Exploring the factors motivating continued Lay First Responder participation in Uganda: a mixed-methods, 3-year follow-up

Abstract

BackgroundThe WHO recommends training lay first responders (LFRs) as the first step towards establishing emergency medical services (EMS) in low-income and middle-income countries. Understanding social and financial benefits associated with responder involvement is essential for LFR programme continuity and may inform sustainable development.MethodsA mixed-methods follow-up study was conducted in July 2019 with 239 motorcycle taxi drivers, including 115 (75%) of 154 initial participants in a Ugandan LFR course from July 2016, to evaluate LFR training on participants. Semi-structured interviews and surveys were administered to samples of initial participants to assess social and economic implications of training, and non-trained motorcycle taxi drivers to gauge interest in LFR training. Themes were determined on a per-question basis and coded by extracting keywords from each response until thematic saturation was achieved.ResultsThree years post-course, initial participants reported new knowledge and skills, the ability to help others, and confidence gain as the main benefits motivating continued programme involvement. Participant outlook was unanimously positive and 96.5% (111/115) of initial participants surveyed used skills since training. Many reported sensing an identity change, now identifying as first responders in addition to motorcycle taxi drivers. Drivers reported they believe this led to greater respect from the Ugandan public and a prevailing belief that they are responsible transportation providers, increasing subsequent customer acquisition. Motorcycle taxi drivers who participated in the course reported a median weekly income value that is 24.39% higher than non-trained motorcycle taxi counterparts (p<0.0001).ConclusionsA simultaneous delivery of sustained social and perceived financial benefits to LFRs are likely to motivate continued voluntary participation. These benefits appear to be a potential mechanism that may be leveraged to contribute to the sustainability of future LFR programmes to deliver basic prehospital emergency care in resource-limited settings.

Bystander intervention is associated with reduced early mortality among injury victims in Cameroon

“…As road traffic injuries constitute the injury mechanism for nearly three quarters of the patients in our cohort, and commercial vehicles transport over half of injured patients, our findings suggest taxi and mototaxi drivers potentially represent an ideal target for LFR training in Cameroon. Mototaxi drivers have been trained as first responders elsewhere in sub-Saharan Africa, including Uganda, Chad, Nigeria, and Sierra Leone, with associated evidence of increase in access to prehospital care [ 8 – 11 ]. However, cultural context varies greatly between settings and buy-in from LFR trainees is critical to intervention feasibility.…”

The Current Status and Challenges of Prehospital Trauma Care in Low- and Middle-Income Countries: A Systematic Review

“…A follow-up study noted that confidence levels and knowledge retention remained high after 2 years, and the majority of those trained had used their skills in practice (22). Similar programs were implemented in Chad and Sierra Leone; both found increased confidence after 6 months (25,27).…”

“…There were 11 studies that discussed the effects of first responder training in LMICs, comprising 7428 participants of various backgrounds, including health care professionals and non-medical community members [23][24][25][26][27][28][29][30][31][32][33] . Non-medical community members, in this context, include police officers, firefighters, taxi drivers, commercial drivers, and the general public.…”

Bystander intervention is associated with reduced mortality among injury victims in Cameroon

“…4 Among LFR programs piloted across multiple sub-Saharan African countries, evaluations have been restricted to LFR educational outcomes, program cost effectiveness, and prehospital patient analyses without longitudinal clinical outcomes due to the lack of prospective data following LFR implementation. 8,[10][11][12] Without longitudinal clinical data to measure patient outcomes following prehospital LFR care, evaluation of LFR program efficacy has been limited. In 2015, we developed the Cameroon Trauma Registry (CTR), a prospective, ongoing, multisite trauma registry that has since collected data on over 30,000 patients across four medical centers: Laquintinie Hospital, Regional Hospital of Limbe, Catholic Hospital of Pouma, and Regional Hospital of Edea.…”