|Year : 2021 | Volume
| Issue : 1 | Page : 38-47
Knowledge and awareness of basic life support among nonhealth-care providers in Riyadh
Ahmed Sayed Khashaba1, Mogbel Khalaf Alharbi2, Madawi Saleh Alghunaim3, Leena Abdulrahman Alsemari3, Wasaif Salh Almohaimeed4
1 Department of Basic Sciences, Riyadh Elm University, Riyadh, KSA
2 Research Student, College of Medicine, King Abdulaziz University for Health Sciences, Riyadh, KSA
3 Research Student, College of Pharmacy, King Saud University, Riyadh, KSA
4 Research Student, College of Medicine, Qassim University, Buraidah, KSA
|Date of Submission||14-Jul-2020|
|Date of Decision||15-Sep-2020|
|Date of Acceptance||28-Oct-2020|
|Date of Web Publication||17-Apr-2021|
Dr. Ahmed Sayed Khashaba
Associate Professor of Medical Physiology, Department of Basic Sciences, Riyadh Elm University, Riyadh 12734
Source of Support: None, Conflict of Interest: None
Introduction: Sudden cardiac arrest is a life-threatening emergency and a leading cause of mortality worldwide. According to the World Health Organization, cardiovascular disease is the most common cause of death in Saudi Arabia.
Aims: This study aims to evaluate the level of knowledge and awareness toward basic life support (BLS) among nonhealth-care professionals in Riyadh.
Methods: This cross-sectional descriptive survey was done using random sampling during the time period of June 2020. Data were collected using self-administered online questionnaire which was adapted from a validated questionnaire that was used previously in a similar study. The questionnaire contained three parts: (i) demographic data, (ii) questions on awareness related to BLS, and (iii) questions on the level of BLS knowledge. Descriptive statistics were analyzed using IBM SPSS Version 25, and Chi-square test was used to find association between the level of knowledge and demographic factors.
Results and Discussion: A total of 429 respondents completed the questionnaire: 80% were females and majority were 21–30 years old (39.4%). Our results demonstrated that only 22% had previous BLS training of which 43% had good knowledge and 56% had poor knowledge about BLS. There was a significant association between the level of BLS knowledge with gender (P = 0.007), education (P = 0.006), and occupation (P = 0.049). Nearly 84.4% of the respondents were aware that their knowledge in BLS was insufficient.
Conclusions: Overall, the level of knowledge and awareness among nonhealth-care professionals in Riyadh are poor. Introduction of BLS courses in the education curriculum is highly recommended.
Keywords: Awareness, basic life support, knowledge, nonhealth-care providers, Riyadh
|How to cite this article:|
Khashaba AS, Alharbi MK, Alghunaim MS, Alsemari LA, Almohaimeed WS. Knowledge and awareness of basic life support among nonhealth-care providers in Riyadh. Saudi J Oral Sci 2021;8:38-47
|How to cite this URL:|
Khashaba AS, Alharbi MK, Alghunaim MS, Alsemari LA, Almohaimeed WS. Knowledge and awareness of basic life support among nonhealth-care providers in Riyadh. Saudi J Oral Sci [serial online] 2021 [cited 2021 Jun 22];8:38-47. Available from: https://www.saudijos.org/text.asp?2021/8/1/38/313927
| Introduction|| |
Sudden cardiac arrest is one of the most common types of life-threatening emergency and a leading cause of mortality worldwide. It is a sudden failure of the heart in which it cannot contract and pump blood effectively that within few minutes can lead to death if not encountered and appropriately managed. According to the World Health Organization (WHO), cardiovascular diseases are estimated to account for 37% of deaths due to noncommunicable diseases in the Kingdom of Saudi Arabia (KSA). Unfortunately, 80% of the cases occurred at home, which is also known as out-of-hospital cardiac arrests (OHCA). It has a poor survival rate with only 10.8% compared to patients that had an in-hospital cardiac arrest, 22.3%–25.5%.,
Basic life support (BLS) is a key component of survival as it helps to recognize several life-threatening emergencies promptly, give high-quality chest compressions, and deliver appropriate ventilation. This simple and effective maneuver, if performed well and in a timely manner, will decrease the chance of mortality in the most emergency situations., The fact that an emergency can happen anytime and anywhere, the chance of getting early life support depends on anyone near who knows the procedure. The lack of training and incompetence to deal with these emergencies will lead to tragic consequences. Therefore, it is crucial to have at least one family member who can give BLS.
Several studies have been conducted inside and outside of KSA to evaluate the level of knowledge and awareness of BLS and majority of the studies focused on healthcare professionals,,, school, and university students. The findings revealed that the overall outcome of awareness was average, and the score of knowledge of BLS was poor. An assessment among the nonmedical community on the knowledge and awareness of BLS, particularly in the city of Riyadh, KSA is limited. Hence, this study aims to evaluate the level of knowledge and awareness toward BLS and the association with demographic factors among nonhealth-care providers in Riyadh.
- To evaluate the level of knowledge and awareness among nonhealth-care providers toward BLS in Riyadh
- To identify the associations between the demographic factors and the level of BLS knowledge.
| Subjects and Methods|| |
Study design and data collection
This study was a cross-sectional descriptive study that was designed to assess the knowledge and awareness toward BLS among nonhealth-care providers via a self-administered online questionnaire. This study was conducted in Riyadh, KSA, and data were collected in June 2020.
The sample size calculated for this study is 337. The sample size was determined based on a 5% margin of error, 95% confidence interval, 50% response distribution, and 20,000 estimated population size.
The questionnaire was adopted and modified from Subki et al. and National Healthcare Provider Solutions, derived from the BLS provider handbook and adhered to the latest International Liaison Committee on Resuscitation and Emergency Cardiovascular Care guidelines. The questions were created using Google Form and administered online. The questionnaire contained multiple-choice questions and consisted of three parts. The first part focused on the participants' demographic data, including age, gender, education, and occupation. The second part contained questions on BLS awareness level, and the third part contained questions related to basic knowledge on BLS including on how to perform BLS techniques and cardiopulmonary resuscitation (CPR) properly [Appendix 1: Questionnaire]. A score of 5 or more on part three of the survey questions was considered a passing score. The questionnaire was developed in two languages; English and Arabic. The link to the questionnaire was randomly distributed via E-mail and social media platforms. The questionnaire did not contain the name and details of the participants to maintain confidentiality.
The inclusion criteria were all males and females, nonhealth-care providers who are 18 years old and above, and currently residing in Riyadh, Saudi Arabia. Participants who are below 18 years old, health-care providers or refused to participate were excluded.
Ethical approval for this study was obtained from the Institutional Review Board of Riyadh Elm University with approval number SRS/2020/11/202/193.
Demographic data were presented as frequency and percentage. The association between different variables was determined via Chi-square test. All statistical analyses were done using IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.
| Results|| |
The demographic data of this study are shown in [Table 1]. A total of 429 respondents participated in this study. The response rate was not possible to determine due to the online nature of the questionnaire where the participants can ignore the link if they wished not to take part. Majority of the respondents were female (80%, n = 343), in the 21–30 years age group (39.4%, n = 169). Of the respondents, 56.6% (n = 243) had a degree (Bachelor's/Master's) and 34% (n = 146) with high school background. Most of the respondents were students (59.2% (n = 254), 13.5% (n = 58) were homemakers, and 12.6% (n = 54) were working in the private sectors.
[Table 2] showed the total numbers and percentages of respondents who had taken the BLS training course according to the demographic background. A total of 332 respondents had no BLS training, and only 97 respondents had taken the BLS course. According to the age group, the majority who had BLS training were between the age of 21 and 30 years old (51.5%, n = 50) with more female respondents took the training (80.4%, n = 78) compared to male respondents (19.5%, n = 19). With regard to the education background, the majority of respondents who had BLS training were degree holders (70.1%, n = 68). According to our survey, majority of the respondents who had BLS training were students (62.8%, n = 61).
|Table 2: The total numbers and percentages of respondents who have taken basic life support course according to demographic background|
Click here to view
The level of knowledge among respondents with BLS training is presented in [Table 3], and its association across different demographic factors was analyzed using the Chi-square test. Overall, out of 97 respondents who had previous BLS training, only 42 of them were classified to have good BLS knowledge (scores above 5), and 55 respondents were found to have poor BLS knowledge (scores below 5).
|Table 3: The level of basic life support knowledge according to demographic background|
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Among different age groups, 54.7% (n = 23) who had good BLS knowledge were between the age of 21 and 30 years. Moreover, female respondents (92.8%, n = 39) had good BLS knowledge in comparison to males (7.1%, n = 3). Respondents with degree background and respondents who are students were also found to have good BLS knowledge in this survey, 88% (n = 37) and 78.5% (n = 33), respectively.
There was a significant association between the level of BLS knowledge with gender (P = 0.007), education level (P = 0.006), and occupation status (P = 0.049). These findings were supported with a moderate positive strength of R-value ranged between 0.2 and 0.3 for the above three factors.
There was no significant association found among the level of BLS knowledge and age group (P = 0.074).
[Table 4] displays the responses of the self-awareness questions among the respondents. Majority of the respondents (89.5%, n = 384) reported that they have never been in a situation that required them to do CPR. The respondents' first reaction when they encounter a person with cardiac arrest showed that majority of them would begin CPR immediately (56.2%, n = 241), while 29.8% (n = 128) respondents said that they would drive the victim to the nearest hospital. Seventy-seven percent (77.6%, n = 333) of the respondents reported that they know the number to call for an ambulance. However, 73.4% (n = 315) said that they do not know where to register for BLS training in the city of Riyadh.
Overall, 84.4% (n = 362) believed that their knowledge of BLS is not sufficient and 85.8% (n = 368) think that BLS course should be mandatory. Majority of the respondents (70.6%, n = 303) suggested that BLS courses should be mandatory in schools and universities to increase the skills and awareness of the community toward CPR and BLS, while 16.1% (n = 69) believed that social media could play a role in increasing the awareness of BLS among the community of Riyadh.
The distribution of self-grading on the level of BLS knowledge is presented in [Table 5]. In this survey, only 17.5% (n = 17) of the respondents believed that they have good knowledge of BLS and 34% (n = 33) declared that their knowledge on BLS is average. Nearly half of the respondents who underwent BLS training previously declared that their knowledge on BLS is poor (19.5%, n = 19) and below average (28.8%, n = 28).
|Table 5: Self-perception on basic life support knowledge among respondents who underwent basic life support training|
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| Discussion|| |
Knowledge and awareness on BLS are essential not only for healthcare professionals but also for every individual in the community, to save lives as well as to improve the overall quality of community health. Therefore, the present study was conducted to assess the level of knowledge and awareness among nonhealth-care professionals in the city of Riyadh.
Our results demonstrated that only 22% out of 429 respondents had previous BLS training course, whereas 77% had no previous experience with BLS training. This result is similar to a study reported by Ahmad et al. that found only 20% out of 360 respondents had BLS training. This finding could be due to the type of the sample population who are nonhealth-care professionals, and according to Abbas et al., the knowledge and awareness of trained individuals were more than the untrained individuals. This could be explained by the fact that health-care professionals should have hands-on courses regularly in order to master the skills and refresh knowledge about BLS.,
Our findings on the level of BLS knowledge among the respondents who underwent BLS training showed that only less than half (43%) possessed a good knowledge of BLS while 56% had poor knowledge about BLS. These findings are in accordance with a study reported by Subki et al. that demonstrated the theoretical knowledge level of BLS among the nonmedical population in Jeddah, Saudi Arabia, was below average, where only 39.2% of the participants passed the test. Besides, numerous studies have proven the poor level of BLS knowledge among female students in Riyadh, among Egyptian medical students as well as among health-care professionals (i.e., doctors, medical students, and nursing staff). The main reason for such lack of knowledge could be due to lesser practical exposure about BLS in their daily activities, which leads to reduced memory retention. It has been shown in many studies that the knowledge and skills of BLS/CPR decrease following 6 months after training. Hence, based on the current findings, a mandatory introductory course on BLS as well as practical demonstration must be incorporated in the school and university curriculum so that students will get early exposure to the program. Refresher courses must be organized frequently for both health-care professionals and nonhealth-care professionals to update knowledge and skills. Appropriate training of BLS improves survival rates of cardiac arrest patients, and hands-on practice is essential for a better CPR outcome.
In the present study, we found a poor level of awareness about BLS as perceived by the respondents; 84.4% believed that their knowledge on BLS was insufficient and almost majority of them (89.5%) had never been in a situation that required them to do CPR. From the survey conducted, half of the respondents (56.2%) stated that they would start CPR immediately when encountered with a person with cardiac arrest and 77.6% stated that they know the correct number to call for an ambulance during an emergency. These outcomes reflect a positive attitude toward BLS awareness. However, 73.4% of the respondents declared that they do not know the place to register for BLS program in Riyadh. A similar pattern of results was obtained in a study conducted by Chandrasekaran et al. that reported the awareness of BLS among students, doctors, and nurses of medical, dental, homeopathy, and nursing colleges is very poor with 84.82% of the respondents scoring <50%. According to this survey, majority of the respondents stated that BLS courses should be mandatory in schools and universities, while social media could be a good platform to spread awareness on BLS. Therefore, as an effort to educate the community, posters on BLS awareness campaigns should be made available and accessible across the city center and public transportations in Riyadh, while video tutorials on BLS knowledge and CPR techniques should be made freely available on all social media platforms and television.
This study has some limitations that the level of awareness was not obtained through objective scoring or assessment methods, but it was based on respondents' perceptions. Besides, BLS practical skills were not assessed among the respondents. Therefore, more objective approaches need to be undertaken for a more accurate assessment of BLS knowledge and awareness in future studies.
| Conclusions|| |
This study demonstrated that the level of knowledge and awareness of BLS among the nonhealth-care community in Riyadh is poor and needs to be improved. Therefore, this study recommends including BLS training course in the schools' and universities' curriculum where the students can be trained effectively on the skills and knowledge of BLS. Furthermore, regular refresher courses are necessary to provide hands-on experience. It is also suggested that the community in Riyadh to actively participate in government-funded training programs to increase the public's exposure and awareness to BLS education.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| Appendix 1|| |
Appendix 1: Questionnaire
The objective of this study is to collect data on the level of knowledge and awareness towards basic life support among Riyadh population along with the associated influencing factors. Please respond to the questionnaire as truthfully as possible. All information will be treated with strictest confidential and for research purposes only.
This questionnaire consists of three parts:
Part A: Respondent's information
Part B: Information related to awareness of BLS
Part C: Information related to knowledge of BLS
Part A: Respondent's information
1. Age group:
◻ Above 60
◻ High school
◻ Degree (bachelor's/masters)
◻ Others: ______________________ (please state)
◻ Government job
◻ Private job
◻ Others: ______________________ (please state)
Part B: Information related to awareness of BLS
5. Have you ever taken a BLS training course?
6. Do you think a BLS course should be mandatory?
◻ I do not know
7. Have you ever been in a situation that required you to do cardiopulmonary resuscitation?
8. If yes, did you resuscitate the person?
◻No, please state the reason: ______________________________
9. Do you feel your knowledge about BLS is sufficient?
10. If you encounter a person with cardiac arrest, what is the first action you will take?
◻ Start resuscitation immediately
◻ Call for an ambulance
◻ Drive the victim to a hospital
◻ Wait for someone to help the victim
11. In the case of calling for an ambulance, do you know the number to call?
12. Do you know where you can register for a BLS program in the city of Riyadh?
13. Which of the following methods would help to increase the skills and awareness of the community towards CPR and BLS?
◻ Mandatory courses in schools and universities
◻ Social Media
◻ Training courses at certified centers
◻ Others: ______________________
Part C: Information related to knowledge of BLS
14. The compression to ventilation ratio for one rescuer giving CPR to individuals of ANY age is:
15. How often should rescuers switch roles when performing two-rescuer CPR?
◻ After every cycle of CPR
◻ After every two cycles of CPR
◻ After every five cycles of CPR
◻ After every 10 cycles of CPR
16. The proper steps for operating an AED are:
◻ Power on the AED, attach electrode pads, shock the individual, and analyze the rhythm
◻ Power on the AED, attach electrode pads, analyze the rhythm, clear the individual, and deliver shock
◻ Attach electrode pads, check pulse, shock individual, and analyze rhythm
◻ Check pulse, attach electrode pads, analyze rhythm, shock patient
17. Where should you attempt to perform a pulse check in a child who is anywhere from 1 year to puberty?
◻ Brachial artery
◻ Ulnar artery
◻ Temporal artery
◻ Carotid or femoral artery
18. The initial basic life support steps for adults are:
◻ Assess the individual, give two rescue breaths, defibrillate, and start CPR
◻ Assess the individual, activate EMS and get AED, check pulse, and start CPR
◻ Check pulse, give rescue breaths, assess the individual, and defibrillate
◻ Assess the individual, start CPR, give two rescue breaths, and defibrillate
19. The critical characteristics of high-quality CPR include which of the following?
◻ Starting chest compressions within 10 seconds of recognition of cardiac arrest
◻ Pushing hard and fast
◻ Minimizing interruptions
◻ All of the above
20. The five steps in the Adult Chain of Survival include all the following except:
◻ Early CPR
◻ Rapid defibrillation
◻ Advanced airway placement
◻ Integrated post-cardiac arrest care
21. The 2015 AHA guidelines for CPR recommended BLS sequence of steps are:
◻ Chest compressions, airway, breathing
◻ Airway, breathing, check pulse
◻ Airway, breathing, chest compressions
◻ None of the above
22. Which of the following are signs of airway obstruction?
◻ Poor air exchange
◻ High-pitched noise while inhaling
◻ Inability to speak
◻ All of the above
23. In an adult with an advanced airway in place during two-rescuer CPR, how often should the breaths be administered?
◻ Every 2–3 s (20–30 breaths/min)
◻ Every 4–5 s (12–15 breaths/min)
◻ Every 6–8 s (8–10 breaths/min)
◻ Every 10–12 s (5–6 breaths/min)
24. What is the recovery position for someone who survived after using CPR?
◻ Sitting for half an hour
◻ Lying on one side
◻ Standing and try to walk for a few steps
◻ Lying on back
25. Grade your knowledge on BLS:
◻ Below average
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]