Barriers and facilitators to delivering bystander cardiopulmonary resuscitation in deprived communities: a systematic review

Abstract

Background: There is a higher incidence of cardiac arrest in economically deprived areas; however, data show that bystander cardiopulmonary resuscitation (CPR) in those areas is lower. This results in lower survival rates, placing those communities at a double disadvantage. This systematic review explored the barriers and facilitators to engaging with bystander CPR in deprived communities. Methods: Studies were eligible for inclusion if they addressed any barrier or facilitator to performing bystander CPR or being trained in CPR or training others. Studies had to either be set in a deprived area or examine a deprived population. Selected studies were published between January 2000 and December 2017 and reported on primary research. No language limitations were applied. Searches were conducted in the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsycINFO, PubMed, and Web of Science Core Collection. Unpublished ‘grey’ literature was also searched as well as the reference lists of any relevant studies. Results: The systematic review highlighted several main factors acting as barriers or facilitators to engaging with bystander CPR in deprived communities: (1) the willingness to learn or perform CPR, (2) the confidence to perform CPR, and (3) self-reported likelihood of performing CPR. The review also revealed additional barriers to engaging with CPR which are specific to – or more acute for – individuals from socioeconomically deprived backgrounds or areas. Discussion: We found little evidence suggesting that the willingness to perform or learn bystander CPR is lower in deprived communities compared to the general population. However, the confidence to perform CPR in deprived communities was affected by some measures of socioeconomic status. The results also crucially highlighted other barriers more acute in deprived communities: the risk to personal safety in administering CPR; the fear of legal consequences; and the lack of community cohesion and other cultural barriers.

Relationship of Public Interest in Cardiopulmonary Resuscitation with Cardiac Arrest Epidemiology and National Socioeconomic Indicators: Exploratory Infodemiology Study

“…6 Alongside the RSV associations, the study revealed the positive correlation of bystander CPR rate with country's population growth, birth rate, and the percentage of individuals using the Internet and the negative correlation of bystander CPR with population death rate, mortality from road traffic injuries, poverty, and unemployment rates. This is in line with previous research showing that socioeconomically-advantaged communities have higher engagement of bystanders in response to OHCA 12,13 that for instance could be related with better availability of public CPR education 14 or implementation of other system-level interventions known to be effective in improving bystander CPR rates (eg, dispatch-assisted CPR programs).…”

Public attitudes towards bystander CPR and their association with social deprivation: Findings from a cross sectional study in North England

“…[13][14][15] This gives rise to questions regarding the reliability of participants subjective responses as to how they may act, versus how they do act when faced with a real OHCA event. However, the findings support more recent evidence; a review of BCPR in deprived communities identified that willingness to perform or learn BCPR was not influenced by deprivation, 29 rather a range of contextual and environ-mental factors determined administration of BCPR. 30 Factors other than individual SES are likely to contribute to lower levels of BCPR in deprived communities, such as cultural identity and social cohesion.…”

Socio-Economic Status Has a Limited Association with Knowledge and Attitudes Towards Bystander Cardiopulmonary Resuscitation: A Cross-Sectional Study in North England

“…These findings were unexpected given the previously identified association between BCPR rates and social deprivation in the region 5,17 , and evidence that individuals experiencing OHCA are less likely to receive BCPR in deprived areas. [14][15][16] However, the findings support more recent evidence; a review of BCPR in deprived communities identified that willingness to perform or learn BCPR was not influenced by deprivation 28 , rather a range of contextual and environmental factors determined administration of BCPR. 29 Factors other than individual SES are likely to contribute to lower levels of BCPR in deprived communities, such as cultural identity and social cohesion.…”

“…Categories of employment status derived from the UK Household Longitudinal Study 25 ; categories of household income from the Government Statistical Service 26 and occupation classifications from the Office of National Statistics. 28 Patient/public involvement helped develop relevant questions and piloted the survey instrument to ensure face validity, appropriateness and brevity. Feedback was incorporated into the final version of the survey instrument.…”