A mediation analysis of the effect of practical training on the relationship between demographic factors, and bystanders' self-efficacy in CPR performance.

Wonjeong Yoon,Young Sun Ro,Sung-Il Cho,Abraham Salinas-Miranda

doi:10.1371/journal.pone.0215432

Wonjeong Yoon, Young Sun Ro + Show 2 more

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https://doi.org/10.1371/journal.pone.0215432

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Abstract

This study examined the mediation effect of practical training on the relationship of demographic characteristics with bystander self-efficacy in cardiopulmonary resuscitation (CPR) performance. We used nationwide, cross-sectional data from the Korea Community Health Survey and analyzed 25,082 Korean adults who participated in CPR training within the last 2 years. A mediation model was applied to explore the pathway from demographic characteristics via CPR practical training to self-efficacy in CPR performance. A multiple logistic regression analysis was performed to examine each path in the mediation model. Of the 25,082 respondents recently trained, 19,168 (76.8%) practiced on a manikin. In the unadjusted CPR practical training model, the demographic characteristics associated with high self-efficacy in CPR performance were male gender (odds ratio [OR] = 2.54); 50s age group (OR = 1.30); college or more (OR = 1.39) and high school education (OR = 1.32); white collar (OR = 1.24) and soldier (OR = 2.98) occupational statuses. The characteristics associated with low self-efficacy were 30s age group (OR = 0.69) and capital (OR = 0.79) and metropolitan (OR = 0.84) areas of residence (p < 0.05). In the adjusted CPR practical training model, the significance of the relationship between demographics and self-efficacy in CPR performance decreased in male gender, 30s age group, college or more and high school education, and soldier occupational status (i.e., partial mediation), and disappeared in metropolitan residents (i.e., complete mediation). The degree of the mediating effect of CPR practical training on self-efficacy differed for each demographic characteristic. Thus, individualized educational strategies considering recipient demographics are needed for effective practice-based CPR training and improving bystander CPR performance.

Highlights

Cardiopulmonary resuscitation (CPR) is a fundamental technique of basic life support and its training for the general public is emphasized by the American Heart Association guidelines [1]
The demographic characteristics associated with selfefficacy in CPR performance were gender, age, education level, and occupation (p < 0.001)
CPR practical training using manikins was related to self-efficacy in CPR performance (p < 0.001)

Summary

Introduction

Cardiopulmonary resuscitation (CPR) is a fundamental technique of basic life support and its training for the general public is emphasized by the American Heart Association guidelines [1]. CPR training is being deployed in the form of national initiatives (e.g., registration program, school curriculum, and driver’s license) in many countries, including Denmark, Sweden, Japan, and Germany, which is expected to improve bystander CPR performance and increase the survival rates from out-of-hospital cardiac arrest (OHCA) [2, 3]. Self-efficacy, a belief in one’s ability to perform CPR, is one of the indicators for evaluating the effectiveness of CPR training on actual performance [4,5,6,7]. Despite the apparent effectiveness of practice-based training in cultivating self-efficacy to perform CPR in a real situation, lecture-based, mass CPR courses without the hands-on practice remain in Korea. Understanding the tendency for participation in CPR practice-based training on a demographic basis would be expected to increase the bystander CPR scale

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