Table 1
PFO strategy in developing research question.
| Population (P) | Community adults, age 19 years and above |
| Prognostic Factors (F) | The factors or barriers that could influence the outcome (community willingness to perform CPR and using an AED) |
| Outcome (O) | Community willingness to perform CPR and using an AED |
Figure 1
Flow diagram of the searching process.
Table 2
Results of the quality assessment.
| STUDY | RESEARCH DESIGN | QA1 | QA2 | QA3 | QA4 | QA5 | NUMBER OF CRITERIA FULFILLED | INCLUSION IN THE REVIEW |
|---|---|---|---|---|---|---|---|---|
| Bylow et al. [21] | QN (R) | Y | Y | Y | Y | Y | 5/5 | ✓ |
| Cheskes et al. [22] | QN (DC) | Y | Y | Y | Y | Y | 5/5 | ✓ |
| Fan et al. [23] | QN (DC) | Y | Y | Y | Y | Y | 5/5 | ✓ |
| Hawkes et al. [24] | QN (DC) | Y | Y | Y | Y | Y | 5/5 | ✓ |
| Krammel et al. [25] | QN (NR) | Y | N | Y | C | Y | 3/5 | ✓ |
| Lee et al. [26] | QN (NR) | Y | Y | Y | Y | Y | 5/5 | ✓ |
| Liaw et al. [27] | QN (NR) | Y | Y | Y | N | Y | 4/5 | ✓ |
| Pei-Chuan Huang et al. [28] | QN (DC) | Y | Y | Y | Y | Y | 5/5 | ✓ |
| Pei-Chuan Huang et al. [29] | QN (DC) | Y | Y | Y | Y | Y | 5/5 | ✓ |
| Post et al. [30] | QN (NR) | Y | Y | Y | Y | Y | 5/5 | ✓ |
| Qian et al. [31] | QN (DC) | Y | Y | Y | Y | Y | 5/5 | ✓ |
| Shams et al. [32] | QN (DC) | Y | Y | Y | Y | Y | 5/5 | ✓ |
| Son et al. [33] | QN (DC) | Y | Y | Y | Y | Y | 5/5 | ✓ |
[i] Notes: QL = Qualitative; QN (R) = Quantitative randomized controlled trials; QN (NR) = Quantitative non-randomized; QN (DC) = Quantitative descriptive; MX = Mixed-Method; Y = Yes; N = No; C = Can’t tell.
Table 3
A summary of the studies included in this study.
| FIRST AUTHOR (YEAR)COUNTRY, PERIOD OF STUDY | STUDY COVERAGE | SAMPLE SIZE AND POPULATION | INTERVENTION | COMPARISON | FACTORS ASSOCIATED WITH WILLINGNESS | BARRIERS |
|---|---|---|---|---|---|---|
| Bylow (2019) Sweden, 2014–2016 | BLS (CPR and AED) | 1,231 Public in the community | Basic life support training intervention | To compare the effectiveness of two BLS training intervention, self-learning training or traditional instructor-led training | Training | Not applicable |
| Cheskes (2016) Canada, 1 week | CPR | 428 Adults living in Canada | Not applicable | Chest-compression-only CPR (CCO-CPR) compared to traditional CPR with mouth-to-mouth (MTM) ventilations | Gender, type of CPR training | Lack of knowledge, fear of litigation, lack of skill confidence |
| Fan (2016) Hong Kong, 2 November–15 December 2015 (excluding Saturdays and public holidays) | AED | 401 All pedestrians in the vicinity of a mass transit railway (MTR) station in six locations across different districts of Hong Kong | Not applicable | Comparison of first aiders with non–first aiders | Training | Not applicable |
| Hawkes (2019) United Kingdom, May 2017 | CPR and PAD | 2,084 UK adults | Not applicable | CCO-CPR, CPR, and Public Access Defibrillator (PAD) training | Age, gender, occupation, marital status, training, length of time since last training, confidence in performing CPR | Not applicable |
| Krammel (2018) Austria, August–September 2014 | BLS (CPR and AED) | 501 Residents of Vienna (Austria) | Not applicable | Comparison of gender and age-specific aspects of awareness and knowledge | Age, gender | Not applicable |
| Lee (2021) South Korea, February 2012, December 2016, and December 2018 | AED | 3,069 Daegu Metropolitan City, South Korea | Not applicable | 973 in the 2012 survey (first group), 1,095 in the 2016 survey (second group), and 1,001 in the 2018 survey (third group) | Gender, length of time since last training, legal obligation, awareness of how to use an AED | Lack of knowledge, fear of litigation, injuring victim due to using AED, not interested in AED |
| Liaw (2020) Malaysia, February–November 2018 | CPR and AED | 184 Employees from UNIMAS, Malaysia | Training program on how to use the AED and perform CPR | To determine the effectiveness of the training program, to improve the perception of using AED and performing CPR (‘pre-test’ vs. ‘post-test’) | Training, perception, confidence behavior | Fear of disease transmission, injuring victim due to performing CPR, injuring own self due to performing CPR, injuring victim due to using AED, injuring own self due to using AED |
| Pei-Chuan Huang (2019) Taiwan, April–June 2013 | CPR | 1,073 Public in Taiwan | Not applicable | Not applicable | Gender, training, legal obligation | Fear of legal responsibilities, injuring victim due to performing CPR |
| Pei-Chuan Huang (2021) Taiwan, April–June 2013 | AED | 1,073 Public in Taiwan | Not applicable | Not applicable | Gender, training, attitude | Fear of legal responsibilities, lack of skill confidence, injuring victim due to using AED |
| Post (2019) United States | CPR and AED | 769 Coaches of high school teams and club teams with high school-aged athletes in 3 sports (basketball, soccer, and volleyball) | High school coaches were required to undergo annual CPR/AED training | Emergency preparedness and training existed between coaches of high school teams and coaches of high school-aged club teams | Training | Not applicable |
| Qian (2021) People’s Republic of China, October–December 2020 | BLS (CPR and AED) | 2,812 Urban residents in Nantong City | None | Residents with first aid experience and residents without first aid experience | Age, education level, occupation, training | Fear of legal responsibilities, fear of disease transmission, injuring victim due to performing CPR, performing MTM artificial respiration, concern that peoples around them will complain, unwillingness to touch strangers |
| Shams (2016) Lebanon, 1 March–30 June 2015 | CPR and AED | 948 University students in Lebanon | Not applicable | Not applicable | Social grade, training, confidence in performing CPR | Lack of knowledge, fear of disease transmission, injuring victim due to performing CPR, poor hygiene of victim, presence of vomit or blood |
| Son (2017) South Korea, 3–14 February 2012 | CPR and AED | 1,000 Adults aged 19 years or above living in Daegu metropolitan city. | Not applicable | Type of CPR education, total no. of CPR education sessions attended, period from the last CPR education session, AED training included in CPR education | Age, gender, education level, type of CPR training, length of time since last training, number of times trained, confidence in performing CPR, legal obligation | Not applicable |
Table 4
Factors analysed in each of the included studies.
| FACTORS | AUTHOR | FACTORS INFLUENCING WILLINGNESS TO PERFORM CPR/USE AN AED | STRENGTH OF ASSOCIATION/SIGNIFICANCE LEVEL | |
|---|---|---|---|---|
| Socio-demographics | ||||
| Age | Younger age | Hawkes et al. [24] | aged 18 to 34 years are less likely to phone EMS compared with those aged ≥35 years |
|
| aged 18 to 34 years were significant indicators had undergone any type of training and training in CPR, both in the past 5 years. |
| |||
| Krammel et al. [25] | age <45 years are highest willingness to perform CPR compared to 45 years and above |
| ||
| age <45 years are highest willingness to use AED compared to 45 years and above |
| |||
| Qian et al. [31] | 18–29 years |
| ||
| Son et al. [33] | the rates of willingness to perform CPR decreased with older age |
| ||
| Gender | Male | Son et al. [33] | male respondents reported a willingness to perform CPR |
|
| Lee et al. [26] | willingness to use AEDs were male |
| ||
| Pei-Chuan Huang et al. [28] | men were more likely to perform CPR than women |
| ||
| Pei-Chuan Huang et al. [29] | men were more likely use AED |
| ||
| Hawkes et al. [24] | women were less likely than men to go and get an AED, and use an AED |
| ||
| Krammel et al. [25] | female individuals reported a significantly lower willingness to initiate CPR and to use an AED device |
| ||
| Women | Cheskes et al. [22] | women were more likely indicate a willingness to perform CPR |
| |
| Education Level | Higher education level | Son et al. [33] | college graduates or respondents with a higher level of education. |
|
| Qian et al. [31] | postgraduate and above |
| ||
| Social grade/Occupation | Shams et al. [32] | earning higher income |
| |
| Hawkes et al. [24] | social grade A, B, or C1* |
| ||
| Qian et al. [31] | different type of occupation |
| ||
| Marital status | Married | Hawkes et al. [24] | married or living as married is a predictive factor to perform CO-CPR, CPR and were more likely to go and get an AED |
|
| Training | ||||
| Type of CPR training | Interest to participate in CPR training course and belief that the public should participate in CPR training courses | Pei-Chuan Huang et al. [28] | those who expressed interest in attending a course |
|
| those who believed that the public should participate in CPR training courses |
| |||
| Interest to participate in an AED training course and belief that the public should learn how to use AEDs | Pei-Chuan Huang et al. [29] | those who expressed interest to participate in a training course |
| |
| those who believed that the public should learn how to use AEDs |
| |||
| Previous CPR training | Shams et al. [32] | previous CPR training were significant predictors of willingness to perform CPR in the event of a cardiac arrest |
| |
| First aid experience and without first aid experience | Qian et al. [31] | those with first aid experience were more willing to attempt rescue than those without first aid experience |
| |
| First aiders with and without AED training | Fan et al. [23] | those with AED training were also more likely to commence CPR and were more likely to try to locate an AED and apply it |
| |
| Instructor-led training and self-learning training | Bylow et al. [21] | instructor-led training resulted in a statistically significant higher total score, self-assessed knowledge, and willingness to act immediately compared to self-learning training |
| |
| Didactic plus practise group and didactic only group | Son et al. [33] | the rate of CPR willingness in the didactic plus practice group was significantly higher than that in the didactic only group |
| |
| didactic plus practise group found to be significantly associated with CPR willingness compared to didactic only group |
| |||
| CCO-CPR and traditional CPR with MTM ventilation | Cheskes et al. [22] | the proportion of respondents willing to provide CCO-CPR was significantly greater than the proportion of respondents willing to perform traditional CPR with MTM ventilations |
| |
| High school coaches and club coaches | Post et al. [30] | high school coaches having greater levels of emergency preparedness for immediate medical care during practices and competitions than club sport coaches |
| |
| CCO-CPR, CPR and PAD training | Hawkes et al. [24] | having ever trained in CPR (CO-CPR and/or CPR) was the most important factor in the willingness of an individual to call EMS |
| |
| having ever trained in CPR (CO-CPR and/or CPR) was the most important factor in the willingness of an individual to perform CPR |
| |||
| training in defibrillator use ever were the most significant predictive factors for an individual’s willingness to go and get or use an AED |
| |||
| Length of time since last training | Lee et al. [26] | CPR training experience in the previous 2 years were associated with willingness to use AEDs |
| |
| Son et al. [33] | Interval of less than 6 months |
| ||
| AED training was included in CPR education |
| |||
| Hawkes et al. [24] | training in CPR in the past 5 years |
| ||
| training in AED in the past 5 years |
| |||
| Number of times trained | Son et al. [33] | group receiving CPR education on 4 or more occasions |
| |
| Attitude | Positive attitude | Pei-Chuan Huang et al. [29] | “belief that the public should learn how to use AEDs” were the independent factors associated with a higher willingness among bystanders to use AEDs |
|
| Perceived norms | Social pressure | Lee et al. [26] | perception of “awareness of how to use an AED” |
|
| Liaw et al. [27] | perception of “using AED is important for unresponsive victims” |
| ||
| perception of “AED practice drills should be performed on a regular basis” |
| |||
| Self-efficacy | Perceptions of their capacity to engage in the behaviour with a predictable result | Shams et al. [32] | confident in one’s ability to apply an AED, or perform CPR. |
|
| Son et al. [33] | confidence in performing CPR |
| ||
| Hawkes et al. [24] | having witnessed an arrest was associated with a greater likelihood to perform CPR and to use an AED |
| ||
| Liaw et al. [27] | increase the confidence to perform CPR, use AED, identify victims with no signs of life, and the willingness to perform CPR and AED without hesitancy |
| ||
| Legal obligation | Son et al. [33] | increased the respondent’s willingness to perform CPR in South Korea under Korean EMS laws |
| |
| Lee et al. [26] | increased the respondent’s willingness to use AEDs in South Korea under Korean EMS laws |
| ||
| Pei-Chuan Huang et al. [28] | increased the respondent’s willingness to perform CPR in Taiwan under limited Good Samaritan immunity |
| ||
[i] Notes: *High managerial, administrative, or professional; B: intermediate managerial, administrative, or professional; C1: supervisory, clerical, and junior managerial, administrative, or professional.
Table 5
Barriers analysed in each of the included studies.
| BARRIERS | STUDIES |
|---|---|
| Lack of knowledge | Cheskes et al. [22]; Shams et al. [32]; Lee et al. [26] |
| Fear of litigation/legal responsibilities | Cheskes et al. [22]; Pei-Chuan Huang et al. [28]; Lee et al. [26]; Pei-Chuan Huang et al. [29]; Qian et al. [34] |
| Lack of skill confidence | Cheskes et al. [22]; Pei-Chuan Huang et al. [29] |
| Fear of disease transmission | Shams et al. [32]; Liaw et al. [35]; Qian et al. [34] |
| Injuring victim due to performing CPR | Shams et al. [32]; Pei-Chuan Huang et al. [28]; Liaw et al. [35]; Qian et al. [34] |
| Injuring own self due to performing CPR | Liaw et al. [35] |
| Injuring victim due to using AED | Liaw et al. [35]; Lee et al. [26]; Pei-Chuan Huang et al. [29] |
| Not interested in AED | Lee et al. [26] |
| Injuring own self due to using AED | Liaw et al. [35] |
| Poor hygiene of victim | Shams et al. [32] |
| Presence of vomit or blood | Shams et al. [32] |
| Performing mouth-to-mouth artificial respiration | Qian et al. [34] |
| Concern that peoples around them will complain | Qian et al. [34] |
| Unwillingness to touch strangers | Qian et al. [34] |