Abstract This research aimed to assess nonprescription medicine knowledge, first aid knowledge, and compared the knowledge scores with and without previous training among school health teachers in Phayao Province, Northern Thailand. This cross-sectional study included school health teachers from primary and secondary schools by using the quota and purposive sampling methods. The data were collected using a self-administered questionnaire with three sections: socio-demographic characteristics, nonprescription medicine assessment, and first aid assessment. The data were gathered and analyzed using descriptive and independent sample t-test analysis. A total of 152 school health teachers participated in this study, with a response rate of 94.4%. The mean age was 41.5 ± 10.6 years, and 92.8% of the teachers were females. The majority (97.4%) of the teachers did not have a degree related to health sciences. 73.0% of the teachers had no previous nonprescription medicine training, while 59.2% had no previous first aid training. Only 15.8% of teachers were knowledgeable in nonprescription medicine, and only a few (0.7%) were knowledgeable in first aid.  In addition, higher knowledge scores of nonprescription medicines (P-value < 0.001, 95% CI = 1.71 – 3.69) and first aid (P-value < 0.001, 95% CI = 2.83 – 4.19) were statistically significant among the teachers who had received previous training. This highlights the importance of training teachers about the use of nonprescription medicines and first aid management so they can respond appropriately to first aid needs in schools and could be incorporated into a support policy and integrated into the teachers’ training curriculum.

Keywords: First aid, First aid knowledge, Nonprescription medicines, School health services, School health teachers

Funding: The authors are grateful for the research funding provided by the University of Phayao (Grant number: FF65-RIM146), from the Science, Research, and Innovation Fund, Thailand.

Citation: Pansakun, N., Kantow, S., Pudpong, P., Chaiya, T. 2024. Assessment of nonprescription medicine and first aid knowledge among school health teachers in northern Thailand. Natural and Life Sciences Communications. 23(3): e2024028.

INTRODUCTION

Schools are essential for children to acquire knowledge, socio-emotional skills, including self-regulation and resilience, and critical thinking skills that provide the foundation for a healthy future (World Health Organization, 2021). Currently, most schoolchildren spend roughly six to nine hours a day five days a week in school (Pansakun, 2021), and are vulnerable to getting injured or ill during their activities (Qureshi et al., 2018; AlYahya et al., 2019). Access to education and a safe and supportive school environment have been linked to better health outcomes. In turn, good health is linked to reduced drop-out rates and greater educational achievement (World Health Organization, 2021).

Schoolchildren might experience a medical emergency because of injuries or unexpected major illnesses that occur in schools. During the academic year, they also may receive medications for acute illnesses or on an as-needed basis (PRN) while attending school (Lowe et al., 2022). Unintended injuries in schoolchildren are the most common and often need immediate and possibly lifesaving care, which is known as “first aid” (Ganfure et al., 2018; Al Gharsan and Alarfaj, 2019). Ensuring optimal management of schoolchildren medication and first-aid regimens is necessary to ensure health and safety while improving schoolchildren’s ability to learn and play and enhance their overall quality of life (Lowe et al., 2022). In spite of its substantial importance, school emergency preparedness is regularly insufficient due to obstacles such as geographical features and infrastructure, staff education and training, and financial resources. School health teachers are often the main individuals to observe and handle situations requiring first aid or handling medical emergencies in the absence of any health professionals (Joseph et al., 2015; Qureshi et al., 2018; AlYahya et al., 2019). Consequently, school health teachers should be knowledgeable in first aid and be able to put it into practice (Hosapatna et al., 2019). They also need to be updated continually on their knowledge and skills to keep up to date with first-aid recommendations (Joseph et al., 2015; Abelairas-Gómez et al., 2021; Nur Fariduddin and Sin Siau, 2022). However, many studies have shown that the level of knowledge and right basic practice of first aid among school health teachers is generally poor (Pek, 2017; Ganfure et al., 2018; Taklual et al., 2020).

Injuries are a common occurrence and can happen at any time of the day. A study revealed that the majority of school-related injuries occur in the school playground, during physical activities, on school buildings, or while commuting to and from school (Waibel and Misra, 2009). In Thailand, there is limited information about schoolchildren injuries in school settings at the national level. However, the situation mortality caused by injuries trends to remain constant among children less than 15 years reported the average number of deaths per year was 1,799 children or about 5 people per day. The main causes of death from injuries were unintentional injuries, including road traffic injuries, drowning, threats to breathing, and electric shock (Department of Diseases Control Thailand, 2022). Given the extended time children spend at school and the absence of parents or caregivers during school hours, it is crucial for schools to have trained personnel capable of providing immediate care (Ganfure et al., 2018).

The main caregivers in schools for children are school health teachers, and they are their first-line protectors as well as first responders in the event of children emergencies. However, first aid and basic medication do not appear to be mandatory content in the university training of teachers. Previous studies have found that school health teachers have little knowledge of first aid and nonprescription medicine and that most of them are newly recruited with scant experience providing school health services due to inadequate training (Yimlamai and Chanthapasa, 2016; Onjon et al., 2018). Furthermore, school health teachers are typically delegated this task, although most of them are unlicensed assistive personnel who do not have medical or first aid training. Hence, it is essential school health teachers be trained in first aid and nonprescription medicine management. This state of affairs highlights the importance of having an assessment that detects the extent of knowledge school health teachers possess regarding first aid and nonprescription medicine.

The existing literature highlights the prevalence of injuries among schoolchildren and emphasizes the importance of trained school health teachers. However, there is a significant lack of research specific to Northern Thailand, particularly regarding the proficiency of school health teachers in first aid and nonprescription medicine management. This study aims to address this gap by evaluating their knowledge and skills, providing insights for tailored training programs in the region. Despite recommendations from the Department of Health, minimal research has been conducted on the provision of first aid or caregivers' background knowledge regarding medication in schools. Therefore, this pioneering study aims to assess the knowledge of nonprescription medicines and first aid among school health teachers in Phayao Province, Northern Thailand, comparing scores between those with and without prior training.

MATERIAL AND METHODS

Study design and procedure

A cross-sectional study design was conducted on primary and secondary public school in Phayao Province, between June and October 2022. There are 234 public schools in the nine districts in Phayao Province, all of which fall under Phayao’s administration education office. The quota sampling method was employed to select public schools, ensuring representativeness by sampling from the total schools distributed in each district. Participants were chosen using the purposive sampling method, with one head of school health teacher selected from each school. An official letter was written to Phayao’s administration education office and school administrators. After permission was obtained, the researchers made an appointment with the participants to collect research data at each school. Participants were approached by investigators in the school’s waiting room. Written informed consent was obtained from the participants in the study. The average time required to complete the questionnaire was 10 – 20 minutes. Participants were required to complete the questionnaire in that time to ensure that the information was authentic. Ethical consideration was approved by the Institution of Phayao Human Ethics Committee (UP-HEC 1.2/037/65).

Sample size

The sample size calculation was based on Cochran’s finite proportion formula (Cochran, 1977) especially in light of the scant literature that has investigated the school health teachers’ knowledge of first aid and nonprescription medicine in Northern Thailand’s schools as well as in the study area. The estimated proportion of the attribute present in the population 50%, a confidence level of 95%, an error margin of 5%, and population size 234. Resulting in a sample size of 147. Incomplete questionnaires may have been received because the data were obtained through self-administered questionnaires that were answered voluntarily. Finally, a 10% non-response rate was added, and the total number of study participants became 162. The inclusion criteria required participants to be active head school health teachers who had worked full-time in the study area schools for a minimum of one year, demonstrating teaching experience. Additionally, participants needed to express willingness to participate in the research.

Instrumentation

A self-administered questionnaire developed by the researchers, based on a survey of relevant literature and similar studies (Satyapan et al., 2019; Department of Health Thailand, 2022) The questionnaire consists of three sections in Thai.

The first section comprises nine items describing the socio-demographic characteristics of the school health teachers, such as school affiliation, gender, age, level of education, a degree related to health sciences, years of experience in teaching, years of experience in school health services, and previous medication and first aid training.

The second section comprises 30 items that were used to assess nonprescription medicine knowledge. For each question, a correct answer was coded as 1 point and an incorrect answer as 0 points. The total nonprescription medicine knowledge score ranges from 0 to 30, and higher scores indicate a more in-depth knowledge of nonprescription medicine. This was then converted to a percentage, and Bloom’s cut-off point was used to classify the knowledge into three levels (Bloom, 1968). Those who scored 60% or less were classified as low (score ≤ 18), 61 – 80% moderate (score range 19-24), and more than 80% high (score ≥ 25).

The last section comprised 20 items that were used to assess first aid knowledge. The total school first aid knowledge score ranges from 0 to 20, and higher scores indicate a more in-depth knowledge of first aid. Bloom’s cut-off point was utilized to categorize the knowledge into three categories, and this was also translated to a percentage (Bloom, 1968). Those who scored 60% or less were categorized as having a low (score ≤ 12), 61 – 80% a moderate level (score range from 13 to 16), and more than 80% a high level (score ≥ 17). Three experts from nursing, public health, and pharmacology reviewed the questionnaire items to assess the index for item-objective congruence (IOC > 0.5). A pilot study of the questionnaire was carried out with 30 school health teachers from a school in Upper Northern Thailand that was not included in the main study population by completing online surveys.

In addition, the Kuder-Richardson Formula 20 for a measure of reliability for a test with binary variables was used to validate the questionnaire's internal consistency. The reliability coefficient for the entire questionnaire on nonprescription medicine knowledge was 0.81, and ranged from 0.80 – 0.82 in each question. The reliability coefficient for the entire questionnaire on first aid knowledge was 0.74, and ranged from 0.70 – 0.74 in each question.

Statistical analyses

Data cleaning and verifying were done before the analysis. SPSS version 26.0, licensed from the University of Phayao (SPSS Inc., Chicago, IL, USA), was used to conduct statistical analysis. Individuals with incomplete data were excluded from the analysis. Descriptive statistics such as frequencies, percentages, means, and standard deviations, as well as tables, were used to present the socio-demographic characteristics, the answers relating to the school health teachers’ knowledge of nonprescription medicine and first aid, and the level of such knowledge. We used an independent t-test to compare the scores of school health teachers with and without prior training in nonprescription medicine and first aid. A P-value < 0.05 was considered statistically significant. 

RESULTS

A total of 152 respondents participated in the study, representing a response rate of 94.4%. Most of the participants (92.8%) were female, with a mean age of 41.5 ± 10.6 years. The majority (71.1%) held bachelor’s degrees. On the other hand, 97.4% of responders lacked health-related qualifications. More than two-thirds of school health teachers (76.3%) had fewer than five years’ experience in school health services. Only 41 (27.0%) had prior medication training, whereas 62 (40.8%) had prior first aid training (Table 1).

Table 1. Socio-demographic characteristics of respondents.

This study revealed that only 15.8% of respondents had high knowledge, approximately 17.1% had low knowledge, and more than two-thirds (67.1%) had moderate knowledge of nonprescription medications. The mean knowledge score was 21.4 ± 2.98 points. Of the total respondents, only a few (0.7%) had high-level first aid knowledge, nearly a quarter (23.0%) had moderate knowledge, and more than three-quarters (76.3%) had a low level of first aid knowledge. The mean knowledge score was 10.6 ± 2.71 points (Table 2).

Table 2. Levels of school health teachers’ knowledge of nonprescription medicine and first aid.

The study established the proportion of school health teachers who responded correctly or incorrectly to various test questions. This was mainly to identify which aspects of the school health teachers’ knowledge were weaker or stronger. Most (96.1%) of the participants correctly responded that paracetamol is a pain reliever and fever reducer, while 95.4% knew that decongestants can cause drowsiness which could lead to impaired driving. Most of the teachers knew a stomachic mixture can be used to relieve heartburn (92.8%). On the contrary, nearly three-quarters (71.7%) incorrectly believed that oral rehydration salts (ORS) are used to replace dehydration from exercise and that diarrhea medications and ORS can be used interchangeably. In reply to the statement that more than 10 tablets of paracetamol should not be taken per day or for more than five consecutive days, 70.4% agreed. Furthermore, 66.4% of the participants believed that activated charcoal could be taken for diarrhea along with other medications (Table 3).

Table 3. The frequency and percentage of correct and incorrect nonprescription medicine answers by school health teachers.

Note. ^f False statement

The majority (90.1%) of the respondents knew that carefully administering a drug by mouth is not the best way to treat those who have fainted and become unconscious while experiencing abdominal pain, vomiting, or a high temperature. Tenderness in the right lower abdomen is one of the symptoms of appendicitis (86.2%), and in the event of a stab wound, if there is something broken in the wound, do not pull or move it to see the depth of the wound (82.2%). In the case of an individual who is hyperventilating, 88.8% of the participants agreed that the individual should take, long, deep breaths to fully oxygenate their bodies, while 77.6% of the teachers believed students experiencing epileptic seizures should use a mouthpiece to prevent clenching their teeth; 76.3% of the sample agreed that people who faint and do not feel awake for 30 minutes should be taken directly to hospital (Table 4).

Table 4. The frequency and percentage of correct and incorrect first-aid answers by school health teachers.

Note. ^f False statement

According to comparison analyses, the mean scores for knowledge of nonprescription medications were 2.70 points higher in the group of school health teachers with prior training (23.4 ± 2.67) than in the group of school health teachers without prior training (20.7 ± 2.77). The difference was highly statistically significant, with a P-value < 0.001 (95% CI = 1.71 – 3.69) (Table 5). Similarly, the mean first-aid knowledge scores of participants were 3.51 points higher among school health teachers with prior training (12.6 ± 2.17) than among those without prior training (9.1 ± 2.03). The difference was highly statistically significant, with a P-value < 0.001 (95% CI = 2.83 – 4.19) (Table 5).

Table 5. Comparisons of school health teachers with and without prior training regarding their knowledge of nonprescription medications and first aid.

Note. * P-value < 0.001

DISCUSSION

The results of this study revealed that more than two-thirds (34.9%) of school health teachers had experience in school health services less than, or equal to, one year; almost all (97.4%) had no health-related qualifications; more than three-quarters (76.3%) had less than five years’ experience in school health services; and less than half of the school health teachers had previous nonprescription medicine or first aid training. This could imply that, despite their advanced education, school health teachers still lack critical knowledge of nonprescription medicine and first aid. This finding is in line with previous studies conducted in Northeast Thailand (Yimlamai and Chanthapasa, 2016; Apaisoongnern and Chanthapasa, 2019). It is also consistent with the Health Intervention and Technology Assessment Program (HITAP) of the Ministry of Public Health in Thailand (Onjon et al., 2018). The consistent pattern observed across multiple studies and assessments underscores the pressing need for comprehensive reforms and interventions aimed at enhancing the qualifications and preparedness of school health teachers. Addressing these systemic gaps is crucial for ensuring the effective delivery of health services within educational settings and for promoting the well-being of students throughout Thailand.

Our findings show that the number of respondents who had high knowledge of nonprescription medicine was lower than that of respondents who had poor knowledge of nonprescription medicine. It is also noteworthy that participants’ knowledge of nonprescription medicine was assessed using questions related to essential uses that require household remedies. This outcome may be attributable to the fact that school health teachers were recently hired with little or no expertise in this field, the turnover rate was high, the career path for the role was unclear, and inadequate or nonexistent training was offered (Onjon et al., 2018), yet these individuals were unlicensed assistive personnel without medical training (Canham et al., 2007). However, obtaining this baseline is important to note deficiencies and plan appropriate interventions. Without adequate safeguards and oversight in place, the management of medications in a school setting is difficult. Medication errors are preventable events that may harm students or lead to inappropriate use of medication (Best et al., 2022).

Surprisingly, more than three-quarters of participants had inadequate knowledge of first aid. This bolsters the findings of a prior study in Thailand that found inadequate or low levels of first aid knowledge (Yimlamai and Chanthapasa, 2016; Onjon et al., 2018; Apaisoongnern and Chanthapasa, 2019). Our finding is similar to previous studies conducted in Riyadh, Saudi Arabia, where 85.1% of teachers and school instructors were found to be poorly qualified (AlYahya et al., 2019). Likewise, a study conducted in Gondar City (Workneh et al., 2021) and Addis Ababa, Ethiopia (Ganfure et al., 2018), found that more than half of the teachers had poor knowledge of first aid. A possible justification for this difference might be due to the difference in the data collection tool used in each study. However, it could be inferred that in developing countries, school health services tend to have a poor understanding of the basic concepts of first aid and are often neglected (Al-Samghan et al., 2015; Hosapatna et al., 2019), whereas in developed countries they are better equipped with first aid facilities and have trained medical personnel on the school campus (Hosapatna et al., 2019). This disparity could directly impact the management of common ailments, including the provision of first aid care and referrals.

The current study also shows that higher knowledge scores for nonprescription medicines and first aid were highly statistically significant among respondents who had received previous training. This finding is supported by a study conducted in Northern California, in which audit results highlighted the importance of training in medication administration and management at schools (Canham et al., 2007). It also directs attention to viewing training not as a once-a-year event, but as a process (Canham et al., 2007; Siitonen et al., 2015). According to the results of this study, teachers who had first aid training in the past were much more knowledgeable about first aid than teachers who had not (Joseph et al., 2015; AlYahya et al., 2019; Midani et al., 2019; Brito et al., 2020). This suggests that it may be essential for teachers to have training in nonprescription medications and first aid management in order to respond effectively to first aid needs and requirements (Joseph et al., 2015; Leite et al., 2018; Abelairas-Gómez et al., 2021; Workneh et al., 2021; Pais-Roldán et al., 2022).

In Thailand, however, medicine without a prescription and first aid are not mandatory subjects in teacher education programs. Therefore, it could be concluded that in order to ensure that school health teachers have the necessary relevant knowledge about non-prescription medicines and first aid to be able to care for their students, both adequate school health teachers’ training and additional training in those subjects are required. This represents a major challenge for school health teachers. To overcome these challenges, it is important to produce guidelines at both national and local levels for instructing schools on how to deal with nonprescription medicines and first aid management. Such guidelines could be formulated in collaboration between the health care center, school staff, and parents. The lack of mandatory training reflects broader global issues in health education and policy, necessitating curriculum reforms and policy initiatives to equip educators with essential health knowledge. To enhance school health practices, Thailand should integrate non-prescription medicine and first aid modules into teacher training, provide specialized training for current school health teachers, implement national policies mandating training in these areas, develop collaborative guidelines, and establish monitoring and evaluation systems, involving parents and communities in supporting health initiatives.

Some limitations of the study should be acknowledged. First, a limitation bias occurred as a result of the cross-sectional design because the information was collected at specific time points, and no causal relationship could be inferred. Second, the generalizability of the findings to schools in other parts of the country might be compromised since this study was conducted in a limited study area, including the sampling methods utilized. Finally, the lack of sufficient similar studies is limited compared with other studies. Future research could focus on longitudinal studies to track changes over time in school health teachers' knowledge and practices. Experimental studies could evaluate the effectiveness of specific training programs, while comparative research may assess different training modalities. Qualitative research could explore teachers' perceptions and experiences in-depth. Intervention studies could measure the impact of integrating health modules into teacher training, and investigations into parental and community involvement could provide valuable insights. These avenues of research aim to enhance school health practices in Thailand and promote student well-being.

CONCLUSIONS

More than two-thirds of school health teachers had moderate knowledge of nonprescription medicines and first aid, while nearly one-fifth of them had low knowledge of nonprescription medicine. Moreover, only a few of the respondents had a high level of knowledge of first aid, whereas more than three-quarters had a low level of first aid knowledge. In addition, higher knowledge scores of nonprescription medicines and first aid were highly statistically significant among the respondents who had received previous training. This highlights the importance of training teachers about the use of nonprescription medicines and first aid management so they can respond appropriately to first aid needs in schools (such as school health teachers who should be able to diagnose, treat students with nonprescription medications, and explain the effects of the medications they are taking). Policymakers in education can be incorporated into a support policy and integrated into the teachers’ training curriculum. Additionally, it should be emphasized that educational activities pertaining to first aid and nonprescription medicine are a type of training and/or qualification on the subject and must be carried out annually in accordance with the legislation.

ACKNOWLEDGEMENTS

The authors would like to acknowledge and express our sincere appreciation to Phayao’s administration and education office, school administrators, and school health teachers for their cooperation in obtaining permission and providing the information for this study. We also thank the School of Public Health, University of Phayao, for supporting the official letter. This work was supported by the University of Phayao (Grant number: FF65-RIM146), from the Science, Research, and Innovation Fund. 

AUTHOR CONTRIBUTIONS

Conceptualization: Nattapon Pansakun, Supakan Kantow, Punyisa Pudpong, Tatsanee Chaiya. 

Data curation: Nattapon Pansakun, Supakan Kantow, Punyisa Pudpong. 

Formal analysis: Nattapon Pansakun, Supakan Kantow.

Methodology: Nattapon Pansakun, Supakan Kantow.

Project administration: Nattapon Pansakun, Supakan Kantow.

Visualization: Nattapon Pansakun, Supakan Kantow, Punyisa Pudpong,

Tatsanee Chaiya.

Writing – original draft: Nattapon Pansakun, Tatsanee Chaiya

Writing – review & editing: Nattapon Pansakun, Supakan Kantow, Punyisa Pudpong, Tatsanee Chaiya.

CONFLICT OF INTEREST

The authors declare that there is no conflict of interest.

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