Out-of-hospital cardiac arrest and bystander response: Awareness, knowledge, attitudes, and training in multi-ethnic communities

Abstract

Prompt bystander response more than doubles the odds of survival from out-of-hospital cardiac arrest (OHCA). Previous training is a significant factor in bystander willingness to provide cardiopulmonary resuscitation (CPR) or use a defibrillator. This thesis contributes to an understanding of barriers to training uptake and willingness to respond to OHCA in multi-ethnic communities of New South Wales (NSW) and discusses strategies to address the barriers. Registry data analysis found bystander CPR provision in NSW was lower for females, older adults, in residential locations and socioeconomically disadvantaged areas. A community-based intervention (FirstCPR cluster randomised study) was developed to increase community-wide training and willingness to respond to OHCA. It was designed to be delivered digitally and in-person and emphasised the use of material that included localised features and references. Process evaluation of FirstCPR highlighted that access to laypersons via their community organisations while feasible, can be challenging and resource-intensive. Uptake varied and was greater in social organisations compared with sports clubs. Contextual factors such as restrictions related to the COVID-19 pandemic limited participation. Factors such as time, interest, ability to congregate, capacity and commitment of organisation leaders to engage with the program and foster its facilitation played a significant role. Those who engaged highly valued in-person sessions and opportunities to practise skills on a manikin. CPR training was significantly lower among immigrants. Willingness to perform CPR was also lower but was mediated by previous training. Improved access to training that addresses barriers of language, cost and commonly-held fears is likely to have a positive impact. An intervention like FirstCPR is unlikely to be the “magic bullet” and concerted efforts in public campaigns are needed accompanied by messaging that addresses cultural sensitivities.