Perceptions of the professional role of paramedics in Imbabura: Beyond emergency response in the public health system

Abstract

Paramedics represent a strategic resource for strengthening health systems, particularly in disease prevention and health promotion functions, although their role has traditionally been limited to emergency response. In Ecuador, there is scarce evidence on how paramedics perceive their professional role beyond prehospital care. Objective: To describe the perceptions and experiences of paramedics from Imbabura province, Ecuador, regarding their professional role within the public health system, identifying perceived effectiveness and challenges in their performance. Methods: A cross-sectional descriptive study was conducted with 50 paramedics from Imbabura (68% men, mean age=39.2 years). A 42-item instrument distributed across five dimensions was designed and validated: perception of current role, knowledge in public health, perceived barriers, perceived efficacy, and attitudes toward role expansion. A 5-point Likert scale was used. Reliability was assessed using Cronbach's Alpha and McDonald's Omega. Factorial structure was analyzed using Principal Component Analysis with oblique Promax rotation. Results: The instrument demonstrated excellent reliability (α=0.802-0.910; ω=0.822-0.912). Factor analysis confirmed a five-component structure that explained 56.9% of total variance (χ²Bartlett=1445.26, p<.001). Paramedics perceive their role as strongly limited to emergencies (M=45.2/50), present low knowledge about public health functions (M=13.8/40), identify multiple institutional barriers (M=40.1/45), and show moderate-high resistance to expanding their functions (M=27.7/40). Conclusions: Paramedics in Imbabura maintain a restricted self-perception of their professional role, focused exclusively on emergency response, with limited knowledge about their potential contribution to disease prevention and health promotion.