Knowledge of and Attitudes Toward Bystander CPR Among Thais in Auckland
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Introduction: Bystander cardiopulmonary resuscitation (CPR) is a key factor in improving survival from out-of-hospital cardiac arrest. Yet many studies show that minority ethnicities exhibit lower rates of bystander CPR compared to majority groups because of language socioeconomic, and cultural barriers. Thai are one such distinct minority ethnic group within New Zealand, due to increasing immigration from Thailand, particularly into Auckland city. A study in Thailand showed a lower rate of bystander CPR compared to New Zealand; the bystander CPR rate among Thais in Auckland is unknown. This study aims to examine the knowledge of and attitudes toward bystander CPR among Thais in Auckland, to understand the barriers and facilitators to performing bystander CPR within this population, and to uncover ways of increasing the rate of bystander CPR among minority ethnic groups. Method: The paradigm of pragmatism underpinned this research project. A questionnaire collected both qualitative and quantitative data: this was a mixed-methods study. The questionnaire was deployed in identical paper-based and online forms. It included both closed and open-ended questions, to collect quantitative and qualitative data respectively. The two types of data were analysed separately, then integrated where possible. Frequency, percentage and logistic regression were applied to the quantitative data; content analysis was utilised to condense the qualitative data into themes. Integration of the two types of data informed the interpretation process. Results: There were 110 respondents to the questionnaire from Thais who lived in Auckland. Twenty-seven percent had previous CPR training, but most of these had only trained once and more than five years ago. The major reasons that prevented Thais in Auckland from attending CPR training courses were that they did not know how to join and did not have time. The CPR trained participants had limited recall of CPR knowledge. Lack of CPR knowledge, low confidence, and fear of doing further harm to a victim were the major barriers to performing bystander CPR. Even though our participants were concerned about those barriers, Thais in Auckland exhibited a high willingness (nearly 80 percent) to perform CPR. This willingness was grounded in the notion of ‘helping’ – a key value in both Thai cultural and Buddhist teaching. Conclusions: In order to overcome poor CPR knowledge and to increase confidence, CPR training and refresher courses should be more accessible, especially for minority ethnic groups. They could be shortened, and knowledge made easier to retain if hands-only CPR was taught. CPR training in schools should be encouraged. Our study showed that cultural and religious values among Thais in Auckland over-rode their lack of knowledge, low confidence and fears, motivating their willingness to intervene and provide bystander CPR. Such values should be utilised in CPR training courses; training should be done in culturally appropriate ways. Concepts such as ‘helping’ could be used to support and encourage bystander CPR and training among Thais in Auckland. Training could take place at Thai Buddhist temples, with the support of the Abbot. The deep-rooted cultural values that underpin attitudes towards bystanders intervening to provide CPR are deserving of future investigation, in all ethnicities within the New Zealand population.