Discussion
Younger adults were shown to have a lower willingness to perform CPR, which was comparable with a previous local study.9 It was suggested that one’s life experience in adulthood might boost their sense of social responsibility and self-efficacy, becoming more willing to perform resuscitation. Higher monthly income was associated with a higher willingness to use AED, which could be attributed to higher awareness of technology and social awareness.10
Knowledge was not a significant predictor of either willingness to perform CPR or use an AED, although knowledge is crucial for one to perform CPR and use an AED correctly. A previous study revealed that only 29% of participants who had just completed the BLS training were willing to offer CPR, suggesting that knowing how to perform CPR does not necessarily translate into willingness.7 Promotors of BLS should be alert to this potential ‘know-do’ gap of performing CPR and using an AED among the general public and address the determinants of intention through behavioural framework during the training.
All three TPB determinants were associated with willingness to perform CPR and use an AED. A positive attitude believing in the desired outcomes of performing BLS and an obligation to save others’ lives would favour the behaviour.8 Subjective norms refer to one’s perceived expectations from their significant others and the community.8 If society had a high expectation of one to perform CPR and use an AED, the individual would have a higher willingness to do so.11 Perceived behavioural control is the perceived ease or difficulty of performing a behaviour.8 People who have higher perceived behavioural control towards CPR and AED, not limited to their actual capability but also prompts and support from the surroundings, would be more willing to perform BLS.
A recent scientific statement from the AHA advocated an ‘intention-focused model for bystanders’ to boost the bystander CPR rate, which incorporated the TPB into the framework.12 This echoed our study and guided BLS promoters to enhance public willingness to perform bystander BLS using an intention-based approach by addressing the TPB determinants. Moreover, an earlier study summarised five themes for laypersons to participate in resuscitation to an OHCA, including ‘have competence’, ‘have courage’, ‘feel exposed’, ‘feel an obligation’ and ‘sense of humanity’.13 These indeed complement the TPB determinants, providing more concrete objectives to address laypersons’ needs during resuscitation attempts, as illustrated in figure 2.
Figure 2TPB determinants and themes for laypersons to an OHCA response.13 Attitude (red), subjective norms (green) and perceived behavioural control (blue) are the TPB determinants presented at the centre. The themes for laypersons to an OHCA response were presented at the outer ring using the corresponding colours of the TPB determinants, which create vivid objectives to promote BLS in the community. BLS, basic life support; OHCA, out-of-hospital cardiac arrest; TPB, theory of planned behaviour.
Other than BLS training, there were numerous strategies to enhance the public willingness to perform CPR and use an AED in an OHCA crisis. For instance, the local postdispatch advice system was updated to include OHCA to guide bystanders performing CPR and using an AED by standard scripts,14 which could boost the perceived behavioural control towards CPR and AED use. A Korean study has revealed that among those OHCA victims who received bystander CPR, 79.0% of the bystanders were prompted by the dispatcher’s advice.15
The enactment of the Good Samaritan Law could promote bystander resuscitation by addressing subjective norms and reinforcing the culture of helping others in the community. It is in force around the globe, including China, the UK, Ireland and the USA, yet, not in HK.16 Indeed, a local study revealed that laymen showed support for the enactment of the law as it addresses their need to be protected from legal liability, which was recognised as a significant barrier for them in OHCA resuscitation.9 17 18
Innovative solutions have been developed to facilitate resuscitation in OHCA. For example, a mobile application alerting surrounding users of crises nearby was available.19 In Singapore, taxi and private drivers were equipped with first aid training and put AEDs on their vehicles under the ‘AED-on-Wheels’ programme.20 The application will alert nearby drivers to potential OHCA, bringing the AED and recruiting trained lay rescuers to the scene. In HK, even though there are more publicly available AEDs, innovative ideas to help laymen actively search for an AED and perform resuscitation are still wanted.
There were several limitations in this study. First, convenience sampling could result in a biased sample and limited representativeness of the HK community. An overestimated willingness to perform BLS was probable as a higher proportion of healthcare professionals and those who have previously trained with bystander resuscitation were sampled. Second, the online survey was limited to those who have internet access, which could neglect those from lower socio-economic status. Third, around 200 responses had substantial missing data, with willingness unanswered, which were excluded from the analysis. These may represent a group of respondents who were less interested in this topic or failed to complete the questionnaires as they were unfamiliar with online survey technologies. Lastly, our study analysed willingness to undertake CPR and AED use collectively. However, different components of bystander resuscitation may be associated with variations in psychological constructs, which were not addressed in our current analysis and warranted further investigation.
