Background
Overall survival rate for out-of-hospital cardiac arrest rarely exceeds 5%. While bystander cardiopulmonary resuscitation (CPR) can increase survival for cardiac arrest victims up to four times, bystander CPR rates remain low in Canada (15%). Survivors have a quality of life similar to the general population. Most cardiac arrest victims are men in their sixties; they usually collapse in their own home (85%), where bystander CPR rates are even lower. The event is witnessed by a family member or bystander 50% of the time. These statistics appear to support a strategy of targeted CPR training for an older population that is most likely to witness a cardiac arrest event. Interest in CPR training appears to decrease with advancing age. When a group of elders were asked why they had not sought CPR training in the past, most mentioned the inconvenience of having to leave the house, bad health, or cost. Some respondents did not understand why they should perform CPR when they can call 9-1-1. Behaviour surrounding CPR training and performance has never been studied using the theoretical constructs of a well validated behavioural theory (the Theory of Planned Behaviour).

Objectives
The overall goal of this study is to conduct a survey to better understand the behavioural factors associated with successful CPR knowledge transfer in an independent-living older population (aged 55 or more). Specific objectives are: 1) to conduct semi-structured qualitative interviews to identify factors influencing CPR training and performance behaviours; 2) to develop a survey instrument about factors influencing CPR training and performance behaviours based on a systematic review of the literature, the results of the semi-structured interviews, and theoretical constructs; and 3) to conduct a telephone survey among an independent-living population aged 55 or more using the survey instrument, and to identify factors and strategies that might be targeted by KT interventions.

Methods
Objective 1: We will record semi-structured qualitative interviews conducted among 20 randomly selected participants aged 55 or older, and perform inductive analyses to identify categories and themes. Objective 2: The survey instrument will be developed based on a completed systematic review of the literature, and results from objective 1. The two behaviours under study will be "seeking CPR training and providing CPR to a cardiac arrest victim". The survey will be organized using the theoretical constructs of the theory of planned behaviour which measure: behavioural intentions, attitudes, subjective norms, and perceived behavioural control. Assessments for each of the four theoretical constructs will include direct and indirect belief-based measures; each measure will use a minimum of three items on a 5-point Likert scale. Our survey should measure a minimum of fifty items. Pilot testing on target community-dwelling seniors will ensure face validity and clarity of survey presentation, measure internal consistency of scale items, as well as content validity, and test-retest reliability. Objective 3: We will develop and conduct a nation-wide telephone survey using random digit dialing. The telephone survey will be centrally administered by the Institute for Social Research, York University, and stratified by province and large or small communities in order to obtain a representative random sample of the Canadian population. The study population will include all men and women aged 55 or older, living independently in the community, with the ability to communicate in English or French. We will seek to obtain a participation rate of 60% or greater. We estimate requiring approximately 500 respondents to identify factors and strategies for improving CPR Knowledge Translation in our target population. Analyses will include measures of sampling bias, reliability of the measures, construct validity, as well as multiple regression analyses to identify constructs and beliefs most salient to seniors' decisions about whether to attend CPR classes or perform CPR.

Relevance to the Objectives of the Resuscitation and Knowledge Transfer Initiative
The results of our survey will provide us with invaluable insight into factors influencing the interest in CPR training and performance among a targeted group of individuals most susceptible to witness a victim in cardiac arrest. We plan to apply our findings and evaluate their impact during randomized controlled trials of various interventions designed to promote attendance to CPR classes, and CPR performance.

OHRI members:

Dr. Christian Vaillancourt
Dr. Jeremy Grimshaw
Dr. Jamie Brehaut
Dr. Ian Stiell
Dr. George Wells
Manya Charette
Ann Kasaboski

Other members:

Dr. Martin Osmond, Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario