| dc.description.abstract | Emergency care systems are essential for delivering rapid critical care, and the bystander, as the initial system activator, is crucial to its responsiveness. This study investigated the impact of bystander training on the responsiveness of pre-hospital emergency health care delivery in Nairobi City County, Kenya. An unmatched case-control design using mixed methods was employed, drawing theoretical guidance from the Theory of Planned Behaviour, the Bystander Intervention Model, the Golden Hour Theory, and Queuing Theory. Data were collected from 752 households, the Emergency Operations Centre (EOC), and Accident & Emergency (A&E) departments using questionnaires, Focus Group Discussions (FGDs), Key Informant Interviews (KIIs), and checklists. Quantitative data were analysed with SPSS using descriptive statistics, a Difference-in-Differences (DiD) model to measure the intervention's causal effect, and correlation analysis. Qualitative data were thematically analysed using NVivo 12. The study demonstrated that bystander training had a positive impact on several emergency response metrics. The training increased participants' knowledge (adjusted p=0.022 DiD) and improved overall decision-making capabilities (adjusted p=0.003 model). Crucially, the intervention led to meaningful improvements in composite willingness-to-help scores (p<0.001), primarily by reducing psychological barriers such as fear of being judged (p=0.001), concerns about legal consequences (p<0.001), and bystander waiting tendencies (p<0.001). Operationally, the training significantly increased the number of emergency calls placed (p=0.048), the number of patients receiving care (p=0.001), and ambulance utilization rates (p<0.0001). Most importantly, training of bystanders significantly reduced emergency notification intervals (P<0.001) with a large unadjusted DiD effect of 38.4. The intervention group experienced a 76% reduction in delays exceeding 15 minutes (from 80.4% to 4.1%) and a notable increase in responses within 0−5 minutes, confirming the training’s effectiveness in accelerating early emergency recognition and response. However, despite these numerous positive outcomes, the training did not improve the responsiveness times of pre-hospital emergency healthcare delivery in measured intervals: response (p=0.136), transportation (p=0.354), activation (p=0.851), and handover (p=0.818). The findings underscore the training's effectiveness in accelerating early response actions. It was recommended that the study results be used by the MOH, policymakers, and implementers to develop strategies for improving pre-hospital emergency healthcare delivery and increasing survival rates, including the incorporation of a bystander training component in the WHO Emergency Care System Framework (ECSF), thus overcoming some of the challenges faced by the health care systems in responding to emergencies.
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