Knowledge, self-efficacy, and fears following a multi-station first aid workshop for health-adjacent trainees in Karachi, Pakistan: a single-arm pre-post evaluation with exploratory three-month retention

Low- and middle-income countries bear over 90% of global injury-related mortality yet largely lack formal prehospital emergency systems, leaving laypersons as the primary point of care. In Pakistan, nearly 90% of out-of-hospital cardiac arrests are witnessed, but bystander resuscitation rates remain critically low, attributable to knowledge deficits, absent Good Samaritan protections, and unaddressed psychological barriers. Rigorous multi-domain evaluations of first aid training that simultaneously examine knowledge acquisition, self-efficacy, attitudinal barriers, and medium-term retention remain limited in South Asian contexts. A single-centre, single-arm, pre-post quasi-experimental study evaluated a structured multi-station first aid workshop at a tertiary academic institution in Karachi. A convenience sample of 132 health-adjacent trainees completed six competency-based stations covering cardiopulmonary resuscitation, haemorrhage control, fracture management, foreign body airway obstruction, and burns, delivered through didactic teaching, video demonstration, mannequin-based simulation, and facilitated scenario exercises. Paired data were available for 68 participants on knowledge, 100 on self-efficacy, 65 on perceived barriers, and 15 at three-month follow-up. Knowledge scores increased from a mean of 5.9 to 9.1 out of 13 (Cohen's d = 1.06), a large effect. Statistically significant item-level improvements were observed in 9 of 13 items, with the greatest gains in chest-compression rate, first response to witnessed cardiac arrest, and choking management. Self-efficacy improved significantly across all seven assessed domains, with mean gains of approximately 38 to 55 points on a 100-point scale. Perceived barriers, including fear of legal liability, patient harm, and performance panic, remained unchanged. Exploratory three-month knowledge retention averaged approximately 96% among returners, although this is likely a modest upper bound, as returners scored marginally higher post-training and the comparison was underpowered. The intervention produced substantial short-term gains in knowledge and self-efficacy. The persistence of psychological and legal barriers despite these gains suggests that cognitive instruction alone is insufficient to translate preparedness into bystander action, underscoring the need for integrated legal education and barrier-focused psychological components in future curricula.