Factors influencing willingness to perform cardiopulmonary resuscitation and use an automated external defibrillator: a convergent parallel mixed-methods study

Vollständiger Abstract

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Abstract Background This study applied the Theory of Planned Behavior (TPB) and the Intention-Focused Model for Bystander Cardiopulmonary Resuscitation (CPR) Performance to examine the associations between attitude, perceived norms, self-efficacy and intention to perform CPR and use an automated external defibrillator (AED); the mediating role of intention and the moderating roles of knowledge, training, and barriers concerning behavioral willingness; and stakeholder perspectives regarding factors influencing willingness to perform CPR and use an AED. Methods The present convergent parallel mixed-methods study collected quantitative and qualitative data concurrently, analyzed them independently, and integrated the data during interpretation to compare, contrast, and synthesize the findings. The quantitative strand was prioritized and involved 449 participants from a CPR program (2018–2020) who met the inclusion criteria. The quantitative data were collected using the Factors Influencing Community Willingness to Perform CPR and Use an AED (FIXED) questionnaire and analyzed using structural equation modeling (SEM). The qualitative strand involved 10 stakeholders (basic life support [BLS] instructors, healthcare staff, village community members, community leaders, nongovernmental organization [NGO] representatives) to explain and contextualize the quantitative results. The qualitative data were collected through semi-structured interviews and underwent deductive thematic analysis. Results Partial least squares-SEM demonstrated that self-efficacy was the strongest predictor of intention (effect size: large, β = 0.515, p < .001, f² = 0.353). Attitude was positively associated with intention despite its small effect (β = 0.206, p < .001, f² = 0.053). Perceived norms had a statistically significant but practically negligible association with intention (β = 0.094, p = .014, f² = 0.010). Intention significantly mediated the relationships between self-efficacy, attitude, perceived norms, and behavioral willingness, with self-efficacy having the strongest indirect effect. Knowledge, training, and barriers did not significantly moderate the intention and behavioral willingness relationship. Qualitative findings identified psychological factors, skill-related factors, and contextual constraints influenced behavioral willingness. Conclusions Self-efficacy was the strongest factor associated with intention to perform CPR and use an AED, whereas attitude and perceived norms contributed to a lesser extent. The findings highlighted the importance of confidence-building strategies in CPR and AED education programs and supported theory-informed interventions to strengthen intention and behavioral willingness to respond to out-of-hospital cardiac arrest.