Evaluating barriers to community CPR education
Introduction
Out-of-hospital cardiac arrest (OHCA) remains a persistent public health issue, affecting more than 356,000 people annually in the United States [1]. The provision of bystander cardiopulmonary resuscitation (CPR) has been consistently linked to improved rates of survival and neurological recovery [2], [3], [4], [5], [6], [7], [8], [9]. Despite the overwhelming evidence that bystander CPR benefits victims of OHCA, its rates of performance vary greatly and remain low in most areas of the United States [2], [4], [10].
In an effort to increase the rate of bystander CPR, in 2008, the American Heart Association began to promote not-for-certification compression-only CPR training for laypersons. Compression-only CPR is a simple technique that is easily taught to laypeople and has been found to alleviate several barriers to the provision of bystander CPR including fear of infection and decreasing the time it takes to initiate compressions [11]. Many local and state emergency medical services (EMS) agencies and public health systems have embraced this public education concept and now offer compression-only or “hands only” CPR training regularly.
Despite an increased emphasis on community CPR education, barriers to course delivery persist. A “one size fits all model” may not address concerns related to geographic and student-specific social determinants. Many groups lag behind significantly in bystander CPR rates, most notably the socioeconomically disadvantaged, the non-college educated, and non-English speakers [12].
A more nuanced understanding of CPR learner preferences is likely to improve educational outreach and give greater access to resources. Accordingly, an effective model of CPR education has the potential to promote increased delivery of bystander CPR and ideally affect overall survival rates after OHCA.
The primary purpose of our study is to describe the general public’s preferences regarding CPR education as it relates to course format, time of day, and location of course delivery. The second aim is to report and understand the preferences of groups that have traditionally been underrepresented in participating in bystander CPR courses.
Section snippets
Methods
We analyzed data collected at large public gatherings held in Baltimore, Maryland, between May 23, 2015, and February 11, 2017. The survey (Fig. 1) was a 23-item single-page instrument intended to be completed by people attending a large gathering such as a fair or festival. It was designed with the help of literacy experts to be comprehended at a third-grade reading level and included an informed consent statement. The survey tool was pilot tested in small group sessions where feedback was
Data management and analysis
The paper survey data were entered manually into a Microsoft Access database (Seattle, WA). In order to stratify for socioeconomic status, we used the percent of people living in poverty in the respondents’ self-reported home zip codes and organized them into three a priori categories: low-poverty (0–9.9%), moderate-poverty (10–19.9%), and high-poverty (≥20%) areas. Poverty has previously been shown to limit health-seeking behaviors as well as provide an economic disincentive to learning health
Results
Five-hundred thirty-five surveys were collected, and 13 were excluded for incompleteness, leaving a total of 522 complete surveys. Six surveys were then excluded for indicating an age less than 14, leaving 516 surveys for analysis (Fig. 2).
The average age of respondents was 36.9 years (range, 14–84). Sixty-three percent of respondents were female. Fifty-four percent reported having a college education or higher. The racial/ethnic breakdown of respondents was 55% white, 36.6%
Discussion
Our study results describe social and logistical factors preferred by survey respondents and suggest strategies for improving community outreach regarding CPR education. Prior studies demonstrated that increased community CPR training correlates with increased rates of survival after OHCA, including good neurologic outcome [14]. The majority of participants in our study had previous CPR training (n = 352, 68.2%), which is congruent with a reported national average of 65% of adults [15].
Limitations
Significant challenges are implicit in our study, as in all survey-based research. First, our surveys were collected in a single urban jurisdiction, so our findings might not be generalizable to other locations. Additionally, the technique of convenience sampling has the potential to introduce a degree of selection bias.. Also, given the open and informal nature of the community events, it was not possible to determine the total number of people who were approached, impeding our ability to
Conclusion
This study analyzed data collected from participants at large public gatherings in an inner-city environment to assess the public’s opinions and preferences regarding the logistics of CPR education. We found commonalities in both location preference and style preference among all socioeconomic groups represented by the participants in our survey. The most favored location among all respondents were local libraries. The least favored site for CPR education were local learning stations during
Funding/Support
No funding or support to declare.
Conflict of Interest/Acknowledgment
Andrew J. Bouland serves as a board member for the Compress & Shock Foundation, a nationally recognized not-for-profit organization that provides resources for free community CPR training. He has no financial interest in that organization. The manuscript was copyedited by Linda J. Kesselring, MS, ELS, the technical editor/writer in the Department of Emergency Medicine at the University of Maryland School of Medicine.
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