Assessing the Links Between First Aid Training and Community Resilience

Assessing the links between first Aid trAining And community resilience Research report l Research, Evaluation & Impact

Assessing the links between first aid training and community resilience 1 Assessing the links between first Aid trAining And community resilience Joanna White, Researcher, British Red Cross Alison McNulty, Senior Researcher, British Red Cross

2 Assessing the links between first aid training and community resilience

Assessing the links between first aid training and community resilience 3 Acknowledgements Research, Evaluation & Impact are very grateful for the support of the First Aid Education team. We are also grateful to all of the wonderful participants, and the first aid training coordinators and members of the community and workplaces who helped us contact them.

4 Assessing the links between first aid training and community resilience Copyright © 2011 Any part of this publication may be cited, translated into other languages or adapted to meet local needs without prior permission of the British Red Cross, provided that the source is clearly stated. This publication does not necessarily represent the decisions or stated policy of the British Red Cross. ISBN 978-0-900228-09-4

Assessing the links between first aid training and community resilience 5 executive summary 7 1 introduction 13 1.1 Defining ‘community’ 13 1.2 Understanding community resilience 14 1.3 Identifying the outcomes of first 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 contents 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 first aid training 30 3.6 Interrelationships between community and individual resilience 31 4 conclusions 35 5 recommendations 39 6 references 43

6 Assessing the links between first aid training and community resilience

Assessing the links between first aid training and community resilience 7 Executive Summary 1. the context 1.1 From July 2010 to January 2011 the Research, Evaluation and Impact team undertook a study to assess the links between first aid training and community resilience. 1. 2 As a starting point, we defined three primary concepts or features of concepts used in this study – community, community resilience, and first aid outcomes. 1.3 Focus groups and a survey were the primary tools used for data collection. The survey was administered to both a control as well as an intervention (experimental) group. 1.4 Five main indicators of community resilience were identified as: > Social connectedness – feel part of the community, people in the community know the respondent, watch out for each other, and are willing to help each other. > Community efficacy – people in the community are willing to provide first aid to each other, can be relied upon to provide first aid, and are likely to take action in a scenario in which no emergency services are available.

8 Assessing the links between first aid training and community resilience > Learning – this refers to the acquisition 2.1.2 willingness of information, where people in the > Willingness to provide first aid as a first aid community know the respondent has training outcome, in contrast, is not found to had first aid training, know first aid be related to having been trained in first aid, themselves, and the respondent knows and is thus not supported as an outcome of someone in the community to go to first aid training. However, willingness was for help if ever they need first aid. found to be related to some community > Readiness to respond – have preparations resilience indicators – specifically, social in place to respond to a first aid connectedness, community efficacy, and emergency, and reason for attending knowing someone who can be turned to for first aid training. help (learning). As such, willingness may be > Facilitating economic wellbeing and able to be influenced through a greater equality of access to first aid training – understanding of these indicators. attending first aid training for employment purposes, and removing financial barriers to first aid training (financial barriers to 2.2 Community resilience indicators first aid training were identified from the qualitative data and were not asked Taking each indicator of community resilience about in the survey itself). separately, a fuller picture of the relationships with first aid training can be illustrated: 2. our findings 2.2.1 social connectedness > Being socially connected is related to an 2.1 Outcomes of first aid training individual’s willingness to act, with those stating a willingness to act also reporting 2.1.1 confidence they feel part of a community, the community > This study supports confidence as an outcome watch out for each other, and that people in of first aid training, with attendance at first aid the community are willing to help each other. training, especially multiple training, helping Communities trained together showed greater to increase people’s confidence to provide first social connectedness in terms of the respondent aid. However this confidence was found to feeling more strongly a part of the community dissipate over time when comparing those with than those that were not (94% vs. 91%), and recent training to those who had previously those individuals trained more than once more received training. strongly agreed that people in their community watch out for each other (85% vs. 75%).

Assessing the links between first aid training and community resilience 9 2.2.2 community efficacy > Similar to social connectedness, community efficacy did not appear to be a direct result of first aid training, however aspects were related to willingness and confidence to provide first aid. Community efficacy is heightened in those who are trained together as a community, compared to those who are not. In addition, those who are trained more than once more strongly agreed that people in their community are willing to provide first aid to each other in an emergency, compared to those trained only once (76% vs. 65%). > Analysis of qualitative data also suggests a benefit to community efficacy if community members are trained together. In the words of one participant: “I feel that if you are learning with people you know you are more likely to undertake the challenge together and be more comfortable with touching people initially that you know than a complete stranger. their community has first aid skills, it seems Once people are trained they are more willing that learning may be further enhanced by to go into the outside world knowing they training people as a community. are qualified and capable of doing first aid to a stranger.” 2.2.4 spread of knowledge > Levels of both willingness and confidence > In terms of first aid outcomes, the willingness were higher for people who had shared first of a respondent to provide first aid was aid skills or knowledge or had recommended significantly positively related to all aspects training to someone else, than those who of community efficacy, where people who are had not. willing to provide first aid are also likely to agree that their community has each of the > Nearly all (95%) of the Trained respondents community efficacy measures. had told someone they had received first aid training, and around two thirds had shared 2.2.3 learning first aid skills or knowledge (63%) or > People who agreed that they know someone in recommended first aid training to someone their community to go to for first aid help were else (67%). This knowledge was most often both more willing and confident to give first spread to family and friends. However, these aid than those who did not agree. figures appear to be at odds with the lower reports of knowing who to turn to for first aid > It is encouraging that Trained respondents help (71%) and knowing people who can give (intervention/experimental group) more so first aid (28%). This perhaps suggests that the than the Control respondents know who to spread of knowledge may occur beyond the turn to for first aid help (35% vs. 25%). identified communities or families/friends – However, this is likely to be driven, at least into other arenas of people’s lives. in part, by having attended that training with other members of their community, since those 2.2.5 readiness to respond in the Control group had similar levels of > Communities which have undertaken agreement to those in the Trained group who preparations in order to be ready to respond had not been trained with other members of to a first aid emergency are likely to be those their community (25% and 26% respectively). in which other community members were In addition, given the positive relationship trained alongside the respondent. Indeed, between the number of training sessions and communities in which the respondent was increased knowledge, and those individually trained as an individual were three times more trained reporting lesser knowledge of who in likely to report they had no preparations in

10 Assessing the links between first aid training and community resilience 2.4 Individual resilience > First aid training appears to be positively related to individual resilience. The majority of Trained respondents thought they were more capable as a person (84%), and reliable in an emergency (73%), as a result of their first aid training. > Willingness and confidence to give first aid were both positively related to individual resilience, where those who were willing and confident were likely to exhibit resilience traits. > However, the relationship between first aid training and individual resilience differed between respondents – respondents who had received workplace training tended to exhibit overall higher levels of individual resilience traits. > There are links between individual and community resilience, for example people place than communities in which other who more strongly agreed that they could members were also trained (9% vs. 3%). usually find their way out of difficult situations rated their communities higher in social > People tended to view first aid training connectedness in terms of people watching itself as being an important step towards out for, and being willing to help each other. being ready to respond. For example, one Similarly, those who more strongly agreed respondent noted that first aid training that they are someone others can generally rely “would help communities by enabling on in an emergency also more strongly agreed people to take steps to protect themselves that people in their community know that they and others from further injury”. (the respondent) have had first aid training. 2.2.6 facilitating economic wellbeing and > Not all aspects of individual resilience relate equality of access to first aid training to community resilience. It seems that the > The study found first aid training had a resilience of individuals may contribute to potential to impact upon economic wellbeing certain features of community resilience, but (that is, first aid as an employment facilitator). for the community to be resilient as a whole Where the reason for attendance at a first aid other conditions must also be present. session was employment related, respondents were significantly more willing and confident to give first aid than those who attended 2.5 The effect of age because it was part of a course they were on (for example academic or vocational) and > The age of the respondent was also an therefore a requirement. important factor in both community and individual resilience, as younger respondents often exhibited lower resilience than older 2.3 Effects of community type on respondents. Respondents aged 19 years and community resilience under were also the least willing and confident to give first aid. To get greater clarity on what > Communities based, at least in part, on where was driving these relationships, we examined a respondent lives geographically scored lower the data on young people who had attended on nearly all measures of community resilience first aid training in a group and/or who had as compared to other types of communities, attended training repeatedly compared to such as those based on social groups. This those who had not. The age effect did not reinforces the need to consider many different diminish in any significant way. It does appear types of communities when targeting training. that younger people are less likely to exhibit

Assessing the links between first aid training and community resilience 11 strong resilience features. British Red Cross’ types of environment that the study suggests focus on young people/schools, therefore, are conducive to growing resilience features. is an important strategy to facilitate the growth of young people’s resilience using first aid as a vehicle. 4. recommendations/ways forward 3. conclusions 4.1 Disseminate the findings of this survey in accessible and creative ways and to a range 3.1 This study has identified linkages between of audiences both internal and external to features of community resilience and first aid the British Red Cross. training. While it is not possible to establish a causal relationship, we do identify significant 4.2 Explore the targeting of training to existing relationships between features such as ‘communities’. Qualitative data suggest that willingness and confidence to administer those who attend as a group feel more first aid and constituent elements of resilience comfortable together and thus learn more, such as social connectedness, community and there is a sense that they could work efficacy, learning and the spread of learning/ together in an emergency. Additionally, the knowledge/skills. training should be targeted at social groups rather than groups defined solely by 3.2 We have also identified that the context and geography, as this is where we see most frequency of training are significant factors impact.1 where community resilience features are present. In other words, in those people 4.3 Offer repeat training to first aid trainees in trained together and repeatedly we find light of the benefits raised herein, and given heightened measures of the resilience the fact that confidence is known to dissipate elements tested for. after a time. 3.3 We have found significant evidence to suggest 4.4 A further examination by the first aid and that willingness is not an outcome of first aid Research, Evaluation and Impact teams of training. Put another way, first aid training those resilience features that appear to per se will not increase our willingness to influence willingness (in particular) and administer first aid in an emergency. confidence – that is, social connectedness However, confidence to administer first aid is and community efficacy. an outcome of first aid training, although this wanes with the passing of time. 4.5 Continue to focus on first aid training through youth and schools as a way of 3.4 Age appears to be an important factor – targeting young people and creating an young people (19 and under) exhibited lower environment in which they can grow their levels of the resilience features measured in own resilience. the study than those over 19, suggesting this age group may be a one for greater focus. 4.6 Apply caution when labelling/defining communities as ‘vulnerable’. Many of the 3.5 The study suggests that the current first communities defined as vulnerable in this aid approach – in particular CBFA – has study did not see themselves in this way. significant potential to support the development of resilience, especially when 4.7 Explore how the messages of positive administered within the context of social benefits can be best communicated to groupings and repeated training. The findings potential beneficiaries with the aim of also support the current CBFA approach as encouraging a greater uptake of first aid a means to reduce inequality (of access), and training. promote a beneficiary-led/tailored approach to delivering the service. 3.6 One way forward for the first aid 1 As of November 2011, the Research, Evaluation & Impact and First Aid department, therefore, is to ensure that Education teams are carrying out a second research study to further examine the relationship between being trained together as a community training increasingly happens within the and the links between first aid training and community resilience. This research will examine additional factors such as type of course, type of community, and proportion of community members trained.

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Assessing the links between first aid training and community resilience 13 1 Introduction key aim of the British Red Cross Saving Lives, Changing Lives strategy 2010 – 2015 is to facilitate the building of A resilience in communities to help them prepare for and withstand disasters. An underlying assumption at the British Red Cross is that first aid training helps to build community resilience, through communities being better able to “rely on their own skills to save lives” (ICRC, 2010, p11). In March 2010 the Senior Management Team agreed to commission internal research into the outcomes and impacts of first aid training in communities and the links with community resilience, to ensure that this British Red Cross strategic priority is underpinned by evidence. The aim of this research, therefore, is to examine whether there is evidence of community resilience as a result of receiving British Red Cross first aid training. 1.1 defining ‘community’ The majority of community resilience literature views communities in geographic terms, for example groups of people living in

14 Assessing the links between first aid training and community resilience the same neighbourhood, town or city, who for example a community may be resilient against are likely to be vulnerable to the same risks. an economic downturn but not a health epidemic. As pointed out by Twigg (2007), this does not In order to examine whether there is evidence take into account other conceptual types of of community resilience as a result of receiving communities, such as those based around a first aid training, the current research focuses shared culture or interest. In addition, people on community resilience in terms of a first aid can be members of more than one community emergency (that is, an emergency in which first at the same time, and large communities can aid could help). contain smaller ones (Twigg, 2007). Accordingly, core components of resilience The current research, therefore, considers were only included in this research if they were a community to be a group of people who considered to contribute to a community’s ability interact with each other on a regular basis to withstand or overcome a first aid emergency. and share common characteristics, interests, The key recurring components of community or activities. resilience to a first aid emergency, as identified by the British Red Cross and in external literature, 1.2 understanding community are listed below: resilience > Social connectedness – including sense of community and perceived social support The Civil Contingencies Secretariat (CCS), within the community (Nzegwu, 2010; Cutter, on behalf of the UK government, defines Emrich & Burton, 2009; Norris et al., 2008; community resilience as “communities and Gurwitch et al., 2007). individuals harnessing local resources and expertise to help themselves in an emergency, > Community efficacy for a first aid emergency in a way that complements the response of the – including belief in the community’s capacity emergency services” (Cabinet Office, 2011, p4). to deal with an emergency, and expectation for Accordingly, resilient communities recognise action (Daly et al., 2009; Norris et al., 2008; and value the resources they have, and actively Sampson, Raudenbush & Earls, 1997). engage with their vulnerabilities to cope with and adapt to the situation (Nzegwu, 2010). > Learning – including acquisition of information, knowledge of risks and The resilience of a community differs depending mitigation, skills, and having the resource on the scenario (Forgette & Van Boening, 2009), within the community and knowing where

Assessing the links between first aid training and community resilience 15 to access it (Nzegwu, 2010; Cabinet Office, of British Red Cross first aid training were 2010; Twigg, 2007). identified: > Readiness to respond to a first aid emergency > Increased competence in first aid delivery, (Twigg, 2007). confidence in first aid skills, and willingness to provide first aid in an emergency situation > Economic wellbeing and equality (Nzegwu, (British Red Cross, 2010; Penrose, 2009; 2010; Norris et al., 2008). Van de Velde et al., 2009). > Health – which can affect a community’s > Increased self-esteem and social confidence ability to deliver first aid as well as the number (British Red Cross, 2009). of people in the community who might need it (Nzegwu, 2010; Cutter et al., 2009). > Increased knowledge of and engagement with other British Red Cross services (British In addition, resilient communities are considered Red Cross, 2010). to consist of resilient individuals (Cabinet Office, 2010). > Help with employment (Laurie, 2008). > Reduced accident injury rates (ICRC, 2010; 1.3 identifying the outcomes of Lingard, 2002; McKenna & Hale, 1982). first aid training at the british red cross Following a review of external literature and internal British Red Cross documents relating to first aid training, the following key outcomes

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Assessing the links between first aid training and community resilience 17 2 Method The present research had a mixed-methods design, using both focus groups and a survey to gather data. 2.1 focus groups There were two stages of focus groups. The first stage (n=2) were used to test theoretical concepts gained from the existing literature and inform the questionnaire design. The second (n=4) sought qualitative data to further elucidate the quantitative findings of the survey. Participants (n=37) had previously received community based first aid (CBFA) for vulnerable groups from the British Red Cross. The groups were: > Elderly in supported living, Dundee (n=8) > Young people who were not in employment, education or training (Prince’s 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).

18 Assessing the links between first aid training and community resilience It was not possible to organise focus groups with 2.2.1 Sample people who received workplace training within the available timeframe due to not being able to The survey sample comprised of two groups: access the data. an intervention group who had received first aid training from the British Red Cross between April and September 2010 (referred to herein as 2.2 survey ‘Trained’), and a control group, for comparison, from those who were booked on to receive first The survey included questions on respondent aid training in 2011. All, therefore, had either demographics, features of the first aid training received, or were booked to receive, first aid they received (or will receive) from the British Red training provided by the British Red Cross – Cross, individual resilience, community resilience, including Red Cross Training, community-based and willingness and confidence to provide first aid (CBFA – both public and in groups), first aid. and schools. The first stage of focus groups helped to test out the questionnaire and make amendments. 2.3 measuring our concepts In addition, 83 participants formed a pilot for the questionnaire. 2.3.1 ‘Community’ There were two different versions of the Respondents were given our definition of questionnaire. The first was for those people community (see section 1.1), and asked to think who had already received first aid training. The of a community that they belonged to and told second was for those who had not yet received that the subsequent questions about community their training, and did not include the questions in the questionnaire referred to their chosen from the first version that related specifically to community. having had first aid training.

Assessing the links between first aid training and community resilience 19 2.3.2 Key indicators of community resilience considered The indicators of community resilience considered appropriate to include in the survey were: social connectedness (“I feel I am a part of this community”, “most members of this community know me”, “people in this community watch out for each other”, and “people in this community are willing to help each other”); community efficacy for a first aid emergency (“people in this community are willing to provide first aid to each other in an emergency”, “people in this community cannot rely on each other to provide first aid in an emergency” (negatively coded), and in a disaster scenario “how likely do you think people in your community would be to take action and give first aid?”); learning (“not many people in this community know that I have had first aid training” (negatively coded), “if I ever need first aid, I know someone in the community who I can go to for help”, and “not many people in this community know how to give first aid in an emergency” (negatively coded)); readiness to respond; and economic wellbeing and equality of access to first aid training. 2.3.3 Key indicators of individual > Whether the respondent had received first aid resilience considered training from the British Red Cross between April and September 2010 (Trained group), or The indicators of individual resilience included were booked on to receive first aid training in were feeling capable or determined as a person 2011 (Control group). (both of which are aspects of self-esteem also), feeling that you can find a way out of difficult > Whether people had ever, or never, been situations, feeling that people can rely on you trained. in an emergency, and feeling proud of accomplishments in life. > Whether other members of the community were trained alongside the respondent. 2.3.4 Key components of first aid > Whether people had been trained once or training considered multiple times. The proposed first aid training outcomes included > Recency of previous first aid training. in the research were willingness to provide first aid, confidence to provide first aid, increased knowledge of other British Red Cross services, increased self-esteem, and help with employment. In addition, certain features of the first aid training itself were also considered in terms of whether they relate to community resilience. These features were:

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Assessing the links between first aid training and community resilience 21 3 Results 3.1 response rate The exact response rate cannot be calculated because it is unknown how many questionnaires were actually passed on by third-party community contacts. However, we are satisfied that 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, and only 13% (n=80) were in the Control group. One reason that the Control group was smaller is because attendance is often not organised very far in advance, and so potential respondents cannot be identified. Only 23% (n=18) of the Control group had never had first aid training before. Of all respondents, one-third (33%) were classified by the British Red Cross as vulnerable to a first aid emergency. Respondents were asked about the reasons why they attended, or will attend, the British Red Cross first aid training. As shown in figure 1, the most common reason for attending first aid training was “to be prepared in case of an

22 Assessing the links between first aid training and community resilience FIgURE 1 REASoN FoR ATTENDINg FIRST AID TRAININg TO BE PREPARED IN CASE OF AN EMERGENCY FOR THE SAFETY OF MY FAMILY TO BE OF ASSISTANCE TO OTHERS OUTSIDE OF MY FAMILY FOR MY JOB OR TO HELP ME FIND WORK son FOR MY OWN SAFETY A OUT OF INTEREST re PART OF A COURSE ANOTHER REASON 0 10 20 30 40 50 60 70 80 Percent emergency”, although people were able to give to agree that they felt part of the community more than one reason. Where people said they if other members of that community were had “another reason” for attending first aid trained alongside them, compared with if they training, it was often because they belonged to received the first aid training as an individual 3 Guides or Scouts, or coached a sports team. (94% compared with 91%, respectively). Note that the reason “part of a course” refers, for example, to a vocational or academic course, > Trained respondents who had received first rather than a specific first aid course. aid training more than once were significantly more likely to agree that people in their Almost all (97%) of the Trained respondents community watch out for each other as were satisfied or very satisfied with the first aid compared with those who had only been training they received from the British Red Cross. trained the once (85% compared with In illustration, one respondent commented that 75%, respectively).4 “I am very grateful for the brilliant training I received from the British Red Cross”. > People who were more willing to give first aid in an emergency were significantly more likely to agree that they felt part of their community, 3.3 indicators of community that people in the community watch out for resilience each other, and that people in the community are willing to help each other, than those who were less willing.5 3.3.1 Social connectedness > Conversely, confidence in ability to provide > The social connectedness of a community first aid was not related to any aspects of social was similar between the Trained and Control connectedness. This suggests that the degree groups, and, within the Control group, those of social connectedness is not affected by this having had previous training or not. more cognitive feature of first aid – that is, 2 3 Mean is displayed within the range of 1-5, others trained 4.4: trained > Respondents were significantly more likely individually 4.3, t(447)=-2.25, p<0.05. 4 Mean is displayed within the range of 1-5, more than once 4.1: once 4.0, 2 The terms ‘significant’ and ‘statistically significant’ in this report refer to t(489)=-2, p<0.05. the findings having been statistically tested with the results of this test 5 Mean is displayed within the range of 1-40. Feel part of community, indicating that the results obtained were less than 5% due to chance. agree 34.8: do not agree 32.7, t(564)=-2.74, p<0.01. Watch out for each This is expressed as the probability (p) of the result occurring by chance other, agree 34.8: do not agree 33.4, t(559)=-2.43, p<0.05. Willing to being (=) less than (<) a given percentage (0.05). help each other, agree 34.8: do not agree 32.8, t(562)=-3.15, p<0.01.

Assessing the links between first aid training and community resilience 23 people’s confidence in their ability to provide first aid. It seems, therefore, that social connectedness is not a result of first aid training as a whole and instead may already be established before attending training, although it is heightened in those who are trained together as a community, and for those individuals who are trained more than once. 3.3.2 Community efficacy for a first aid emergency > Community efficacy was similar between the Trained and Control groups, and, within the Control group, those having had previous training or not. This suggests that community efficacy is also not a result of first aid training as a whole. > Respondents in the Trained group tended to more strongly agree with all aspects of trained would be able to cope better in an community efficacy if other members of that emergency, for example in one respondent’s community were trained alongside them, words “between us, we’re going to be able compared with if they received the first aid to cope”. training as an individual.6 > People who were more willing to provide > Trained respondents who had received first first aid were also significantly more likely aid training more than once were significantly to agree that their community had each of more likely to agree that people in their the community efficacy measures.8 community are willing to provide first aid to each other in emergency, as compared with > Confidence was only significantly related those who had only been trained the once to two out of the three community efficacy 7 (76% compared with 65%, respectively). measures. Respondents who more strongly agreed that people in their community could > Analysis of qualitative data also suggests a rely on each other to provide first aid, or benefit to community efficacy if community that their community would take action in members are trained together: the scenario described, were more confident about their personal ability to give first aid 9 “I feel that if you are learning with people than those who did not. Respondent you know you are more likely to undertake the confidence was not related to a community’s challenge together and be more comfortable willingness to provide first aid to each other. with touching people initially that you know than a complete stranger. Once people are As with social connectedness, this suggests trained they are more willing to go into the that while community efficacy is not caused by outside world knowing they are qualified attendance at first aid training, it is heightened in and capable of doing first aid to a stranger.” those who are trained together as a community, and for those who are trained more than once. > Qualitative data further suggests that communities in which more people were 8 Mean is displayed within the range of 1-40. Willing to provide first aid to each other, agree 34.9: do not agree 33.6, t(511)=-2.49, p<0.05. Rely on 6 Mean is displayed within the range of 1-5. Willing to provide first aid to each other to provide first aid, agree 35.1: do not agree 33.6, t(516)=- each other, agree 4.0: do not agree 3.9, t(407)=-2.31, p<0.05. Rely on 3.17, p<0.01. Take action in scenario, agree 34.6: do not agree 32.8, each other to provide first aid, agree 3.9: do not agree 3.7, t(410)=-2.63, t(468)=-2.14, p<0.05. p<0.01. Take action in scenario, agree 3.4: do not agree 3.2, t(371)=- 9 Mean is displayed within the range of 1-20. Rely on each other to 2.07, p<0.05. provide first aid, agree 16.2: do not agree 15.2, t(513)=-3.65, p<0.01. 7 Mean is displayed within the range of 1-5, more than once 4.0: once 3.8, Take action in scenario, agree 15.8: do not agree 14.6, t(468)=-2.34, t(444)=-2.31, p<0.05. p<0.05.

24 Assessing the links between first aid training and community resilience FIgURE 2 AgREEMENT ThAT PEoPlE IN ThEIR CoMMUNITy KNoW hoW To gIvE FIRST AID By RECENCy oF RESPoNDENT’S PREvIoUS TRAININg 70 60 gree 50 A 40 30 20 Percent who 10 0 In the last year 1 to 5 years ago 6 or more years ago when hAd trAining PreViously 3.3.3 Learning > Of those in the Control group who had been trained at some point in the past, people who > A direct link emerged between learning and had been trained more recently were more first aid training, where Trained respondents likely to agree or strongly agree that people were one-and-a-half times more likely to agree in their community know how to give first that people in their community know how to aid (figure 2). give first aid in an emergency (35% compared 10 with 25%, respectively). However, this link > Within the Trained group, people who appears to have been driven by having had been trained more than once were attended training with other community significantly more likely than those who members rather than attending training at all, had only been trained the once to agree as Control respondents had similar levels of that people in their community know they agreement to those in the Trained group who (the respondent) had been trained (41% 12 had not been trained with other members of compared with 30%, respectively). their community (25% and 26% respectively agreed or strongly agreed). > Communities in which other members had attended the first aid training alongside the > In terms of knowing someone in the respondent scored higher on all aspects of community to go to for first aid help, Control learning than communities in which the respondents had similar agreement to Trained, respondent was trained as an individual.13 but were two-and-a-half times more likely than Trained to answer “don’t know” to the > Respondents who did not attend the first question (13% compared with 5%, aid training alongside other members of their respectively). community were two-and-a-half times more likely than those who did to answer that > Within the Control group itself, people they “don’t know” if many people in the who had been trained previously were over community know how to give first aid six times more likely to agree that people in (25% compared with 10%, respectively). their community know that they will be receiving first aid training than those who 12 Mean is displayed within the range of 1-5, more than once 3.1: once 2.8, had never been trained (50% compared t(397)=-2.74, p<0.01. 11 13 Mean is displayed within the range of 1-5. People know that respondent with 8%, respectively). had first aid training, others trained 3.2: trained individually 2.8, t(365)=- 10 Mean is displayed within the range of 1-5, Trained 3.1: Control 2.8, 3.75, p<0.01. Know someone to go to for first aid help, others trained t(412)=1.99, p<0.05. 4.1: trained individually 3.6, t(430)=-5.63, p<0.01. People know how to 11 Mean is displayed within the range of 1-5, trained previously 3.4: never give first aid, others trained 3.2: trained individually 2.9, t(324)=-2.45, trained 2.5, t(69)=-2.75, p<0.01. p<0.05.

Assessing the links between first aid training and community resilience 25 > The benefits of learning as a community, rather than an individual, were also commented on in the focus groups, as captured in the following words: “if one of us has forgotten, another two will remember”. > People who agreed that they know someone in their community to go to for first aid help were both more willing and confident to give first aid than those who did not agree.14 > Confidence was also related to whether others in the community know the respondent has had first aid training. People who reported that they did know were more confident in their own ability to give first aid than those who did not.15 Willingness was not related to this. > Qualitative responses also support a link between first aid training and learning. Many identified first aid knowledge as a key gain of first aid training, and thought that training would equip people in the community with the skills needed to act in an emergency. In “When I told other members of my addition, one respondent noted that first aid community I had attended a first aid course, training would only build community 4 others went on to do first aid courses also resilience if “the communities were aware so we can be better able to cope with accidents of who was first aid trained”. and emergencies.” This implies that first aid training, regardless > Levels of both willingness and confidence of recency, has an impact on the resilience of a were higher for people who had shared first community through learning about the resource of aid skills or knowledge or recommended first aid and who can provide this when required. training to someone else than those who had And as with social connectedness and community not.16 Whether or not people had told someone efficacy, learning in the community is enhanced about their training was not related to either through training as a community. willingness or confidence. spread of knowledge The high rate of spread of knowledge is > Nearly all (95%) of the Trained respondents promising, as is the evidence that it is has an had told someone they had received first aid effect on the community and appears to be training, and around two thirds had shared influenced by the outcomes of first aid training. first aid skills or knowledge (63%) or recommended first aid training to someone else (67%). This knowledge was most often 3.3.4 Readiness to respond spread to family and friends. > Over half of respondents said their community > The importance of spreading knowledge had access to a first aid kit (68%) or had taken about first aid training is illustrated by one steps to reduce risks to their health and safety respondent in response to an open-ended (54%). Eleven percent had done “something question: else”, and this often included having a designated trained first aider, or having taken the first aid training itself. Qualitative evidence 14 Mean is displayed within the range of 1-40 for willingness, and 1-20 for confidence. Willingness, agree 34.9: do not agree 33.8, t(536)=-2.02, 16 Mean is displayed within the range of 1-40 for willingness, and 1-20 for p<0.05. Confidence, agree 16.1: do not agree 15.3, t(534)=-2.53, confidence. Willingness by whether shared, shared 35.3: did not share p<0.05. 33.2, t(529)=-4.52, p<0.01. Willingness by whether recommended, 15 Mean is displayed within the range of 1-40 for willingness, and 1-20 for recommended 35.0: did not recommend 33.6, t(532)=-2.84, p<0.01. confidence. Willingness, agree 34.9: do not agree 33.8, t(536)=-2.02, Confidence by whether shared, shared 16.5: did not share 15.1, t(527)=- p<0.05. Confidence, agree 16.1: do not agree 15.3, t(534)=-2.53, 5.33, p<0.01. Confidence by whether recommended, recommended p<0.05. 16.3: did not recommend 15.4, t(529)=-3.55, p<0.01.

26 Assessing the links between first aid training and community resilience aid training to be prepared in case of an emergency. This, along with attending training for the safety of family (47%), to be of assistance to others outside of the family (46%) and for one’s own safety (29%) could also be considered as putting preparations in place to enable an effective response. > Reason for attending training also showed a difference between those in the Control group who had previously or had never been trained; where those with previous training were almost one-and-a-half times more likely to say they were attending the upcoming training in order to be prepared for an emergency (79% compared with 56%, respectively).20 > People in the Trained group who had been trained multiple times were one-and-a-half times more likely than those trained once to say that they attended the training for their job or to help find work (34% compared with suggested that first aid training would, in the 21%, respectively), whereas those trained only words of one respondent, “help communities once were almost twice as likely to say it was by enabling people to take steps to protect for a course they were on (32% compared themselves and others from further injury”. with 17%, respectively).21 > Having preparations in place was generally > People who attended or will attend the similar between Trained and Control training because of a course they were on were respondents, although Trained were less willing to give first aid than people who 22 significantly more likely than Control to say attended or will attend for any other reason. their community had done “something else” This suggests that people who attend first aid 17 (12% compared with 1%, respectively). training for their own personal reasons are more willing to give first aid than those who > Within the Control group itself, respondents attend because it is mandatory, or again, this who had been trained previously were almost could be a result of multiple training, as those twice as likely as those who had never been on a course were likely to have only been trained to say their community had taken steps trained the once. to reduce risks to health and safety (63% 18 compared with 33%, respectively). Communities which have undertaken preparations in order to be ready to respond > Within the Trained group, communities in to a first aid emergency are likely to be those in which other members did not attend first aid which other community members were trained training alongside the respondent were three alongside the respondent. In addition, it is times more likely to have no preparations promising that people see first aid training itself in place than communities in which the as being an important step towards being ready respondent was trained alongside other to respond. members (9% compared with 3%, 19 respectively). > As previously mentioned, two-thirds (63%) of respondents attended or will attend first 20 Mean is displayed within the range of 0-1, trained previously 0.79: never 17 Mean is displayed within the range of 0-1, Trained 0.12: Control 0.01, trained 0.56, t(78)=-2.02, p<0.05. t(507)=2.90, p<0.01. 21 Mean is displayed within the range of 0-1. For a job or to help find work, 18 Mean is displayed within the range of 0-1, trained previously 0.63: never more than once 0.34: once 0.21, t(536)=-2.70, p<0.01. For a course, trained 0.33, t(75)=-2.11, p<0.05. more than once 0.17: once 0.32, t(536)=3.63, p<0.01. 19 Mean is displayed within the range of 0-1, others trained 0.03: trained 22 Mean is displayed within the range of 0-40, attended for a course 32.5: individually 0.09, t(387) =2.52, p<0.05. did not attend for a course 35.0, t(585) =4.44, p<0.01.

Assessing the links between first aid training and community resilience 27 3.3.5 Economic wellbeing and equality of access to first aid training > As previously shown, one-third (33%) of all respondents attended or will attend first aid training for their jobs or to help find work. This is considered to contribute to facilitating the economic wellbeing of the respondent by assisting with employment. > People who attended or will attend first aid training for their job or to help find work were significantly more willing and confident than those who attended because of a course they were on.23 However, levels of willingness and confidence were similar between economic and the other reasons for attending training. > The importance of first aid training for people seeking employment was illustrated in the focus groups. For one respondent, “it shows you can do something”, and for another, who was seeking work as a carer, “everywhere that you go for a job they ask you if you have done Removing financial barriers to accessing first first aid training”. They also noted that they aid learning and providing this skill to those thought employers would particularly respect seeking to enhance their employability are both first aid training delivered by the British Red community resilience indicators. Their presence Cross because it is a reputable organisation. in British Red Cross first aid training is clearly positive evidence of the presence and potential > In addition to help with employment, the growth of these community resilience elements whole CBFA approach to first aid training, in our current approach. which offers free training to people considered by the British Red Cross to be vulnerable to a first aid emergency but who might not 3.3.6 Effect of community type on otherwise be able to afford it, is designed to community resilience reduce inequality in the access to first aid training. > Communities based, at least in part, on where the respondent lived geographically scored > The importance of offering free or lower on nearly all community resilience 24 affordable training was illustrated in the measures than other types of communities. qualitative analysis. One respondent stated: > Geographic communities were also “The only thing preventing people attending significantly less likely than other types of first aid courses may be cost. If training could community to have access to a first aid kit be arranged in large community groups and (59% compared with 76%, respectively) or costing could be brought down, there may have taken steps to reduce health and be more people joining in.” 24 Mean is displayed within the range of 1-5. Feel part of community, based on where live 4.2: not based on where live 4.4, t(568)=2.91, p<0.01. Members know me, based on where live 4.0: not based on where live 4.3, t(565)=4.26, p<0.01. Watch out for each other, based on where live 4.0: not based on where live 4.1, t(563)=2.48, p<0.05. Willing to 23 Mean willingness score is displayed within the range of 0-40, and the help each other, based on where live 4.0: not based on where live 4.2, confidence intervals are 31.2-33.8 (mean 32.5) for ‘course’, and 35.1- t(568)=2.76, p<0.01. Willing to provide first aid to each other, based on 36.4 (mean 35.7) for ‘job or to find work’ (at the 95% confidence level). where live 3.8: not based on where live 4.0, t(515)=3.31, p<0.01. Rely The mean confidence score is displayed within the range of 0-20, and on each other to provide first aid, based on where live 3.6: not based the confidence intervals are 14.8-16.1 (mean 15.4) for ‘course’, and on where live 3.9, t(518)=4.84, p<0.01. People know respondent had 16.2-17.0 (mean 16.6) for ‘job or to find work’ (at the 95% confidence first aid training, based on where live 2.6: not based on where live 3.3, level). Confidence intervals give an estimated range of values in which t(397)=6.40, p<0.01. Know someone to go to for first aid help, based on the ‘true’ value is likely to fall. Because neither of the confidence intervals where live 3.7: not based on where live 4.0, t(540)=3.72, p<0.01. People for willingness or confidence to give first aid for people who attended for know how to give first aid, based on where live 2.9: not based on where a course or for a job overlaps, we can be 95% confident that the scores live 3.2, t(410)=2.86, p<0.01. Take action in scenario, no significant are significantly different from each other. difference.

28 Assessing the links between first aid training and community resilience FIgURE 3 AgREEMENT ThAT INDIvIDUAl RESIlIENCE INCREASED AS A RESUlT oF FIRST AID TRAININg A MORE CAPABLE PERSON resilience MORE RELIABLE IN AN EMERGENCY l A idu A MORE DETERMINED PERSON V indi BETTER AT FINDING MY WAY on OUT OF DIFFICULT SITUATIONS ct A P im 0 10 20 30 40 50 60 70 80 90 Percent safety risks (46% compared with 62%, 3.4 individual resilience respectively).25 3.4.1 Relationship between individual This reinforces the need to consider a range of resilience and first aid training different types of communities when targeting or promoting training. The majority of Trained respondents thought that they were more capable and reliable in an emergency as a result of their first aid training 3.3.7 Effect of age on community (figure 3). resilience > The qualitative data also suggests that first While we cannot determine to what extent other aid training can have a positive psychological community members matched the respondent effect that is separate from learning the specific in terms of age, the age of a respondent also skills. For example one respondent explained appeared to relate to the degree to which they “having this kind of training makes people agreed with the community resilience measures; feel more capable and valued to provide useful where those aged 19 years or under had the help to others”, and another commented lowest levels of agreement across the questions “it feels good being able to help”. 26 asked. > The focus groups also revealed that people thought they would now feel less helpless in an emergency as a result of their first aid training. In the words of one respondent: 25 Mean is displayed within the range of 0-1. Access to a first aid kit, based on where live 0.59: not based on where live 0.76, t(504)=4.30, p<0.01. “It’s an emotional thing as well, you know, Reduce risks to health and safety, based on where live 0.46: not based like you won’t feel helpless if you came across on where live 0.62, t(504)=3.62, p<0.01. 26 The following percentages are for those in each age group who agreed that. If you’re in that position then you or strongly agreed with each question. Percentages are given in the wouldn’t just be standing there not knowing following age group order: 19 years or under, 20 – 39 years, 40 – 59 years, 60 years or over. Feel part of community: 75%, 91%, 92%, 98%. what to do. You are able to take action.” Members know me: 78%, 81%, 88%, 90%. Watch out for each other: 65%, 83%, 82%, 89%. Willing to help each other: 64%, 88%, 89%, 94%. Willing to provide first aid to each other: 58%, 80%, 75%, 76%. > Although Trained respondents rated the Rely on each other to provide first aid: 58%, 66%, 68%, 67%. Take factors of individual resilience highly, it action in scenario: 83%, 92%, 96%, 95%. People know respondent had first aid training: 32%, 40%, 41%, 46%. Know someone to go to for first was the Control group who exhibited the aid help: 71%, 76%, 77%, 80%. People know how to give first aid: 26%, 39%, 34%, 31%.

Assessing the links between first aid training and community resilience 29 strongest individual resilience. Control to agree with these statements more strongly respondents agreed with all aspects of than younger respondents.31 individual resilience, apart from pride in accomplishment, more strongly than It is promising that first aid training is positively Trained respondents.27 However, this related to individual resilience; namely that difference could potentially be explained people think they are more capable as a person by the high percentage of workplace and reliable in an emergency as a result of their respondents in the Control group (53%), training, and that people with greater individual which was more than twice that of the resilience exhibit greater willingness and Trained group (21%). When explored confidence to provide first aid. However, the further, it was the workplace respondents relationships appear to be stronger for some who exhibited significantly higher levels people than others, where those who received 28 of individual resilience. training in the workplace exhibited greater individual resilience than those who received > Willingness and confidence to give first aid other types of training, and those aged 19 years were both moderately positively correlated or under exhibited lower individual resilience with the capable and reliable aspects of than older respondents. 29 individual resilience. The more willing respondents were to give first aid, the more It must also be noted that we cannot determine strongly they agreed that they were a capable the direction of these relationships, so it is person (r=0.35) or reliable in an emergency unclear as to whether individual resilience is built (r=0.46). Confidence showed the same pattern, as a result of first aid training, or that people where respondents who were more confident with greater resilience to begin with are naturally to give first aid were likely to more strongly more willing, confident, or likely to recognise the agree they were a capable person (r=0.41) benefits of training. or reliable in an emergency (r=0.43). With regards to feeling that aspects of individual resilience had increased as a result of first aid, willingness was higher amongst those who more strongly agreed that their capability had increased (r=0.41), and both willingness and confidence were higher amongst those who more strongly agreed they were more reliable in an emergency following training (willingness r=0.41; confidence r=0.43). > Comparison of individual resilience across respondents also revealed that it varies with age. Strength of agreement that the respondent was a determined person, reliable in an emergency, and proud that they had 30 accomplished things in life, all increased with age, where older respondents tended 27 Mean is displayed within the range of 1-5. Capable, Trained 4.1: Control 4.4, t(608)=-3.97, p<0.01. Determined, Trained 4.0: Control 4.3, t(605)=- 3.23, p<0.01. Can find a way out of difficult situations, Trained 4.0: Control 4.2, t(607)=-3.24, p<0.01. Reliable in an emergency, Trained 3.9: Control 4.2, t(607)=-2.89, p<0.01. 28 Mean is displayed within the range of 1-5. Capable, workplace 4.4: not workplace 4.1, t(576)=-4.87, p<0.01. Can find a way out of difficult situations, workplace 4.1: not workplace 4.0, t(575)=-3.29, p<0.01. Reliable in an emergency, workplace 4.1: not workplace 3.9, t(575)=- 3.72, p<0.01. 29 The correlation between two variables is the extent to which there is a linear relationship between them. That is, the degree to which one increases if the other increases (positive correlation), or one decreases as the other increases (negative correlation). The closer to 1 or -1, the stronger the relationship. 30 Reported as a statistically significant positive linear regression. Regressions indicate the relationship between two variables, where the typical value of a dependent variable changes when the independent 31 Positive linear relationship. Determined F(1,597)=8.32, p<0.01. Reliable variable varies. Positive linear relationships show that the higher the in an emergency F(1,599)=3.91, p<0.05. Proud of accomplishments score on one variable, the higher the other is on average. F(1,599)=8.22, p<0.01.

30 Assessing the links between first aid training and community resilience TABlE 1 willingness and confidence to give first aid by age Very/quite willing Very/quite confident Age Percent 19 years and under 84 77 20 – 39 years 93 87 40 – 59 years 95 89 60 years and over 92 79 3.5 elaborating on the outcomes People who had been trained more than once of first aid training were more confident to provide first aid than those who had only been trained once.34 > Overall, people were significantly more willing to provide first aid to people they know than > Within the Control group, there was no people they did not know.32 difference in confidence between those who had or had never received training. However, > People were also more willing to help if the among those in the Control group who incident was less severe. That is, more people had been trained, there was a significant were quite or very willing to help someone relationship between recency of training and who was choking (94%) or had a minor burn confidence to give first aid, where people who (94%) compared with someone who was had been trained within the last 5 years were unconscious and breathing (92%) or not significantly more confident than those who 35 breathing (89%), or who had a severe bleed had been trained 6 or more years ago. (90%). Similarly, more people were quite or very confident in their ability to give first aid > There was strong qualitative evidence that in less severe situations (88% for minor people felt more confident to provide first aid situations compared with 82% for severe). as a result of their training. According to one respondent: > Willingness and confidence also varied depending on age. As shown in table 1, those “Ignorance of how to apply first aid can lead aged 19 years and under had lower levels of to a lack of confidence, which can lead to no willingness and confidence than people in older action being taken… I might hesitate in case age groups. I made things worse, but if I have repeated refresher courses, my confidence should increase, leading to me having a try! Memory 3.5.1 Evidence for increased confidence fades very fast and I would welcome yearly as an outcome of first aid training courses (if money available).” > When comparing the confidence of the Control group versus the Trained group, the Trained 3.5.2 Questioning willingness as an group were more confident in their ability to outcome of first aid training 33 provide first aid. > There was no difference in willingness between > Confidence was also compared between those the Trained and Control group, or between in the Trained group who had received first aid those within the Control group who had or training previous to their most recent training, had never been trained. and those who had only been trained once. 32 Mean is displayed within the range of 1-20, know 17.8: did not know 34 Mean is displayed within the range of 1-20, more than once 16.3: once 16.7, t(1224)=7.37, p<0.01. 15.2, t(529)=-3.83, p<0.01. 33 Mean is displayed within the range of 1-20, Trained 16.0: Control 14.4, 35 Mean is displayed within the range of 1-20, within the last 5 years 15.9: 6 t(608)=4.50, p<0.01. or more years ago 12.7, t(54)=3.61, p<0.01.

Assessing the links between first aid training and community resilience 31 > Debate within the focus groups also indicated that willingness was not always affected by first aid training. In some cases people were more willing as a result of their training, for example the refugee group had previously thought they might get in trouble for helping someone who later died, and “didn’t know that if someone collapses that you can help them”. However, other people said they were willing to help anyway without training, and several referred to this willingness as “instinct”. It appears, therefore, that first aid training, especially multiple training, helps increase people’s confidence to provide first aid, although this confidence may dissipate over time. However first aid training did not appear to influence people’s willingness to help, and willingness may therefore be an inherent trait that people bring with them to the training, and/or is a trait that can be influenced by other factors. > Community efficacy appears to be facilitated 3.5.3 Increased knowledge of and by learning. Communities in which many engagement with other British Red people knew how to give first aid were also Cross services considered to be willing to provide first aid and likely to take action in a disaster scenario. > Less than one-third (28%) had learnt about Similarly, respondents were more likely to other British Red Cross services at their first agree that people in their community could aid training. Of these, half (52%) had shared rely on each other to provide first aid if they this information with someone else. (the respondent) knew someone within that community who they could go to for first 37 3.6 interrelationships between aid help. community and individual > Regarding learning, respondents who more resilience strongly agreed that they knew someone in the community to whom they could go for first aid help also tended to agree that others 3.6.1 Community resilience in the community knew that they (the interrelationships respondent) had had first aid training. This suggests a reciprocal relationship, resulting in > Social connectedness may be a conduit each knowing the other has first aid skills through which other indicators can operate. that could be accessed if necessary.38 In particular, feeling part of the community was positively linked to knowing someone > Knowing someone in the community to go to to go to for help and the likelihood that a for first aid help was, perhaps unsurprisingly, community would take action in the disaster positively related to whether many people in 39 scenario. In addition, respondents who agreed that community knew how to give first aid. that people in their community watch out for This illustrates the importance of knowing each other were also likely to agree that they what resources are available and where to knew someone in the community to go to for access them. first aid help if necessary.36 37 Positive linear relationships between: people know how to give first aid and willing to provide first aid to each other, F(27,248)=5.86, p<0.05; 36 Positive linear relationships between: feel part of community and know people know how to give first aid and community action in scenario, someone to go to for first aid help, F(27,248)=12.54, p<0.01; feel part of F(27,248)=5.86, p<0.05; rely on each other to provide first aid and know community and community action in scenario, F(27,248)=12.54, p<0.05; someone to go to for first aid help, F(27,248)=7.56, p<0.01. watch out for each other and know someone to go to for first aid help, 38 Positive linear relationship, F(27,248)=7.23, p<0.01. F(27,248)=24.28, p<0.05. 39 Positive linear relationship, F(27,248)=7.23, p<0.01.

32 Assessing the links between first aid training and community resilience 3.6.2 Spread of knowledge and are willing to provide first aid to each other community resilience in an emergency (shared 77% compared with 67%, respectively; recommended 77% It is not possible to determine whether the compared with 68%, respectively).41 people who respondents had told, shared, or recommended first aid training to belonged to > People who had shared or recommended the same community they were answering the were significantly more likely to agree that community resilience questions about. Despite they knew someone in the community they this, spread of knowledge still showed some could go to for help (shared 79% compared interesting relationships with community with 70%, respectively; recommended 79% 42 resilience. compared with 69%, respectively). > Those who had told someone about their This suggests that knowledge may be spread training were significantly more likely than internally within and external to the communities those who had not to agree that the people in a respondent belongs to. However, communities their community are willing to help each other to which knowledge is spread do exhibit higher (87% compared with 74%, respectively). community resilience. Similarly, those who had shared first aid skills or knowledge were significantly more likely than those who had not to agree that they felt 3.6.3 Relationship between community a part of their community (91% compared and individual resilience with 89%, respectively).40 > People who more strongly agreed that they > People who had shared skills or knowledge, or could usually find their way out of difficult recommended training, were significantly more likely to agree that people in their community 41 Mean is displayed within the range of 1-5. Shared 4.0: did not share 3.8, t(441)=-2.80, p<0.05. Recommended 4.0: did not recommend 3.8, t(445)=-2.77, p<0.01. 40 Mean is displayed within the range of 1-5. Told 4.2: did not tell 3.8, 42 Mean is displayed within the range of 1-5. Shared 3.9: did not share t(491)=-2.14, p<0.05. Shared 4.3: did not share 4.2, t(493)=-2.06, 3.7, t(471)=-2.56, p<0.05. Recommended 3.9: did not recommend 3.7, p<0.05. t(474)=-2.78, p<0.01.

Assessing the links between first aid training and community resilience 33 situations rated their communities higher they felt proud of accomplishing first aid in social connectedness in terms of people training.46 watching out for, and being willing to help, each other.43 > Communities that had no preparations in place to be ready to respond to a first aid > Those who more strongly agreed that they emergency were significantly more likely than were someone others could generally rely on those who did to have low levels of certain in an emergency also more strongly agreed aspects of social connectedness, community that people in their community knew they efficacy, and learning.47 had had first aid training.44 It appears, therefore, that while there is a link > People who felt proud that they had between individual and community resilience to a accomplished things in life were likely first aid emergency, there is a distinction between to have told someone about the first aid them. The resilience of individuals may contribute training they had received.45 to certain aspects of community resilience, but for the community to be resilient as a whole, other > Pride in having accomplished first aid conditions must also be present. training was significantly related to all aspects of spreading knowledge, where people who told (85% compared with 46 Mean is displayed within the range of 1-5. Told 4.1: did not tell 3.4, 56%, respectively), shared (88% compared t(526)=-4.74, p<0.01. Shared 4.2: did not share 3.9, t(524)=-4.15, with 77%, respectively), or recommended p<0.01. Recommended 4.1: did not recommend 3.9, t(527)=-3.37, (85% compared with 81%, respectively) p<0.01. 47 Mean is displayed within the range of 1-5, and 1-4 for the scenario. were significantly more likely to agree that Members know me, no preparations 3.8: have preparations 4.2, t(489)=2.49, p<0.05. Watch out for each other, no preparations 3.6: have preparations 4.1, t(490)=3.91, p<0.01. Willing to provide first aid, 43 Positive linear relationships between: can find a way out of difficult no preparations 3.5: have preparations 4.0, t(451)=2.86, p<0.05. Rely situations and community watch out for each other, F(27,248)=5.73, on each other to provide first aid, no preparations 3.3: have preparations p<0.05; can find a way out of difficult situations and community willing 3.8, t(452)=2.37 p<0.05. Know someone to go to for first aid help, to help each other, F(27,248)=5.86, p<0.05. no preparations 3.2: have preparations 3.9, t(467)=3.93, p<0.01. 44 Positive linear relationship, F(27,248)=6.33, p<0.05. Take action in scenario, no preparations 3.8: have preparations 4.2, 45 Positive linear relationship, F(27,248)=7.50, p<0.05. t(471)=3.59, p<0.01.

34 Assessing the links between first aid training and community resilience

Assessing the links between first aid training and community resilience 35 4 Conclusions > This study has identified linkages between features of community resilience and first aid training. While it is not possible to establish a causal relationship, we do identify significant relationships between features such as willingness and confidence to administer first aid and constituent elements of resilience such as social connectedness, community efficacy, learning and the spread of learning/ knowledge/skills. > We have also identified that the context and frequency of training are significant factors where community resilience features are present. In other words, in those people trained together and repeatedly we find heightened measures of the resilience elements tested for. > We have found significant evidence to suggest that willingness is not an outcome of first aid training. Put another way, first aid training per se will not increase our willingness to administer first aid in an emergency. However, confidence to administer first aid is an outcome of first aid training, although this wanes with the passing of time.

36 Assessing the links between first aid training and community resilience > Age appears to be an important factor – > In conclusion, therefore, this study has found young people (19 and under) exhibited lower support for a positive relationship between levels of the resilience features measured in first aid training and features of community the study than those over 19, suggesting this resilience. Although this is not unanimous age group may be a one for greater focus. support, the study has highlighted areas where relationships can be heightened by influencing > The study suggests that the current first the community resilience factor itself through aid approach – in particular CBFA – has means not directly related to a first aid significant potential to support the outcome. Namely, this study makes development of resilience, especially when recommendations towards achieving greater administered within the context of social community resilience by enhancing what is groupings and repeated training. The findings already present; for example, working with also support the current CBFA approach a group where members know and interact as a means to reduce inequality (of access), with each other. In addition, the benefits of and promote a beneficiary-led/tailored attending training more than once and the approach to delivering the service. subsequent impact on community resilience, have also been identified. > One way forward for the first aid department, therefore, is to ensure that training increasingly happens within the types of environment that the study suggests are conducive to growing resilience features.

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38 Assessing the links between first aid training and community resilience

Assessing the links between first aid training and community resilience 39 5 Recommendations 5.1 Disseminate the findings of this survey in accessible and creative ways and to a range of audiences both internal and external to the British Red Cross. 5.2 Explore the targeting of training to existing ‘communities’ (defined by the group as themselves constituting a group of people who interact with each other regularly). The qualitative and quantitative data both suggest that those who attend as a group feel more comfortable together and thus learn more, and there is a sense that they could work together in an emergency. Additionally, the training should be targeted at social groups rather than groups defined solely by geography, as this is where we may see the 48 most impact. 48 As of November 2011, the Research, Evaluation & Impact and First Aid Education teams are carrying out a second research study to further examine the relationship between being trained together as a community and the links between first aid training and community resilience. This research will examine additional factors such as type of course, type of community, and proportion of community members trained.

40 Assessing the links between first aid training and community resilience 5.3 Offer repeat training to first aid trainees in 5.7 Apply caution when labelling/defining light of the benefits raised herein, and given communities as ‘vulnerable’. Many of the the fact that confidence is known to dissipate communities defined as vulnerable in this after a time. study did not see themselves in this way. 5.4 A further examination by the First Aid and 5.8 Explore how the messages of positive Research, Evaluation & Impact teams of benefits can be best communicated to those resilience features that appear to potential beneficiaries with the aim of influence willingness (in particular) and encouraging a greater uptake of first aid confidence – that is, social connectedness training. and community efficacy. 5.5 The findings support the CBFA approach as a means to reduce inequality (of access), and promote a beneficiary-led/tailored approach to delivering the service. 5.6 Continue to focus on youth and schools as a way of targeting young people and creating an environment in which they can grow their own resilience.

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42 Assessing the links between first aid training and community resilience

Assessing the links between first aid training and community resilience 43 6 References British Red Cross (2010). Community-based First Aid Outputs and Outcomes. First Aid Education Department, British Red Cross internal document. British Red Cross (2009). Inclusive First Aid: Programme Report and Evaluation. British Red Cross internal document. Cabinet Office (2010). Building the Big Society. Retrieved February 27, 2011, from www.cabinet- office.gov.uk/news/building-big-society Cutter, S.L., Emrich, C.T., & Burton, C.G. (2009). Baseline Indicators for Disaster Resilient Communities. University of South Carolina, Community and Regional Resilience Institute (CARRI) workshop presentation. Retrieved August 09, 2010, from http://www.resilientus. org/library/Susan_Cutter_1248296816.pdf Daly, M., Becker, J., Parkes, B., Johnston, D., & Paton, D., (2009). Defining and measuring community resilience to natural disasters. Tephra, 22, 15-18. Forgette, R., & Van Boening, M. (2009). Measuring and Modelling Community Resilience: SERP and DyME. Retrieved August 05, 2010,

44 Assessing the links between first aid training and community resilience from http://www.serri.org/publications/ Norris, F., Stevens, S., Pfefferbaum, B., Wyche, K., Documents/Ole%20Miss%20Project%20 & Pfefferbaum, R. (2008). Community resilience 80038%20Measuring%20and%20Modeling%20 as a metaphor, theory, set of capacities, and Community%20Resilience%20%20Global%20 strategy for disaster readiness. American Journal Horizons%20Submission%20(Forgette%20 of Community Psychology, 41, 127-150. and%20Boening).pdf Nzegwu, F. (2010). Defining Resilience at British Glendon, A.I., & McKenna, S.P. (1985). Using Red Cross: A Research Study. British Red Cross accident injury data to assess the impact of internal document. community first aid training. Public Health, 99(2), 98-109. Penrose, H. (2009). First Aid Research Amongst the General Public Measuring Confidence, Gurwitch, R.H., Pfefferbaum, B., Montgomery, Competence and Willingness to Act. British Red J.M., Klomp, R.W., & Reissman, D.B. (2007). Cross internal document. Building Community Resilience for Children and Families. Retrieved September 16, 2010, from Sampson, R.J., Raudenbush, S.W., & Earls, F. http://www.nctsnet.org/nctsn_assets/pdfs/edu_ (1997). Neighbourhoods and violent crime: A materials/BuildingCommunity_FINAL_02-12-07. multilevel study of collective efficacy. Science, pdf 277, 918-924. Home Office (2011). Strategic National Twigg, J. (2007). Characteristics of a Disaster Framework on Community Resilience, March Resilient Community: A guidance note. 2011. Retrieved November 07, 2011, from Retrieved September 06, 2010, from http:// http://www.oxfordshire.gov.uk/cms/sites/default/ www.proventionconsortium.org/themes/default/ files/folders/documents/fireandpublicsafety/ pdfs/characteristics/community_characteristics_ emergency/StrategicNationalFramework.pdf en_lowres.pdf International Federation of Red Cross and Red Van de Velde, S., Heselmans, A., Roex, A., Crescent Societies (ICRC), 2010. First Aid for a Vandekerckhove, P., Ramaekers, D., & Aertgeerts, Safer Future, Updated Global Edition. Advocacy B. (2009). Effectiveness of non-resuscitative first report 2010. aid training in laypersons: A systematic review. Annals of Emergency Medicine, 54(3), 447-457. Laurie, E. (2008). Is There a Need for Community-based First Aid (CBFA) in the Northwest of Northern Ireland? British Red Cross internal document. Lingard, H. (2002). The effect of first aid training on Australian construction workers’ occupational health and safety motivation and risk control behaviour. Journal of Safety Research, 33(2), 209-230. McKenna, S.P., & Hale, A.R. (1982). Changing behaviour towards danger: The effect of first aid training. Journal of Occupational Accidents, 4, 47-59. 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: Jonathan Banks, 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 Stickley, Page 33: lloyd Sturdy, Page 34: Jonathan Banks, Page 36: layton Thompson, Page 37: Simon Clark, lloyd Sturdy, Page 38: Jonathan Banks, Page 40: Catherine Mead, Page 41: Jonathan Banks, lloyd Sturdy, Page 42: Simon Clark

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