Factors and Barriers on Cardiopulmonary Resuscitation and Automated External Defibrillator Willingness to Use among the Community: A 2016-2021 Systematic Review and Data Synthesis

Background

Bystander cardiopulmonary resuscitation (CPR) and using an automated external defibrillator (AED) can improve out-of-hospital cardiac arrest survival. However, bystander CPR and AED rates remained consistently low. The goal of this systematic review was to assess factors influencing community willingness to perform CPR and use an AED for out-of-hospital cardiac arrest survival (OHCA) victims, as well as its barriers.

Methods

The review processes (PROSPERO: CRD42021257851) were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) review protocol; formulation of review questions; systematic search strategy based on identification, screening, and eligibility using established databases including Scopus, Web of Science, and Medline Complete via EBSCOhost; quality appraisal; and data extraction and analysis. There is identification of full-text journal articles that were published between 2016 and 2021 and written in English.

Results

Of the final 13 articles, there are six identified factors associated with willingness to perform CPR and use an AED, including socio-demographics, training, attitudes, perceived norms, self-efficacy, and legal obligation. Younger age, men, higher level of education, employed, married, having trained in CPR and AED in the previous 5 years, having received CPR education on four or more occasions, having a positive attitude and perception toward CPR and AED, having confidence to perform CPR and to apply an AED, and legal liability protection under emergency medical service law were reasons why one would be more likely to indicate a willingness to perform CPR and use an AED. The most reported barriers were fear of litigation and injuring a victim.

Conclusions

There is a need to empower all the contributing factors and reduce the barrier by emphasizing the importance of CPR and AEDs. The role played by all stakeholders should be strengthened to ensure the success of intervention programs, and indirectly, that can reduce morbidity and mortality among the community from OHCA.

Translation, Cross-Cultural Adaptation, and Validation of the Malay-Version of the Factors Influencing Community Willingness to Perform Cardiopulmonary Resuscitation and Use an Automated External Defibrillator Questionnaire

Limited factors influence community willingness to perform cardiopulmonary resuscitation and use an automated external defibrillator, making it difficult to take preventive and control measures to improve the survival of patients with out-of-hospital cardiac arrest. In this study, we translated and evaluated the Malay-language version of the cardiopulmonary resuscitation and an automated external defibrillator questionnaire. The translation and evaluation involved three phases: development, translation and cultural adaptation, and validation. Content validity was assessed by five experts, and demonstrated a content validity index of 0.98 and a Fleiss kappa index of 0.159. Construct validity for the multi-item scale performed using factor analysis and involving 100 participants was 0.777. Factor analysis using the varimax rotation method demonstrated the appropriateness of the data in the exploratory factor analysis. Cronbach’s alpha was 0.849, suggesting high reliability. Test–retest reliability involving 45 participants calculated using the intraclass correlation coefficient had a value of 0.723. The findings demonstrate that the Malay-version FIXED questionnaire is a valid and reliable instrument and is ready to be used by health care workers and policymakers to evaluate the factors influencing the community’s willingness to perform cardiopulmonary resuscitation and use an automated external defibrillator.