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Original Research (Original Article) 


Mustafa Ali Alkadhem et al, 2020;4(3):676–681.

International Journal of Medicine in Developing Countries

Knowledge and attitude regarding cardiopulmonary resuscitation among secondary school students in Al Ahsa, Saudi Arabia: a pilot study

Mustafa Ali Alkadhem1, Ali Ibrahim Alshaqaqiq1*, Hussain Ahmed Alshaqaqiq1, Tumadhir Abdullah Alkihsi1, Mohammed Saleh Albattat1

Correspondence to: Ali Ibrahim Alshaqaqiq

*College of Medicine, King Faisal University, Al Hofuf, Saudi Arabia.

Email: i-ali-1416 [at] hotmail.com

Full list of author information is available at the end of the article.

Received: 20 December 2019 | Accepted: 20 January 2020


ABSTRACT

Background:

Sudden cardiac arrest (SCA) is one of the leading causes of death around the world. It is a major life-threatening emergency with high mortality which needs immediate intervention. Cardiopulmonary resuscitation (CPR) plays a fundamental role in the survival of SCA. Studies in Kingdom of Saudi Arabia (KSA) show that only a few victims of SCA receive CPR. The objective of this study is to assess knowledge and attitude about CPR among secondary school students in Al Ahsa, KSA.


Methodology:

This is a cross-sectional study conducted among secondary school students in Al Ahsa, KSA from 2019 to 2020. The study had 387 participants including male and female secondary school students, and the data were collected using an online self-administrated questionnaire.


Results:

Male participants were 50.6%, while female participants were 49.4%. Most of the participants (98.4%) were Saudi. Among the total, 23.8% did not had any information about CPR, and 40.3% stated they didn’t know the meaning of CPR. Only 25.3% of participants had taken a basic life support (BLS) course, and 53.5% thought that the BLS course should be mandatory.


Conclusion:

The findings of the study reflected a poor level of knowledge about BLS and CPR among secondary school students in Al Ahsa, KSA. The introduction of BLS and CPR courses in the curriculum of secondary schools in Al Ahsa city is highly recommended.


Keywords:

Awareness, basic life support, cardiopulmonary resuscitation, male students, female students, secondary school students.


Introduction

Sudden cardiac arrest (SCA) is a major life-threatening emergency with high mortality [1,2]. A considerable proportion of SCA occurs out-of-hospital; also termed as out-of-hospital cardiac arrest (OHCA) [3]. The survival in OHCA is highly affected by early detection and intervention [1]. Time is a key determinant for survival, every minute passes without intervention survival rate drops by 7%–10%, and the patient will die within 10 minutes [4]. Cardiopulmonary resuscitation (CPR) plays a fundamental role in the survival of SCA [1,4]. It is a temporary measure to provide oxygenated blood to vital organs until spontaneous circulation is restored [5]. Even though there is increased emphasis over the importance of CPR, there is still low proportion of victims who get bystander help, and this reflects negatively over survival rate [6,7]. For this reason, in recent years, there have been appeals to incorporate CPR into school curriculums, and to train teachers and students [8,9]. SCA is a leading cause of death in the United States (US) and Europe [1,3]. In 2014, around 45,501 OHCA registered in the US alone, and the survival was poor [2]. In Europe, the incidence of SCA can reach up to 700,000 cases a year [3]. Official estimates regarding incidence of OHCA and bystander help in the kingdom of Saudi Arabia (KSA) are absent. However, there are couple studies that show poor results. One study has shown that only 3% of OHCA victims received bystander CPR [10]. Another study involved 96 OHCA victims, showed that only 20.8% received bystander CPR, and there was low survival rate for non-traumatic arrest victims and a 100% mortality rate in traumatic arrests [11]. Studies in KSA show there is low proportion of OHCA victims who receive bystander CPR [10,11]. Considering the number of secondary school students, if students are knowledgeable about CPR, this can increase the number of OHCA victims who receive help. This is because school-age adolescents are likely to be present at the scene of medical emergency. However, there are limited data about school students’ knowledge of CPR in KSA. To our knowledge, there are only two studies, both of which conducted in Riyadh. One study was assessing CPR knowledge among female secondary school students, which have shown only 17.4% of the participants think they have enough knowledge of CPR [12]. The other study was assessing CPR knowledge among male and female secondary school students, and it has shown 58% of participants did not have any previous information about CPR [13]. There are no similar studies conducted in Al Ahsa. Our study comes as a contribution for exploration efforts of previous studies in this field. In this study, we aim to assess knowledge and attitude regarding CPR among secondary school students in Al Ahsa, KSA. The objective of this study is to assess knowledge and attitude about CPR among secondary school students in Al Ahsa, KSA.


Subjects and Methods

A cross-sectional study conducted among secondary school students in Al Ahsa, KSA. It was carried in the period of 2019–2020. The study sample size was found to include a minimum of 387 participants. It was calculated at 95% confidence interval (CI), and 5% margin of error, based on latest official estimates of secondary school students’ population in Al Ahsa, which show total number of 47,040 students [14]. The study targeted all male and female secondary school students in Al Ahsa, KSA. The population includes all secondary school students in private and public schools, of all the levels. Non-secondary school students and students studying outside Al Ahsa are excluded from the study. Data were collected using an online self-administrated questionnaire that was distributed to the population. The questionnaire consisted of two main parts. The first part contained Sociodemographic data (age, sex, level of education, nationality, parents’ level of education, type of school, and family income). The second part contained questions about CPR knowledge levels and attitude. The questionnaire was adapted from a previous study with minimal changes and additions to suit our study needs [12]. Data were analyzed using the Statistical Package for Social Sciences version 21.0 (IBM Corporation, Armonk, NY). Descriptive analysis was performed by analyzing participants’ responses stratified by age, sex, socioeconomic status, and type of school (public/private). Chi-square test was used with significance level set at p-value ≤ 0.05. Charts, graphs, and tabulations were included for better presentation of the results. Ethical approval was obtained from King Faisal University before carrying out the study. Consent was taken from all the participants, and underage participants were asked to obtain parental consent before filling of the questionnaire. Participants were fully free to withdraw from the study at any time. Confidentiality and privacy of participants was maintained. There was no distribution or disclosure of the participants’ identity. The final paper contains anonymous data and by no means reveals the identity of the participants.


Results

The number of participants in our study who completed the questionnaire and met the inclusion criteria was 387. The mean age of participants was 17.42 with a standard deviation of 1.106 (Figure 1). Male participants were 50.6% while female participants were 49.4% (Figure 2). Most of the participants (98.4%) were of Saudi nationality, and 92.2% of participants were in public schools. About school grades, 15.2% of students were in grade 10, 38.0% in grade 11, and 46.8% in grade 12 (Table 1). Regarding parents' level of education, 37.5% participants' mothers had a university graduate degree, while 7.5% were not educated. Similarly, 37.2% of the participants' fathers had a university graduate degree, while 4.4% of the participants' fathers had no education. Furthermore, most of the participants (35.9%) had a family income between 10,001 and 20,000 SAR per month, and only 16.3% of participants had a family income more than 20,000 SAR per month.

Figure 1. The mean age of participants..

76.2% of participants considered themselves having information about CPR, and 59.7% of participants stated they knew the meaning of CPR. Only 25.3% of participants had taken basic life support (BLS) course, however, only 15.2% of participants feel that their knowledge about BLS is sufficient. 79.8% of participants felt encouraged to take the BLS course due to personal benefits, 10.4% due work or graduation requirements, 8.7% due to experience in which they could not help, and 1.2%, due to other reasons. For the majority of participants (24.5%), the source of information about CPR were school, while internet, movies and TV shows, reading, friends or relative, CPR course, and other means accounted for 21.7%, 21.7%, 13.9%, 11.3%, 5.4%, and 1.3%, respectively (Figure 3).

Figure 2. The gender distribution of participants.

Table 1. Sociodemographic characteristics of participants.

Count %
Level of education Grade 10 59 15.2%
Grade 11 147 38.0%
Grade 12 181 46.8%
School Public 357 92.2%
Private 30 7.8%
Father’s educational level Not educated 17 4.4%
Primary school 45 11.6%
middle School 53 13.7%
Secondary School 103 26.6%
University graduate 144 37.2%
Postgraduate 25 6.5%
Mother’s educational level Not educated 29 7.5%
Primary school 35 9.0%
middle School 65 16.8%
Secondary School 96 24.8%
University graduate 145 37.5%
Postgraduate 17 4.4%
The family income per month Less than 5000 SAR 87 22.5%
5001–10,000 SAR 98 25.3%
10001–20,000 SAR 139 35.9%
More than 20,000 SAR 63 16.3%

The majority of participants (53.5%), thought that the BLS course should be mandatory for all secondary school students, 44.4% thought it should be optional, and only 2.1% thought that it should not be mandatory. 13.7% of participants had encountered a situation that requires CPR, and only 20.8% of them conducted the resuscitation process, while 44.4% of participants did not conduct CPR because they did not know CPR (Table 2).

52.5% of participants stated that they will start CPR first when they encounter a situation that requires BLS, 34.6% will call an ambulance, and 12.9% will take the victim to a hospital. In the CPR situation, the majority of participants (60.7%) state that they will check the airway for breathing first when they encounter the victim, 19.4% will start chest compression, 15.0% do not know, and 4.9% will give mouth-to-mouth breathing. Regarding chest compression to mouth breath ratio, 42.9% of participants did not know and 18.9% stated that they will give 30 compressions: two breaths. Regarding willing to perform mouth-to-mouth rescue breathing on a member of the family, 82.7% of participants would be willing to do, and only 66.9% of them would be willing to do on a stranger (Table 3).

Figure 3. Source of information about CPR.

There is no statistically significant association between knowing the meaning of CPR with the level of education (p = 0.455). 47.2% of grade 12 stated they knew the meaning of CPR, where 39.4% of grade 11 and 13.4% of grade 10 stated the same. Furthermore, 55.9% of grade 12 participants feel that they know sufficient information about BLS comparing to 16.9% of grade 10. There was no statistically significant association between known taken BLS course and level of education (p = 0.133) (Table 4). A statistically significant association has been found between CPR knowledge and family income per month (p = 0.004). Participants, who belong to a family with an income of 10,001–20,000 SAR (39.0%), have a better knowledge comparing to a family with income less than 5,000 SAR. Moreover, 42.9% of participants who have taken the BLS course belonged to the family of income 10,001–20,000 SAR. No statistically significant association has been found between gender and performing mouth-to-mouth rescue breathing on a member of your family (p =0.111). However, a statistically significant association has been found between gender and performing mouth-to-mouth rescue breathing on a stranger (p = 0.001). 75.0% of male participants stated that they would perform mouth-to-mouth rescue breathing on a stranger comparing to 58.6% of female participants.

Table 2. Response of participants on the need for BLS course.

Count %
Do you know the meaning of CPR? Yes 231 59.7
No 156 40.3
Do you have any information about (CPR)? Yes 295 76.2
No 92 23.8
Have you ever taken BLS course? Yes 98 25.3
No 289 74.7
Do you feel that your knowledge about BLS is sufficient? Yes 59 15.2
No 328 84.8
Do you think the BLS course should be mandatory for all secondary school students? Yes 207 53.5
No 8 2.1
Should be optional 172 44.4
Have you ever encountered a situation that required CPR? Yes 53 13.7
No 289 74.7
Not sure 45 11.6

Table 3. Response of participants on willing to perform mouth-to-mouth rescue.

Count %
In CPR situation what you will do to victim FIRST? I don’t know 58 15.0
Checking the airway for breathing(correct) 235 60.7
Chest compression 75 19.4
Mouth to Mouth breathing 19 4.9
How much chest compression to mouth breath you will give in CPR in adults? I don’t know 166 42.9
15 compressions: 1 breath 24 6.2
15 compressions: 2 breaths 100 25.8
30 compression: 2 breaths(correct) 73 18.9
30 compressions: 1 breath 24 6.2
Do you think you would perform mouth-to-mouth rescue breathing on a member of your family? Yes 320 82.7
No 67 17.3
Do you think you would perform mouth-to-mouth rescue breathing on a stranger? Yes 259 66.9
No 128 33.1
What do you do FIRST when you encounter a situation that requires BLS? Call an ambulance(correct) 134 34.6
Take the victim to the hospital 50 12.9
Start CPR 203 52.5

Discussion

Even though the number of participants in this study (387 participants) is lower than other previous studies conducted in KSA, if this study added with other studies conducted in KSA, it can contribute in giving a clearer view for researchers regarding the status of knowledge and attitude of CPR among secondary school students in KSA. The age of the students ranged from 15–21 years. The majority of them were Saudi, and since public schools accept non-Saudis to a smaller extent so it's expected to have a small proportion of non-Saudi students. About 37.2% of students’ fathers and 37.5% of students’ mothers are university graduates, and that reflects the usual trends in the Saudi community since both genders have the same opportunity of higher education. Moreover, almost one-third of the participants were in families with a monthly income between 10,001 and 20,000 SAR. In this study, a poor level of knowledge about BLS and CPR was perceived; 76.2% of the students reported that they have information about CPR; however, only 15.2% feel that their knowledge about BLS is sufficient. This is similar to the study done by Al Harbi et al. [12], where they found that 54.8% reported not having information about BLS and 42.6% did not know CPR. This is also comparable to the findings of another study done in Riyadh, KSA, done by Alanazi et al. [13], in 2013, where they found that 58.1% of females and 58% of male students have proper knowledge of CPR. When compared to an international study done by Kanstad et al. [14] in Norway, 55% of students involved in the study have encountered an SCA event. 59% of them did not know how many chest compressions and mouth ventilation would perform. The findings of poor knowledge of BLS and CPR in our study may be due to the lack of formal education and training in public schools in KSA. The school curriculum provides simple instruction for first aid measures such as home safety measures, but no formal BLS courses are available, neither for teachers nor for students. Unfortunately, according to a study, even university students have poor knowledge of BLS. In a local study done to evaluate BLS knowledge among health students at Princess Nourah bint Abdurrahman University, 87.9% of the participants had very poor knowledge scores in BLS [15]. Regarding the number of students who had attended BLS courses, only 25.3% reported taking BLS courses, even though 53.5% think the BLS course should be mandatory for all secondary school students. In the study of Al Harbi et al. [12], a positive relationship between students of families with high income and the students who had been taking the BLS course has been found. However, in this study, there was no statistically significant association between family income and taking the BLS course. Every member of the community should have good BLS knowledge and practice, and the best strategy to reach to this goal may be through educating the community's future leaders; school students. In New Zealand, where the resuscitation skills such as CPR are taught as an optional offering, a study to assess the impact of the program revealed a significant difference between those who chose the enrollment of the program and those who did not. The recommendation was that greater funding is needed for resuscitation/first aid learning and that the subject must become a compulsory rather than optional component of the school curriculum [16]. This study has some limitations that affect the generalization of the findings. The study was based on an online questionnaire distributed online by the authors; this may have caused a selection bias for the study sample. Moreover, knowledge and attitude were not assessed using an objective scoring system.

Table 4. Association between BLS course and level of education.

Family income
Less than 5,000 SAR 5,001–10,000 SAR 10,001–20,000 SAR More than 20,000 SAR p-value
Do you know the meaning of CPR?
Yes 45 54 94 38 0.079
No 42 44 45 25
Do you have any information about (CPR)?
Yes 54 76 115 50 0.004
No 33 22 24 13
Have you ever taken basic life support (BLS) course?
Yes 19 23 42 14 0.421
No 68 75 97 49
Do you feel that your knowledge about BLS is sufficient?
Yes 24 11 15 9 0.003
No 63 87 124 54
Do you think the BLS course should be mandatory for all secondary school students?
Yes 44 48 79 36 0.060
No 1 6 1 0
Should be optional 42 44 59 27
Have you ever encountered a situation that required CPR?
Yes 16 13 13 11 0.059
No 66 67 112 44
Not sure 5 18 14 8

Conclusion

This study supports findings of the other similar previous studies conducted in KSA. The findings reflected a poor level of knowledge about BLS and CPR among secondary school students in Al Ahsa, KSA. However, an acceptable positive attitude has been found. The positive attitude among the young population should encourage the Ministry of Education to include formal training in school curriculums. This could help in raising awareness about the subject and may lead to an increased percentage of OHCA victims who receive bystander help and increase the odds of survival among victims.


List of Abbreviations

CPR Cardiopulmonary resuscitation
KSA Kingdom of Saudi Arabia
OHCA out-of-hospital cardiac arrest
SCA Sudden cardiac arrest

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

Ethical approval was obtained from College of Medicine at King Faisal University, Research Number: 06/03/2019, on 05/5/2019.


Author details

Mustafa Ali Alkadhem1, Ali Ibrahim Alshaqaqiq1, Hussain Ahmed Alshaqaqiq1, Tumadhir Abdullah Alkihsi1, Mohammed Saleh Albattat1

  1. College of Medicine, King Faisal University, Al Hofuf, Saudi Arabia

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How to Cite this Article
Pubmed Style

Alkadhem MA, Alshaqaqiq AI, Alshaqaqiq HA, Alkihsi TA, Albattat MS. Knowledge and attitude regarding cardiopulmonary resuscitation among secondary school students in Al Ahsa, Saudi Arabia: a pilot study. IJMDC. 2020; 4(3): 676-681. doi:10.24911/IJMDC.51-1576709193


Web Style

Alkadhem MA, Alshaqaqiq AI, Alshaqaqiq HA, Alkihsi TA, Albattat MS. Knowledge and attitude regarding cardiopulmonary resuscitation among secondary school students in Al Ahsa, Saudi Arabia: a pilot study. http://www.ijmdc.com/?mno=78547 [Access: March 29, 2020]. doi:10.24911/IJMDC.51-1576709193


AMA (American Medical Association) Style

Alkadhem MA, Alshaqaqiq AI, Alshaqaqiq HA, Alkihsi TA, Albattat MS. Knowledge and attitude regarding cardiopulmonary resuscitation among secondary school students in Al Ahsa, Saudi Arabia: a pilot study. IJMDC. 2020; 4(3): 676-681. doi:10.24911/IJMDC.51-1576709193



Vancouver/ICMJE Style

Alkadhem MA, Alshaqaqiq AI, Alshaqaqiq HA, Alkihsi TA, Albattat MS. Knowledge and attitude regarding cardiopulmonary resuscitation among secondary school students in Al Ahsa, Saudi Arabia: a pilot study. IJMDC. (2020), [cited March 29, 2020]; 4(3): 676-681. doi:10.24911/IJMDC.51-1576709193



Harvard Style

Alkadhem, M. A., Alshaqaqiq, . A. I., Alshaqaqiq, . H. A., Alkihsi, . T. A. & Albattat, . M. S. (2020) Knowledge and attitude regarding cardiopulmonary resuscitation among secondary school students in Al Ahsa, Saudi Arabia: a pilot study. IJMDC, 4 (3), 676-681. doi:10.24911/IJMDC.51-1576709193



Turabian Style

Alkadhem, Mustafa Ali, Ali Ibrahim Alshaqaqiq, Hussain Ahmed Alshaqaqiq, Tumadhir Abdullah Alkihsi, and Mohammed Saleh Albattat. 2020. Knowledge and attitude regarding cardiopulmonary resuscitation among secondary school students in Al Ahsa, Saudi Arabia: a pilot study. International Journal of Medicine in Developing Countries, 4 (3), 676-681. doi:10.24911/IJMDC.51-1576709193



Chicago Style

Alkadhem, Mustafa Ali, Ali Ibrahim Alshaqaqiq, Hussain Ahmed Alshaqaqiq, Tumadhir Abdullah Alkihsi, and Mohammed Saleh Albattat. "Knowledge and attitude regarding cardiopulmonary resuscitation among secondary school students in Al Ahsa, Saudi Arabia: a pilot study." International Journal of Medicine in Developing Countries 4 (2020), 676-681. doi:10.24911/IJMDC.51-1576709193



MLA (The Modern Language Association) Style

Alkadhem, Mustafa Ali, Ali Ibrahim Alshaqaqiq, Hussain Ahmed Alshaqaqiq, Tumadhir Abdullah Alkihsi, and Mohammed Saleh Albattat. "Knowledge and attitude regarding cardiopulmonary resuscitation among secondary school students in Al Ahsa, Saudi Arabia: a pilot study." International Journal of Medicine in Developing Countries 4.3 (2020), 676-681. Print. doi:10.24911/IJMDC.51-1576709193



APA (American Psychological Association) Style

Alkadhem, M. A., Alshaqaqiq, . A. I., Alshaqaqiq, . H. A., Alkihsi, . T. A. & Albattat, . M. S. (2020) Knowledge and attitude regarding cardiopulmonary resuscitation among secondary school students in Al Ahsa, Saudi Arabia: a pilot study. International Journal of Medicine in Developing Countries, 4 (3), 676-681. doi:10.24911/IJMDC.51-1576709193