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

Chapter 1 Introduction

This research was funded by the Scottish Government to inform the Scotland’s Out-of-Hospital Cardiac Arrest Strategy^[3] and associated activities. It presents findings from an omnibus survey of Scottish adults. The report starts with this introductory chapter which presents: background to the study; the research aims and objectives; method, sample and analysis. Chapter two discusses key findings and the focus of the last chapter is conclusions and next steps. The attached document contains the core data tables produced from the survey.

1.1 Background

Survival rates from out-of hospital cardiac arrest (OHCA) in Scotland are currently estimated at 1 in 20 adults^[4]. Victims of OHCA who receive bystander Cardio-Pulmonary Resuscitation (CPR) are far more likely to survive to hospital discharge than those who do not. Internationally, the largest improvements in survival after OHCA are associated with an increase in the rates of bystander CPR^[5]. In March 2015 the Scottish Government launched Scotland’s Out-of-Hospital Cardiac Arrest Strategy which seeks to;

“improve outcomes after out-of-hospital cardiac arrest (OHCA) and an ambition that by 2020 Scotland will be an international leader in the management of OHCA”^[6].

The study was funded by the Scottish Government to inform delivery of four strategy aims which centre on public administration of CPR:

• To ensure that those who witness an out-of-hospital cardiac arrest (OHCA) promptly call 999 and are enabled to carry out immediate CPR and use a Public Access Defibrillator (PAD), where available, until support arrives.
• To increase the rate of bystander CPR.
• To equip an additional 500,000 with CPR skills by 2020 and create a nation of life savers.
• To encourage a greater public awareness of the ‘right thing to do’ and an increased willingness to help when present as a bystander at an OHCA.

1.2 Aim and research objectives

The overall aim of the study was to inform the OHCA Scotland Strategy, in particular to improve people in Scotland’s understanding, knowledge, experience of, and attitudes to, bystander CPR. A primary purpose for this is to inform a social marketing strategy and/or health behaviour change activities to address the barriers to responding to OHCA and improve the rate of bystander CPR.

Linked to these were four research objectives:

1. To gather baseline information on the number of people trained in CPR (along with how and when this took place) from which to monitor progress over the five year lifespan of Scotland’s OHCA strategy.
2. To understand why people are not CPR trained and assess interest in receiving CPR training.
3. To explore the barriers and facilitators to administering bystander CPR.
4. To explore public attitudes and behaviour towards bystander CPR.

1.3 Methods

A face-to-face survey was the most appropriate method to collect robust data. To make the best use of resources, data was collected from questions in a rolling general population, face to face, omnibus survey. An omnibus survey is a cost effective and time saving mode of survey data collection with samples that are large enough to be representative of the Scottish adult population. The Institute for Social Marketing (ISM) commissioned questions in the TNS-BMRB Scottish Opinion Survey (SOS) which is conducted in the home, using CAPI (Computer Assisted Personal Interviewing). Qualitative follow-up research to explore findings in more detail may be the focus of a subsequent study and future funding is being sought for that.

Running parallel to this commission were two complimentary but separate studies to provide evidence for the Out of Hospital Cardiac Arrest Strategy for Scotland. First was a literature review conducted by Rebecca Stirzaker, a PhD student intern with the Scottish Government Health Analytical Services. Second, is a qualitative study seeking to better understand the experience and impact of administering CPR. This research is ongoing, led by the Resuscitation Research Group in Edinburgh, funded by the Resuscitation Council UK, and primarily involves semi-structured interviews with approximately 40 people who have administered ‘bystander’ CPR. The literature review informed the survey questions and both studies will provide evidence to develop a social marketing strategy intended to increase the rate of bystander CPR.

1.3.1 Sample and analysis

Data collection took place over a two week period in early August 2015 with a sample of 1027 adults aged 16 or over. Data were weighted to ensure the sample was representative in terms of age, sex and social grade. The sample prolife is shown in Table 1.

Table 1: Sample profile

Descriptive statistics are presented in the report. To ensure that the sample reflects the demographic profile of the wider population of Scotland weighted data is presented.

This report includes bivariate analysis to examine potential differences by gender, age, social grade^[7], and working status. Where statistically significant differences were found, by demographic characteristics, these are noted (denoted by a p value less than 0.05, meaning that there is a less than 5% risk of concluding that a difference exists when there is no actual difference).