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Exploring the factors motivating continued Lay First Responder participation in Uganda: a mixed-methods, 3-year follow-up
  1. Peter G Delaney1,
  2. Zachary J Eisner2,
  3. T Scott Blackwell3,
  4. Ibrahim Ssekalo3,
  5. Rauben Kazungu3,
  6. Yang Jae Lee4,
  7. John W Scott5,
  8. Krishnan Raghavendran5
  1. 1 University of Michigan Medical School, Ann Arbor, Michigan, USA
  2. 2 McKelvey School of Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
  3. 3 Empower Through Health, Mayuge, Uganda
  4. 4 Washington University School of Medicine, St. Louis, Missouri, USA
  5. 5 Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
  1. Correspondence to Peter G Delaney, University of Michigan Medical School, Ann Arbor, MI 48109, USA; petergde{at}


Background The WHO recommends training lay first responders (LFRs) as the first step towards establishing emergency medical services (EMS) in low-income and middle-income countries. Understanding social and financial benefits associated with responder involvement is essential for LFR programme continuity and may inform sustainable development.

Methods A mixed-methods follow-up study was conducted in July 2019 with 239 motorcycle taxi drivers, including 115 (75%) of 154 initial participants in a Ugandan LFR course from July 2016, to evaluate LFR training on participants. Semi-structured interviews and surveys were administered to samples of initial participants to assess social and economic implications of training, and non-trained motorcycle taxi drivers to gauge interest in LFR training. Themes were determined on a per-question basis and coded by extracting keywords from each response until thematic saturation was achieved.

Results Three years post-course, initial participants reported new knowledge and skills, the ability to help others, and confidence gain as the main benefits motivating continued programme involvement. Participant outlook was unanimously positive and 96.5% (111/115) of initial participants surveyed used skills since training. Many reported sensing an identity change, now identifying as first responders in addition to motorcycle taxi drivers. Drivers reported they believe this led to greater respect from the Ugandan public and a prevailing belief that they are responsible transportation providers, increasing subsequent customer acquisition. Motorcycle taxi drivers who participated in the course reported a median weekly income value that is 24.39% higher than non-trained motorcycle taxi counterparts (p<0.0001).

Conclusions A simultaneous delivery of sustained social and perceived financial benefits to LFRs are likely to motivate continued voluntary participation. These benefits appear to be a potential mechanism that may be leveraged to contribute to the sustainability of future LFR programmes to deliver basic prehospital emergency care in resource-limited settings.

  • prehospital care
  • prehospital care
  • basic ambulance care
  • prehospital care
  • first responders
  • global health

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  • Handling editor Margaret Samuels-Kalow

  • Twitter @PeterGDelaney, @ZacharyJEisner

  • Contributors PGD, ZJE, TSB, YJL, JWS and KR participated in study conception and design. TSB, IS and RK participated in data collection. PGD and ZJE analysed the data and wrote the manuscript. All authors revised the manuscript for important intellectual content, with JWS and KR providing overall direction. All authors made substantial contributions to the study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study received ethical approval by TASO (The AIDS Support Organization) (Kampala, Uganda) and the Uganda National Council on Science and Technology (Kampala, Uganda) (#TASOREC/32/16-UG-REC-009).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request from

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.