Basic Life Support and Resuscitation Knowledge, Situation, and Attitudes Questionnaire

Abstract

The Basic Life Support and Resuscitation-Related Knowledge, Situation, and Attitudes Questionnaire (BLS-KSAQ), developed by Gradvohl et al. (2023), is an instrument designed to assess adolescents’ comprehension of and response to Basic Life Support (BLS) and resuscitation procedures within practical, real-world scenarios. The questionnaire items were systematically created through comprehensive literature reviews to ensure content validity and relevance to contemporary BLS guidelines.

The BLS-KSAQ structure is divided into two main parts. Part I collects General Information (14 items), covering socio-demographic data (3 items), health behaviors (10 items), and previous BLS training experience (1 item). Part II focuses specifically on BLS, encompassing 36 items measuring Knowledge, 2 items measuring Situation assessment, and 8 items measuring Attitude. Initial data collection involved primary and secondary school students in Hungary who participated in formal BLS education initiatives.

Initial validation efforts reported positive findings regarding Test-Retest Reliability and validity. A subset of eight knowledge items was identified as effective based on psychometric analysis, particularly concerning the difficulty index and stability over time.

Keywords

Attitudes, Basic Life Support, Knowledge, Primary School Students, Resuscitation, Secondary School Students

Authors

Gradvohl, Edina, Lukács, Ágnes J., Takács, Johanna, Fritúz, Gábor, Falus, András, Feith, Helga Judit

Purpose

The primary purpose of the BLS-KSAQ is to serve as an evaluative tool for measuring the effectiveness of educational programs focused on Basic Life Support (BLS) training. It specifically targets primary and secondary school students, aiming to quantify their acquisition of life support knowledge and their preparedness for resuscitation actions.

By assessing changes in knowledge, situational awareness, and pro-social attitudes before and after training interventions, the questionnaire helps educators and public health officials determine the success and necessary improvements of school-based BLS curricula aimed at increasing bystander CPR rates.

Construct

The BLS-KSAQ is designed to measure three distinct yet related psychological and behavioral constructs relevant to emergency medical response among adolescents: Knowledge, Situation assessment, and Attitude.

The Knowledge domain assesses factual understanding of critical BLS steps, such as chest compression rates, depth, and the proper use of equipment like the Automated External Defibrillator (AED). The Situation domain evaluates the respondent’s ability to recognize a cardiac emergency and make appropriate decisions regarding intervention (e.g., initiating CPR). Finally, the Attitude domain measures underlying beliefs, motivations, and willingness to participate in first aid and help distressed individuals, reflecting the affective component necessary for bystander intervention.

Validity

The validation process utilized several psychometric approaches, including assessment of test validity and item difficulty indexing.

For the two Situation items, validity was supported by two separate measurements showing a strong, positive correlation. The eight Attitude items demonstrated generally moderate to strong psychometric properties: six items exhibited a moderate positive significant Pearson’s product-moment correlation coefficient, one item displayed a strong positive correlation, while only one item showed a non-significant correlation.

Item difficulty for the Knowledge section was determined using a subsample (n = 123) of participants who had no prior life support experience, thereby minimizing response bias. Analysis revealed that nine items fell within the acceptable difficulty range (20% to 80% correct response rate). However, 15 items were deemed outside this optimal range, with 14 items being too easy (greater than 80% correct) and one item being too difficult (less than 20% correct).

Reliability

The primary measure of stability was Test-Retest Reliability, calculated following a 10-day interval between administrations. Analysis of the 36 knowledge statements revealed varied reliability coefficients (r).

Specifically, ten items demonstrated a strong test-retest correlation (r > 0.7), classifying them as highly reliable items. Nine items showed a moderate correlation (0.4 < r < 0.7). Conversely, eight statements exhibited a low correlation (r < 0.4), indicating these items were non-reliable for stable measurement over time. These results guided the selection of the most reliable items for future use.

Factor Analysis

No formal factor analysis was indicated or reported during the development and initial validation of the BLS-KSAQ.

Instrument

Test Type: Original, Inventory/Questionnaire

Format: The instrument is divided into two main parts totaling 60 items. Part I (General Information) includes 14 items (3 socio-demographic, 10 health behavior, 1 previous BLS training). Part II (BLS Focus) comprises 46 items (36 Knowledge, 2 Situation, and 8 Attitude items).

Language Available: English

Population Group: Human (Male, Female)

Age Group: Childhood (birth–12 yrs), School Age (6–12 yrs), Adolescence (13–17 yrs)

Population Details: Respondents were Primary School Students and Secondary School Students who participated in BLS educational initiatives in Hungary.

Test Methodology: Test Validity, Test Reliability, Test-Retest Reliability

Keywords

Attitudes, Basic Life Support, Knowledge, Primary School Students, Resuscitation, Secondary School Students

Authors

Gradvohl, Edina:

• Affiliation: Faculty of Health Sciences, Semmelweis University

• Affiliation Email addresses: [email protected]

• Correspondence Address: Semmelweis University, Faculty of Health Sciences, Vas street 18, Budapest, Hungary, H-1088.

Lukács, Ágnes J.:

• Affiliation: Faculty of Health Sciences, Semmelweis University

Takács, Johanna:

• Author ORCID Identifier: orcid.org/0000-0002-8709-8826

• Affiliation: Faculty of Health Sciences, Semmelweis University

Fritúz, Gábor:

• Affiliation: Department of Anesthesiology and Intensive Therapy, Semmelweis University

Falus, András:

• Affiliation: Department of Genetics, Cell, and Immunobiology, Semmelweis University

Feith, Helga Judit:

• Author ORCID Identifier: orcid.org/0000-0001-8855-5059

• Affiliation: Faculty of Health Sciences, Semmelweis University

Permissions & Fee and Test Year

Permissions: May use for Research/Teaching.

Commercial Use: No

Fee: No

Test Year: 2023

Website: The instrument is distributed under a Creative Commons license (CC BY 4.0): creativecommons.org/licenses/by/4.0/deed.en.

References

Gradvohl, E., Lukács, Á. J., Takács, J., Fritúz, G., Falus, A., & Feith, H. J. (2023). Development and validation of the questionnaire on resuscitation-related knowledge and attitude for adolescents. Evaluation and Program Planning, 100, 1–9. doi.org/10.1016/j.evalprogplan.2023.102338

Items of the Basic Life Support and Resuscitation-Related Knowledge, Situation, and Attitudes Questionnaire

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way. This is a 16-item measure, representing the key items identified during validation. The test items are available in Figure 3, Page 7 of the source reference.

Knowledge

• K13: How many chest compressions should be given to someone who is unconscious and not breathing?

• K14-5: If you have an automated defibrillator (resuscitation device), anyone can use it, turn it on, and follow its instructions.

• K15-1: You have to tell your name when you call the ambulance.

• K16-3: Do you need to start resuscitation if someone’s side is paralyzed and they are trying to talk with difficulty?

• K16-4: Do you need to start resuscitation if someone breathes very fast?

• K16-7: Do you need to start resuscitation if, instead of breathing, we see and hear snoring, especially if suddenly turning the head back?

• K17: How deep should the chest be pushed during an adult’s resuscitation?

• K18-3: What is the AED used for?

Situation, Attitude

• S2: In this situation, if necessary, would you start CPR (i.e., apply chest compressions) on the man?

• AI1: It is important for me to have the basic knowledge of first aid so that I can help people in need.

• AI2: A child can be expected to help someone in need.

• AI3: Anyone who does not help someone in distress, even if they have the opportunity, should be punished.

• AI5: At a given moment, we may have more important things to do than stopping to give someone first aid.

• AI6: It would be depressing if I could not participate in the care of a troubled person while I was there.

• AI7: I only help a person in trouble if I hope it will make their condition better.

• AI8: It would be a good thing if every child could provide first aid.