Exploring the knowledge, attitudes, and behaviour of the general public to responding to out-of-hospital cardiac arrest

Executive Summary

Bystander CPR is a key determinant of survival after Out-of-Hospital Cardiac Arrest (OHCA). Increasing rates of bystander CPR is a core element of Scotland’s Strategy for OHCA.

This study collected data to inform Scotland’s Out-of-Hospital Cardiac Arrest Strategy^[1] and help create a social marketing strategy and health behaviour change activities to address the barriers to responding to OHCA and improve the rate of bystander Cardio-Pulmonary Resuscitation (CPR) in Scotland. Data were gathered through the TNS-BMRB Scottish Opinion Survey (SOS); a rolling general population face-to-face omnibus survey of a sample of 1027 of the Scottish adult population (aged 16 and over) in early August 2015.

This report presents the key findings and conclusions in addition to the research aims and objectives; method, sample and analysis. The attached document contains the core data tables produced from the survey.

Key findings - CPR training

The proportion of respondents who were trained in CPR was 52%. However most were trained some time ago - 44% over five years and just 28% within the last year. The median time elapsed since CPR training was more than 2 years but less than 5 years. The majority of respondents who were CPR trained received this training because it was a requirement of their employment or was offered to them through their employment or voluntary work (78%). Over two fifths (42%) of respondents who had not been CPR trained said it was something they would like to do. The main reasons for not being CPR trained were because ‘the thought had never occurred’ (28%) or respondents had not been given the opportunity (29%).

Key findings - Administering CPR

One fifth (21%) of respondents said that they would not know if CPR was required and half (50%) would not be confident to administer CPR. As would be expected, confidence to conduct CPR was higher amongst respondents who had received training (93% trained compared with 70% not trained). It is also important to note that over a quarter (27%) of respondents who were trained in CPR said that they would not be confident to administer CPR. Levels of confidence in attempting CPR improved significantly to 82% in the situation where it was indicated that a 999 call handler would talk respondents through what to do.

Just over one in ten respondents (13%) had previously administered CPR. The majority (72%) of respondents indicated that they would be likely to give CPR if they were the only bystander present. Of particular note is that over two fifths (44%) of respondents who were CPR trained said it was unlikely or they did not know if they would act if they were the only person. When respondents were asked why they thought people would not give CPR 34% felt it may be because the person did not have the skills or confidence to give CPR, a further 30% cited fear of making things worse or of being sued. There was strong public support for administering CPR – 77% agreed that everyone should be trained in CPR and 83% agreed that they would rather try giving CPR than do nothing.

Key findings – Social factors associated with responses

In this initial analysis we found three factors associated with knowledge, experience, and attitudes toward bystander CPR:

• Age - the older a person is, the less likely they were to be CPR trained and show willingness to be CPR trained. They were also more likely to have had CPR training more than five years previously and be the least confident to administer bystander CPR. These findings are particularly relevant considering that most OHCA happen in the homes of older people.
• Social grade^[2] – people in professional managerial and non-manual occupations (according to the household’s main income earner’s occupation) were more likely than those in manual, unskilled occupations and long-term unemployed people (social grades C2DE) to be CPR trained and be more confident to administer CPR if talked through by a call handler.
• Working status - people who were working were more likely to be CPR trained, be trained more recently and show higher levels of confidence to administer CPR.

Based on the findings from this study our suggested priorities for a social marketing strategy to improve the rate of bystander CPR include:

• Engagement with people who are not CPR trained and improve the number of people who would like to be CPR trained.
• Specially target older people, people in social grade C2DE and people who are not required to be CPR trained for their employment or voluntary work.
• Address the barriers to administering CPR by building confidence and addressing myths/fears around administering CPR (e.g. making things worse; fear of being sued or catching a disease).