Knowledge and attitude on cardiopulmonary resuscitaton education of primary and secondary schoolteachers in China

To the Editor: Early bystander cardiopulmonary resuscitation (CPR) is crucial for survival and long-term quality of life of patients with out-of-hospital cardiac arrest.[1] Training schoolchildren how to perform CPR is highly recommended by many countries and health organizations, including the World Health Organization.[2,3] Schoolteachers with previous training are highly suggested as CPR instructors to teach schoolchildren.[4,5] The CPR knowledge and previous training of the teachers are very important for their willingness to teach CPR and the quality of their teaching.[6,7] A 6-year longitudinal study confirmed that teachers who previously attended a 60-min theoretical and practical CPR course could provide adequate resuscitation training in schools.[8] In Belgium, some Flemish primary schoolteachers had a high interest in CPR training and were also willing to teach CPR.[7] In China, little is known about teachers’ CPR knowledge and the attitude toward CPR education. The main goal of this study was to evaluate Chinese primary and secondary teachers’ current CPR knowledge, previous training, and the attitude toward CPR education. We conducted a prospective anonymous online survey. Our online questionnaire was designed using the Tencent questionnaire website (https://wj.qq.com/mine.html) and spread through WeChat, which is a widely used social media tool and also a convenient sampling method for administering questionnaires in China. The questionnaire was designed based on the European Resuscitation Council Guidelines for Resuscitation 2015 and previously documented scenario-based surveys.[7,9] The 24-item questionnaire comprised four distinct aspects: (1) demographic information, including age, sex, and educational cycle; (2) current awareness of CPR and previous CPR training; (3) willingness and attitude toward participating in CPR training and teaching; and (4) automated external defibrillator (AED)-related information and CPR knowledge, including recognition of cardiac arrest, hand placement for performing chest compressions, compression depth and rate, and compression–ventilation ratio. The study participants included primary and secondary schoolteachers who were willing to complete the questionnaire by clicking on the online connection via WeChat. Questionnaires submitted between January 24 and February 8, 2018 were collected for analysis. The results of this online survey were exported from the Tencent questionnaire website. A total of 5556 questionnaires were collected, of which 5324 were valid. Data analysis was performed using SPSS software (version 20.0 for Windows; SPSS, Inc., Chicago, IL, USA). Categorical variables were presented as percentages and analyzed using the χ2 test. We considered the difference to be statistically significant when P value was less than 0.05. Among the 5324 participants, 2329 were primary schoolteachers and 2995 were secondary schoolteachers. Of the participants, 96.8% had previously heard about CPR, with the highest proportion of participants learning about CPR from television (70.0%) and the lowest proportion from newspapers (39.1%). Previous CPR training experience was common (54.0%) [Table 1]. Furthermore, significant differences in previous CPR training were observed between schoolteachers of different ages, with the highest proportion of previous training in schoolteachers aged 30 to 39 years (60.7%) and the lowest proportion in teachers aged 50 years or older (36.6%). This result suggests that 30 to 39-year-old schoolteachers can be potential CPR teachers [Table 2].Table 1: Previous training status and the attitude toward CPR education of primary and secondary schoolteachers in China, n (%).Table 2: Training status and attitude toward training and teaching CPR to schoolteachers of different ages, n (%).Most schoolteachers knew how to assess consciousness (71.9%) and respiration (51.1%). The majority of the teachers knew correct hand placement (77.4%) and hand posture (80.9%) for correct chest compression. However, only 18.0% knew the depth of chest compression, 29.1% knew the frequency of chest compressions, and 28.4% could select the correct ratio of chest compressions and artificial respiration. Only a minority of teachers (16.2%) knew how to use AEDs and only 12.7% were aware of the placement of AEDs in the neighborhood. Therefore, we should strengthen further learning and systematic reviews of teachers’ theoretical CPR knowledge [Table 3].Table 3: Current situation of CPR theoretical knowledge and AED information of schoolteachers, n (%).Importantly, in China, 96.4% of the participants responded that they would like to attend CPR training, 93.1% supported the development of a curriculum on CPR training in school, and 91.8% stated their willingness to teach CPR [Table 1]. In Barcelona, 83% of secondary schoolteachers identified the school as the best setting to perform a CPR training program and 69% of them were willing to teach CPR in classes.[10] Danish secondary schoolteachers were unwilling to perform CPR training unless they had acquired enough CPR skills through previous training.[11,12] Schoolteachers conducting CPR training in school are more likely to be realized in China if the relevant supporting policies, clear curriculum guidelines, and training-related equipment are available. In summary, our findings revealed that Chinese primary and secondary schoolteachers have a preliminary understanding of CPR, but they lacked exact theoretical knowledge of CPR. More than half of them had experienced previous CPR training and had a high interest in participating in and conducting CPR training. Funding This study was supported by the grants from the General Research Program of Zhejiang Medical and Health (Class A) (No. 2016KYA179) and the General Scientific research project of Zhejiang Education Department (No. Y201738452).