Barriers and facilitators to learning and using first aid skills for road traffic crash victims in Nepal: a qualitative study

Background Road traffic injuries are a major global public health problem despite being avoidable and preventable. In many low- and middle-income countries, the victims of road traffic crashes do not receive care at the scene and may die before reaching hospital. In low- and middle-income countries where prehospital emergency medical services are not well established, bystanders have the potential to save lives by providing first aid. Nepal has rising rates of road traffic injuries and emergency medical services are early in development. There is limited evidence on the factors that influence people in Nepal to become trained in first aid and to use their first aid skills. Objectives To understand the barriers and facilitators to learning first aid and to applying those skills to help road traffic crash victims in Nepal. Design Qualitative study using semistructured interviews. Setting Kathmandu, Lalitpur, Bhaktapur, Kaski and Makwanpur districts in Nepal. Participants We interviewed three groups of participants: (1) members of the public who had never been trained in first aid, (2) members of the public who had been trained in first aid and (3) first aid trainers. Data sources Interviews explored reasons why people may be interested in being trained and factors that would inhibit being trained or applying their first aid skills. Interviews were transcribed, translated into English and analysed thematically. Results Respect from the public, a desire to help those in need and confidence to apply skills were important factors in encouraging people to learn and apply first aid. Barriers included lack of time and financial implications of providing first aid. The fear of social and legal consequences if the patient had a poor outcome, a lack of confidence to apply skills and lack of trust shown to first aiders by some members of the community discouraged learning and using first aid skills. Limitations Participants were mostly from urban and semiurban areas. People with more difficult access to health care may have held different views. People who were untrained in first aid and agreed to participate may hold different views to those who were not recruited, as they had interest in the topic. Conclusions Members of the public can be encouraged to learn and apply first aid skills to help road traffic crash victims, but there are multiple barriers to engagement in first aid. Providing legal protection from prosecution for first aiders, raising public awareness of the value of first aid, addressing financial constraints and provision of refresher training may address these barriers. Future work Research to address the barriers to the creation of a Good Samaritan law appears warranted. The perspectives of other groups often involved in the care and/or transport of road traffic crash victims, such as taxi drivers, would add to our understanding of factors affecting the application of first aid. The gendered stereotypes reported by female first aiders warrant further exploration. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme as award number 16/137/49.