Realist synthesis identifies approaches to CPR training access in underserved communities

Lay responders can improve outcomes after out-of-hospital cardiac arrest by calling emergency services, performing CPR and using a defibrillator. In parts of England, higher OHCA incidence and lower rates of lay-responder CPR occur in socioeconomically disadvantaged and ethnically diverse areas. Researchers conducted a realist evidence synthesis and incorporated primary data from four workshops with South Asian and Black African and Caribbean communities to develop an initial programme theory for engaging these groups in CPR training.

The resulting theory comprises eight context-mechanism-outcome configurations covering three stages: building access and overcoming mistrust of perceived outsiders or establishment figures; addressing practical barriers to attendance; and creating an engaging training environment that supports active learning. Trusting, collaborative relationships with influential community voices were identified as a thread across all stages. The synthesis also suggests using culturally informed two-way discussion, opportunities to rehearse responses to barriers to acting, and practical skills training informed by behaviour change techniques.

The findings offer a framework for developing and evaluating future training interventions, rather than evidence that a particular approach improves CPR rates or survival. The authors describe the theory as initial; its proposed mechanisms and outcomes require testing in implementation and evaluation.