Knowledge and attitude of community health workers about first aid

Cassia Vitória de Oliveira Santos¹, Vitória Araújo de Sousa Macêdo², Rosana dos Santos Costa³, Fabio Rodrigues Trindade⁴, Adelianna de Castro Costa⁵

^1,2,3,4,5Federal University of Piaui. Teresina (PI), Brazil.

Introduction

First Aid (FA) is defined as providing immediate care to victims of accidents or sudden illness in life-threatening situations. Thus, this care must be carried out by the person closest to the victim, to maintain their vital functions and prevent their state of health from worsening until specialized assistance arrives.¹ It is therefore understood that any and all people need to be able to provide FA since emergencies happen without time or place. 

The Community Health Worker (CHW) is a professional who is part of the Family Health Strategy (FHS) team and, in the universe of Primary Health Care (PHC), they play a multifaceted role and establish a vital bridge between the community and the health service. However, the effectiveness of their work goes beyond collecting information about the families and community in their area of responsibility and also includes the ability to deal with unforeseen situations, such as urgencies and emergencies.²

Among the situations that require immediate action in the out-of-hospital environment are sudden death, choking, poisoning, and seizures, among others. Data on the incidence of these events is scarce, however, it is estimated that in Brazil there are more than 200,000 cardiorespiratory arrests a year, and, of these, around 180,000 occur outside of a hospital, with an estimate that four out of five arrests occurred in the home environment.³ As for choking in particular, the number of deaths in the country between 2009 and 2019 reached 2,148 cases in the age group up to nine years old, with cases of airway obstruction due to food ingestion, mainly in homes and schools.⁴

However, despite the high incidence of these events in the community, it has been observed that in many regions there are gaps in the knowledge and practice of CHWs concerning FA.³ In this sense, it is emphasized that in the context of community health, the interaction of CHWs with the population is not limited to the transmission of information, but involves building bonds of trust. Therefore, investing in continuing training for CHWs regarding FA not only improves their technical skills but also strengthens the relationship of trust with the community.⁵

Given the importance of training CHWs in FA, as a fundamental strategy to strengthen the primary healthcare network and the rapid response to adverse incidents, this study aimed to analyze the knowledge and attitude of CHWs regarding FA before and after an educational intervention.

Method

This is a study with a quasi-experimental design, characterized by intervention in a single group, with pre- and post-intervention evaluations. 

The research took place in the municipality of Teresina (PI). The municipality has approximately 868,000 inhabitants and 264 FHS teams, which cover 95.7% of the population. These teams are distributed among the four regional health centers: South, North, East, and Southeast.⁶

Due to accessibility criteria, we chose to collect data from CHWs linked to the North health region, which has 43 FHS teams and a total of approximately 196 CHWs. By calculating the sample size for finite populations, with a margin of error of 5% and a 95% confidence level, the estimated sample was 110 participants. Of this total, 17 participants had their data collection instruments excluded due to incomplete answers, so the final sample consisted of 93 CHWs. In addition, the inclusion criterion was CHWs who were in the course of their duties. Those on leave, on vacation, or away for any other reason were excluded. 

After authorization from the coordinators of the northern regional health office, contact was made with the CHWs via a Google Forms® link, which was distributed through the area supervisors of this regional health office. Access to the link provided directed the CHWs to a form that presented the aim of the study, the data collection method, the dates and times of the FA educational intervention, and the invitation to take part in the study. It was emphasized that participation was voluntary and without financial compensation. Professionals who agreed to take part in the study had to fill in the registration form on the same form.

The data was collected in three stages. In the first, a pre-test (data collection instrument) was applied to previously assess the CHWs' knowledge and attitude towards FA. In the second, an educational intervention on FA was carried out. In the third stage, the same instrument from the first stage was reapplied as a post-test to assess the knowledge and attitudes acquired after the educational intervention.

The data collection instrument was designed specifically for the study. The procedure consisted of questions about the participants' sociodemographic and occupational characteristics (age, gender, self-reported skin color, schooling, family income, marital status, length of time working as a CHW), knowledge about FA, and attitudes towards urgent and emergencies. The last two questions mentioned had ten questions each, based on the protocol of the American Heart Association⁷ and the European Resuscitation Council.⁸

The questions on knowledge had “true”, “false” and “don't know” as alternative answers. For the investigation into attitude, the last characteristic addressed in the data collection instrument, a Likert scale with five levels of answers was used: “strongly agree”, “agree”, “disagree”, “strongly disagree” and “no opinion”.

The FA educational intervention was carried out in an auditorium geographically located in the central area of the northern health region, in the form of a face-to-face extension course registered with the Pro-Rectory for Extension and Culture at the Federal University of Piauí, with a total class load of 10 hours, divided into two shifts. To allow CHWs to participate in the planned activity, two classes were offered on different dates.

The methodology used was a theoretical-practical approach, with the use of mannequins and simulation equipment, as well as other materials such as gauze, bandages, immobilization splints, a pocket face mask for ventilation, and the reproduction of slides and videos. The topics covered included basic life support, choking, seizures, burns, bleeding, musculoskeletal injuries, fainting, and fever. To carry out the practical part of the activity in each of the shifts, the participants were divided into four groups, which rotated through practical stations, each with different themes. Each station had the guidance of a monitor previously trained in FA techniques. 

To compare the pre- and post-intervention results, criteria were used based on the number of correct answers each participant got. These criteria were defined as follows: good, for those who got eight or more correct; fair, for those who got five to seven correct; and poor, for those who got four or fewer correct. The objective was to get a minimum of 70% right in the post-intervention period.^9-10

To analyze the data regarding the students' knowledge of the subject, “adequate question” was considered for correct answers and “not adequate” for wrong answers or when marked as “don't know”. As for attitude, the question was considered to be appropriate when the correct answer was marked “strongly agree” or “agree”, and the question was considered to be “not appropriate” when the incorrect answer was marked “strongly disagree” or “disagree”.

The data was organized in Microsoft Office Excel® spreadsheets and exported to the Statistical Package for the Social Sciences (SPSS Statistics), version 21.0. The analysis was carried out using descriptive statistics, with frequencies, measures of central tendency, and dispersion. Data normality was checked using the Kolmogorov-Smirnov test and the relationship between pre- and post-intervention correct answers was analyzed using the Wilcoxon test; the significance level was set at 5%.

The study was submitted to the Ethics Committee of the Municipal Health Foundation and to the Research Ethics Committee (REC) of the Federal University of Piauí (UFPI), approved under Opinion No. 6.709.607. It is worth mentioning that this study met all the requirements of Resolution No. 466/2012 of the National Health Council (NHC).¹¹

Results

This study analyzes the knowledge and attitudes of CHWs before and after an educational intervention on FA. Table 1 shows that the majority of CHWs are aged between 41 and 50 (40.9%), are female (71.0%), self-declare as brown (71.0%) and black (19.4%) and are married or in a stable union (58.1%).

As for education, 50.5% of these professionals have completed secondary school and 49.5% have completed higher education. The length of time they have worked as CHWs shows that the majority have between 11 and 20 years' experience (49.5%), or more than 21 years (46.2%). In terms of family income, most families earn between three and five minimum wages (59.1%), followed by those earning between one and two minimum wages (34.4%). 

Table 1 - Distribution of the sample according to sociodemographic variables. Teresina (PI), Brazil, 2024.

Variables	n	%
Age
31 to 40	13	14.0
41 to 50	38	40.9
51 to 60	35	37.6
> 60	7	7.5
Sex
Male	20	21.5
Female	66	71.0
No answer	7	7.5
Self-reported skin color
White	9	9.7
Brown	66	71.0
Black	18	19.4
Marital status
Married/stable union	54	58.1
Single/divorced/widowed	39	41.9
Education
High school	47	50.5
Higher education	46	49.5
Time working as a CHW
< 5 years	1	1.1
5 to 10 years	3	3.2
11 to 20 years	46	49.5
≥ 21 years	43	46.2
Family income
< 1 MW	1	1.1
1 to 2 MW	32	34.4
3 to 5 MW	55	59.1
> 5 MW	5	5.4

Table 2 shows the distribution of correct answers in the pre- and post-test. It can be seen that in the post-test, compared to the pre-test, there was an increase in the number of correct answers, both in the questions relating to knowledge and in the questions relating to attitudes.

In terms of CHWs' knowledge of FA, the pre-test showed that the questions with the lowest percentage of correct answers were about the unconscious victim (23.7%) and the influence of comorbidities on the prognosis of burns (32.3%). The questions with the highest percentage of correct answers were about choking in babies (88.2%) and the possibility of transmitting seizures (78.5%). Regarding the questions on attitude, in the pre-test, the questions with the lowest percentage of correct answers were on how to deal with cardiorespiratory arrest in drowning (5.4%) and on how to deal with fever in children (19.4%). 

As for the post-test, the lowest percentages of correct answers to the knowledge questions were about the use of homemade products for burns (60.2%) and the influence of comorbidities on the prognosis of burns (61.3%). The questions with the most correct answers were about choking in adults and choking in babies, both with 97.8%. As for attitude, the fewest correct answers were on how to deal with cardiorespiratory arrest in drowning (52.7%) and how to deal with a victim who is unconscious (67.7%).

Table 2 - Distribution of correct answers in the pre- and post-test. Teresina (PI), Brazil, 2024.

Question	Question summary	Pre-test		Post-test
		Correct answers		Correct answers
Questions about knowledge		n	%	n	%
Q1	Unconscious victim	22	23.7	70	75.3
Q2	Adult choking	37	39.8	91	97.8
Q3	Baby choking	82	88.2	91	97.8
Q4	Introduction of objects into victim's mouth during seizure	39	41.9	84	90.3
Q5	Transmission of seizures	73	78.5	88	94.6
Q6	Influence of comorbidities on burn prognosis	30	32.3	57	61.3
Q7	The relationship between compression and ventilation during cardiopulmonary resuscitation	37	39.8	60	64.5
Q8	Depth of chest compression in babies during cardiopulmonary resuscitation	32	34.4	88	94.6
Q9	Use of home-made products for burns	44	47.3	56	60.2
Q10	Fainting due to exposure to high temperatures	63	67.7	83	89.2
Questions about attitude
Q 1	Non-pharmacological management of fever in children	18	19.4	76	81.7
Q 2	Management of choking in infants	38	40.9	73	78.5
Q3	Management of a victim with a convulsive seizure	50	53.8	79	84.9
Q4	Management of a fracture with bone misalignment	74	79.6	85	91.4
Q5	Management of bruises resulting from trauma	48	51.6	68	73.1
Q6	Management of a victim with severe bleeding	69	74.2	88	94.6
Q7	Management of blisters from burns	69	74.2	87	93.5
Q8	Management of cardiopulmonary arrest in drowning	5	5.4	49	52.7
Q9	Management of an unconscious victim	39	41.9	63	67.7
Q10	Management of a victim in an unsafe place for the rescuer	41	44.1	69	74.2

Table 3 shows that before the educational intervention, the majority of CHWs got a fair score (64.5%) for knowledge, and in the post-test, the majority got a good score (78.5%). As for the questions on attitude, most of them were fair (50.5%) in the pre-test and good (63.4%) in the post-test.

Table 3 - Distribution of the sample according to the classification based on the number of correct answers to the questions on knowledge and attitude. Teresina (PI), Brazil, 2024.

Ranking based on correct answers	Pre-intervention		Post-intervention
Questions about knowledge	n	%	n	%
Good	4	4.3	73	78.5
Average	60	64.5	18	19.4
Poor	29	31.2	2	2.2
Questions about attitude
Good	6	6.5	59	63.4
Average	47	50.5	29	31.2
Poor	40	43.0	5	5.4

The Wilcoxon test, shown in Table 4, revealed a statistically significant increase in the number of correct answers to questions on knowledge (Z= -8.111; p = 0.001) and attitude (Z= -8.007; p = 0.001) when faced with situations involving the provision of FA, before and after an educational intervention on the subject. This table also shows that the average number of correct answers related to knowledge went from 4.94 to 8.26; the median went from five to eight questions, and the number of CHWs who answered 70% of the questions or more went from nine to 89. As for the questions on attitude, before and after the educational intervention, the average varied from 4.84 to 8.01, the median from five to eight, and the number of correct answers greater than or equal to 70% went from 14 to 83.

Table 4 - Descriptive statistics of correct answers on FA knowledge and attitude pre- and post-educational intervention. Teresina (PI), Brazil, 2024.

Descriptive statistics	Correct answers on knowledge		Correct answers on attitude
	Before	After	Antes	Depois
Mean	4.94	8.26	4.84	8.01
Median	5.0	8.0	5.0	8.0
Standard deviation	1.480	1.151	1.702	1.448
Minimum	1	4	0	4
Maximum	9	10	8	10
≥ 70% correct	9	89	14	83
Wilcoxon test	Z= -8.111; p = 0.001		Z= -8.007;  p = 0.001

Discussion

CHWs in Brazil's Unified Health System (UHS) play a fundamental role as community providers, often residing in the areas where they work, which gives them intimate knowledge of local lifestyles, traditions, and culture. In addition, these workers can develop essential communication, service coordination, teaching, advocacy, and interpersonal skills, positively impacting the health of the communities in which they work.¹²

The profile of CHWs found in this study is similar to that of other studies^13-14 and shows that the majority of these professionals are aged between 41 and 50 and have been working in the profession for more than 10 years. This indicates the existence of a mature and experienced workforce, possibly as a result of the fact that they are hired through public tenders, which gives them greater job stability and a reduction in turnover.^15-16 In terms of gender, women are predominant in this profession, which may be a reflection of the female image as the caregiver, as well as being an occupation in which the professional does not need to move away from the community in which she lives, a factor that allows her to enter the job market with fewer implications for domestic activities and childcare since most of them are married or live in a stable union.^15,17

Other sociodemographic aspects presented by the majority of CHWs in this and other studies^15,18 refer to the higher prevalence of brown skin color, complete high school, and family income of three to five minimum wages. The 2022 Census¹⁹ showed that most Brazilians consider themselves to be brown, a reality that coincides with the results of these studies. To be hired as a CHW, some municipalities require a minimum level of secondary education,²⁰ which justifies the results found here. It is worth noting, however, that almost half of CHWs have completed higher education, which can facilitate the acquisition of new knowledge, better performance of their duties, and a greater increase in family income.¹⁵

The preparation of CHWs to provide emergency care to a victim in urgencies and emergencies can be decisive in saving lives.²¹ The analysis of the correct answers to the questions before the educational intervention, in terms of both knowledge and attitude towards providing emergency care, oscillated in large numbers from poor to fair. After the intervention, the concept was considered good. Similar results were also found in a study carried out in Juazeiro do Norte (CE),²² which shows that periodic training for these professionals leads to an improvement in knowledge of the area, which contributes to a reduction in morbidity and mortality in the community.²³

Knowledge of topics related to unconscious victims, with burns, as well as attitudes towards cardiopulmonary arrest in drowning and fever in children, had the lowest percentage of correct answers before the educational intervention. This is similar to a study carried out in Belo Horizonte (MG), which also showed low knowledge among CHWs on these topics.²⁴ This reality raises a concern, as the timely identification of unconsciousness, the rapid activation of the emergency service, and the immediate initiation of appropriate maneuvers for each case can be decisive for the victim's recovery.²⁵

Analysis of the questions after the educational intervention showed a significant increase in the number of correct answers; however, regarding knowledge, the questions on the subject of burns maintained, as in the pre-test, lower percentages of correct answers. It is noteworthy that burns are a very common accident in the home and that most people have had some experience of them and often cling to empirical knowledge and practices that are not scientifically recommended. Aspects such as these indicate resistance to changing attitudes towards burns,³ which may justify the results found here.

Drowning, the leading cause of death among children between the ages of one and four, requires appropriate assistance. When the victim is in cardiorespiratory arrest due to this cause, immediate and specific actions are essential, such as a greater number of ventilations when compared to cardiorespiratory arrest caused by other events.²⁶ These precautions are often unknown to most people, who may be resistant to change when faced with new information.²⁷ This objection may explain the lower percentage of correct answers to the questions on attitude, both in the pre- and post-tests. 

One of the topics with the highest percentage of correct answers in the post-test was choking, both in children and adults. This percentage is extremely important, as choking is a common and potentially fatal accident, especially in homes and schools.⁴ Improving CHWs' ability to deal with this situation can significantly reduce the associated mortality and morbidity, as well as their confidence at the time of action. A solid understanding of FA by CHWs not only promotes safety in communities but also increases the quality of care provided, parameters that contribute to mitigating damage and preserving lives.²

The post-test carried out after the educational intervention showed an increase in the number of correct answers to all questions. The average number of correct answers almost doubled in some questions when compared to the pre-test. The Wilcoxon test showed a statistically significant difference between the number of correct answers before and after the educational intervention, which demonstrates the effectiveness of this activity in improving CHWs' knowledge and attitude towards FA. It should also be noted that the positive changes in the number of correct answers in the post-test have also been shown in other studies, in which the participants also showed an increase in the number of correct answers to the questions after the educational action.^10,28

However, although the educational intervention carried out in this study was effective, there are still challenges and gaps in certain topics. On the other hand, the results presented here suggest that the interventions not only improve CHWs' technical knowledge but also strengthen their confidence and ability to make correct decisions in emergencies.²⁹ Therefore, it is worth emphasizing that continuing education and pedagogical adaptations are necessary to maintain and improve CHWs' professional skills over time, to provide more effective and safer emergency care when necessary, given their relevance in the context of community health.³⁰

Therefore, the importance of FA training for CHWs is undeniable, especially considering the crucial role these professionals play in the community. As they are often the first to arrive at the scene of an accident or emergency, CHWs have the opportunity to provide immediate assistance to the victim, which can be decisive for the outcome of the incident. In this context, investing in CHW training is fundamental to strengthening the primary healthcare network and ensuring a rapid and effective response to adverse incidents.²³

Conclusion

The CHWs' knowledge and attitude about FA before the educational intervention ranged from poor to fair; after the intervention, the concept was rated as good. The statistical test showed that the educational intervention was effective in improving the concepts, given the significant increase in the number of correct answers in the post-test compared to the pre-test.

Regularly training CHWs in FA enables them to acquire solid knowledge and appropriate skills to act, when necessary, in urgent emergencies in the community they assist. In this way, CHWs providing help in an appropriate way can both increase the population's confidence in the health system and increase the chances of survival for victims who need immediate care, thus contributing to a reduction in morbidity and mortality.

Authors Contributions

Study design: Cassia Vitória de Oliveira Santos, Vitória Araújo de Sousa Macêdo, Rosana dos Santos Costa, Fabio Rodrigues Trindade, Adelianna de Castro Costa. Data collection:  Cassia Vitória de Oliveira Santos, Vitória Araújo de Sousa Macêdo, Rosana dos Santos Costa, Fabio Rodrigues Trindade, Adelianna de Castro Costa. Analysis and interpretation of data: Cassia Vitória de Oliveira Santos, Vitória Araújo de Sousa Macêdo, Rosana dos Santos Costa, Fabio Rodrigues Trindade, Adelianna de Castro Costa. Manuscript writing: Cassia Vitória de Oliveira Santos, Vitória Araújo de Sousa Macêdo, Rosana dos Santos Costa, Fabio Rodrigues Trindade, Adelianna de Castro Costa. Critical review of the manuscript: Cassia Vitória de Oliveira Santos, Vitória Araújo de Sousa Macêdo, Rosana dos Santos Costa, Fabio Rodrigues Trindade, Adelianna de Castro Costa. Approval of the final version of the text: Cassia Vitória de Oliveira Santos, Vitória Araújo de Sousa Macêdo, Rosana dos Santos Costa, Fabio Rodrigues Trindade, Adelianna de Castro Costa.

Conflict of interest

The authors have declared that there is no conflict of interest.

References

1. Cruz KB, Luchesi BM, Cunha PHB, Godas AGL, Cesário ES, Martins TCR. Intervenciones de educación en salud en primeros auxilios en el entorno escolar: una revisión integradora. Enferm. Actual Costa Rica [Internet]. 2020 [cited 24  Aug 19]; 40: 43542. DOI:  http://dx.doi.org/10.15517/revenf.v0i40.43542

2. Silva HPR, Toassi RFC. Educação problematizadora em curso técnico para agentes comunitários de saúde: experiência de produção de significados no trabalho em saúde. Physis. 2022 [cited 2024 May 13];32(03):e320310. DOI: https://doi.org/10.1590/S0103-73312022320310

3. Martins DMB, Brandão MGSA, Araújo FDS, Albano LMC, Àvila ES, Neto NMG et al. Conhecimento e autoconfiança de Agentes Comunitários de Saúde sobre Primeiros Socorros e Parada cardiopulmonar. Rev Cuidarte. 2021[cited 2023 Dec 21];12(2):e1162. DOI: https://doi.org/10.15649/cuidarte.1162 

4. Costa IO, Alves-Felipe RW, Ramos TB, Galvão VBL, Aguiar MSB,Rocha VG. Estudo descritivo de óbitos por engasgo em crianças no Brasil. Revista de Pediatria SOPERJ. Rio de Janeiro; 2021 [cited 2024 Feb 25];21(1):11-14. DOI: http://dx.doi.org/10.31365/issn.2595-1769.v21isupl.1p11-14

5. Lotta G, Pires DNO, Bartos MSH, Gonçalves RC, Chiesa AM, Haddad AEl. São Paulo Carinhosa: formação intersetorial dos Agentes Comunitários de Saúde. Rev Bras Aval. 2022 [cited 2024 Feb 25];11(1):e110822. DOI: http://dx.doi.org/10.4322/rbaval202211008 

6. Fundação Municipal de Saúde de Teresina. Atenção Básica de Teresina é destaque em vinculação da população às equipes de Saúde da Família. Fundação Municipal de Saúde de Teresina. 2023 [cited 2024 Jun 30]. Available from: https://site.fms.pmt.pi.gov.br/noticia/4979/atencao-basica-de-teresina-e-destaque-em-vinculacao-da-populacao-as-equipes-de-saude-da-familia

7. Cheng A, Magid DJ, Auerbach M, Bhanji F, Bigham BL, Blewer AL et al. Part 6: resuscitation education science: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020 [cited 2024 Feb 25];142(2):S551–S579. DOI: https://doi.org/10.1161/CIR.0000000000000903

8. Zideman DA, Singletary EM, Borra V, Cassan P, Cimpoesu CD, Buck E et al. European resuscitation council guidelines 2021: first aid. Resuscitation. 2021 [cited 2024 june 14]; 161:270-290. DOI: https://doi.org/10.1016/j.resuscitation.2021.02.013

9. Oliveira CBS, Nascimento DJS, Gomes GER, Lima MIS, Albuquerque AM. Primeiros socorros na escola: perspectivas do conhecimento e da capacitação de professores. Educação, Ciência e Saúde. 2022 [cited 2024 Feb 25];9(1):138-154. DOI:  http://dx.doi.org/10.20438/ecs.v9i1.448

10. Ilha AG, Cogo SB, Ramos TK, Andolhe R, Badke MR, Colussi G. Ações educativas sobre primeiros socorros com professores da educação infantil: estudo quase experimental. Rev Esc Enferm USP. 2021 [cited 2024 june 14];55:e20210025. DOI: https://doi.org/10.1590/1980-220X-REEUSP-2021-0025

11. Conselho Nacional de Saúde. Resolução nº 466, de 12 de dezembro de 2012. [Internet] Brasília, DF: CNS; 2012 [cited 2024 May 14]; Available from: https://conselho.saude.gov.br/resolucoes/2012/Reso466.pdf
12. Rahman R, Pinto RM, Zanchetta MS, Lu j, Bailey R. Community health agents, nurses and physicians conducting research in Brazil’s family health program . Health Promotion International. 2019 [cited 2024 Feb 25];34(1):i92–i102. DOI: https://doi.org/10.1093/heapro/daz015

13. Nascimento V, Santos E, Santos J, Silva FS, Nunes SG. Caracterização do perfil sócio demográfico dos agentes comunitários de saúde. Encontro de Discentes Pesquisadores e Extensionistas. 2022 [cited 2024 June 24]; 1(01):e202213. Available from: https://revistas.uneb.br/index.php/edpe/article/view/15466

14. Mareco TCS, Gondim FSS, Andrade AM, Barros IS, Costa THGR. Projeto escola do trabalhador: perfil do agente comunitário de saúde. VITTALLE - Revista de Ciências da Saúde; 2020 [cited 2024 June 24];32(2):55–65.  DOI: https://doi.org/10.14295/vittalle.v32i2.9820

15. Maciel FBM, Santos HLPC, Silva RA, Souza EA, Padro NMBL, Teixeira CFS. Agente comunitário de saúde: reflexões sobre o processo de trabalho em saúde em tempos de pandemia de Covid-19. Ciênc Saúde Colet. 2020 [cited 2024 Aug 20]; 25(2):4185-4195. DOI: https://doi.org/10.1590/1413-812320202510.2.28102020

16. Santos RC, Ribeiro LF, Amado CF, Méllo LMBD, Santos L. Condições de trabalho dos agentes comunitários de saúde em um contexto de saúde digital: velhos e novos desafios. Interface (Botucatu). 2024 [cited 2024 Aug 20];  28: e230548. DOI: https://doi.org/10.1590/interface.230548

17. Mello LMBD, Santos RC, Albuquerque RC. Agentes Comunitárias de Saúde: o que dizem os estudos internacionais?. Ciência & Saúde Coletiva. 2023 [cited 2024 Aug 20]; 28(2):501-520. DOI: https://doi.org/10.1590/1413-81232023282.12222022

18. Cabral JF, Gleriano JS, Nascimento JDM. Perfil sociodemográfico e formação profissional de agentes comunitários de saúde. Rev Interdisciplinar Estud Saúde Uniarp. 2019 [cited 2024 May 13]; 8(2), 193–209. DOI: https://doi.org/10.33362/ries.v8i2.1537

19. IBGE. Instituto Brasileiro de Geografia e Estatística. Censo brasileiro de 2022. Rio de Janeiro; 2023. [cited 2024 May 13]; Available from: https://censo2022.ibge.gov.br/panorama

20. Brasil. Lei nº 13.595, de 5 de janeiro de 2018. Dispõe sobre o exercício profissional dos Agentes Comunitários de Saúde e dos Agentes de Combate às Endemias e dá outras providências. Diário Oficial da União, Brasília (DF); 8 de janeiro de 2018. Avaliable from: http://legislacao.planalto.gov.br/legisla/legislacao.nsf/Viw_Identificacao/lei%2013.595-2018?OpenDocument 

21. Yin G, Chen L, Wu Y, Zhao F, Zhu Q, Lin S. The implementation of a community-centered frst aid education program for older adults—community health  workers perceived barriers. BMC Health Services Research; 2023 [cited 2024 Aug 20];  23:128. DOI: https://doi.org/10.1186/s12913-023-09142-y

22. Melo OHPA, Nascimento MMX, Sampaio LRL, Vidal ECF, Pinheiro WR, Trigueiro ESO. Ações educativas em primeiros socorros para agentes comunitários de saúde. Rev Observatório Econ Latinoamericana. Curitiba; 2023 [cited 2024 June 24]; 21(12):25327-25350. DOI: https://doi.org/10.55905/oelv21n12-102

23. Correia LFR, Feitosa AF, Apolinário MVF, Ferreira ES, Braga ST, Pinheiro WR. The importance of teaching and learning first aid techniques for laypersons: integrative review. Rev Pesq Cuidado Fundam Online. 2024 [cited 2024 June 24]; 16:e11605. DOI: https://doi.org/10.9789/2175-5361.rpcfo.v16.11605

24. Cornelio GOS, Vieira AMS, Andrade BB, Ferreira ACL, Vieira BLC. Educação Permanente: conhecimento dos agentes comunitários de uma unidade básica de saúde sobre primeiros socorros. In: Anais do 8º Simpósio Brasileiro de Vigilância Sanitária  - Vol. 1, 2019; Belo Horizonte. Campinas, Galoá, 2020 [cited 2024 Feb 25]. Available from: https://proceedings.science/simbravisa-2019/trabalhos/educacao-permanente-conhecimento-dos-agentes-comunitarios-de-uma-unidade-basica?lang=pt-br

25. Bertoldo CS, Wickert DC, Maciel VdQS, Piccin C, Silva JL, Munhoz OL, et al. Noções básicas de primeiros socorros: relato de experiência de um projeto de extensão rural. Rev Bras Promoc Saúde [Internet]. 2019 [cited 2024 June 25];32:1-10. Available from: https://ojs.unifor.br/RBPS/article/view/8255 

26. David Szpilman e Diretoria 2022-26. Coleção SOBRASA 2023. Sociedade Brasileira de Salvamento Aquático SOBRASA - Available from: http://www.sobrasa.org 

27. Guy K, Ritchie A, Tumuhimbise P, Balinda E, Nasim K, Kalanzi M, Wipfli H. Mixed-methods community assessment of drowning and water safety knowledge and behaviours on Lake Victoria. Inj Prev. 2024 [cited 2024 May 13]; 10:ip-2023-045106. DOI: https://doi.org/10.1136/ip-2023-045106

28. Arruda-Barbosa L de, Salhah S, Vasconcelos IG, Sales AFG, Sales MC. Oficinas como ferramentas para ensino de primeiros socorros no ensino médio. Rev Bra de Edu e Saude [Internet]. 2020 [cited 2024 June 25]; 10(3):171-6. DOI: https://doi.org/10.18378/rebes.v10i3.8146

29. Oliveira WB, Gonçalves SHMS, Muller PS, Carmo HO. Impacto da capacitação em primeiros socorros sobre o conhecimento de educadores e agentes escolares. Revista de Divulgação Científica Sena Aires. 2022 [cited 2024 May 13]; 11(2):220-231. DOI:https://doi.org/10.36239/revisa.v11.n2.p220a231 

30. Paiva WR, Rodrigues VA da S. Treinamento de primeiros socorros para leigos e profissionais de saúde: avaliação de aprendizagem. Rev. Enf. UFJF [Internet]. 2024 [cited 2024 June 03] 10(1). DOI: https://doi.org/10.34019/2446-5739.2024.v10.40871

Corresponding Author

Cassia Vitória de Oliveira Santos.

E-mail:cassiavosantos@gmail.com

© The Author(s) 2025. This work is licensed under Creative Commons Attribution 4.0 International. License text for use: https://creativecommons.org/licenses/by/4.0/