Zhong Zhikang, Li Weiwei, Zhou Lin, Liu Liang
Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
Department of Geriatrics, People's Hospital of Wuhan University, Wuhan, Hubei, China.
PLoS One. 2025 Jul 23;20(7):e0327439. doi: 10.1371/journal.pone.0327439. eCollection 2025.
This study investigated the underlying causes for the current low rate of cardiopulmonary resuscitation (CPR) implementation among lay rescuers. Specifically, the study aimed to identify the factors that influence both the intention to perform CPR and the subsequent translation of this intention into actual behavior. The ultimate goal was to propose strategies to significantly enhance the rate of bystander CPR.
A qualitative study employing purposive sampling was undertaken, with semi-structured interviews conducted between January 1, 2022, and May 20, 2022. The collected data were analyzed thematically using Nvivo software.
A total of 29 lay rescuers participated in this study, and 11 thematic categories were identified across the four constructs of the Theory of Planned Behavior (TPB). Within the domain of attitudes, two primary themes emerged, each comprising two subthemes: (1) Emotional resistance to the death event and (2) recognition of the potential benefits of rescue, including the prospect of external rewards and the realization of intrinsic self-worth. For perceived norms, three themes were identified: (1) The bystander effect, (2) the encouraging influence of peers, and (3) personal motivation arising from one's career. With respect to perceived behavioral control (PBC), three themes and two subthemes emerged: (1) Consideration of potential consequences, encompassing concerns about legal disputes and the fear of disease transmission; (2) the dual impact of public opinion pressure; (3) low self-efficacy. Finally, in relation to actual control, three themes and two subthemes were demonstrated: (1) Acquisition of CPR skills; (2) the influence of situational factors at the scene, including both supportive elements such as public facilities or procedures and obstructive factors, such as a diminished sense of responsibility at specific locations; (3) the impact of the patient's condition.
This study extends the TPB in the context of bystander CPR interventions by (1) integrating both emotional (death anxiety) and cognitive dimensions of attitude formation under stress, (2) reconceptualizing PBC as context-dependent, influenced by legal risks and automated external defibrillator (AED) accessibility, and (3) addressing the tension between the bystander effect and moral obligation through normative adjustments. To improve intervention rates, it is crucial to target emotional barriers (virtual reality (VR)-based anxiety reduction) and address systemic constraints (AED availability and simplified Good Samaritan laws) while leveraging artificial intelligence tools to reinforce positive norms. Future work is encouraged to validate the model's cross-cultural applicability and assess interventions such as community AED programs and VR training aimed at bridging the gap between bystander hesitation and timely CPR delivery.
本研究调查了当前普通施救者实施心肺复苏术（CPR）比例较低的潜在原因。具体而言，该研究旨在确定影响实施心肺复苏意愿以及随后将该意愿转化为实际行为的因素。最终目标是提出策略以显著提高旁观者实施心肺复苏的比例。
采用立意抽样进行定性研究，于2022年1月1日至2022年5月20日进行半结构化访谈。使用Nvivo软件对收集的数据进行主题分析。
共有29名普通施救者参与本研究，在计划行为理论（TPB）的四个结构中识别出11个主题类别。在态度领域，出现了两个主要主题，每个主题包含两个子主题：（1）对死亡事件的情感抗拒；（2）认识到救援的潜在益处，包括外部奖励的前景和内在自我价值的实现。对于感知规范，确定了三个主题：（1）旁观者效应；（2）同伴的鼓励影响；（3）个人职业产生的动机。关于感知行为控制（PBC），出现了三个主题和两个子主题：（1）对潜在后果的考虑，包括对法律纠纷的担忧和对疾病传播的恐惧；（2）舆论压力的双重影响；（3）自我效能感低。最后，关于实际控制，展示了三个主题和两个子主题：（1）心肺复苏技能的掌握；（2）现场情境因素的影响，包括公共设施或程序等支持性因素以及特定地点责任感降低等阻碍性因素；（3）患者病情的影响。
本研究通过以下方式在旁观者心肺复苏干预背景下扩展了计划行为理论：（1）将压力下态度形成的情感（死亡焦虑）和认知维度整合在一起；（2）将感知行为控制重新概念化为依赖情境，受法律风险和自动体外除颤器（AED）可及性影响；（3）通过规范调整解决旁观者效应与道德义务之间的矛盾。为提高干预率，关键是针对情感障碍（基于虚拟现实（VR）减轻焦虑）并解决系统限制（AED可用性和简化的《好撒玛利亚人法》），同时利用人工智能工具强化积极规范。鼓励未来的工作验证该模型的跨文化适用性，并评估诸如社区AED项目和VR培训等旨在弥合旁观者犹豫与及时实施心肺复苏之间差距的干预措施。
