Primary health care nurses' knowledge, attitudes, and self-reported first-aid preparedness regarding opioid overdose in Egypt: a cross-sectional study

Abstract Background Primary health care nurses may encounter patients at risk of opioid overdose, yet evidence regarding their preparedness in low- and middle-income settings is limited. This study assessed nurses' knowledge, attitudes, and self-reported first-aid preparedness regarding opioid overdose and examined factors associated with preparedness. Methods A multicenter cross-sectional study was conducted among 131 nurses working in seven primary health care centers in Tanta City, El-Gharbia Governorate, Egypt. Participants completed the 45-item Opioid Overdose Knowledge Scale, the 28-item Opioid Overdose Attitudes Scale, and a 16-item self-reported first-aid preparedness questionnaire. Data were summarized descriptively, associations were examined using Spearman rank correlations, and factors associated with preparedness were assessed using negative binomial regression. Results The mean knowledge score was 9.01 ± 7.01 out of 45, and all participants scored below the prespecified 60% knowledge threshold. The mean preparedness score was 1.79 ± 3.29 out of 16; 123 nurses (93.9%) had low preparedness and 8 (6.1%) had high preparedness. The mean attitude score was 104.19 ± 8.51; 66 nurses (50.4%) were classified as neutral and 65 (49.6%) as positive. Attitude was positively correlated with preparedness (Spearman ρ = 0.565, p < 0.001), whereas knowledge was not (ρ = -0.147, p = 0.094). In the adjusted analysis, rural residence (IRR = 0.063, 95% CI 0.019–0.213, p < 0.001) and higher educational-level category (IRR = 0.298, 95% CI 0.121–0.733, p = 0.008) were associated with lower preparedness scores; knowledge and attitude were not independently associated with preparedness. Conclusions Marked deficits in opioid-overdose knowledge and self-reported first-aid preparedness were identified, particularly in naloxone use, emergency response, and post-rescue care. Primary care organizations should implement standardized, simulation-based overdose-response education that combines technical knowledge, practical skills, confidence building, and stigma reduction.