Background: Bystander cardiopulmonary resuscitation (CPR) and using an automated external defibrillator (AED) can improve out-of-hospital cardiac arrest survival. However, bystander CPR and AED rates remained consistently low. The goal of this systematic review was to assess factors influencing community willingness to perform CPR and use an AED for out-of-hospital cardiac arrest survival (OHCA) victims, as well as its barriers. Methods: The review processes (PROSPERO: CRD42021257851) were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) review protocol; formulation of review questions; systematic search strategy based on identification, screening, and eligibility using established databases including Scopus, Web of Science, and Medline Complete via EBSCOhost; quality appraisal; and data extraction and analysis. There is identification of full-text journal articles that were published between 2016 and 2021 and written in English. Results: Of the final 13 articles, there are six identified factors associated with willingness to perform CPR and use an AED, including socio-demographics, training, attitudes, perceived norms, self-efficacy, and legal obligation. Younger age, men, higher level of education, employed, married, having trained in CPR and AED in the previous 5 years, having received CPR education on four or more occasions, having a positive attitude and perception toward CPR and AED, having confidence to perform CPR and to apply an AED, and legal liability protection under emergency medical service law were reasons why one would be more likely to indicate a willingness to perform CPR and use an AED. The most reported barriers were fear of litigation and injuring a victim. Conclusions: There is a need to empower all the contributing factors and reduce the barrier by emphasizing the importance of CPR and AEDs. The role played by all stakeholders should be strengthened to ensure the success of intervention programs, and indirectly, that can reduce morbidity and mortality among the community from OHCA.

Out-of-hospital cardiac arrest (OHCA) remains a leading cause of sudden cardiac death globally. Early bystander intervention using CPR and an AED significantly improves survival outcomes. This study aimed to assess willingness to perform CPR and use an AED among non-healthcare community participants in a CPR fun run, and to identify influencing factors. A cross-sectional study was conducted in Melaka, Malaysia, between November 2021 and October 2022, involving 217 randomly selected participants who had previously taken part in the Melaka CPR Fun Run from 2018 to 2020. Data were collected using the validated FIXED questionnaire, covering sociodemographic, knowledge of CPR and AED, training status, perceptions regarding CPR and the use of an AED, attitudes, self-efficacy, subjective norms, and barriers. The mean willingness score to perform CPR and use an AED was 33.14 ± 7.87 out of 40. Only three factors remained significantly associated with willingness: self-efficacy (β = 0.950, p < 0.001), perception (β = 0.569, p < 0.001), and barriers (β = −0.403, p < 0.001). Notably, for the subgroup analysis showed that participants who attended more CPR training sessions had better perception (r = 0.155, p = 0.022) and self-efficacy (r = 0.246, p < 0.001. Participants demonstrated a high willingness to perform CPR and use an AED. Willingness was significantly influenced by self-efficacy, perception, and perceived barriers. Although CPR training did not directly affect willingness, it showed a weak but significant correlation with improved perception and self-efficacy. These findings highlight the need for interventions that enhance psychological readiness, beyond just increasing training frequency, to strengthen community response in out-of-hospital cardiac arrest situations.

Limited factors influence community willingness to perform cardiopulmonary resuscitation and use an automated external defibrillator, making it difficult to take preventive and control measures to improve the survival of patients with out-of-hospital cardiac arrest. In this study, we translated and evaluated the Malay-language version of the cardiopulmonary resuscitation and an automated external defibrillator questionnaire. The translation and evaluation involved three phases: development, translation and cultural adaptation, and validation. Content validity was assessed by five experts, and demonstrated a content validity index of 0.98 and a Fleiss kappa index of 0.159. Construct validity for the multi-item scale performed using factor analysis and involving 100 participants was 0.777. Factor analysis using the varimax rotation method demonstrated the appropriateness of the data in the exploratory factor analysis. Cronbach’s alpha was 0.849, suggesting high reliability. Test–retest reliability involving 45 participants calculated using the intraclass correlation coefficient had a value of 0.723. The findings demonstrate that the Malay-version FIXED questionnaire is a valid and reliable instrument and is ready to be used by health care workers and policymakers to evaluate the factors influencing the community’s willingness to perform cardiopulmonary resuscitation and use an automated external defibrillator.

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.

OBJECTIVE: End-of-life care (EOLC) in the emergency department (ED) is a growing global necessity. This study aimed to assess the level of knowledge and attitudes toward EOLC among ED healthcare workers. METHODS: A prospective and cross-sectional study was conducted involving 155 healthcare workers at a tertiary ED. The Palliative Care Knowledge Tool (PCKT) and the Frommelt Attitude toward Care of the Dying (FATCOD) Scale were adapted, translated into Malay, and validated for use. Participants completed validated, self-administered questionnaires assessing knowledge using FATCOD the PCKT and attitudes toward EOLC using the FATCOD Scale. The primary outcomes were the healthcare workers’ knowledge and attitudes, with secondary analysis exploring associated factors. RESULTS: The overall level of knowledge on EOLC among healthcare workers was poor with a mean score of 8.54 (±2.97) out of 17. Despite this, attitudes toward EOLC were positive with a mean score of 92.61 (±8.80) out of 120. A weak positive correlation was found between knowledge and attitudes ( r = 0.186, n = 155, P = 0.020 ) . The factors such as education level, work experience, and profession were significantly associated with variations in knowledge and attitudes. CONCLUSION: This study revealed that despite poor knowledge of EOLC among healthcare workers in the ED, their attitudes toward managing dying patients were positive. The weak correlation between knowledge and attitudes suggests a modest link between these domains.