ORIGINAL RESEARCH |
https://doi.org/10.5005/jp-journals-10077-3296 |
Knowledge, Awareness, and Attitude about Basic Life Support and Emergency Medical Services among Dental Students in Manipal University College Malaysia: A Cross-sectional Study
1–7Department of Conservative Dentistry and Endodontics, Manipal University College Malaysia (MUCM), Melaka, Malaysia
Corresponding Author: Ramanathan Ravi, Department of Conservative Dentistry and Endodontics, Manipal University College Malaysia (MUCM), Melaka, Malaysia, Phone: 0125568002, e-mail: ramnath.ramesh@gmail.com
Received: 16 October 2023; Accepted: 26 February 2024; Published on: 27 April 2024
The incidence of cardiovascular disease (CVD) is on the rise among dental patients, leading to an increased risk of developing emergencies. Life-threatening emergencies may not be common to happen in a dental office, however, the likeliness to occur has increased with increased levels of stress. A dental practice is mired in many risks that lead to life-threatening emergencies. Therefore, all dentists must have sufficient knowledge and be versed with the protocols to manage and handle critical situations and emergencies effectively and efficiently, which is life-saving and imperative in a dental setting. Aim: To assess the knowledge, awareness, and attitude among year 3, 4, and 5 dental students regarding basic life support (BLS). Materials and methods: A cross-sectional study was conducted on a sample of dental students (n = 183) in Manipal University College Malaysia (MUCM). Participants completed the Microsoft (MS) form questionnaire, including questions to obtain students’ demographics and questions to evaluate their knowledge, awareness, and attitude of students toward BLS. These questions were then analyzed using the Chi-squared test and Fisher’s exact test. Results: All of them (183) completed the survey with a response rate of (100%). Female participant’s awareness was higher than the male counterparts, but it did not differ significantly (p-value > 0.05). Year 3 dental students showed a higher awareness level compared to year 4 and 5 dental students (p-value > 0.05). There was a significant difference in the attitude of students toward BLS among year 3, 4, and 5 dental students (p-value < 0.05). Conclusion: Despite students exhibiting a positive attitude toward BLS training, some of them never underwent any formal BLS training. This gap must be bridged immediately to address this issue. Basic life science programs must not only be imparted in the course curriculum but be updated at constant intervals and time. How to cite this article: Ravi R, Nangia T, Wai LP, et al. Knowledge, Awareness, and Attitude about Basic Life Support and Emergency Medical Servicesamong Dental Students in Manipal University College Malaysia: A Cross-sectional Study. J South Asian Assoc Pediatr Dent 2024;7(1):11–15. Source of support: Nil Conflict of interest: NoneABSTRACT
Keywords: Attitude, Awareness, Basic life support, Emergency medical services, Knowledge
INTRODUCTION
The primary cause of mortality in Malaysia is attributed to ischemic heart disease. According to the Department of Statistics Malaysia, it accounted for 17% of the 109,155 deaths that were medically verified in 2020.1 Among the 13 districts in Malaysia, Perak has the highest number of deaths due to ischemic heart disease, followed by Selangor and Johor.1 Among ischemic heart diseases, the primary cause of morbidity and mortality in Malaysia is acute myocardial infarction (AMI) persistently.1 Based on the Journals of the American College of Cardiology,2 58% of cardiovascular disease (CVD) deaths across the world in 2019 among 18.6 million were in Asia, a largely populated continent with diverse cultures, ethnicities, socioeconomic groups, and healthcare settings. Asia is plagued with challenges in the prevention and treatment of CVD.2 As per records of the World Health Organization, heart disease is the primary cause of mortality globally.3 Therefore, knowledge of basic life support (BLS) is critically important.
Basic life support (BLS) is imperative and necessary in saving lives following cardiac arrest. It is the competency and knowledge of medical procedures that can save one from critical, life-threatening emergencies such as respiratory arrest, heart attack, or airway complications until professional help arrives or medical care is provided at the health care facility. The role of BLS is to ensure sufficient ventilation, circulation, and prevention of irreversible damage to the central nervous system from hypoxia or anoxia until a means can be obtained to reverse the underlying cause.4
Dentists must be familiar and well-versed with the recommendations and guidelines of the treatment of patients with cardiac-related issues and exercise caution in providing effective and adequate care and handling any emergency during the treatment. Evaluating and assessing the knowledge about BLS and emergency medical services of students will pave the way to identify and bridge the gaps in clinical knowledge and procedural execution that will enhance the efficiency of treatment and care.
AIM
To assess the knowledge, awareness, and attitude among year 3, 4, and 5 dental students regarding BLS.
OBJECTIVE
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To assess and compare the knowledge, awareness, and attitude about BLS among dental students in MUCM.
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To determine the level of knowledge about BLS among dental students in MUCM.
MATERIALS AND METHODS
A questionnaire-based cross-sectional study among clinical year dental students from years 3, 4, and 5 of Manipal University College Malaysia (MUCM) was done to assess the knowledge, awareness, and attitude about BLS. The universal sampling method was applied to include all the clinical year students in the Faculty of Dentistry, MUCM, that is, from years 3, 4, and 5. The sampling frame is the list of clinical year BDS students enrolled in MUCM.
Sample size calculation was done using a sample size calculator provided by a statistician, with a study estimate of 41.9% from Shahabe et al.,5 precision = 5%, population size N = 183, and the required sample size is n = 125.
The questionnaire was obtained from the key article, with permission taken from the original author, Shahabe et al.6 An online survey via Microsoft Teams was conducted to facilitate data collection.
The structured questionnaire consisted of four main parts. The first part consisted of the general demo (demographic questions including year of study, gender, age, and ethnicity). The second part contained questions determining the level of knowledge of the participants about BLS. The third part had questions assessing the awareness of the participants about BLS. The fourth consisted of questions assessing the attitude of the participants toward BLS. The study was conducted over 1 year (June 2022 to 2023), obtaining due ethical clearance from the MUCM Ethical and Research Committee on 21st June 2021.
The data collected was subjected to statistical analysis. The frequency, percentage of knowledge, awareness, and attitude were calculated based on the choice of response given. The knowledge domain was analyzed using the Chi-squared and Fisher’s exact test; awareness and attitude were subjected to Fisher’s exact test, respectively.
RESULTS
All 183 responses were accounted for statistical analysis. The age of participants was within the range of 18–28, with a mean age of 22.1257. Table 1 displays the distribution of participants according to year of study, gender, age, and ethnicity.
| Parameters | Respondents (n) | Respondents (%) |
|---|---|---|
| Year of study | ||
| Year 3 (BDS12) | 68 | 37.16% |
| Year 4 (BDS11) | 64 | 34.97% |
| Year 5 (BDS10) | 51 | 27.87% |
| Gender | ||
| Male | 50 | 27.32% |
| Female | 133 | 72.68% |
| Age | ||
| Below 22 | 59 | 32.24% |
| 22 and above | 124 | 67.76% |
| Ethnicity | ||
| Chinese | 99 | 54.10% |
| Indian | 59 | 32.24% |
| Malay | 12 | 6.56% |
| Others | 13 | 7.10% |
The distribution of the overall knowledge status among the respondents is represented in Figure 1. Table 2 depicts the mean and standard deviation (SD) of awareness and knowledge scores according to the year of study. There was no significant difference in the distribution of mean awareness scores across the three different years of study of the respondents (p-value > 0.05). However, there was a significant difference in the distribution of mean knowledge scores across the three different years of study of the respondents (p-value < 0.05).
| Year 3 (n = 68) | Year 4 (n = 64) | Year 5 (n = 51) | p-value | ||||
|---|---|---|---|---|---|---|---|
| Scores | Mean | SD | Mean | SD | Mean | SD | |
| Awareness | 2.5294 | 0.8547 | 2.4781 | 0.8874 | 2.4902 | 0.7314 | 0.222 |
| Knowledge | 3.8824 | 1.4407 | 4.6094 | 0.9531 | 4.3137 | 1.0486 | 0.043 |
Fig. 1: Overall knowledge status
Based on Table 2, more than half of the participants (99, 54.10%) have a poor level of knowledge of BLS. As shown in Figure 2, 80.87% of the participants did not know the correct sequence of resuscitation in BLS, and 78.69% of the participants did not know the normal number of breaths/minutes. However, most of the participants (>60%) did know how to feel the radial artery for a pulse, emergency drugs and their route of administration, correct depths of chest compression for adults, the correct ratio of chest compression to rescue breaths, and to attempt abdominal thrust in responsive choking person.
Fig. 2: Overall awareness status
The level of knowledge of BLS (Table 3) of students was categorized into good (knowledge score ≥ 4) and poor (knowledge score < 4) based on the median score. The distribution of level of knowledge between years 5 and 4, did not differ significantly (p-value > 0.0167). The distribution of level of knowledge between years 5 and 3, did not differ significantly as well (p-value > 0.0167). However, the level of knowledge distribution between years 3 and 4 differs significantly (p-value < 0.0167).
| Year of study | Level of knowledge | p-value | |||
|---|---|---|---|---|---|
| Knowledge level | Number of students | Good (score ≥ 4) | Poor (score < 4) | ||
| Good (score ≥4) | 84 (45.90%) | Year 3 (BDS 12) | 24 (35.29%) | 44 (64.71%) | 0.0342 |
| Poor (score < 4) | 99 (54.10%) | Year 4 (BDS 11) | 37 (57.81%) | 27 (42.19%) | |
| Year 5 (BDS 10) | 23 (45.10%) | 28 (54.90%) | |||
The level of BLS knowledge distribution amongst different ethnic groups (Table 4) did not differ significantly (p-value > 0.05). For Malay and Indian ethnicity, more than half of the participants have good knowledge of BLS, with percentages of 66.67 and 52.54%, respectively. For Chinese and “others” ethnicity, little >50% of the participants have poor knowledge of BLS, with a percentage of 42.42 and 23.08%, respectively.
| Ethnicity | Level of knowledge | p-value | |
|---|---|---|---|
| Good (score ≥ 4) | Poor (score < 4) | ||
| Chinese | 42 (42.42%) | 57 (57.58) | 0.0962 |
| Indian | 31 (52.54%) | 28 (47.46%) | |
| Malay | 8 (66.67%) | 4 (33.33%) | |
| Others | 3 (23.08%) | 10 (76.92%) | |
Table 5 shows the self-grading knowledge distribution based on the different years of study, which differ significantly among the different years of study (p-value < 0.001). The majority (65%) of the participants graded themselves with average knowledge of BLS.
| Knowledge | Year 3 (n = 68) | Year 4 (n = 64) | Year 5 (n = 51) | p-value | |||
|---|---|---|---|---|---|---|---|
| n | % | n | % | n | % | ||
| Good | 0 | 0 | 3 | 4.69 | 0 | 0 | <0.001 |
| Average | 40 | 58.82 | 53 | 82.81 | 26 | 50.98 | |
| Below average | 20 | 29.41 | 6 | 9.38 | 19 | 37.25 | |
| Poor | 8 | 11.76 | 2 | 3.13 | 6 | 11.76 | |
Figure 2 depicts the overall awareness distribution among the respondents. Based on this, most of the participants (>77%) had heard about BLS and did not know the full form of automated external defibrillator (AED) and the emergency number of contact as well. However, there’s 88.52% of the participants did not know the year in which the guidelines for BLS were revised. As shown in Table 6, more than half of the participants (104, 56.83%) have a high level of awareness toward BLS.
| Year of study | Level of awareness | p-value | |||
|---|---|---|---|---|---|
| Awareness level | Number of students | High (score ≥ 3) | Low (score < 3) | ||
| Good (score ≥4) | 104 (56.83%) | Year 3 (BDS 12) | 41 (60.29%) | 27 (39.71%) | 0.2519 |
| Poor (score <4) | 79 (43.17%) | Year 4 (BDS 11) | 39 (60.94%) | 25 (39.06%) | |
| Year 5 (BDS 10) | 24 (47.06%) | 27 (52.94%) | |||
The distribution of attitude (Table 7) had no significant difference among the different years (p-value > 0.05). Most of the year 3 and 4 students have a high-level of awareness toward BLS, with percentages of 60.29% and 60.94%, respectively. While 52.94% of year 5 students have a low-level of awareness toward BLS. The distribution of the level of awareness between years 5 and 4, years 5 and 3, and years 3 and 4 did not differ significantly (p-value > 0.0167). Table 8 depicts the various attitude-related responses between the genders that did not differ significantly (p-value > 0.05).
| Attitude | Year 3 | Year 4 | Year 5 | p-value | ||||
|---|---|---|---|---|---|---|---|---|
| Options | n | % | n | % | n | % | ||
| Have you had previous BLS training? | Yes | 64 | 96.72 | 62 | 96.88 | 51 | 100 | 0.242 |
| No | 4 | 3.28 | 2 | 3.13 | 0 | 0 | ||
| Do you want more BLS training? | Yes | 33 | 48.53 | 34 | 53.13 | 40 | 78.43 | 0.015 |
| No | 14 | 20.59 | 12 | 18.75 | 5 | 9.8 | ||
| Don’t know | 21 | 30.88 | 18 | 28.13 | 6 | 11.76 | ||
| Do you think BLS training should be mandatory in the curriculum? | Yes | 59 | 86.76 | 63 | 98.44 | 49 | 96.08 | 0.032 |
| No | 5 | 7.35 | 0 | 0 | 0 | 0 | ||
| Don’t know | 4 | 5.88 | 1 | 1.56 | 2 | 3.92 | ||
| If you have had no BLS training outside of college, what was the reason? | It’s not important | 0 | 0 | 1 | 1.56 | 1 | 1.96 | 0.864 |
| Busy schedule | 21 | 30.88 | 15 | 23.44 | 14 | 27.45 | ||
| Not interested | 7 | 10.09 | 5 | 7.81 | 3 | 5.88 | ||
| Cost of the course | 9 | 13.24 | 9 | 14.06 | 10 | 19.61 | ||
| No answer | 31 | 45.59 | 34 | 53.13 | 23 | 45.10 | ||
| Attitude | Male | Female | p-value | |||
|---|---|---|---|---|---|---|
| Options | n | % | n | % | ||
| Have you had previous BLS training? | Yes | 2 | 33.3 | 4 | 66.7 | 0.665 |
| No | 48 | 27.1 | 129 | 72.9 | ||
| Do you want more BLS training? | Yes | 29 | 27.1 | 78 | 72.9 | 0.448 |
| No | 11 | 35.5 | 20 | 64.5 | ||
| Don’t know | 10 | 22.2 | 35 | 77.8 | ||
| Do you think BLS training should be mandatory in the curriculum? | Yes | 48 | 28.1 | 123 | 71.9 | 0.875 |
| No | 1 | 20 | 4 | 80 | ||
| Don’t know | 1 | 14.3 | 6 | 85.7 | ||
| If you have had no BLS training outside of college, what was the reason? | It’s not important | 2 | 100 | 0 | 0 | 0.157 |
| Busy schedule | 11 | 22 | 39 | 78 | ||
| Not interested | 6 | 40 | 9 | 60 | ||
| Cost of the course | 7 | 25 | 21 | 75 | ||
| No answer | 24 | 27.4 | 64 | 72.7 | ||
DISCUSSION
According to the studies and reports, ischemic heart disease remains the prime cause of mortality in Malaysia, with 18,515 deaths, and accounts for 17% of all medically certified deaths in 2020. In all cardiac arrest cases, BLS is vital to support the patient’s circulation until the advanced life support team arrives. Hence, it is mandatory to impart knowledge regarding BLS to healthcare professionals.
In the current study, a greater number of dental students exhibited a positive attitude, which is in concordance with a study conducted by Kumar et al.7 and Roshana et al.8 About 96.72% of the students had attended BLS training sessions in the past. A certain proportion of dental students did not receive any BLS training before, and they received training only in year 3 of the course curriculum, with no reinforcement or refresher later in the course. Around 93.44% of dental students think BLS training is important in saving lives and mandatory in the course curriculum. BLS hands-on courses and training should be carried out regularly to reinforce the knowledge necessary for better cognition. The knowledge and awareness levels of trained students were significantly higher of untrained students, according to a recent study.9 However, the skill and knowledge about BLS post 6 months of training (10–15) had significant differences.
Differences in scores among different years of study were statistically significant except for the comparison between year 3 and 5 dental students. Year 3 students have the highest awareness as they are stepping into clinical years and receive BLS training. Although the study involved all clinical years of dental students in MUCM, the study was unable to assess hands-on skills. The limitation of the study is that it only assesses knowledge, attitude, and awareness, whereas skills and practice are not evaluated to match the data obtained.
CONCLUSION
Based on the study, year 3 dental students from the university showed the highest awareness, followed by years 4 and 5. In addition, year 4 dental students have the highest knowledge score toward BLS. Despite students exhibiting a positive attitude toward BLS training, some of them never underwent any formal BLS training. This gap must be bridged immediately to address this issue. Basic life science programs must not only be imparted in the course curriculum but be updated at constant intervals and time.
ORCID
Ramanathan Ravi https://orcid.org/0009-0005-4204-2991
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