European Journal of Cardiovascular Medicine

Cardiopulmonary resuscitation (CPR) is a life-saving procedure essential for the immediate management of cardiac arrest. When an individual experiences cardiac arrest, their heart stops beating effectively, halting blood flow and oxygen delivery to vital organs. CPR, which involves a series of chest compressions and rescue breaths, plays a critical role in maintaining circulatory flow and oxygenation during this medical emergency. The timely application of CPR significantly increases the chances of survival and recovery, providing a crucial window of opportunity until professional medical help arrives. Despite its critical importance and the simplicity of the procedure, public awareness and proficiency in CPR remain alarmingly low in many regions across the globe. This gap in knowledge and skills can lead to dire consequences, highlighting the urgent need for widespread CPR training and education.1-7

The state of Jammu & Kashmir, with its unique socio-cultural and geographical landscape, poses distinct challenges and opportunities in public health education. The region's diverse population, encompassing various religious, cultural, and ethnic groups, requires tailored health education approaches to ensure inclusivity and effectiveness. Additionally, Jammu & Kashmir has experienced significant socio-political disturbances over the years, which have adversely affected the accessibility and quality of health education and emergency services. These disturbances have led to infrastructural challenges, limited healthcare resources, and disrupted public health initiatives, making it difficult to implement consistent and comprehensive health education programs. In such a context, assessing the level of CPR awareness and preparedness among the residents of Jammu & Kashmir becomes imperative. Understanding the current state of CPR knowledge in this region is crucial for identifying gaps and devising strategies to improve emergency response and health outcomes.

This study aims to bridge the knowledge gap by evaluating the awareness and understanding of CPR among the general public in Jammu & Kashmir. By conducting a thorough assessment of the current knowledge levels, the study seeks to uncover specific areas where educational interventions are needed. The goal is to highlight regions and demographic groups that require targeted training and resources to enhance CPR proficiency. Ultimately, this research aims to inform the development of tailored educational programs and public health initiatives that can effectively address the unique challenges of Jammu & Kashmir. Enhancing CPR awareness and preparedness in this region will not only improve emergency response capabilities but also contribute to building a more resilient and health-conscious community.

Objectives of the Study:

The primary objective is to gauge awareness and knowledge about Cardiopulmonary resuscitation (CPR) among general public of Jammu & Kashmir.

• Research Approach -Descriptive
• Research Design- Cross-sectional survey design
• Study area: Jammu & Kashmir
• Study duration- between January 2024 to March 2024
• Study population: The study's target population encompassed all adults aged 18 and above who had been residents of Jammu & Kashmir 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% regarding Cardiopulmonary 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 regarding Cardiopulmonary 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 regarding Cardiopulmonary 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 Jammu& Kashmir 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.

The study collected data from 400 participants residing in Jammu & Kashmir, providing a comprehensive overview of their socio-demographic characteristics and CPR knowledge levels.

The socio-demographic characteristics of the study population, as shown in Table 1, reveal a diverse participant base. Among the 400 respondents, the age distribution was fairly balanced, with 29.8% aged 18-30 years, 25.3% aged 31-40 years, 22.3% aged 41-50 years, and 22.8% aged over 50 years. Gender distribution was slightly skewed towards males, who constituted 55.3% of the sample, while females made up 44.8%. In terms of marital status, 40.3% were single, 57.3% were married, and 2.5% fell into other categories. Employment status indicated that 54.8% were employed, 20.3% were unemployed, and 25.0% were students. Educationally, 10.3% had education below high school, 34.8% completed high school, 39.8% were graduates, and 15.3% had postgraduate or higher qualifications.

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

Table 2 details the participants' knowledge regarding CPR, with varying levels of awareness across the 20 questions. Notably, 74.8% correctly identified the primary purpose of CPR, and 70.3% knew the first step in assessing an unresponsive person. Knowledge of the recommended compression-to-breath ratio was correctly answered by 65.3%, while 59.8% understood the appropriate chest compression depth. Awareness of the correct number of compressions per minute was at 54.8%. Half of the participants (50.3%) knew when to stop CPR, and 47.8% were aware of the correct hand placement. Knowledge about checking for breathing and opening the airway was lower, with 45.3% and 40.3% correct responses, respectively. Rescue breaths were correctly understood by 37.3%, and awareness of an AED and its usage stood at 35.3% and 32.8%, respectively. The correct steps for using an AED were known by 29.8%. Fewer participants could identify cardiac arrest signs (27.8%), perform CPR on children (25.3%), or know the differences in infant CPR (22.3%). The recovery position was correctly identified by 20.3%, with only 17.8% aware of how often CPR skills should be refreshed. Knowledge about duration of checking the pulse and which pulse to be checked was particularly low, at 15.3% and 12.8%, respectively.

Table 3 categorizes overall CPR knowledge scores among participants. Only 10.3% of respondents achieved a 'Very Good' score (16-20 correct answers), while 25.3% fell into the 'Good' category (12-15 correct answers). A significant proportion, 39.8%, scored in the 'Fair' range (8-11 correct answers), and 24.8% had a 'Poor' understanding with fewer than 8 correct answers. This distribution highlights a substantial need for improved CPR education within the population.

Table 3: Overall CPR Knowledge Score Categories

The univariate analysis in Table 4 examines the association between socio-demographic variables and CPR knowledge levels. Younger participants (18-30 years) had higher proportions of 'Very Good' and 'Good' scores compared to older age groups, with statistical significance (p=0.001). Males generally performed better than females, but the difference was marginally significant (p=0.05). Single participants were more likely to have better CPR knowledge than married ones (p=0.03). Employment status also influenced CPR knowledge, with employed individuals performing better (p=0.02). Education level was a strong predictor, with those having higher educational attainment (graduates and above) scoring significantly better (p=0.001).

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

The findings of this study provide a comprehensive overview of CPR awareness and preparedness among the residents of Jammu & Kashmir. The data reveal critical insights into the socio-demographic factors influencing CPR knowledge and highlight significant gaps that require targeted educational interventions.

The socio-demographic distribution of the study population indicates a balanced representation across age groups, with a slight skew towards males. This demographic profile is consistent with other studies conducted in similar regions, where male participants often outnumber females in survey-based research due to cultural and societal norms that influence participation rates. The educational distribution shows that a significant portion of the population has at least a high school education, which is encouraging for the implementation of public health education programs. However, the fact that a notable percentage of the population has only below high school education underscores the need for simplified and accessible CPR training materials.

The overall CPR knowledge levels in Jammu & Kashmir are concerning. Only 10.3% of participants scored in the 'Very Good' category, indicating a high level of proficiency. In comparison, a substantial 39.8% of respondents fell into the 'Fair' category, and 24.8% were classified as having 'Poor' CPR knowledge. These findings align with former studies conducted in various regions globally, which have consistently reported low levels of CPR awareness and skills among the general public.8-13

Age, gender, marital status, religion, employment status, and education level were all found to significantly influence CPR knowledge. Younger participants (18-30 years) demonstrated better CPR knowledge compared to older age groups, which mirrors findings from former studies indicating that younger individuals are more likely to be exposed to CPR training through educational institutions or social media. The slight gender disparity, with males performing better than females, has also been observed in previous research, suggesting the need for gender-specific educational strategies to bridge this gap.12-17

Marital status emerged as a significant factor, with single individuals showing better CPR knowledge than married ones. This could be due to younger, single individuals having more opportunities and motivation to engage in health education activities. Employment status also influenced CPR knowledge, highlighting the need for workplace-based CPR training programs. The strong correlation between higher education levels and better CPR knowledge is consistent with former studies, reinforcing the importance of integrating CPR training into educational curricula.16-19

Comparing our results with former studies, it is evident that the low levels of CPR awareness and proficiency are a widespread issue, not confined to Jammu & Kashmir. Previous studies in both developed and developing countries have reported similar challenges, with factors such as lack of access to training, cultural barriers, and socioeconomic disparities contributing to the problem.18-21

Implications for Public Health Interventions

The findings of this study underscore the urgent need for comprehensive CPR training programs tailored to the unique socio-cultural context of Jammu & Kashmir. Public health authorities should prioritize the development of accessible, community-based training sessions that consider the educational and cultural backgrounds of the population. Additionally, leveraging digital platforms and social media could enhance the reach and effectiveness of these programs, particularly among younger age groups.

Gender-specific strategies, such as female-only training sessions, could help address the gender disparity in CPR knowledge. Workplace-based training programs could also be beneficial, given the significant influence of employment status on CPR knowledge levels. Collaborating with educational institutions to incorporate CPR training into school and college curricula could ensure that the younger generation is well-equipped with these vital skills.

In conclusion, this study highlights a significant gap in CPR awareness and preparedness among the residents of Jammu & Kashmir, reflecting a broader global issue observed in previous studies. The findings reveal that a substantial portion of the population lacks adequate CPR knowledge, with only a small percentage demonstrating high proficiency. Socio-demographic factors such as age, gender, marital status, employment status, and education level play a critical role in influencing CPR knowledge levels. These insights underscore the urgent need for targeted, culturally sensitive educational interventions to improve CPR proficiency across the region. Implementing community-based training programs, leveraging digital platforms, and incorporating CPR education into school and workplace curricula are essential steps towards enhancing emergency response capabilities and building a more resilient, health-conscious community in Jammu & Kashmir. Addressing these gaps will not only improve individual preparedness but also contribute to better health outcomes and a safer society.

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