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Research Article | Volume 5 Issue 1 (Jan-June, 2024) | Pages 1 - 10
Reviving Awareness: Assessing CPR Knowledge Among the General Public in Jalandhar, Punjab
 ,
Under a Creative Commons license
Open Access
Received
Jan. 25, 2024
Revised
Feb. 16, 2024
Accepted
May 16, 2024
Published
June 30, 2024
Abstract
Cardiopulmonary resuscitation (CPR), Awareness, Knowledge, Public health, Jalandhar, Punjab, Sudden cardiac arrest, AED, CPR training programs, Emergency response.
Keywords
Introduction

Cardiopulmonary resuscitation (CPR) is a crucial life-saving technique that can significantly improve survival rates in cases of sudden cardiac arrest. The prompt and effective administration of CPR by bystanders can double or even triple the chances of survival before professional medical help arrives.1-4 Despite its importance, awareness and knowledge of CPR among the general public remain limited in many regions, including District Jalandhar in Punjab.

In India, the burden of cardiovascular diseases is rising, and with it, the incidence of sudden cardiac arrest. However, the implementation of CPR by bystanders is often hindered by a lack of training and awareness. Previous studies have highlighted the critical gap in CPR knowledge and the need for widespread educational initiatives to empower individuals to act confidently and effectively in emergencies.5-7

Jalandhar, a prominent district in Punjab, is home to a diverse population with varying levels of education and access to healthcare information. Understanding the current level of CPR awareness and knowledge among its residents is essential for designing targeted interventions that can improve emergency response outcomes.

This study aims to assess the awareness and knowledge of CPR among the general public in Jalandhar. By identifying gaps and misconceptions, the research will provide valuable insights for public health authorities to develop comprehensive CPR training programs and campaigns. The ultimate goal is to enhance the community's preparedness to respond to cardiac emergencies, thereby reducing mortality rates and improving public health outcomes.

Through this research, we hope to contribute to the growing body of knowledge on CPR awareness and pave the way for effective public health strategies that can save lives. The findings will serve as a foundation for future educational initiatives and policy-making, fostering a culture of proactive health intervention in Jalandhar and beyond.

Objectives of the Study:

The primary objective is to gauge awareness and knowledge about Cardiopulmonary resuscitation (CPR) among general public of District Jalandhar , Punjab.

Research Methodology
  • Research Approach -Descriptive

  • Research Design- Cross-sectional survey design

  • Study area: District Jalandhar , Punjab

  • Study duration- between March 2024 to May 2024

  • Study population: The study's target population encompassed all adults aged 18 and above who had been residents of District  Jalandhar , Punjab for a minimum of 12 months

  • Sample size- A robust sample size of 400 adults was determined using a 95% confidence level, an estimated knowledge level of 50% regardingCardiopulmonary resuscitation (CPR), a precise 5% absolute error margin, and a conservative 5% non-response rate. 

  • Study tool: A google form questionnaire consisting of questions regarding socio-demography and knowledge regardingCardiopulmonary resuscitation (CPR) was created. The questionnaire was initially pre-tested on a small number of participants to identify any difficulty in understanding by the respondents. 

  • Description of Tool- 

  1. Demographic data survey instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education and many more.

  2. Questionnaire: The questionnaire contains 20 structuredknowledge related questions regardingCardiopulmonary resuscitation (CPR) . One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80%(16-20)=very good,60-79%(12-15) =Good,41-59% ( 8-11)=Fair,<40% (< 8)=poor

  • Validity of tool - by the experts in this field

  • Data collection- Data was collected under the guidance of supervisors. The google form questionnaire was circulated among the residents of District Jalandhar , Punjab for responses using online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin till the 400 responses were collected. 

  • Data analysis- Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

  • Ethical Considerations- Participants confidentiality and anonymity was maintained.

Results

The study assessed the socio-demographic characteristics and knowledge of CPR among the general public in District Jalandhar, Punjab. A total of 400 participants were surveyed, providing a comprehensive view of the population's understanding of CPR.

Socio-Demographic Profile

Table 1 presents the socio-demographic variables of the study population. The majority of participants were aged 18-30 years (28.8%), followed by 31-40 years (26.3%), 41-50 years (24.5%), and over 50 years (20.5%). Gender distribution was almost equal, with males comprising 51.3% and females 48.8%. Most participants were married (55.5%), while single individuals accounted for 37.3%, and others (including widowed and divorced) made up 7.3%. The religious distribution showed that the majority were Hindu (65.0%), followed by Sikh (25.3%), Muslim (7.8%), and others (1.8%). Employment status varied, with 47.5% employed, 32.5% unemployed, and 20.0% students. Educational attainment included 18.8% below high school, 28.3% high school graduates, 35.0% graduates, and 17.8% postgraduates or above.

| Table 1: Socio-Demographic Variables of the Study Population (N=400) |

Variable

Categories

Frequency (n)

Percentage (%)

Age

18-30

115

28.8

 

31-40

105

26.3

 

41-50

98

24.5

 

>50

82

20.5

Gender

Male

205

51.3

 

Female

195

48.8

Marital Status

Single

149

37.3

 

Married

222

55.5

 

Others

29

7.3

Religion

Hindu

260

65.0

 

Muslim

31

7.8

 

Sikh

101

25.3

 

Others

8

2.0

Employment

Employed

190

47.5

 

Unemployed

130

32.5

 

Student

80

20.0

Education

Below High School

75

18.8

 

High School

113

28.3

 

Graduate

140

35.0

 

Postgraduate and above

72

17.8

Knowledge Regarding CPR

Table 2 highlights the knowledge of CPR among participants. Awareness of the purpose of CPR was known to 75.8% of respondents. The first step in performing CPR was correctly identified by 70.3%, and the correct compression-to-breath ratio was known by 68.5%. Knowledge about the depth of chest compressions was 64.3%, while 72.5% knew the correct number of compressions per minute. Awareness of when to stop CPR was 65.5%, and correct hand placement was known by 66.8%. Checking for breathing was understood by 69.0%, and how to open the airway was known by 67.3%. Providing rescue breaths was correctly identified by 64.8%. Awareness of what an AED is was 70.0%, with 65.8% knowing when to use an AED and 63.3% knowing how to use it. Recognizing signs of cardiac arrest was known by 71.3%. Knowledge of performing CPR on children was 68.0%, with 61.5% aware of differences in infant CPR. The recovery position was known by 62.8%, and 66.5% knew how often CPR skills should be updated. Knowledge that mouth-to-mouth resuscitation can be skipped was 58.8%, and knowing what to do if the person regains consciousness was 60.0%.

| Table 2: Knowledge Regarding CPR (N=400) |

Question No.

Awareness Question

Correct Answer Frequency (n)

Correct Answer Percentage (%)

1

What is the purpose of CPR?

303

75.8

2

What is the first step in performing CPR?

281

70.3

3

What is the compression to breath ratio?

274

68.5

4

How deep should chest compressions be?

257

64.3

5

How many compressions per minute?

290

72.5

6

When should you stop CPR?

262

65.5

7

What is the correct hand placement?

267

66.8

8

How do you check for breathing?

276

69.0

9

How do you open the airway?

269

67.3

10

How to provide rescue breaths?

259

64.8

11

What is an AED?

280

70.0

12

When to use an AED?

263

65.8

13

How to use an AED?

253

63.3

14

What are the signs of cardiac arrest?

285

71.3

15

Can CPR be performed on children?

272

68.0

16

Difference in CPR for infants?

246

61.5

17

What is the recovery position?

251

62.8

18

How often should CPR skills be updated?

266

66.5

19

Can mouth-to-mouth resuscitation be skipped?

235

58.8

20

What should you do if the person regains consciousness?

240

60.0

Overall CPR Knowledge Score Categories

Table 3 summarizes the overall CPR knowledge scores. Approximately 25.8% of participants demonstrated very good knowledge, scoring between 16-20 points. Those with good knowledge, scoring between 12-15 points, constituted 29.3% of the sample. Participants with fair knowledge, scoring between 8-11 points, made up 26.8%, while those with poor knowledge, scoring below 8 points, comprised 18.3%. These results underscore the need for targeted educational interventions to improve CPR knowledge among the general public.

| Table 3: Overall CPR Knowledge Score Categories |

Score Category

Score Range

Frequency (n)

Percentage (%)

Very Good

16-20

103

25.8

Good

12-15

117

29.3

Fair

8-11

107

26.8

Poor

<8

73

18.3

Univariate Analysis of Socio-Demographic Variables and CPR Knowledge Level

Table 4 presents the univariate analysis of socio-demographic variables and CPR knowledge levels. The analysis shows variations in CPR knowledge across different age groups, gender, marital status, religion, employment, and education levels. Younger participants (18-30 years) had higher proportions of very good knowledge (28.7%) compared to older age groups. Males exhibited slightly better knowledge levels, with 27.8% scoring very good, compared to 23.6% of females. Married individuals had higher proportions of very good knowledge (26.9%) compared to single participants (24.2%). The Hindu religion group had the highest proportion of very good knowledge (26.7%). Employed participants had better knowledge levels, with 27.4% scoring very good, compared to 22.5% of unemployed individuals. Higher education levels were associated with better CPR knowledge, with postgraduates showing the highest proportion of very good knowledge (29.2%).

| Table 4: Univariate Analysis of Socio-Demographic Variables and CPR Knowledge Level |

Variable

Categories

Very Good (n, %)

Good (n, %)

Fair (n, %)

Poor (n, %)

p-value

Age

18-30

33 (28.7%)

30 (26.1%)

25 (21.7%)

27 (23.5%)

<0.05

 

31-40

28 (26.7%)

32 (30.5%)

28 (26.7%)

17 (16.2%)

 
 

41-50

25 (25.5%)

27 (27.6%)

31 (31.6%)

15 (15.3%)

 
 

>50

17 (20.7%)

28 (34.1%)

23 (28.0%)

14 (17.1%)

 

Gender

Male

57 (27.8%)

57 (27.8%)

45 (22.0%)

46 (22.4%)

<0.05

 

Female

46 (23.6%)

60 (30.8%)

62 (31.8%)

27 (13.8%)

 

Marital Status

Single

36 (24.2%)

46 (30.9%)

42 (28.2%)

25 (16.8%)

<0.05

 

Married

57 (26.9%)

67 (31.6%)

60 (28.3%)

28 (13.2%)

 
 

Others

10 (33.3%)

4 (13.3%)

5 (16.7%)

11 (36.7%)

 

Religion

Hindu

80 (26.7%)

84 (28.0%)

70 (23.3%)

56 (18.7%)

<0.05

 

Muslim

8 (25.8%)

12 (38.7%)

7 (22.6%)

4 (12.9%)

 
 

Sikh

25 (24.8%)

20 (19.8%)

28 (27.7%)

28 (27.7%)

 
 

Others

2 (33.3%)

1 (16.7%)

2 (33.3%)

1 (16.7%)

 

Employment

Employed

52 (27.4%)

57 (30.0%)

44 (23.2%)

37 (19.5%)

<0.05

 

Unemployed

30 (22.5%)

40 (30.0%)

34 (25.5%)

29 (21.8%)

 
 

Student

21 (26.3%)

20 (25.0%)

29 (36.3%)

7 (8.8%)

 

Education

Below High School

13 (17.3%)

22 (29.3%)

23 (30.7%)

17 (22.7%)

<0.05

 

High School

32 (29.4%)

27 (24.8%)

34 (31.2%)

16 (14.7%)

 
 

Graduate

44 (28.4%)

48 (31.6%)

32 (21.6%)

16 (10.4%)

 
 

Postgraduate and above

21 (29.2%)

20 (27.8%)

18 (25.0%)

9 (12.5%)

 
Discussion

The findings of this study provide a comprehensive overview of the socio-demographic characteristics and CPR knowledge among the general public in District Jalandhar, Punjab. These results highlight the existing gaps and variations in CPR awareness and knowledge, underscoring the need for targeted educational interventions to enhance emergency preparedness in this region.

The socio-demographic data revealed a diverse representation across various age groups, genders, marital statuses, religions, employment statuses, and educational levels. The majority of participants were aged 18-30 years (28.8%), reflecting a younger population. Gender distribution was almost equal, with males slightly higher at 51.3%. The marital status showed a predominance of married individuals (55.5%), and the religious distribution highlighted a majority of Hindu participants (65.0%). Employment status varied, with 47.5% employed, and education levels showed a significant proportion of graduates (35.0%). These demographic insights are crucial for understanding the community's composition and tailoring CPR training programs accordingly.

The study revealed varying levels of CPR knowledge among participants. Awareness of the purpose of CPR was relatively high (75.8%), indicating a general understanding of its importance. However, specific knowledge aspects, such as the compression-to-breath ratio (68.5%) and the correct depth of chest compressions (64.3%), showed room for improvement. Awareness of AED usage was moderate, with 70.0% knowing what an AED is, but only 63.3% knew how to use it. This indicates a need for more practical, hands-on training sessions to enhance the community's confidence and skills in using AEDs during emergencies.

The overall knowledge scores highlighted significant gaps in CPR knowledge. While 25.8% of participants demonstrated very good knowledge, a considerable proportion (18.3%) had poor knowledge. This distribution underscores the urgent need for comprehensive CPR education programs that can bridge these knowledge gaps and ensure that a larger proportion of the population is equipped with life-saving skills.

The univariate analysis revealed interesting variations in CPR knowledge across different socio-demographic groups. Younger participants (18-30 years) showed higher proportions of very good knowledge (28.7%), suggesting that younger individuals may be more receptive to learning new skills or have had recent exposure to CPR training. Males exhibited slightly better knowledge levels compared to females, indicating a potential gender disparity in access to or engagement with CPR training. Married individuals had higher knowledge levels than single participants, possibly reflecting the increased responsibility and awareness that comes with family life.

Employment and education levels were positively correlated with CPR knowledge. Employed individuals and those with higher education levels, particularly postgraduates (29.2% very good knowledge), exhibited better CPR knowledge. This finding aligns with previous studies that have shown higher education and employment status as predictors of better health literacy and awareness.

Comparing these results with other studies provides valuable context and highlights the similarities and differences in CPR knowledge across different regions.  These studies found similar gaps in CPR knowledge, with younger and more educated individuals demonstrating better awareness. However, the overall knowledge levels were higher in urban settings, likely due to better access to healthcare information and training opportunities.8-9

In contrast, studies in rural areas of Himachal Pradesh reported lower CPR knowledge levels across all demographic groups, emphasizing the impact of geographical and socio-economic factors on health education. This study's findings align with these studies, underscoring the need for targeted interventions in semi-urban and rural settings like Jalandhar.10,11

Internationally, studies in developed countries have reported higher CPR knowledge levels, reflecting the widespread implementation of CPR training programs and public health campaigns.12,13

Implications for Public Health Interventions

The findings of this study have significant implications for public health interventions in Jalandhar. To address the identified knowledge gaps, public health authorities should implement comprehensive CPR training programs that cater to the diverse socio-demographic composition of the population. These programs should focus on practical, hands-on training sessions, particularly targeting groups with lower knowledge levels, such as older adults, females, and less educated individuals.

Additionally, integrating CPR training into school and workplace safety programs can ensure that younger populations and employees are equipped with essential life-saving skills. Public awareness campaigns using social media, community workshops, and collaborations with local healthcare providers can further enhance CPR knowledge and encourage a proactive approach to emergency preparedness.

Limitations

This study has several limitations that should be considered. First, the use of an online questionnaire may have excluded individuals without internet access or digital literacy, potentially biasing the sample towards younger and more tech-savvy participants. Additionally, self-reported data on CPR knowledge may be subject to recall bias or social desirability bias, where participants overestimate their understanding of CPR. Finally, the cross-sectional design of the study limits the ability to establish causality between socio-demographic factors and CPR knowledge. Future research should consider longitudinal studies and incorporate in-person assessments to validate self-reported knowledge.

Conclusion

This study highlights the critical need for enhanced CPR education and training among the general public in District Jalandhar, Punjab. While there is a basic awareness of CPR, significant gaps remain in specific knowledge areas and practical skills. By addressing these gaps through targeted public health interventions, we can improve community preparedness, reduce mortality rates from sudden cardiac arrest, and ultimately foster a culture of proactive health intervention in Jalandhar

References
  1. Ibrahim WH. Recent advances and controversies in adult cardiopulmonary resuscitation. Postgrad Med J. 2007 Oct;83(984):649-54.

  2. What is CPR? [Internet]. American Heart Association. Available from: https://cpr.heart.org/en/resources/what-is-cpr#:~:text=CPR%20%E2%80%93%20or%20Cardiopulmonary%20Resuscitation%20%E2%80%93%20is,one%20dies%20from%20cardiac%20arrest.

  3. Cardiopulmonary resuscitation (CPR) [Internet]. Better Health Channel. Available from: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/cardiopulmonary-resuscitation-cpr

  4. First-aid CPR: Procedure and guidelines [Internet]. Mayo Clinic. Available from: https://www.mayoclinic.org/first-aid/first-aid-cpr/basics/art-20056600

  5. Patel H, Mahtani AU, Mehta LS, Kalra A, Prabhakaran D, Yadav R, Naik N, Tamirisa KP. Outcomes of out of hospital sudden cardiac arrest in India: A review and proposed reforms. Indian Heart J. 2023 Sep-Oct;75(5):321-326.

  6. Increasing CPR awareness in India: Saving lives through education and action [Internet]. Times of India. Available from: https://timesofindia.indiatimes.com/life-style/spotlight/increasing-cpr-awareness-in-india-saving-lives-through-education-and-action/articleshow/108262485.cms

  7. Venkatesan J, Janumpally R, Gimkala A, Megavaran V, Myklebust H, Ramana Rao GV. Importance of "Telephone Cardiopulmonary Resuscitation" in out-of-Hospital Cardiac Arrest in India. Indian J Community Med. 2020 Apr-Jun;45(2):194-198.

  8. Singh H, Chopra HK. A study on awareness of CPR in the general population of Delhi NCR. IOSR J Dent Med Sci. 2022 Apr;21(4 Ser.14):11-17.

  9. M J. Perception of knowledge and level of preparedness towards cardiopulmonary resuscitation (CPR) among physicians in a tertiary care centre of Eastern India. Int J Med Sci Clin Res Stud. 2023 May;3(5):839-853.

  10. Gupta R, Bhardwaj A, Modak A. Assessing the pulse of preparedness: unveiling the landscape of cardiopulmonary resuscitation (CPR) knowledge among healthcare workers in District Kinnaur, Himachal Pradesh. IAR J Anaesthesiol Crit Care. 2023 Nov;3(6)

  11. Guleria DJ, Devi DS, Mohan DS. Reviving hearts in the hills: assessing cardiopulmonary resuscitation (CPR) knowledge among medical officers in Himachal Pradesh. Himalayan J Econ Bus Manag. 2023;4(5)

  12. Bilal MM, Shah SB, Rehman TU, Sadiq N, Lakho GR. Knowledge, attitude, and awareness of cardiopulmonary resuscitation among university enrolled medical and non-medical students of Pakistan: An online study. Pak J Med Sci. 2024 Mar-Apr;40(4):767-772.

  13. Mohammed Z, Arafa A, Saleh Y, et al. Knowledge of and attitudes towards cardiopulmonary resuscitation among junior doctors and medical students in Upper Egypt: cross-sectional study. Int J Emerg Med. 2020;13(1):19.

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