The Iterative Development and Testing of an Interactive Mobile Application for Skill Retention of Cardiopulmonary Resuscitation Among High School Students: A Pilot Study

Abstract

Abstract:

Background

Locations concentrated with High School (HS) students tend to have lower out-of-hospital cardiac arrest (OHCA) survival rates. Mobile applications (apps) have the capability to augment cardiopulmonary resuscitation (CPR) skill retention as a low-cost, accessible training method.

Methods

An iterative process to develop an app to reinforce CPR skills emphasizing hand placement, compression rate, real-time feedback, and recurring tips is described. The app was tested on HS students to measure its impact on quality and comfort of CPR using Likert surveys and skills assessments before and after one month of usage. CPR Score and compression rate were measured using the Laerdal™ Little Anne Manikin QCPR software.

Results

Fourteen HS students participated in a prospective observational study. It was found that the use of the developed app was associated with improved CPR performance (80.43% v. 87.86%, p=0.01-0.02, 95% CI=2.20-12.66) after one month. Additionally, improvements were demonstrated in compression rate accuracy (21.43% v. 64.29%, p=0.041, 95% CI=0.132-0.725), increased comfort performing CPR (3.86 v. 4.79, p<0.001, 95% CI =0.99-1.00) and comfort performing CPR on strangers (2.71 v. 4.42, p<0.001, 95% CI=1.24-2.19). In addition, for every time the app was used, CPR performance increased by 0.5668% (p=0.0182).

Conclusion

Findings suggest that mobile apps may have promising implications as augmentative tools for CPR curriculums.

Keywords

Cardiopulmonary Resuscitation (CPR)Mobile Applications (apps)Simulation Basic Life Support Mobile Technology High School Students

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References

Ahn

, Cho

, Oh

, Song

, Lim

T. H.

, Kang

, & Lee

(2016). Evaluation of Smartphone Applications for Cardiopulmonary Resuscitation Training in South Korea. BioMed Research International , 2016, 1–8. doi:10.1155/2016/641871.

American Heart Association. (2000). Part 3: Adult Basic Life Support. Circulation , 102(I22-I59). doi: 10.1161/circ.102.suppl_1.I-22

Anderson

, & Jiang

(2020). Teens, Social Media & Technology 2018. https://www.pewresearch.org/internet/2018/05/31/teens-social-media-technology-2018/

Benjamin

E. J.

, Virani

S. S.

, Callaway

C. W.

, Chamberlain

A. M.

, Chang

A. R.

, Cheng

, et al. (2018). Heart Disease and Stroke Statistics—2018 Update: A Report From the American Heart Association. Circulation , 137(12). doi:10.1161/cir.000000000000055.

Chase

T.J.G.

, Julius

, Chandan

J.S.

, et al.Mobile learning in medicine: an evaluation of attitudes and behaviours of medical students. BMC Med Educ 18, 152 (2018). https://doi.org/10.1186/s12909-018-1264-5

Cheng

, Kessler

, Mackinnon

, Chang

T. P.

, Nadkarni

V. M.

, Hunt

, et al. (2016). Reporting Guidelines for Health Care Simulation Research. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare , 11(4), 238–248. doi:10.1097/sih.000000000000015.

CPR Scoring. (n.d.). https://laerdal.com/us/support/scoring/

Duval

, Pepe

P. E.

, Aufderheide

T. P.

, Goodloe

J. M.

, Debaty

, Labarère

, . (2019). Optimal Combination of Compression Rate and Depth During Cardiopulmonary Resuscitation for Functionally Favorable Survival. JAMA Cardiology , 4(9), 900. doi:10.1001/jamacardio.2019.271.

Ericsson

K. A.

, & Harwell

K. W.

(2019). Deliberate Practice and Proposed Limits on the Effects of Practice on the Acquisition of Expert Performance: Why the Original Definition Matters and Recommendations for Future Research. Frontiers in Psychology , 10. https://doi.org/10.3389/fpsyg.2019.02396

10.

Fagerland

M. W.

, Lydersen

, & Laake

(2013). The McNemar test for binary matched-pairs data: Mid-p and asymptotic are better than exact conditional. BMC Medical Research Methodology , 13(1). doi:10.1186/1471-2288-13-9.

11.

González-Otero

D. M.

, Ruiz

J. M.

, Gauna

S. R.

, Gutiérrez

J. J.

, Daya

, Russell

J. K.

, . (2018). Monitoring chest compression quality during cardiopulmonary resuscitation: Proof-of-concept of a single accelerometer-based feedback algorithm. Plos One , 13(2). doi:10.1371/journal.pone.019281.

12.

Green

B. L.

, Kennedy

, Hassanzadeh

, Sharma

, Frith

, & Darling

J. C.

(2015). A semi-quantitative and thematic analysis of medical student attitudes towards M-Learning. Journal of Evaluation in Clinical Practice , 21(5), 925–930. doi:10.1111/jep.1240.

13.

Hasselqvist-Ax

, Riva

, Herlitz

, Rosenqvist

, Hollenberg

, Nordberg

, . (2015). Early Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest. New England Journal of Medicine , 372(24), 2307–2315. doi:10.1056/nejmoa140579.

14.

Huang

S.L.

, & Chen

C. T.

(2018). How consumers become loyal fans on Facebook, Computers in Human Behavior , Volume 82, Pages 124–135, https://doi.org/10.1016/j.chb.2018.01.006.

15.

Jafri

F. N.

, Dadario

N. B.

, Kumar

, Silverstein

S. R.

, Quintero

, Larsen

E. A.

, Fasciglione

, Mirante

, Ellsworth

, Amicucci

, & Ricca

(2021). The Addition of High-Technology Into the Stop the Bleed Program Among School Personnel Improves Short-Term Skill Application, Not Long-Term Retention. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, Publish Ahead of Print . https://doi.org/10.1097/sih.0000000000000546

16.

Kalz

, Lenssen

, Felzen

, Rossaint

, Tabuenca

, Specht

, & Skorning

(2014). Smartphone Apps for Cardiopulmonary Resuscitation Training and Real Incident Support: A Mixed-Methods Evaluation Study. Journal of Medical Internet Research , 16(3). doi:10.2196/jmir.295.

17.

Kang

S. H.

(2016). Spaced Repetition Promotes Efficient and Effective Learning. Policy Insights from the Behavioral and Brain Sciences , 3(1), 12–19. doi:10.1177/237273221562470.

18.

Lee

, Chao

, Huang

, Fang

, Wang

, Chuang

, Kang

, Hsin

, Lin

, Fang

, & Li

(2018). Cognitive Style and Mobile E-Learning in Emergent Otorhinolaryngology-Head and Neck Surgery Disorders for Millennial Undergraduate Medical Students: Randomized Controlled Trial. J Med Internet Res , 20(2):e56. doi: 10.2196/jmir.8987

19.

Lin

, & Cheng

(2015). The role of simulation in teaching pediatric resuscitation: Current perspectives. Advances in Medical Education and Practice, 239 . doi:10.2147/amep.s6417.

20.

Metelmann

, Metelmann

, Schuffert

, Hahnenkamp

, & Brinkrolf

(2018). Medical Correctness and User Friendliness of Available Apps for Cardiopulmonary Resuscitation: Systematic Search Combined With Guideline Adherence and Usability Evaluation. JMIR MHealth and UHealth , 6(11). doi:10.2196/mhealth.965.

21.

Offiah

, Ekpotu

, Murphy

, Kane

, Gordon

, O'Sullivan

, Sharifuddin

, Hill

ADK

, & Condron

CM.

(2019). Evaluation of medical student retention of clinical skills following simulation training. BMC Med Educ . 19(1):263. doi: 10.1186/s12909-019-1663-2.

22.

Okuda

, & Quinones

(2008). The use of simulation in the education of emergency care providers for cardiac emergencies. International Journal of Emergency Medicine , 1(2), 73–77. doi:10.1007/s12245-008-0034-.

23.

Papastergiou

(2009). Digital Game-Based Learning in high school Computer Science education: Impact on educational effectiveness and student motivation. Computers & Education , 52(1), 1–12. doi:10.1016/j.compedu.2008.06.00.

24.

Rivera

N. T.

, Kumar

S. L.

, Bhandari

R. K.

, & Kumar

S. D.

(2016). Disparities in Survival with Bystander CPR following Cardiopulmonary Arrest Based on Neighborhood Characteristics. Emergency Medicine International , 2016, 1–8. doi:10.1155/2016/698375.

25.

RStudio Team. (2021). RStudio: Integrated Development Environment for R. Boston, MA. http://www.rstudio.com/

26.

Sailer

, Hense

J. U.

, Mayr

S. K.

, & Mandl

(2017). How gamification motivates: An experimental study of the effects of specific game design elements on psychological need satisfaction. Computers in Human Behavior , 69, 371–380. doi:10.1016/j.chb.2016.12.03.

27.

Scheff

S. W.

(2016). Chapter 8 - Nonparametric Statistics. In Fundamental statistical principles for the neurobiologist: A survival guide (pp. 157–182). Amsterdam: Academic Press is an imprint of Elsevier. doi:10.1016/B978-0-12-804753-8.00008-7.

28.

Schooley

, Walczak

, Hikmet

, & Patel

(2016). Impacts of mobile tablet computing on provider productivity, communications, and the process of care, International Journal of Medical Informatics , 88, 62–70. doi:10.1016/j.ijmedinf.2016.01.010.

29.

Sutton

R. M.

, Nadkarni

, & Abella

B. S.

(2012). “Putting It All Together” to Improve Resuscitation Quality. Emergency Medicine Clinics of North America , 30(1), 105–122. doi:10.1016/j.emc.2011.09.00.

30.

Welbers

, Konijn

E. A.

, Burgers

, de Vaate

A. B.

, Eden

, & Brugman

B. C.

(2019). Gamification as a tool for engaging student learning: A field experiment with a gamified app. E-Learning and Digital Media , 16(2), 92–109. https://doi.org/10.1177/2042753018818342

31.

Witt

R. E.

, Kebaetse

M. B.

, Holmes

J. H.

, Ryan

L-Q.

, Ketshogileng

, Antwi

, Kovarik

, & Nkomazana

(2016). The role of tablets in accessing information throughout undergraduate medical education in Botswana. International Journal of Medical Informatics , 88, 71–77, doi:10.1016/j.ijmedinf.2016.01.006.

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