Enhancing Mothers’ Preparedness for Home Safety and Emergency Response: The Effect of Simulation-Based First Aid Training among Mothers of Under-Five Children

Introduction

Unintentional home injuries and acute medical emergencies remain major global causes of morbidity and mortality among children and vulnerable household members. Despite significant advances in child survival, preventable injuries such as drowning, burns, falls, and poisoning continue to cause substantial mortality, with an estimated 4.8 million deaths among children under five in 2023.¹ The home environment constitutes the most common setting for these incidents, and caregivers, particularly mothers, often serve as the first responders.^1,2 Prompt and correct first-aid responses can markedly reduce morbidity and prevent fatal outcomes.^3,4 However, evidence consistently shows that caregivers frequently lack adequate confidence, practical knowledge, and skills to manage home emergencies effectively. Studies reveal poor retention of safety education, unsafe household practices, and limited behavioral change following conventional informational interventions.² Studies conducted in community and clinical settings suggest that brief informational counseling alone often does not translate into safer behaviors or sufficient practical skills; combining education with hands-on practice and safety equipment yields better outcomes.^2,3 While structured training can enhance first-aid knowledge, skill retention typically declines without hands-on practice or scenario exposure.⁵

Simulation-based training (SBT), which incorporates realistic scenarios, role-play, and task trainers, has demonstrated effectiveness in improving knowledge, psychomotor skills, teamwork, and self-efficacy across healthcare and community settings.^6,7 It provides a safe environment for learners to practice rare but high-impact events, receive feedback, and build situational awareness, skills crucial for lay caregivers acting under stress and resource constraints.^6,8

Extending SBT to community caregiver education, particularly for mothers as primary in-home responders, represents a promising yet underexplored avenue. Recent studies indicate that scenario-based and hands-on interventions enhance first-aid knowledge, confidence, and certain safety behaviors among caregivers.^5,9 Nevertheless, there is limited evidence on long-term skill retention, real-world behavior change, and comparative effectiveness against traditional didactic approaches.^5,10 Mothers play a pivotal role in household safety, especially for infants and young children, as the most injury-prone age group. Research evidence linked maternal awareness and self-efficacy with improved emergency responses and child outcomes.¹¹ Therefore, targeting mothers with simulation-based first-aid curricula tuned to common household emergencies (choking, burns, drowning response, basic life support, bleeding control, and safe evacuation) may fill an important gap by building both procedural competence and the situational confidence needed to act under pressure.

SBT aligns with adult learning theory through deliberate practice, contextualized scenarios, and structured feedback, fostering durable skill acquisition and real-world transfer.⁶ It can also be flexibly adapted to local contexts and implemented through brief, resource-efficient modules.^5,8 Strengthening maternal preparedness thus contributes not only to injury prevention but also to household and community resilience.

Despite its potential, evidence directly assessing the effects of simulation-based first-aid training for mothers on measurable outcomes such as skill retention, real emergency performance, or injury reduction remains scarce. Existing research primarily targets mothers, the frontline caregivers, and decision-makers in most households. Using simulation methods that have proven effective in clinical education, this study aims to produce transferable evidence on training design, skill retention intervals, and potential effects on injury outcomes. Addressing this gap, the present study evaluates the impact of a culturally adapted SBT curriculum on mothers’ first-aid competence, confidence, and household safety practices. By focusing on mothers as frontline responders, the study aims to generate actionable evidence to inform scalable interventions that reduce preventable home injuries and enhance community emergency preparedness.

Conceptual framework

The conceptual framework of this study ( Figure 1) shows how simulation-based first aid training affects mothers’ knowledge, skills, self-efficacy, and preparedness. This, in turn, leads to safer household habits and a decrease in child illness and death from home injuries. It combines principles from Knowles’ Adult Learning Theory (Andragogy), Bandura’s Self-Efficacy Theory, and the Haddon Matrix for Injury Prevention. These models together explain how simulation-based first aid training can enhance mothers’ safety preparedness at home and their ability to respond in emergencies.

According to Knowles’ Adult Learning Theory, adults are self-directed and learn best through experiential, problem-centered activities that are immediately applicable.¹³ Simulation-based training aligns with these principles by providing realistic, hands-on experiences that strengthen knowledge retention and skill acquisition. Within this model, simulation functions as an active learning strategy that connects theoretical understanding to mothers’ real-life caregiving roles. Bandura’s Self-Efficacy Theory proposes that one’s belief influences behavior in their ability to perform it successfully.¹⁴ Simulation promotes self-efficacy through mastery experiences (practicing first aid), vicarious learning (observing peers), and verbal feedback, thereby increasing confidence and the likelihood of correct first-aid application. The Haddon Matrix provides a framework for understanding and preventing injuries by addressing human, equipment, and environmental factors before, during, and after an injury event.¹⁵ Simulation training enhances maternal capacity to respond effectively during and after incidents, thereby minimizing injury severity and improving outcomes.

Integrating these theories suggests that simulation-based first-aid training enhances mothers’ knowledge and skills,¹³ self-efficacy and confidence,¹⁴ and emergency responsiveness,^6,8,15 thereby contributing to safer homes and reduced child morbidity and mortality from preventable home injuries.

Subject and methods

Methods

The study was conducted through three phases:

Phase I: Assessment and preparation phase

Step I- Stating clear objectives

A-General objective

At the end of the simulation-based first aid training, the mothers will be empowered to ensure home safety and respond effectively to emergencies.

B-Specific objectives

Phase III: Evaluation phase

After the implementation of the simulation-based training, the evaluation phase is performed.

Results

Table 1 illustrates the sociodemographic characteristics of the 144 mother participants, providing insights into the composition of the study sample. The mean age of the mothers was 27.9 years, with a relatively homogeneous age distribution and a low standard deviation (±5.0). Approximately two-thirds of the participants had completed their basic education (62.5%). Most mothers were married (93.1%). In terms of residency, more than half of the participants lived in urban areas (52.8%), while the remainder came from rural backgrounds (47.2%). Additionally, 55.6% of the participants lived in nuclear families. Financially, 54.2% of mothers reported having sufficient income, indicating a level of financial stability within the cohort. A small proportion of mothers (19.4%) were employed, suggesting a balance between home care and work responsibilities.

Figure 1. The impact of simulation-based first aid training in home safety and emergency response conceptual framework.

Created by the author: Hantira NY, 2025.

Table 2 presents the pre- and post-simulation training evaluation of mothers’ first aid knowledge and home safety practices, highlighting the observed differences. Post-simulation, mothers’ first aid knowledge showed a significant improvement, with a mean score of 86.4 ± 18.2 compared to a pre-simulation mean of 36.9 ± 24.0. The impact of the simulation training on first aid knowledge was substantial, as indicated by η² ≈ 0.7886, demonstrating that 78.86% of the variance in knowledge was attributable to the training. Similarly, mothers’ home safety practices exhibited notable enhancement following the simulation training, with a mean score of 91.6 ± 16.4 compared to 29.9 ± 12.9 before training. The effect of simulation training on home safety practices was exceptionally large, as evidenced by η2 ≈ 0.9023, indicating that 90.23% of the variance in these practices was explained by the training. These findings underscore the profound and meaningful impact of simulation training in enhancing participants’ knowledge and practices.

Table 3 presents the post-simulation mother emergency self-confidence assessment. The table indicates that 77.1% of mothers reported being strongly satisfied with the simulation experience. Additionally, 83.3% of the mothers stated that the content was highly useful and relevant to the training, 85.4% noted that the training was very easy to understand and apply the learning skills. Regarding their confidence in mastering the skills, three-quarters of the mothers (75%) expressed being highly confident in having mastered all the skills. Lastly, 88.9% of the mothers demonstrated high confidence levels in their emergency response confidence scores following the simulation training.

Table 4 displays the correlation matrix examining the relationships between mothers’ first aid knowledge, home safety practices, and emergency response confidence. A statistically significant and strong positive relationship was observed between the total score of mothers’ first aid knowledge and their home safety practices (r = 0.791; p < 0.001), as well as between mothers’ first aid knowledge and their emergency response confidence (r = 0.703; p < 0.001). Additionally, a statistically significant moderate positive correlation was identified between mothers’ home safety practices and their emergency response confidence (r = 0.698; p < 0.001).

Discussion

Worldwide, accidents and injuries are leading causes of child mortality. Mothers and family members, as primary responders in home settings, require comprehensive awareness of childhood accidents and first-aid practices. Simulation-based first-aid training addresses knowledge gaps and enhances responders’ competence.¹⁸ It also empowers mothers through experiential learning, promoting self-efficacy in managing household emergencies and fostering reflective practice for improved preparedness.¹⁹

The present study evaluated the impact of simulation-based first-aid training on mothers’ preparedness for home safety and emergency response. A total of 144 mothers participated, with a mean age of 27.9 years. Approximately two-thirds had completed basic education, and a small proportion were employed, reflecting a balance between home care and work responsibilities. These sociodemographic characteristics support the feasibility of simulation-based training. Consistent with Wani et al.,¹⁸ the findings indicate that mothers are motivated and receptive to acquiring proper first-aid training.

The current study demonstrated a significant improvement in mothers’ first-aid knowledge following simulation-based training. The effect was substantial, with η² ≈ 0.7886, indicating that 78.86% of the variance in knowledge was attributable to the intervention. These results align with Liu et al.,²⁰ who reported that simulation training enhanced parental management capacity, relationships, and intrinsic motivation. The improvement likely reflects mothers’ motivation to provide optimal care and safeguard their children, effectively reinforced through well-structured simulation sessions.

Although homes designed for adults often contain hidden hazards for children, these risks can be mitigated through proactive identification and intervention. Continuous adaptation of the environment ensures a safe, stimulating space for play, while fostering children’s understanding of safety concepts enhances overall home safety. Such outcomes are achievable when parents receive competent training and apply it in practice.²¹

Parents, particularly mothers, play a crucial role in protecting children both indoors and outdoors. Reducing injury risk requires a multifaceted approach, including modification of the home environment, enforcement of relevant laws and regulations, and implementation of educational programs and training to enhance awareness of childhood injury prevention.²² In this regard, the current study revealed a significant improvement in mothers’ home safety practices following simulation-based training. The effect was exceptionally large (η² ≈ 0.9023), indicating that 90.23% of the variance in practices was attributable to the intervention. These results highlight the substantial and meaningful impact of simulation training on enhancing both knowledge and practical safety behaviors.

Simulation has been shown to effectively enhance self-confidence.²³ In a systematic review, Alrashidi et al. reported four key outcomes: increased confidence in performing clinical tasks, improved teamwork abilities, greater confidence in community work, and enhanced communication with patients and team members.²⁴ On the same note, the current study presents that the post-simulation mother emergency self-confidence assessment indicates that more than three-quarters of the mothers reported being strongly satisfied with the simulation experience. They also added that the content was highly useful and relevant to the training; they noted that the training was very easy to understand and apply the learning skills. Regarding their confidence in mastering the skills, three-quarters of the mothers expressed being highly confident in having mastered all the skills. Lastly, most of them demonstrated high confidence levels in their emergency response confidence scores following the simulation training.

Similarly, participants in a study by Gabbouj et al.²⁵ reported increased confidence in skill development and knowledge acquisition through simulation, enabling competent performance of essential tasks within clinical settings.

The current study conducted a correlation analysis among the examined variables. Results revealed a strong, significant positive correlation between mothers’ overall first-aid knowledge and home safety practices, as well as between knowledge and emergency response confidence. Additionally, a moderate, significant positive correlation was found between home safety practices and emergency response confidence. These findings underscore the effectiveness of simulation training in achieving its intended outcomes, consistent with previous studies.^26–28

Limitations of the study

Although this study provides valuable insights into the effectiveness of simulation-based first aid training for mothers, several limitations should be acknowledged. The quasi-experimental one-group design without a control group limits the ability to establish causality. The convenience sampling from selected primary health centers may restrict the generalizability of the findings to other populations. Self-reported data on safety practices may have been affected by recall or social desirability bias. In addition, the short-term post-test did not assess long-term knowledge retention or behavioral change. While the simulation sessions reflected real-life scenarios, they may not fully replicate the stress and unpredictability of actual emergencies. Future studies should employ randomized controlled designs, include more diverse samples, and incorporate follow-up assessments to examine the sustained impact of simulation-based training on mothers’ real-life emergency responses.

Conclusion and recommendations

In conclusion, findings of the current study confirmed both hypotheses, showing significant post-training improvements in first aid knowledge, home safety practices, and emergency response confidence. The large effect sizes highlight simulation as a highly effective educational approach that enhances mothers’ competence and readiness to manage home emergencies.

Ethical approval and consent to participate

The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval was obtained from the Institutional Review Board (Approval No.: Research Code 90-b, dated November 16, 2023). Permission to conduct the study was granted by the selected Primary Health Care centers.

Human ethics and consent to participate declarations

The study involved human participants and obtained IRB approval and informed consent in accordance with the principles outlined in the Declaration of Helsinki.

Informed consent was obtained from each participant after they received detailed information about the study. Written and verbally informed consent was obtained, where verbal consent with a witness was obtained from some participants due to low literacy levels, as approved by the ethics committee.

Confidentiality and anonymity of data were ensured, and participants were informed of their right to withdraw at any time without consequences.

Declaration of generative AI and AI-assisted technologies in the writing process

During the preparation of this work, the authors used ChatGPT to improve the manuscript’s readability and language. After using this tool, the authors reviewed and edited the content as needed and took full responsibility for the final version of the manuscript.