Survey of first-aid knowledge and attitudes among predominantly young, educated adults in Pakistan

First aid provided by lay responders in community, household, workplace, and other emergency settings can reduce preventable illness and death; however, first-aid knowledge, skills, and access to training remain uneven in low- and middle-income countries. Pakistan lacks nationally representative evidence on public first-aid knowledge and attitudes. This study had two objectives: first, to assess first-aid knowledge among adults in Pakistan; and second, to evaluate their attitudes toward first-aid training and identify sociodemographic and geographic differences to inform public health training strategies. We conducted a nationwide cross-sectional survey from September to November 2025 using a structured, bilingual (Urdu/English) questionnaire adapted from validated instruments. Non-probability quota sampling with an equal quota of 70 participants from each of seven provinces and territories recruited adults (≥ 18 years) through community sites and online dissemination. Healthcare workers and ALS-trained individuals were excluded. Knowledge (6-item score; higher = better) and attitude (3-item Likert score, 3–15; higher = more positive) were predefined outcomes. Descriptive statistics summarized distributions. χ² tests assessed categorical associations, one-way ANOVA compared provincial mean scores, and simple linear regression identified predictors of knowledge and attitude. Listwise deletion addressed missing data. Analyses were conducted using SPSS v26. Among 490 respondents, 52.4% were female and 47.6% were male; 89.2% were aged 18–30 years. Equal representation ( n = 70 each) was obtained from Azad Jammu & Kashmir, Sindh, Punjab, Khyber Pakhtunkhwa, Balochistan, Islamabad, and Gilgit-Baltistan. The mean knowledge score was 3.71 ± 1.45 out of 6; 43.1% had poor, 45.1% moderate, and 11.8% good knowledge. Provincial means differed significantly (ANOVA F(6,483) = 11.478, p < 0.001), with the highest score in Khyber Pakhtunkhwa and the lowest in Sindh. Province of residence was the strongest predictor of knowledge (R²=0.125), followed by education (R²=0.070) and occupation (R²=0.061). Knowledge was significantly associated with gender, marital status, age, education, occupation, and province (all p ≤ 0.001). The mean attitude score was 11.07 ± 2.23. Attitude was significantly associated with education and province ( p ≤ 0.001), with participants from Sindh and Gilgit-Baltistan scoring lower than those from Khyber Pakhtunkhwa. Only 187 (38.2%) participants had attended a first-aid course. Among the 303 who had not, the main barriers were course unavailability (55.8%), insufficient time (21.4%), and course fees (12.3%). First-aid knowledge among adults in Pakistan is moderate, with notable regional and educational disparities, although attitudes toward training are generally positive. Expanding accessible and standardized first-aid education, particularly in underserved regions through blended and community-based approaches, should be a national public health priority to bridge the gap between willingness and capability.