Verbal and non-verbal behaviour and patient perception of communication in primary care: an observational study

Background

Few studies have assessed the importance of a broad range of verbal and non-verbal consultation behaviours.

Aim

To explore the relationship of observer ratings of behaviours of videotaped consultations with patients’ perceptions.

Design and setting

Observational study in general practices close to Southampton, Southern England.

Method

Verbal and non-verbal behaviour was rated by independent observers blind to outcome. Patients competed the Medical Interview Satisfaction Scale (MISS; primary outcome) and questionnaires addressing other communication domains.

Results

In total, 275/360 consultations from 25 GPs had useable videotapes. Higher MISS scores were associated with slight forward lean (an 0.02 increase for each degree of lean, 95% confidence interval [CI] = 0.002 to 0.03), the number of gestures (0.08, 95% CI = 0.01 to 0.15), ‘back-channelling’ (for example, saying ‘mmm’) (0.11, 95% CI = 0.02 to 0.2), and social talk (0.29, 95% CI = 0.4 to 0.54). Starting the consultation with professional coolness (‘aloof’) was helpful and optimism unhelpful. Finishing with non-verbal ‘cut-offs’ (for example, looking away), being professionally cool (‘aloof’), or patronising, (‘infantilising’) resulted in poorer ratings. Physical contact was also important, but not traditional verbal communication.

Conclusion

These exploratory results require confirmation, but suggest that patients may be responding to several non-verbal behaviours and non-specific verbal behaviours, such as social talk and back-channelling, more than traditional verbal behaviours. A changing consultation dynamic may also help, from professional ‘coolness’ at the beginning of the consultation to becoming warmer and avoiding non-verbal cut-offs at the end.     

Touch in primary care consultations: qualitative investigation of doctors’ and patients’ perceptions

Background

Good communication skills are integral to successful doctor–patient relationships. Communication may be verbal or non-verbal, and touch is a significant component, which has received little attention in the primary care literature. Touch may be procedural (part of a clinical task) or expressive (contact unrelated to a procedure/examination).

Aim

To explore GPs’ and patients’ experiences of using touch in consultations.

Design and setting

Qualitative study in urban and semi-rural areas of north-west England.

Method

Participating GPs recruited registered patients with whom they felt they had an ongoing relationship. Data were collected by semi-structured interviews and subjected to constant comparative qualitative analysis.

Results

All participants described the importance of verbal and non-verbal communication in developing relationships. Expressive touch was suggested to improve communication quality by most GPs and all patients. GPs reported a lower threshold for using touch with older patients or those who were bereaved, and with patients of the same sex as themselves. All patient responders felt touch on the hand or forearm was appropriate. GPs described limits to using touch, with some responders rarely using anything other than procedural touch. In contrast, most patient responders believed expressive touch was acceptable, especially in situations of distress. All GP responders feared misinterpretation in their use of touch, but patients were keen that these concerns should not prevent doctors using expressive touch in consultations.

Conclusion

Expressive touch improves interactions between GPs and patients. Increased educational emphasis on the conscious use of expressive touch would enhance clinical communication and, hence, perhaps patient wellbeing and care.     

Patient-initiated camera phone images in general practice: a qualitative study of illustrated narratives

Background

Camera phones have become ubiquitous in the digital age. Patients are beginning to bring images recorded on their mobile phones to share with their GP during medical consultations.

Aim

To explore GP perceptions about the effect of patient-initiated camera phone images on the consultation.

Design and setting

An interview study of GPs based in rural and urban locations in Australia.

Methods

Semi-structured telephone interviews with nine GPs about their experiences with patient-initiated camera phone images.

Results

GPs described how patient-initiated camera phone photos and videos contributed to the diagnostic process, management and continuity of care. These images gave GPs in the study additional insight into the patient’s world. Potential harm resulting from inappropriate use of camera phones by patients was also identified.

Conclusion

Patient-initiated camera phone images can empower patients by illustrating their narratives, thus contributing to improved communication in general practice. Potential harm could result from inappropriate use of these images. GPs shown images on patients’ camera phones should make the most of this opportunity for improved understanding of the patient’s world. There are however, potential medicolegal implications such as informed consent, protection of patient and doctor privacy, and the risk of misdiagnosis.     

Patients' perceptions of GP non-verbal communication: a qualitative study

Background

During doctor–patient interactions, many messages are transmitted without words, through non-verbal communication.

Aim

To elucidate the types of non-verbal behaviours perceived by patients interacting with family GPs and to determine which cues are perceived most frequently.

Design of study

In-depth interviews with patients of family GPs.

Setting

Nine family practices in different regions of Poland.

Method

At each practice site, interviews were performed with four patients who were scheduled consecutively to see their family doctor.

Results

Twenty-four of 36 studied patients spontaneously perceived non-verbal behaviours of the family GP during patient–doctor encounters. They reported a total of 48 non-verbal cues. The most frequent features were tone of voice, eye contact, and facial expressions. Less frequent were examination room characteristics, touch, interpersonal distance, GP clothing, gestures, and posture.

Conclusion

Non-verbal communication is an important factor by which patients spontaneously describe and evaluate their interactions with a GP. Family GPs should be trained to better understand and monitor their own non-verbal behaviours towards patients.     

Older patients and their GPs: shared decision making in enhancing trust

Background

Older patients differ from younger patients in their perceptions of trust in doctors; their sense of shared decision making is particularly associated with their trust in the GP. Enhancing trust and improving shared decision making are thought to have positive health outcomes. Older patients are sometimes reported as being less frequently involved in decisions about their health care, however, and in having more unmet healthcare needs than younger patients.

Aim

This study explored older patients’ trust in their GPs and their perceptions of shared decision making.

Design and setting

Qualitative methods were used. Systematic sampling identified 20 participants, aged ≥65 years, from three GP surgeries in Devon, UK.

Method

A constant comparative approach was applied to thematic analysis of transcribed interviews.

Results

All participants valued feeling involved in decisions but differed regarding how they felt involved. Trust influenced preferences for shared decision making: a trusted GP ‘ally’, to competently manage participants’ increasing health-information requirements throughout the vulnerable ageing process, was important. Trust was affected by factors contributing to the facilitation of involvement. GP characteristics, communication skills, consultation duration, and continuity of care were common themes.

Conclusion

Although limited geographically and subsequently by ethnic group, the present sample allows for reasonable transferability of the study to other UK populations. A range of factors are highlighted for consideration when planning primary healthcare delivery: to facilitate the optimal involvement of older patients in decisions about their health care, while enhancing their trust in the GP; to help minimise potential health inequalities for this patient group.     

The bioload and aflatoxin content of market garri from some selected states in southern Nigeria: public health significance

Background

Garri is consumed by several millions of people in the West African sub-region and in Nigeria in particular regardless of ethnicity and socio-economic class. However production and handling methods have not been standardized resulting in a product with varying quality and safety indices hence varying public health concern.

Objectives

To investigate the microbial contamination level, presence, prevalence and distribution of Aflations B₁, B₂, G₁ and G₂ in market garri with the aim of developing useful indices for safe handling and acceptable public health standards.

Methods

A total of 300 samples comprising of 30 samples each from various market in both urban and rural settings were randomly collected using sterile polyethylene bags. These were analysed for microbiological quality and aflatoxins content using standard procedures.

Results

Eight bacteria genera (Bacillus, Staphylococcus, Streptococcus, Pseudomonas, Clostridium, Salmonella Klebsiella and Coliforms groups) genera and six fungi genera (Aspergillus, Penicillium, Rhizopus, Botrytls, Fusarium and Cladosporium) were detected and isolated. Aflatoxins B₁, B₂, G₁ and G₂ were detected in varying concentrations amongst the samples analysed within and amongst the states investigated with an average occurrence rate of 17.5%

Conclusion

Market garri was found to contain high bioload with vast array of micro-organisms and Aflatoxins in all the states investigated. Results are useful in developing and establishing public health standards for the production and safe handling of garri.     

Difficulties in disclosing the diagnosis of dementia: a qualitative study in general practice

Background

Dementia is an insidious and stigmatised condition, and research indicates that GPs find communicating this diagnosis particularly problematic. Delays in diagnosis may impede optimal patient care. Little research has been published on Australian GPs’ perceptions of barriers to disclosing the diagnosis of dementia.

Aim

To explore GPs’ perceptions of barriers to disclosing the diagnosis of dementia.

Design and setting

Qualitative study in the general practice consultation context.

Method

Semi-structured, audiorecorded interviews were conducted with GPs from three capital cities and one regional centre in Australia. Interviews were transcribed verbatim and thematic analysis was conducted.

Results

GPs’ lack of confidence in having a correct diagnosis, concern to act in patients’ best interests, and the stigma associated with the ‘dementia’ label influenced the disclosure process. GPs found it challenging to identify dementia in the consultation context. It was difficult to raise the issue when both the patient and their family/carer(s) ignore/are unaware of symptoms of cognitive decline. Referral to a specialist was favoured to confirm suspicions, although this did not always result in a definitive diagnosis. Opinions differed as to whether the GP or the specialist was better placed to deliver the diagnosis. GPs preferred disclosure to the patient with his/her family/carer(s) present; associated issues of confidentiality and the importance of offering hope emerged. The severity of the patient’s dementia also guided the diagnostic disclosure process. GPs often used euphemisms for dementia when disclosing the diagnosis, to soften the message.

Conclusion

Complex issues surround the disclosure of dementia. Communicating this diagnosis remains particularly challenging for many GPs.     

Severe depression following á-interferon usage in a patient with chronic myeloid leukemia

Background

Chronic myeloid leukaemia (CML), with a median age of 40 years, is one of the commonest haematological malignancies in Nigeria. Cytoreductive agents, which were hitherto the mainstay of treatment, neither induce cytogenetic nor haematologic remission. Alphainterferon (á-IFN), an endogenous glycoprotein with cytotoxic and natural killer cell enhancer effects has been found to induce haematologic and cytogenetic remission in patients with CML, but neuro-psychiatric complications of á -interferon (á-IFN) usage were not reported in Nigeria.

Objective

To report a case of deliberate self-harm in University Lecturer as a side effect of á-IFN in the treatment of CML

Method

Clinical and laboratory follow up of a patient receiving á-IFN in the management of CML from the time of diagnosis of CML to the point of loss of contact.

Result

Severe depression is a complication that may adversely influence the clinical outcome of á-IFN usage

Conclusions/Recommendations

Although interferon related depression is uncommon, it is suggested that pre-therapy interferon assays and neuro-psychiatric assessment are carried out in prospective users of á-IFNKey words: Chronic myeloid leukaemia, interferon-á, depression     

Patients’ Reported Reasons for Non-Use of an Internet-Based Patient-Provider Communication Service: Qualitative Interview Study

Background

The adoption of Internet-based patient–provider communication services (IPPC) in health care has been slow. Patients want electronic communication, and the quality of health care can be improved by offering such IPPCs. However, the rate of enrollment in such services remains low, and the reasons for this are unclear. Knowledge about the barriers to use is valuable during implementation of IPPCs in the health care services, and it can help timing, targeting, and tailoring IPPCs to different groups of patients.

Objective

The goal of our study was to investigate patients’ views of an IPPC that they could use from home to pose questions to nurses and physicians at their treatment facility, and their reported reasons for non-use of the service.

Methods

This qualitative study was based on individual interviews with 22 patients who signed up for, but did not use, the IPPC.

Results

Patients appreciated the availability and the possibility of using the IPPC as needed, even if they did not use it. Their reported reasons for not using the IPPC fell into three main categories: (1) they felt that they did not need the IPPC and had sufficient access to information elsewhere, (2) they preferred other types of communication such as telephone or face-to-face contact, or (3) they were hindered by IPPC attributes such as login problems.

Conclusions

Patients were satisfied with having the opportunity to send messages to health care providers through an IPPC, even if they did not use the service. IPPCs should be offered to the patients at an appropriate time in the illness trajectory, both when they need the service and when they are receptive to information about the service. A live demonstration of the IPPC at the point of enrollment might have increased its use.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00971139","term_id":"NCT00971139"}}NCT00971139; http://clinicaltrial.gov/ct2/show/{"type":"clinical-trial","attrs":{"text":"NCT00971139","term_id":"NCT00971139"}}NCT00971139 (Archived by WebCite at http://www.webcitation.org/6KlOiYJrW).     

What happens when doctors are patients? Qualitative study of GPs

Background

Current evidence about the experiences of doctors who are unwell is limited to poor quality data.

Aim

To investigate GPs'' experiences of significant illness, and how this affects their own subsequent practice.

Design of study

Qualitative study using interpretative phenomenological analysis to conduct and analyse semi-structured interviews with GPs who have experienced significant illness.

Setting

Two primary care trusts in the West of England.

Method

A total of 17 GPs were recruited to take part in semi-structured interviews which were conducted and analysed using interpretative phenomenological analysis

Results

Four main categories emerged from the data. The category, ‘Who cares when doctors are ill?’ embodies the tension between perceptions of medicine as a ‘caring profession’ and as a ‘system’. ‘Being a doctor–patient’ covers the role ambiguity experienced by doctors who experience significant illness. The category ‘Treating doctor–patients’ reveals the fragility of negotiating shared medical care. ‘Impact on practice’ highlights ways in which personal illness can inform GPs'' understanding of being a patient and their own consultation style.

Conclusion

Challenging the culture of immunity to illness among GPs may require interventions at both individual and organisational levels. Training and development of doctors should include opportunities to consider personal health issues as well as how to cope with role ambiguity when being a patient and when treating doctor–patients. Guidelines about being and treating doctor–patients need to be developed, and GPs need easy access to an occupational health service.     

Continuously variable rating: a new, simple and logical procedure to evaluate original scientific publications

OBJECTIVE:

Impact Factors (IF) are widely used surrogates to evaluate single articles, in spite of known shortcomings imposed by cite distribution skewness. We quantify this asymmetry and propose a simple computer-based procedure for evaluating individual articles.

METHOD:

(a) Analysis of symmetry. Journals clustered around nine Impact Factor points were selected from the medical “Subject Categories” in Journal Citation Reports 2010. Citable items published in 2008 were retrieved and ranked by granted citations over the Jan/2008 - Jun/2011 period. Frequency distribution of cites, normalized cumulative cites and absolute cites/decile were determined for each journal cluster. (b) Positive Predictive Value. Three arbitrarily established evaluation classes were generated: LOW (1.3≤IF<2.6); MID: (2.6≤IF<3.9); HIGH: (IF≥3.9). Positive Predictive Value for journal clusters within each class range was estimated. (c) Continuously Variable Rating. An alternative evaluation procedure is proposed to allow the rating of individually published articles in comparison to all articles published in the same journal within the same year of publication. The general guiding lines for the construction of a totally dedicated software program are delineated.

RESULTS AND CONCLUSIONS:

Skewness followed the Pareto Distribution for (1相似文献   

Physician self-disclosure in primary care: a mixed methods study of GPs’ attitudes,skills, and behaviour

Background

There is a debate in medicine about the use and value of self-disclosure by the physician as a communication tool. There is little empirical evidence about GPs and self-disclosure.

Aim

To explore what GPs’ attitudes, skills, and behaviour are with regard to self-disclosure during a clinical consultation and whether there is a need for the development of training resources.

Design and setting

Mixed methods using open-ended and semi-structured interviews in Auckland, New Zealand, and the surrounding districts.

Method

Sixteen GPs were interviewed on the issue of self-disclosure in clinical practice. A general inductive approach was used for data analysis.

Results

Self-disclosure was common in this group of GPs, contrary to training in some of the groups, and was seen as a potentially positive activity. Family and physical topics were most common, yet psychological and relationship issues were also discussed. Knowing patients made self-disclosure more likely, but a GP’s intuition played the main role in determining when to self-disclose, and to whom. GPs have developed their own guidelines, shaped by years of experience; however, there was a consensus that training would be helpful.

Conclusion

Self-disclosure is common and, in general, seen as positive. Major personal issues were acceptable for some GPs to self-disclose, especially to known patients. Although participants had developed their own guidelines, exposure of trainees to the issue of self-disclosure would be of value to prevent future mistakes and to protect both doctor and patient from any unintended harm, for example, developing a dependent relationship.     

Variations in GP–patient communication by ethnicity,age, and gender: evidence from a national primary care patient survey

Background

Doctor–patient communication is a key driver of overall satisfaction with primary care. Patients from minority ethnic backgrounds consistently report more negative experiences of doctor–patient communication. However, it is currently unknown whether these ethnic differences are concentrated in one gender or in particular age groups.

Aim

To determine how reported GP–patient communication varies between patients from different ethnic groups, stratified by age and gender.

Design and setting

Analysis of data from the English GP Patient Survey from 2012–2013 and 2013–2014, including 1 599 801 responders.

Method

A composite score was created for doctor–patient communication from five survey items concerned with interpersonal aspects of care. Mixed-effect linear regression models were used to estimate age- and gender-specific differences between white British patients and patients of the same age and gender from each other ethnic group.

Results

There was strong evidence (P<0.001 for age by gender by ethnicity three-way interaction term) that the effect of ethnicity on reported GP–patient communication varied by both age and gender. The difference in scores between white British and other responders on doctor–patient communication items was largest for older, female Pakistani and Bangladeshi responders, and for younger responders who described their ethnicity as ‘Any other white’.

Conclusion

The identification of groups with particularly marked differences in experience of GP–patient communication — older, female, Asian patients and younger ‘Any other white’ patients — underlines the need for a renewed focus on quality of care for these groups.     

Perspectives of Family Physicians on Computer-assisted Health-risk Assessments

Background

The firsthand experience of physicians using computer-assisted health-risk assessment is salient for designing practical eHealth solutions.

Objective

The aim of this study was to enhance understanding about computer-assisted health-risk assessments from physicians’ perspectives after completion of a trial at a Canadian, urban, multi-doctor, hospital-affiliated family practice clinic.

Methods

A qualitative approach of face-to-face, in-depth, semi-structured interviews was used. All interviews were audio recorded and field notes taken. Analytic induction and constant comparative techniques were used for coding and analyses. Interpretation was facilitated by peer audit and insights gained from the social exchange theoretical perspective.

Results

Ten physicians (seven female and three male) participated in the interviews. Three overarching themes emerged in relation to computer-assisted health-risk assessments: (1) perceived benefits, (2) perceived concerns or challenges, and (3) feasibility. Physicians unanimously acknowledged the potential of computer-assisted health-risk assessments to open dialogue on psychosocial health risks. They also appreciated the general facilitative roles of the tool, such as improving time-efficiency by asking questions on health risks prior to the consultation and triggering patients’ self-reflections on the risks. However, in the context of ongoing physician-patient relationships, physicians expressed concerns about the impact of the computer-assisted health-risk assessment tool on visit time, patient readiness to talk about psychosocial issues when the purpose of the visit was different, and the suitability of such risk assessment for all visits to detect new risk information. In terms of feasibility, physicians displayed general acceptance of the risk assessment tool but considered it most feasible for periodic health exams and follow-up visits based on their perceived concerns or challenges and the resources needed to implement such programs. These included clinic level (staff training, space, confidentiality) and organizational level (time, commitment and finances) support.

Conclusions

Participants perceived computer-assisted health-risk assessment as a useful tool in family practice, particularly for identifying psychosocial issues. Physicians displayed a general acceptance of the computer tool and indicated its greater feasibility for periodic health exams and follow-up visits than all visits. Future physician training on psychosocial issues should address physicians’ concerns by emphasizing the varying forms of “clinical success” for the management of chronic psychosocial issues. Future research is needed to examine the best ways to implement this program in diverse clinical settings and patient populations.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00385034","term_id":"NCT00385034"}}NCT00385034; http://clinicaltrials.gov/ct2/show/{"type":"clinical-trial","attrs":{"text":"NCT00385034","term_id":"NCT00385034"}}NCT00385034 (Archived by WebCite at http://www.webcitation.org/5pV8AGRgt)     

GPs asking patients to self-rate their health: a qualitative study

Background

In epidemiological research, self-rated health is an independent predictor of mortality, cardiovascular diseases, and other critical outcomes. It is recommended for clinical use, but research is lacking.

Aim

To investigate what happens in consultations when the question ‘How would you assess your general health compared with others your own age?’ is posed.

Design and setting

Authentic consultations with GPs at health centres in Sweden.

Method

Thirty-three planned visits concerning diabetes, pain, or undiagnosed symptoms were voice-recorded. Dialogue regarding self-rated health was transcribed verbatim and analysed using a systematic text condensation method. Speaking time of patients and doctors was measured and the doctors’ assessment of the value of the question was documented in a short questionnaire.

Results

Two overarching themes are used to describe patients’ responses to the question. First, there was an immediate reaction, often expressing strong emotions, setting the tone of the dialogue and influencing the continued conversation. This was followed by reflection regarding their functional ability, management of illnesses and risks, and/or situation in life. The GPs maintained an attitude of active listening. They sometimes reported a slight increase in consultation time or feeling disturbed by the question, but mostly judged it as valuable, shedding additional light on the patients’ situation and making it easier to discuss difficulties and resources. The patients’ speaking time increased noticeably during this part of the consultation.

Conclusion

Asking patients to comparatively self-rate their health is an effective tool in general practice.     

Hospital admissions from nursing homes: a qualitative study of GP decision making

Background

Decisions regarding the hospitalisation of nursing home residents may present a difficult dilemma for GPs. There are pressures to admit very frail patients with exacerbations of illness even though such frailty may limit the possible health gains. As ‘gatekeepers’ to NHS, GPs are expected to make best use of resources and may be criticised for ‘inappropriate’ admissions. Little is understood about the influences on GPs as they make such decisions

Aim

To explore GPs views on factors influencing decisions on admitting frail nursing home residents to hospital.

Design and setting

A purposive sample of 21 GPs from two counties in the South of England.

Method

Data from semi-structured, one-to-one interviews with GPs were analysed using thematic analysis following principles of the constant comparative method.

Results

This study suggests that while clinical assessment, perceived benefits and risks of admission, and patients’ and relatives’ preferences are key factors in determining admissions, other important factors influencing decision making include medico-legal concerns, communications, capability of nursing homes and GP workload. These factors were also perceived by GPs as influencing the feasibility of keeping patients in the nursing home when this was clinically appropriate. Key areas suggested by GPs to improve practice were improving communication (particularly informational continuity), training and support for nursing staff, and peer support for GPs. Local initiatives to address these issues were very variable.

Conclusion

Developing a systematic palliative care approach to address poor documentation and communication, the capability of nursing homes, and medico-legal concerns has the potential to improve decision-making regarding hospital admissions.     

Leveraging Text Messaging and Mobile Technology to Support Pediatric Obesity-Related Behavior Change: A Qualitative Study Using Parent Focus Groups and Interviews

Background

Text messaging (short message service, SMS) is a widely accessible and potentially cost-effective medium for encouraging behavior change. Few studies have examined text messaging interventions to influence child health behaviors or explored parental perceptions of mobile technologies to support behavior change among children.

Objective

Our aim was to examine parental acceptability and preferences for text messaging to support pediatric obesity-related behavior change.

Methods

We conducted focus groups and follow-up interviews with parents of overweight and obese children, aged 6-12 years, seen for “well-child” care in eastern Massachusetts. A professional moderator used a semistructured discussion guide and sample text messages to catalyze group discussions. Seven participants then received 3 weeks of text messages before a follow-up one-on-one telephone interview. All focus groups and interviews were recorded and transcribed verbatim. Using a framework analysis approach, we systematically coded and analyzed group and interview data to identify salient and convergent themes.

Results

We reached thematic saturation after five focus groups and seven follow-up interviews with a total of 31 parents of diverse race/ethnicity and education levels. Parents were generally enthusiastic about receiving text messages to support healthy behaviors for their children and preferred them to paper or email communication because they are brief and difficult to ignore. Participants anticipated high responsiveness to messaging endorsed by their child’s doctor and indicated they would appreciate messages 2-3 times/week or more as long as content remains relevant. Suggestions for maintaining message relevance included providing specific strategies for implementation and personalizing information. Most felt the negative features of text messaging (eg, limited message size) could be overcome by providing links within messages to other media including email or websites.

Conclusions

Text messaging is a promising medium for supporting pediatric obesity-related behavior change. Parent perspectives could assist in the design of text-based interventions.

Trial Registration

Clinicaltrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01565161","term_id":"NCT01565161"}}NCT01565161; http://clinicaltrials.gov/show/{"type":"clinical-trial","attrs":{"text":"NCT01565161","term_id":"NCT01565161"}}NCT01565161 (Archived by WebCite at http://www.webcitation.org/6LSaqFyPP).     

Students’ and parents’ attitudes toward basic life support training in primary schools

Aim

To assess attitudes of students and their parents toward basic life support (BLS) training in primary schools, along with their perceptions of students’ fears toward applying and training BLS.

Methods

In October 2011, a specifically designed, voluntary and anonymous questionnaire was distributed to 7th and 8th grade students and to their parents in two primary schools in Split, Croatia. Completed questionnaires were analyzed to determine the validity of the scale, and to determine sex and group differences in individual items and the whole scale.

Results

The questionnaires were completed by 301 school children and 361 parents. Cronbach’s alpha of the whole scale was 0.83, indicating good internal consistency. The students’ score for the whole attitude scale was 73.7 ± 11.1 out of maximum 95, while the parents’ score was 68.0 ± 11.9. Students’ attitude was significantly more positive than that of the parents (U = 29.7, P < 0.001). The greatest perceived students’ fear toward applying BLS was that they would harm the person in need of BLS.

Conclusion

Our study showed that in Croatia both students in their last two years of primary school and their parents had a positive attitude toward BLS training in primary schools. Implementing compulsory BLS training in Croatia’s primary schools could help increase students’ confidence, quell their fears toward applying BLS, and possibly even increase the survival of bystander-witnessed cardiac arrests.Out-of-hospital cardiac arrests (OHCA) globally affect 55 people per 100 000 a year, with an average survival rate of 7% (1). The main factors associated with increased survival rates of those affected by OHCA are timely bystander cardiopulmonary resuscitation (CPR), initial heart rhythm, return of spontaneous circulation, and pre-hospital defibrillation (2). Early bystander CPR slows the progress of ventricular fibrillation’s progression to asystole (3) and is administered on average 4 minutes earlier than CPR performed by emergency medical services (4). However, bystanders attempt CPR in only 32% of cases (4) mostly because lack of training and fear of causing damage, contracting an infectious disease, and not being able to provide adequate resuscitation (5). In 2003, the International Liaison Committee on Resuscitation recommended CPR training in schools (6) and in 2010 the American Heart Association suggested CPR to be a requirement for high school graduation (7). Introduction of CPR and basic life support (BLS) training in schools could lead to acquisition of these skills by the majority of the world’s population and possibly increase the likelihood of survival from OHCA and other emergency conditions.In Croatia, as in many countries in the world, primary school is the only form of education compulsory for all citizens. It lasts 8 years, with the earliest enrollment age of 6. Research has already shown that children aged 13-14 years can perform chest compressions as well as adults, and that the use of automated external defibrillators can be mastered even at a much earlier age (8,9). This makes children in their final grades (7th and 8th) of primary school ideal candidates for BLS training. In this study, we wanted to assess the attitudes of 7th and 8th graders and their parents toward BLS training in primary schools, as well as both groups’ perceptions of students’ fears toward applying and training BLS.