“Help! My friend’s stopped breathing!”

Would YOU know how to react in a medical emergency?

The problem and its importance
First-aid can be defined as the first assistance or immediate care given to an individual who is either ill or injured, and usually focuses on keeping someone in a stable condition until emergency services arrive (Sharif, Hasan, Jamaludin & Firdaus, 2018). Research by the Red Cross (Red Cross, 2018) found that only 5% of people would be confident in their ability to administer first aid. This premise is supported by research at Warwick University; Hawkins et al. (2017) found that although nearly 1 in 5 people had witnessed a person collapse and require CPR, the majority did not act. These statistics were shocking to us. Consequently, we took it upon ourselves to conduct similar research into this issue. 

Our survey of University of Warwick students revealed that:

• 93% of students would be keen to learn more about first-aid
• 79% were unaware of any first aid societies at Warwick
• Only 7% would be confident every time in how to act during a medical emergency

Figure 1. Student's responses to: "Do you think there's more you could learn about what to to in a medical emergency?"

Attempts have been made by the university to counter these issues, such as the recent LifeSaver SU event. However, It was found that 87% didn’t even know this event existed with only a mere 1 participant stating they’d attended. 

When compared to adults, adolescents are more likely to find themselves in a situation where first-aid is required. These scenarios are often the consequence of physical activity-related injuries at their place of education or neighbourhood (Başer, Çoban, Taşci, Sungur & Bayat, 2007). The number of potentially preventable pre-hospital deaths occurring due to a lack of successful first-aid response remains high and unchanged when compared to figures from the 90s (Oliver & Redmond, 2017). Given the significant potential danger to life caused by the lapse of first aid knowledge, it is of high importance that young people are given more opportunity to learn how to react in an emergency. Consequently, we have formed the Warwick Medical Emergency Movement. Our aim is to cause life-saving behaviour change by encouraging students to engage with, and learn about, first aid. 

Our target audience 

We decided to target Warwick University students for the project. Our initial research demonstrated that this group of individuals were motivated to learn more about first-aid. Additionally, it is well-documented within the literature that individuals are more likely to be persuaded by people who are similar to themselves. When communicators are similar to us we tend to like and subsequently trust them (Priester & Petty, 2003). Therefore, we believed that having common traits with our target audience, such as age and being Warwick students, would lead them to accept our message without critically evaluating its content, ultimately leading to successful behaviour change.  We carefully designed our interventions to make them attractive to the student population. For example, we chose to hold our event at 5 pm on a Monday as this is when most students were available. Additionally, we ensured the desired behaviours were free, accessible and quick to complete due to students often having limited time and disposable income. We wanted students to not only attend our event but utilize opportunities already available at Warwick. The first-aid courses run by Warwick first-aid society are free, short and on campus, making them more appealing to students to increase the likelihood they will attend.

Our intervention methods

1.    Direct engagement with our target audience 

We reached out to students on campus to inform them about the movement, our upcoming event and the first-aid training opportunities available on campus. This was done by simply stopping students around campus and through our stall which was set up for 2 hours on the piazza. Whilst speaking to people we were able to distribute 30 flyers and 140 stickers. We varied the location, day and time of day to reach a wide variety of people.

  








2. The Website and Flyers

Flyers were produced to spread awareness of the event and use social norm techniques to persuade people to attend. 30 flyers were put up in locations around campus with high foot-fall e.g. lecture doors. We also created a webpage which describes the movement’s aims, event details and information about the first-aid opportunities on campus. This website was advertised on the Facebook event and students were directed towards it when engaged with on campus. 

• https://warwickmedicalemergencymovement.com

3.    Our event 

The main aims of our event were to ‘bust common myths’ about how to react in a medical emergency, provide people with essential first-aid tips and encourage people to get involved in the first-aid training opportunities already available on campus. We reached out to Warwick first-aid society and Warwick Wilderness Medicine who agreed to collaborate with us and speak at the event. 20 individuals attended.

4.    Student discount

We contacted numerous local first-aid companies via email to see if they would provide us with a student discount for their courses. The company ‘first-aid response’ agreed to provide a discount which we advertised on our flyers, website and event. This provided another opportunity for students to become first-aid trained if they couldn’t attend the opportunities on campus or wanted an in-depth course. Despite its simplicity, this highlights the power and success associated with “just asking” for a desired  behaviour or outcome. 

Operationalising our Behaviour Change

To verify the impact of the behavioural influence within our interventions, we used responses to the Facebook event page and attendance to the event as measurements. Ultimately we hope that there will be a measurable change in sign-ups to first aid societies at Warwick, however, due to the constraints of this project the data on that will not be available in time.

Psychological and Persuasion Techniques: 

Techniques within the MINDSPACE mnemonic, a framework collating evidence-based influences on behaviour, was used to inform our intervention and enact behavioural change. We chose to focus on five out of the nine effects, with these being most suitable for the context and aims of our intervention.

Messenger 

At our event, members of first-aid related societies, such as ‘Warwick Wilderness Medicine’, delivered short, engaging presentations. This focused on the ‘messenger’ element of the Mindspace mnemonic, as the facts came directly from a credible source, as opposed to a layperson. Dolan et al. (2012) conveyed that the perceived authority of the individual presenting the information has a direct impact on the value we associate with it. Therefore, it was more effective to use a society member who has training and experience rather than information only coming from us. This is supported by a variation of the classic obedience study, where participants were more likely to obey an instruction from a perceived ‘expert’ in a lab coat than an individual dressed normally (Milgram, 1963). 

Norms 

By creating a social norm, or at least the illusion of a norm, it has the potential to enact a behavioural change. Most relevant to the health domain we intend to address, a Cochrane Review by Moreira, Smith & Foxcroft (2009) found that the use of social norms was useful in reducing alcohol misuse in university students. There are two distinct types of social norms: injunctive and descriptive, with the former describing what is commonly believed and the latter referring to what is commonly done (Cialdini, Kallgren & Reno, 1991; DeGroot, Abrahamse & Jones, 2013). To apply this to our goal, we utilized one of our survey statistics and highlighted that “93% of Warwick students said they would be keen to learn more about medical emergencies” as a focal point on the event flyer. This injunctive norm highlights the willingness of Warwick Students to actively ensure they know more about first aid, and we believed this message would encourage other students to ‘follow suit’.

Salience 

Every day we are faced with an onslaught of attention-seeking stimuli, each having the potential to influence our behaviour. Consequently, people have learnt to filter out irrelevant stimuli and only use up their precious attentional resources on stimuli that are novel, simple and personally relevant. Stimuli can attract an individual’s attention through their properties or by the organism’s goals; when designing our intervention, we ensured stimuli had one of these attention-grabbing features (Diyjak, 2019). On our flyer, webpage and event description we repeatedly used the slogan “Would YOU know how to react in a medical emergency?”. The capitalised ‘you’ makes it feel specific to the individual reading and triggers an automatic consideration of the hypothetical scenario, both factors together making it hard to ignore.  

Affect 

When faced with threatening information, an individual’s perceived efficacy influences their response; those who believe they cannot change the threat often ignore or react against it whereas those with high levels of perceived efficacy are likely to show desired constructive behaviours (Nabi, 2015; Witte, 1992). A vast literature demonstrates the role that efficacious beliefs play in instigating and maintaining change in young people (Bandura, 2001). The potential scenario of a medical emergency occurring and no bystanders knowing how to respond is likely to be threatening to most individuals. Attendees at our event were shown a short video about the importance of first aid which contained an emotional medical emergency scene, used as a fear appeal. We ensured the audience felt high self-efficacy in their ability to learn how to react in a medical emergency; we provided basic first aid information and emphasized the numerous accessible first-aid training opportunities on campus. Careful selection of both the video and efficacy boosting information aimed to ensure the individual’s perceived efficacy outweighed the perceived threat, consequently increasing the likelihood of our target desired behaviours. 

Commitment & Ego

A prominent issue in enacting behaviour change is convincing people to exert their willpower and follow through on their intentions. To combat this, research has shown that using a foot-in-the-door technique can increase engagement with health-related interventions (Godin, Vézina-Im, Bélanger-Gravel & Amireault, 2012). This technique works through the exploitation of cognitive dissonance. Gaining the compliance of an individual for a small favour influences their attitudes and, eventually, they adjust their behaviour to align with that attitude to avoid dissonance (Freedman & Fraser, 1966). Public commitment to attitudes has been shown to increase the success of health interventions (Bradford, Grier & Henderson, 2017). By making the initial compliance public, it creates potential social repercussions for not aligning attitude and behaviour. Our interventions looked to gradually increase public commitment by utilising the foot-in-the-door technique and convincing people to wear a small ‘Warwick Medical Emergency Movement’ sticker featuring the statement “I want to save a life”, to publicly affirm their intentions. We also encouraged people to register their interest in the Facebook event to make a public statement on their intentions. Both of these techniques can be seen in the images below.

Future plans for the project 

After the success of our event, we are planning to run another event in Term 3 and hopefully ‘pass the baton’ on to another student who will continue to run termly first-aid awareness events in the next academic year. We believe we have created a strong relationship with both Warwick First Aid and Warwick Wilderness Medicine Societies that can be sustained into the future. The societies appreciated the insight we provided on how to change behaviour and plan to use some of the techniques in their own marketing.

Group members:
- Chloe Benson
- Alicia Patel
- Oliver Milner

References 

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