,

for example a community may be resilient againstan economic downturn but not a health epidemic.In order to examine whether there is evidenceof community resilience as a result of receivingrst aid training, the current research focuses

on community resilience in terms of a rst aidemergency (that is, an emergency in which rstaid could help).

Accordingly, core components of resiliencewere only included in this research if they wereconsidered to contribute to a communitys abilityto withstand or overcome a rst aid emergency.The key recurring components of communityresilience to a rst aid emergency, as identied bythe British Red Cross and in external literature,are listed below:

> Social connectedness including sense ofcommunity and perceived social supportwithin the community (Nzegwu, 2010; Cutter,Emrich & Burton, 2009; Norris et al., 2008;Gurwitch et al., 2007) .

> Community efcacy for a rst aid emergency including belief in the communitys capacityto deal with an emergency, and expectation foraction (Daly et al., 2009; Norris et al., 2008;Sampson, Raudenbush & Earls, 1997) .

> Learning including acquisition ofinformation, knowledge of risks andmitigation, skills, and having the resourcewithin the community and knowing where


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to access it (Nzegwu, 2010; Cabinet Ofce,2010; Twigg, 2007) .

> Readiness to respond to a rst aid emergency(Twigg, 2007) .

> Economic wellbeing and equality (Nzegwu,2010; Norris et al., 2008) .

> Health which can affect a communitysability to deliver rst aid as well as the numberof people in the community who might need it(Nzegwu, 2010; Cutter et al., 2009) .

In addition, resilient communities are consideredto consist of resilient individuals (Cabinet Ofce,2010) .

1.3 Identifying the outcomes ofrst aid training at the BritishRed Cross

Following a review of external literature andinternal British Red Cross documents relatingto rst aid training, the following key outcomes

of British Red Cross rst aid training wereidentied:

> Increased competence in rst aid delivery,condence in rst aid skills, and willingnessto provide rst aid in an emergency situation(British Red Cross, 2010; Penrose, 2009;Van de Velde et al., 2009) .

> Increased self-esteem and social condence(British Red Cross, 2009) .

> Increased knowledge of and engagementwith other British Red Cross services (BritishRed Cross, 2010) .

> Help with employment (Laurie, 2008) .

> Reduced accident injury rates (ICRC, 2010;Lingard, 2002; McKenna & Hale, 1982) .


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The present research had a mixed-methodsdesign, using both focus groups and a surveyto gather data.

2.1 Focus groups

There were two stages of focus groups. The rststage (n=2) were used to test theoretical conceptsgained from the existing literature and inform thequestionnaire design. The second (n=4) soughtqualitative data to further elucidate thequantitative ndings of the survey.

Participants (n=37) had previously receivedcommunity based rst aid (CBFA) for vulnerablegroups from the British Red Cross. The groupswere:

> Elderly in supported living, Dundee (n=8)> Young people who were not in employment,

education or training (Princes Trust), London(n=6) and Colne (n=8)

> Heart support group, Nottingham (n=7)

> People with learning disabilities, Ipswich (n=4)> Congolese refugee group, Norwich (n=4).

2 Method


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It was not possible to organise focus groups withpeople who received workplace training withinthe available timeframe due to not being able toaccess the data.

2.2 Survey

The survey included questions on respondentdemographics, features of the rst aid trainingthey received (or will receive) from the British RedCross, individual resilience, community resilience,and willingness and condence to providerst aid.

The rst stage of focus groups helped to testout the questionnaire and make amendments.

In addition, 83 participants formed a pilot forthe questionnaire.

There were two different versions of thequestionnaire. The rst was for those peoplewho had already received rst aid training. Thesecond was for those who had not yet receivedtheir training, and did not include the questionsfrom the rst version that related specically tohaving had rst aid training.

2.2.1 Sample

The survey sample comprised of two groups:an intervention group who had received rstaid training from the British Red Cross betweenApril and September 2010 (referred to herein asTrained), and a control group, for comparison,from those who were booked on to receive rstaid training in 2011. All, therefore, had eitherreceived, or were booked to receive, rst aidtraining provided by the British Red Cross including Red Cross Training, community-basedrst aid (CBFA both public and in groups),and schools.

2.3 Measuring our concepts

2.3.1 Community

Respondents were given our denition ofcommunity (see section 1.1), and asked to thinkof a community that they belonged to and toldthat the subsequent questions about communityin the questionnaire referred to their chosencommunity.


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2.3.2 Key indicators of communityresilience considered

The indicators of community resilience consideredappropriate to include in the survey were: socialconnectedness ( I feel I am a part of thiscommunity , most members of this communityknow me , people in this community watch outfor each other , and people in this communityare willing to help each other ); communityefcacy for a rst aid emergency ( people in thiscommunity are willing to provide rst aid to eachother in an emergency , people in thiscommunity cannot rely on each other to providerst aid in an emergency (negatively coded),and in a disaster scenario how likely do youthink people in your community would be to take

action and give rst aid? ); learning ( not many people in this community know that I have hadrst aid training (negatively coded), if I everneed rst aid, I know someone in the communitywho I can go to for help , and not many peoplein this community know how to give rst aid inan emergency (negatively coded)); readiness torespond; and economic wellbeing and equality ofaccess to rst aid training.

2.3.3 Key indicators of individual

resilience considered The indicators of individual resilience includedwere feeling capable or determined as a person(both of which are aspects of self-esteem also),feeling that you can nd a way out of difcultsituations, feeling that people can rely on youin an emergency, and feeling proud ofaccomplishments in life.

2.3.4 Key components of rst aidtraining considered

The proposed rst aid training outcomes includedin the research were willingness to provide rstaid, condence to provide rst aid, increasedknowledge of other British Red Cross services,increased self-esteem, and help with employment.

In addition, certain features of the rst aidtraining itself were also considered in terms ofwhether they relate to community resilience.These features were:

> Whether the respondent had received rst aid

training from the British Red Cross betweenApril and September 2010 (Trained group), orwere booked on to receive rst aid training in2011 (Control group).

> Whether people had ever, or never, beentrained.

> Whether other members of the communitywere trained alongside the respondent.

> Whether people had been trained once ormultiple times.

> Recency of previous rst aid training.


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3.1 Response rate

The exact response rate cannot be calculatedbecause it is unknown how many questionnaireswere actually passed on by third-partycommunity contacts. However, we are satisedthat the response rate is at least 42% (n=622).

3.2 Respondents

Of the 622 respondents, the large majority(87%, n=542) were in the Trained group, andonly 13% (n=80) were in the Control group.One reason that the Control group was smalleris because attendance is often not organised veryfar in advance, and so potential respondentscannot be identied. Only 23% (n=18) of theControl group had never had rst aid trainingbefore. Of all respondents, one-third (33%) wereclassied by the British Red Cross as vulnerableto a rst aid emergency.

Respondents were asked about the reasons why

they attended, or will attend, the British RedCross rst aid training. As shown in gure 1,the most common reason for attending rst aidtraining was to be prepared in case of an

3 Results


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0 10 20 30 40 50 60 70 80

TO BE PREPARED IN CAS E

OF AN EMERGENCY

FOR THE SAFETY OF MY FAMILY

FOR MY JOB OR TO

HELP ME FIND WORK

FOR MY OWN SAFETY

OUT OF INTEREST

PART OF A COURSE

ANOTHER REASON

TO BE O F ASSIS TANCE TO

OTHERS OUTSIDE OF MY FAMILY

emergency , although people were able to givemore than one reason. Where people said theyhad another reason for attending rst aidtraining, it was often because they belonged to

Guides or Scouts, or coached a sports team.Note that the reason part of a course refers,for example, to a vocational or academic course,rather than a specic rst aid course.

Almost all (97%) of the Trained respondentswere satised or very satised with the rst aidtraining they received from the British Red Cross.In illustration, one respondent commented thatI am very grateful for the brilliant trainingI received from the British Red Cross .

3.3 Indicators of communityresilience

3.3.1 Social connectedness

> The social connectedness of a communitywas similar between the Trained and Controlgroups, and, within the Control group, thosehaving had previous training or not.

> Respondents were signicantly 2 more likely2 The terms signicant and statistically signicant in this report refer to

the ndings having been statistically tested with the results of this testindicating that the results obtained were less than 5% due to chance.

This is expressed as the probability (p) of the result occurring by chancebeing (=) less than ( Trained respondents who had received rstaid training more than once were signicantlymore likely to agree that people in theircommunity watch out for each other ascompared with those who had only beentrained the once (85% compared with75%, respectively). 4

> People who were more willing to give rst aidin an emergency were signicantly more likelyto agree that they felt part of their community,that people in the community watch out foreach other, and that people in the communityare willing to help each other, than those whowere less willing. 5

> Conversely, condence in ability to providerst aid was not related to any aspects of socialconnectedness. This suggests that the degreeof social connectedness is not affected by thismore cognitive feature of rst aid that is,

3 Mean is displayed within the range of 1-5, others trained 4.4: trainedindividually 4.3, t(447)=-2.25, p


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peoples condence in their ability to providerst aid.

It seems, therefore, that social connectedness isnot a result of rst aid training as a whole andinstead may already be established beforeattending training, although it is heightened inthose who are trained together as a community,and for those individuals who are trained morethan once.

3.3.2 Community efcacy for a rst aidemergency

> Community efcacy was similar between theTrained and Control groups, and, within the

Control group, those having had previoustraining or not. This suggests that communityefcacy is also not a result of rst aid trainingas a whole.

> Respondents in the Trained group tendedto more strongly agree with all aspects ofcommunity efcacy if other members of thatcommunity were trained alongside them,compared with if they received the rst aidtraining as an individual. 6

>

Trained respondents who had received rstaid training more than once were signicantlymore likely to agree that people in theircommunity are willing to provide rst aid toeach other in emergency, as compared withthose who had only been trained the once(76% compared with 65%, respectively). 7

> Analysis of qualitative data also suggests abenet to community efcacy if communitymembers are trained together:

I feel that if you are learning with peopleyou know you are more likely to undertake thechallenge together and be more comfortablewith touching people initially that you knowthan a complete stranger. Once people aretrained they are more willing to go into theoutside world knowing they are qualiedand capable of doing rst aid to a stranger.

> Qualitative data further suggests thatcommunities in which more people were

6 Mean is displayed within the range of 1-5. Willing to provide rst aid toeach other, agree 4.0: do not agree 3.9, t(407)=-2.31, p


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0

10

20

30

40

50

60

70

In the last year 1 to 5 years ago 6 or more years ago

3.3.3 Learning

> A direct link emerged between learning andrst aid training, where Trained respondentswere one-and-a-half times more likely to agreethat people in their community know how to

give rst aid in an emergency (35% comparedwith 25%, respectively). 10 However, this linkappears to have been driven by havingattended training with other communitymembers rather than attending training at all,as Control respondents had similar levels ofagreement to those in the Trained group whohad not been trained with other members oftheir community (25% and 26% respectivelyagreed or strongly agreed).

> In terms of knowing someone in thecommunity to go to for rst aid help, Controlrespondents had similar agreement to Trained,but were two-and-a-half times more likelythan Trained to answer dont know to thequestion (13% compared with 5%,respectively).

> Within the Control group itself, peoplewho had been trained previously were oversix times more likely to agree that people intheir community know that they will bereceiving rst aid training than those whohad never been trained (50% compared

with 8%, respectively).11

10 Mean is displayed within the range of 1-5, Trained 3.1: Control 2.8,

t(412)=1.99, p Within the Trained group, people whohad been trained more than once weresignicantly more likely than those whohad only been trained the once to agreethat people in their community know they(the respondent) had been trained (41%compared with 30%, respectively). 12

> Communities in which other members hadattended the rst aid training alongside therespondent scored higher on all aspects oflearning than communities in which therespondent was trained as an individual. 13

> Respondents who did not attend the rstaid training alongside other members of theircommunity were two-and-a-half times morelikely than those who did to answer thatthey dont know if many people in thecommunity know how to give rst aid(25% compared with 10%, respectively).

12 Mean is displayed within the range of 1-5, more than once 3.1: once 2.8,t(397)=-2.74, p


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> The benets of learning as a community,rather than an individual, were alsocommented on in the focus groups, ascaptured in the following words: if one ofus has forgotten, another two will remember .

> People who agreed that they know someone intheir community to go to for rst aid help wereboth more willing and condent to give rstaid than those who did not agree. 14

> Condence was also related to whether othersin the community know the respondent hashad rst aid training. People who reported thatthey did know were more condent in theirown ability to give rst aid than those whodid not. 15 Willingness was not related to this.

> Qualitative responses also support a linkbetween rst aid training and learning. Manyidentied rst aid knowledge as a key gain ofrst aid training, and thought that trainingwould equip people in the community withthe skills needed to act in an emergency. Inaddition, one respondent noted that rst aidtraining would only build communityresilience if the communities were awareof who was rst aid trained .

This implies that rst aid training, regardlessof recency, has an impact on the resilience of acommunity through learning about the resource ofrst aid and who can provide this when required.And as with social connectedness and communityefcacy, learning in the community is enhancedthrough training as a community.

Spread of knowledge> Nearly all (95%) of the Trained respondents

had told someone they had received rst aidtraining, and around two thirds had sharedrst aid skills or knowledge (63%) orrecommended rst aid training to someoneelse (67%). This knowledge was most oftenspread to family and friends.

> The importance of spreading knowledgeabout rst aid training is illustrated by onerespondent in response to an open-endedquestion:

14 Mean is displayed within the range of 1-40 for willingness, and 1-20 forcondence. Willingness, agree 34.9: do not agree 33.8, t(536)=-2.02,p


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suggested that rst aid training would, in thewords of one respondent, help communitiesby enabling people to take steps to protectthemselves and others from further injury .

> Having preparations in place was generally

similar between Trained and Controlrespondents, although Trained weresignicantly more likely than Control to saytheir community had done something else (12% compared with 1%, respectively). 17

> Within the Control group itself, respondentswho had been trained previously were almosttwice as likely as those who had never beentrained to say their community had taken stepsto reduce risks to health and safety (63%compared with 33%, respectively). 18

> Within the Trained group, communities inwhich other members did not attend rst aidtraining alongside the respondent were threetimes more likely to have no preparationsin place than communities in which therespondent was trained alongside othermembers (9% compared with 3%,respectively). 19

> As previously mentioned, two-thirds (63%)of respondents attended or will attend rst

17 Mean is displayed within the range of 0-1, Trained 0.12: Control 0.01,t(507)=2.90, p People who attended or will attend the

training because of a course they were on wereless willing to give rst aid than people whoattended or will attend for any other reason. 22 This suggests that people who attend rst aidtraining for their own personal reasons aremore willing to give rst aid than those whoattend because it is mandatory, or again, thiscould be a result of multiple training, as thoseon a course were likely to have only beentrained the once.

Communities which have undertakenpreparations in order to be ready to respondto a rst aid emergency are likely to be those inwhich other community members were trainedalongside the respondent. In addition, it ispromising that people see rst aid training itselfas being an important step towards being readyto respond.

20 Mean is displayed within the range of 0-1, trained previously 0.79: nevertrained 0.56, t(78)=-2.02, p


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3.3.5 Economic wellbeing and equalityof access to rst aid training

> As previously shown, one-third (33%) of allrespondents attended or will attend rst aidtraining for their jobs or to help nd work.This is considered to contribute to facilitatingthe economic wellbeing of the respondent byassisting with employment.

> People who attended or will attend rst aid

training for their job or to help nd work weresignicantly more willing and condent thanthose who attended because of a course theywere on. 23 However, levels of willingness andcondence were similar between economic andthe other reasons for attending training.

> The importance of rst aid training for peopleseeking employment was illustrated in thefocus groups. For one respondent, it showsyou can do something , and for another, whowas seeking work as a carer, everywhere thatyou go for a job they ask you if you have donerst aid training . They also noted that theythought employers would particularly respectrst aid training delivered by the British RedCross because it is a reputable organisation.

>

In addition to help with employment, thewhole CBFA approach to rst aid training,which offers free training to people consideredby the British Red Cross to be vulnerableto a rst aid emergency but who might nototherwise be able to afford it, is designed toreduce inequality in the access to rstaid training.

> The importance of offering free oraffordable training was illustrated in thequalitative analysis. One respondent stated:

The only thing preventing people attendingrst aid courses may be cost. If training couldbe arranged in large community groups andcosting could be brought down, there maybe more people joining in.

23 Mean willingness score is displayed within the range of 0-40, and thecondence intervals are 31.2-33.8 (mean 32.5) for course, and 35.1-36.4 (mean 35.7) for job or to nd work (at the 95% condence level).

The mean condence score is displayed within the range of 0-20, andthe condence intervals are 14.8-16.1 (mean 15.4) for course, and16.2-17.0 (mean 16.6) for job or to nd work (at the 95% condencelevel). Condence intervals give an estimated range of values in whichthe true value is li kely to fall. Because neither of the condence intervalsfor willingness or condence to give rst aid for people who attended fora course or for a job overlaps, we can be 95% condent that the scoresare signicantly different from each other.

Removing nancial barriers to accessing rstaid learning and providing this skill to thoseseeking to enhance their employability are bothcommunity resilience indicators. Their presencein British Red Cross rst aid training is clearlypositive evidence of the presence and potential

growth of these community resilience elementsin our current approach.

3.3.6 Effect of community type oncommunity resilience

> Communities based, at least in part, on wherethe respondent lived geographically scoredlower on nearly all community resiliencemeasures than other types of communities. 24

> Geographic communities were alsosignicantly less likely than other types ofcommunity to have access to a rst aid kit(59% compared with 76%, respectively) orhave taken steps to reduce health and

24 Mean is displayed within the range of 1-5. Feel part of community, basedon where live 4.2: not based on where live 4.4, t(568)=2.91, p


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safety risks (46% compared with 62%,respectively). 25

This reinforces the need to consider a range ofdifferent types of communities when targeting

or promoting training.

3.3.7 Effect of age on communityresilience

While we cannot determine to what extent othercommunity members matched the respondentin terms of age, the age of a respondent alsoappeared to relate to the degree to which theyagreed with the community resilience measures;where those aged 19 years or under had thelowest levels of agreement across the questionsasked. 26

25 Mean is displayed within the range of 0-1. Access to a rst aid kit, basedon where live 0.59: not based on where live 0.76, t(504)=4.30, p The focus groups also revealed that peoplethought they would now feel less helpless in anemergency as a result of their rst aid training.In the words of one respondent:

Its an emotional thing as well, you know,like you wont feel helpless if you came acrossthat. If youre in that position then youwouldnt just be standing there not knowingwhat to do. You are able to take action.

> Although Trained respondents rated thefactors of individual resilience highly, itwas the Control group who exhibited the

FIGURE 3 AGREEMENT THAT INDIVIDUAL RESILIENCE INCREASED AS A RESULT OF FIRST AID TRAINING

0 20 3010 40 50 60 70 80 90

A MORE CAPABLE PERSON

MORE RELIABLE IN AN EMERGENCY

A MORE DETERMINED PERSON

BETTER AT FINDING MY WAY

OUT OF DIFFICULT SITUATIONS

I M P A C T O N I N D I V I D U A L R E S I L I E N

C E

PERCENT


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strongest individual resilience. Controlrespondents agreed with all aspects ofindividual resilience, apart from pride inaccomplishment, more strongly thanTrained respondents. 27 However, thisdifference could potentially be explainedby the high percentage of workplacerespondents in the Control group (53%),which was more than twice that of theTrained group (21%). When exploredfurther, it was the workplace respondentswho exhibited signicantly higher levelsof individual resilience. 28

> Willingness and condence to give rst aidwere both moderately positively correlatedwith the capable and reliable aspects of

individual resilience. 29 The more willingrespondents were to give rst aid, the morestrongly they agreed that they were a capableperson (r=0.35) or reliable in an emergency(r=0.46). Condence showed the same pattern,where respondents who were more condentto give rst aid were likely to more stronglyagree they were a capable person (r=0.41)or reliable in an emergency (r=0.43). Withregards to feeling that aspects of individualresilience had increased as a result of rst aid,willingness was higher amongst those who

more strongly agreed that their capability hadincreased (r=0.41), and both willingness andcondence were higher amongst those whomore strongly agreed they were more reliablein an emergency following training (willingnessr=0.41; condence r=0.43).

> Comparison of individual resilience across

respondents also revealed that it varies withage. Strength of agreement that therespondent was a determined person, reliablein an emergency, and proud that they hadaccomplished things in life, all increased 30 with age, where older respondents tended

27 Mean is displayed within the range of 1-5. Capable, Trained 4.1: Control4.4, t(608)=-3.97, p


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3.5 Elaborating on the outcomesof rst aid training> Overall, people were signicantly more willing

to provide rst aid to people they know thanpeople they did not know. 32

> People were also more willing to help if theincident was less severe. That is, more peoplewere quite or very willing to help someonewho was choking (94%) or had a minor burn(94%) compared with someone who wasunconscious and breathing (92%) or notbreathing (89%), or who had a severe bleed

(90%). Similarly, more people were quite orvery condent in their ability to give rst aidin less severe situations (88% for minorsituations compared with 82% for severe).

> Willingness and condence also varieddepending on age. As shown in table 1, thoseaged 19 years and under had lower levels ofwillingness and condence than people in olderage groups.

3.5.1 Evidence for increased condenceas an outcome of rst aid training

> When comparing the condence of the Controlgroup versus the Trained group, the Trainedgroup were more condent in their ability toprovide rst aid. 33

> Condence was also compared between thosein the Trained group who had received rst aidtraining previous to their most recent training,and those who had only been trained once.

32 Mean is displayed within the range of 1-20, know 17.8: did not know16.7, t(1224)=7.37, p There was strong qualitative evidence thatpeople felt more condent to provide rst aidas a result of their training. According to onerespondent:

Ignorance of how to apply rst aid can leadto a lack of condence, which can lead to noaction being taken I might hesitate in caseI made things worse, but if I have repeatedrefresher courses, my condence shouldincrease, leading to me having a try! Memoryfades very fast and I would welcome yearlycourses (if money available).

3.5.2 Questioning willingness as anoutcome of rst aid training

> There was no difference in willingness betweenthe Trained and Control group, or betweenthose within the Control group who had orhad never been trained.

34 Mean is displayed within the range of 1-20, more than once 16.3: once15.2, t(529)=-3.83, p


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> Debate within the focus groups also indicatedthat willingness was not always affected byrst aid training. In some cases people weremore willing as a result of their training, forexample the refugee group had previouslythought they might get in trouble for helpingsomeone who later died, and didnt knowthat if someone collapses that you can helpthem . However, other people said they werewilling to help anyway without training, andseveral referred to this willingness asinstinct .

It appears, therefore, that rst aid training,especially multiple training, helps increase peoplescondence to provide rst aid, although thiscondence may dissipate over time. However rst

aid training did not appear to inuence peopleswillingness to help, and willingness may thereforebe an inherent trait that people bring with themto the training, and/or is a trait that can beinuenced by other factors.

3.5.3 Increased knowledge of andengagement with other British RedCross services> Less than one-third (28%) had learnt about

other British Red Cross services at their rstaid training. Of these, half (52%) had sharedthis information with someone else.

3.6 Interrelationships betweencommunity and individualresilience

3.6.1 Community resilienceinterrelationships

> Social connectedness may be a conduitthrough which other indicators can operate.In particular, feeling part of the communitywas positively linked to knowing someoneto go to for help and the likelihood that acommunity would take action in the disasterscenario. In addition, respondents who agreedthat people in their community watch out foreach other were also likely to agree that theyknew someone in the community to go to forrst aid help if necessary. 36

36 Positive linear relationships between: feel part of community and knowsomeone to go to for rst aid help, F(27,248)=12.54, p Knowing someone in the community to go tofor rst aid help was, perhaps unsurprisingly,positively related to whether many people inthat community knew how to give rst aid. 39 This illustrates the importance of knowingwhat resources are available and where toaccess them.

37 Positive linear relationships between: people know how to give rst aidand willing to provide rst aid to each other, F(27,248)=5.86, p


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3.6.2 Spread of knowledge andcommunity resilience

It is not possible to determine whether thepeople who respondents had told, shared, orrecommended rst aid training to belonged tothe same community they were answering thecommunity resilience questions about. Despitethis, spread of knowledge still showed someinteresting relationships with communityresilience.

> Those who had told someone about theirtraining were signicantly more likely thanthose who had not to agree that the people intheir community are willing to help each other(87% compared with 74%, respectively).Similarly, those who had shared rst aid skillsor knowledge were signicantly more likelythan those who had not to agree that they felta part of their community (91% comparedwith 89%, respectively). 40

> People who had shared skills or knowledge, orrecommended training, were signicantly more

likely to agree that people in their community40 Mean is displayed within the range of 1-5. Told 4.2: did not tell 3.8,

t(491)=-2.14, p People who more strongly agreed that theycould usually nd their way out of difcult

41 Mean is displayed within the range of 1-5. Shared 4.0: did not share3.8, t(441)=-2.80, p


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situations rated their communities higherin social connectedness in terms of peoplewatching out for, and being willing to help,each other. 43

> Those who more strongly agreed that theywere someone others could generally rely onin an emergency also more strongly agreedthat people in their community knew theyhad had rst aid training. 44

> People who felt proud that they hadaccomplished things in life were likelyto have told someone about the rst aidtraining they had received. 45

> Pride in having accomplished rst aidtraining was signicantly related to allaspects of spreading knowledge, wherepeople who told (85% compared with56%, respectively), shared (88% comparedwith 77%, respectively), or recommended(85% compared with 81%, respectively)were signicantly more likely to agree that

43 Positive linear relationships between: can nd a way out of difcultsituations and community watch out for each other, F(27,248)=5.73,p


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> This study has identied linkages betweenfeatures of community resilience and rst aidtraining. While it is not possible to establish acausal relationship, we do identify signicantrelationships between features such aswillingness and condence to administer rstaid and constituent elements of resilience suchas social connectedness, community efcacy,learning and the spread of learning/knowledge/skills.

> We have also identied that the context andfrequency of training are signicant factorswhere community resilience features arepresent. In other words, in those people trainedtogether and repeatedly we nd heightenedmeasures of the resilience elements tested for.

> We have found signicant evidence to suggestthat willingness is not an outcome of rst aidtraining. Put another way, rst aid trainingper se will not increase our willingness toadminister rst aid in an emergency. However,condence to administer rst aid is an outcome

of rst aid training, although this wanes withthe passing of time.

4 Conclusions


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> Age appears to be an important factor young people (19 and under) exhibited lowerlevels of the resilience features measured inthe study than those over 19, suggesting thisage group may be a one for greater focus.

> The study suggests that the current rstaid approach in particular CBFA hassignicant potential to support thedevelopment of resilience, especially whenadministered within the context of socialgroupings and repeated training. The ndingsalso support the current CBFA approachas a means to reduce inequality (of access),and promote a beneciary-led/tailoredapproach to delivering the service.

> One way forward for the rst aid department,therefore, is to ensure that training increasinglyhappens within the types of environment thatthe study suggests are conducive to growingresilience features.

> In conclusion, therefore, this study has foundsupport for a positive relationship betweenrst aid training and features of communityresilience. Although this is not unanimoussupport, the study has highlighted areas whererelationships can be heightened by inuencingthe community resilience factor itself throughmeans not directly related to a rst aidoutcome. Namely, this study makesrecommendations towards achieving greatercommunity resilience by enhancing what isalready present; for example, working witha group where members know and interactwith each other. In addition, the benets ofattending training more than once and thesubsequent impact on community resilience,have also been identied.


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5.1 Disseminate the ndings of this survey inaccessible and creative ways and to a rangeof audiences both internal and external tothe British Red Cross.

5.2 Explore the targeting of training to existingcommunities (dened by the group asthemselves constituting a group of peoplewho interact with each other regularly).The qualitative and quantitative data bothsuggest that those who attend as a group feelmore comfortable together and thus learnmore, and there is a sense that they couldwork together in an emergency. Additionally,the training should be targeted at socialgroups rather than groups dened solely bygeography, as this is where we may see themost impact. 48

48 As of November 2011, the Research, Evaluation & Impact and First AidEducation teams are carrying out a second research study to furtherexamine the relationship between being trained together as a communityand the links between rst aid training and community resilience. Thisresearch will examine additional factors such as type of course, type ofcommunity, and proportion of community members trained.

5 Recommendations


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5.3 Offer repeat training to rst aid trainees inlight of the benets raised herein, and giventhe fact that condence is known to dissipateafter a time.

5.4 A further examination by the First Aid andResearch, Evaluation & Impact teams ofthose resilience features that appear toinuence willingness (in particular) andcondence that is, social connectednessand community efcacy.

5.5 The ndings support the CBFA approach asa means to reduce inequality (of access), andpromote a beneciary-led/tailored approachto delivering the service.

5.6 Continue to focus on youth and schools as away of targeting young people and creatingan environment in which they can grow theirown resilience.

5.7 Apply caution when labelling/deningcommunities as vulnerable. Many of thecommunities dened as vulnerable in thisstudy did not see themselves in this way.

5.8 Explore how the messages of positivebenets can be best communicated topotential beneciaries with the aim ofencouraging a greater uptake of rst aidtraining.


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Photo credits are listed from left to right, in clockwise order BRC

Front Cover: Steve Watkins, Justin Grainge, Page 8: Jonathan Banks, Page 9: Ben Stickley, Page 10: Justin Grainge,Page 12: Layton Thompson, Page 14: Alex Rumford, Page 15: Justin Grainge, Page 16: Justin Grainge, Page 18: JonathanBanks, Page 19: Alex Rumford, Page 20: Jane Rogers, Page 23: Jonathan Banks, Page 25: Lewis Houghton, Page 26:

Aaron McCracken/UNP, Page 27: Jane Rogers, Page 29: Jonathan Banks, Page 31: Mark Edwards, Page 32: Ben St ickl ey,Page 33: Lloyd Sturdy, Page 34: Jonathan Banks, Page 36: Layton Thompson, Page 37: Simon Clark, Lloyd Sturdy, Page38: Jonathan Banks, Page 40: Catherine Mead, Page 41: Jonathan Banks, Lloyd Sturdy, Page 42: Simon Clark
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British Red CrossUK Ofce44 MooreldsLondonEC2Y 9AL