The impact of basic first aid training on knowledge levels of school-aged children

Aim : Children’s increased physical activity and independence, coupled with their inability to take precautions, increases the risk of injury. Learning first aid is crucial in preventing deaths resulting from accidents or injuries, as well as preventing the worsening of the patient’s condition and facilitating recovery. This study was conducted to determine the impact of basic first aid training on knowledge levels of school-aged children. Material and Method: This quasi-experimental study was conducted with 265 students in the 5th grade of four secondary schools in İstanbul. Data were collected using the “Information Form” and “Knowledge Assessment Form for First Aid Training”. Students received 90 minutes of instruction as part of their basic first aid training. Data were collected face-to-face before and one-month after the training. Results : The average age of the students was 10.17±0.45 years and 57.4% (n=152) were female. The students’ mean first aid knowledge scores before and after the training were 63.94±5.35, 92.67±9.70, respectively, and there was a statistically significant difference between them (p<0.05). While the age did not affect the average first aid knowledge scores, it was determined that the gender variable did. Conclusion : It was determined that the basic first aid training given to 5th

activity and independence and their inability to take precautions increase the risk of injury.Accidents can have a significant impact on the physical, psychological, and social health of children, and in some cases, can result in illness, disability, or even death.For this reason, childhood accidents are a public health problem that needs to be emphasized (Akçay and Yıldırımlar, 2018;Özsoy et al., 2019).
First aid is a non-pharmaceutical intervention performed on-site during accidents or life-threatening situations using available tools and equipment, without medical devices, to preserve life or prevent the situation from worsening until paramedics arrive (Turkish Ministry of Health, 2015).Approximately 50 percent of all fatalities occur in the first 30 minutes after an accident or injury has occurred.Considering that approximately 5.1 million people in the world and 250 thousand people in Europe die due to accidents and injuries every year, the importance of first aid practices is more understood (Eurosafe, 2019).
Every year in Turkey, many individuals either lose their lives or become disabled due to accidents, diseases, and disasters that occur at home, work, school, or on the road.Since there will not always be a paramedic at the scene in the early period after any accident/incident, the first aid practices that people in the environment or those affected by the event will do to themselves or others are extremely important (Dieltjens et al., 2013).First aid practices are crucial for preventing death and deterioration of health status with simple interventions.Therefore, students need to know basic first aid practices (Akçay and Yıldırımlar, 2018).In the event of injuries resulting from a school accident, the child is expected to remain calm and administer first aid to their injured friend.They should also report the situation to emergency medical personnel and teachers (Akkan, 2018).
Providing education to school-age children enables them to learn more quickly and be more motivated than adults.First aid education in schools not only teaches students good health habits but also helps them transfer correct health behaviors and knowledge to their families and indirectly to society (Bulduk, 2017;Akkan, 2018;Özsoy et al., 2019;Aksu, 2020).Especially during middle school, children begin to develop abstract thinking skills, allowing them to view their environment from multiple perspectives.Additionally, formal and logical thinking abilities are also developed during this time.Therefore, this is the time when they will be successful in learning the knowledge and practices of first aid (Uray et al., 2003).First aid and health education programs developed during school years can reduce the incidence of adverse events, such as life-threatening accidents (Bulduk, 2017).However, the creation of an effective training plan is just as important as the delivery of the training itself (Akkan, 2018).Studies have reported that the first aid knowledge and skill levels of schoolage children are insufficient, despite the inclusion of basic first aid knowledge in the education curriculum (Akçay and Yıldırımlar, 2018;Aksu, 2020;Düdükçü et al., 2022).Therefore, first aid training should be provided to school-age children.In this context, this study was conducted to determine the impact of basic first aid training on knowledge levels of school-aged children.

MATERIAL AND METHOD
This quasi-experimental, pretest and posttest single group study was conducted between 02 October 2023 -29 December 2023 in four secondary schools located in Ümraniye/İstanbul.The cooperation protocol between the university and the Directorate of National Education (Ümraniye), along with the support of the school administrations, was instrumental in selecting the schools for the research.The population of the research consisted of 5th grade students of the secondary schools where the research was conducted.The study included sections of classes that were recommended by the school's administration.The research sample consisted of students who attended the specified classes and whose parents consented to participate in the study, received face-to-face instruction, and completed the questionnaires in full.The research was conducted with 265 students in nine classes in total in four secondary schools.
This research was carried out within the scope of the "Cooperation for Projects to be Realized to Protect and Improve Children's Health" protocol signed by Istanbul Medeniyet University, Ümraniye District Governorate and Ümraniye National Education Directorate.To carry out the project, necessary permissions were obtained from the University administration and Ümraniye Directorate of National Education.Before starting the research, parents were informed by the school administration.As part of the project activities, the researchers trained students in basic first aid.Education Topics; • General first aid information, The trainings were conducted in a classroom and lasted for two hours.The 'First Aid Seminar for Children' PowerPoint presentation, prepared by Kızılay, was used.Necessary permission was obtained from Kızılay to use the presentation.A total of 18 hours of face-to-face training were provided within the scope of the project.

Data Collection
Data were collected face to face in a classroom.Informed consent was obtained from students' parents before completion of questionnaires and participation in training.Data were collected using the "Information Form" and "Knowledge Assessment Form for First Aid Training".
Information Form: The form developed by the researchers includes questions about the students' age, gender, grade and first aid training (Yalçın, 2010;Bulduk, 2017;Aksu, 2020).
Knowledge Assessment Form for First Aid Training: It was developed by Yalçın in 2010 to correspond to the cognitive goals expected to be acquired in first aid training, and its validity and reliability were tested.It consists of a total of 34 multiple-choice questions includes general first aid information (8 questions), characteristics of the first aider (1 question), human body (1 question), evaluation of the patient/injured person and the scene (9 questions), first aid in case of bleeding (5 questions), first aid in case of burns and frostbite (3 questions), first aid in case of fracture (2 questions), first aid in case of poisoning (3 questions), first aid in respiratory tract obstruction (2 questions).Each question is evaluated as "I don't know", "I know" or "misunderstood".The scoring system for the question is as follows: 'Correct' is worth 3 points, 'I don't know' is worth 2 points, and 'Wrong' is worth 1 point.The highest score from the scale is 102 and the lowest score is 34.The Cronbach's alpha of the original scale was 0.743.In this study, the Cronbach's alpha of the scale was found as 0.896.

Statistical Analysis
Data were evaluated in the SPSS 25.0 program (IBM SPSS Statistics for Windows, Armonk, NY: IBM Corp.) Mean, standard deviation, frequency, percentage, minimum and maximum were used as descriptive statistical methods.The suitability of continuous variables for normal distribution was evaluated with the Kolmogorov-Smirnov test.For intergroup comparisons of continuous variables, the Mann Whitney U test was used for two groups, while the Kruskal-Wallis test was used for multiple groups.T test was used in dependent groups to compare pre-test and post-test score averages.p<0.05 level was considered statistically significant.

Ethical Consideration
This research was conducted in accordance with the principles stated in the Declaration of Helsinki.Ethics committee approval (Number: 2023/2300060012) was obtained from the university.The purpose and voluntary nature of the study were explained to participating students and their parents.Written consent was obtained from the parents.
The distribution of the students' answers to the questions in the "Knowledge Assessment Form for First Aid Training" in the pre-test and post-test are shown in Table 2 and Table 3.The results indicate a significant increase in the rate of correct answers given by students in the post-test of the "Knowledge Assessment Form for First Aid Training" compared to the pre-test.The students' mean first aid knowledge scores before and after the training were 63.94±5.35 and 92.67±9.70,respectively, and there was a statistically significant difference between them (p<0.05).It was determined that the posttest total score of the "Knowledge Assessment Form for First Aid Training" was statistically significantly higher than the pre-test (Table 4).While the age did not affect the average first aid knowledge scores, it was determined that the gender variable did.The mean scores of female students are higher than those of male students, and the difference between them was determined to be statistically significant (p<0.05)(Table 5).

DISCUSSION
This study was conducted to determine the impact of basic first aid training on knowledge levels of schoolaged children.The majority of students aged 9-11 who participated in this study (94.7%) stated that it was necessary to receive training in first aid.When  (Eyi et al., 2016;Bulduk, 2017;Akkan, 2018;Mohammed, 2018;Panda et al., 2019;Aktaş et al., 2020;Cheng et al., 2021;Mehreen et al., 2021;Düdükcü et al., 2022;León-Guereño et al., 2023).Since education is a value that increases awareness, nurses should provide education in schools to improve students' basic first aid knowledge and skills.In addition, incorporating first aid training into the school curriculum can be effective in quickly and accurately addressing accidents and injuries.In a similar study conducted with secondary school students, students received first aid training in two 45-minute sessions and were post-tested four weeks after the training.It was reported that the scores for students' knowledge of first aid increased as a result of the training provided (Aktaş et al. 2020).In a study conducted with primary and secondary school students aged 7-14, it was found that their knowledge about first aid increased after 40 minutes of training (Eyi et al., 2016).

İbrahimoğlu vd.: Çocuklarda temel ilk yardım eğitiminin etkinliği
Studies in various countries have shown that first aid training is effective in increasing secondary students' first aid knowledge.Bánfai et al (2017) conducted a study with students aged 7-14, providing them with theoretical and practical first aid training consisting of three 45-minute sessions.The study found that the training increased the students' knowledge and skills in responding to accidents that may occur at school.
Two studies conducted abroad with secondary school students found a significant increase in their knowledge level two weeks after receiving first aid training (Bandyopadhyay et al.,2017;Panda et al., 2019).The results of this research are similar to the literature.A systematic review study involving students aged 6-10 in America and Europe found that first aid programs improve students' knowledge and skills (Tse et al., 2023).
In the study conducted by Wilks et al (2016) In this study, it was found that while the age did not affect the average first aid knowledge scores, it was determined that the gender variable did.The mean first aid knowledge scores of female students were higher than those of male students.Research shows that students' scores on their knowledge of first aid tend to increase as they get older (Bánfai et al., 2017;Aksu, 2020).The cognitive and motor development of students increases with age, leading to greater success in their knowledge and skills related to first aid practices.This study found that the average first aid knowledge score was not affected by age.This may be due to the fact that the students were in a similar age group.Although this study found that female students had higher average first aid scores than male students, it was reported that gender had no effect on average first aid scores (Bulduk, 2017;Akkan, 2018;Aktaş et al, 2020).It is thought that this difference obtained from this study is only statistically significant, and the differences require further validation with a larger sample size.

CONCLUSION
The study found that the basic first aid knowledge of school-age children was inadequate, but after the training, the students' basic first aid knowledge and skills improved.Children may face various risks during their lives, and it is crucial for them to learn how to cope with these situations to ensure their healthy and safe development.The health and safety of children play a crucial role in the future of societies.Being aware of the potential risks that children may encounter in their daily lives and having basic first aid skills that they can apply in case of any accident or injury will contribute to the protection and maintenance of children's health.Longerterm studies aimed at improving health in schools and ensuring the continuity of educational programs that include awareness-raising activities for parents, teachers and other stakeholders will contribute to the awareness of the society.In addition, it is believed that providing school health services comprehensively to all children by employing nurses with at least a bachelor's degree and school health nursing training in all schools will contribute to the protection and improvement of students' health.

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Patient/injured/crime scene evaluation • First aid for respiratory tract obstructions • First aid for bleeding • First aid for fractures, dislocations and sprains • First aid for disorders of consciousness • First aid for burns and frostbite • First aid in case of poisoning • First aid for animal bites/stings • First aid for foreign objects in eyes, ears and nose

Table 4 .
Comparison of Pre-Test and Post-Test Results for Students' First Aid Knowledge Scores (N=265)

Table 5 .
Comparison of Pre-Test and Post-Test First Aid Knowledge Scores According to Students' Descriptive Characteristics (N=265) Iserbyt et al (2014)2 received one-day basic life support training.Tests were administered one week before, one week after, and eight weeks after the training.It was found that there was a statistically significant increase between the pretest and post-test and the first aid knowledge provided was retained at the 8-week follow-up.They suggest that short, targeted training programs can significantly benefit children by providing them with basic skills and confidence to respond to emergencies(Wilks et al., 2016).Iserbyt et al (2014)reported a significant increase in the skill level of secondary school students after 50 minutes of basic life support training, and the students performed well in practice.In this study, students received two hours of theoretical and practical training, and the post-test administered four weeks after the training showed an increase in student knowledge, consistent with the literature.