Protocol for a systematic review to identify the barriers and facilitators to deliver bystander cardiopulmonary resuscitation (CPR) in disadvantaged communities

Background: A key determinant of survival after out-of-hospital cardiac arrest (OHCA) is bystander CPR (cardio pulmonary resuscitation) which can create a seven fold increase in survival. The experience of other national OHCA survival programmes has shown that increasing bystander CPR improves overall survival. However, existing data suggests that the more economically deprived an area is, the higher the rate of cardiac arrest and, crucially, rates of bystander CPR are lower, meaning lower survival rates.(3,4). Despite high profile awareness raising campaigns, they are generic in focus and do not specifically target people living deprived communities who may require more tailored campaigns and interventions to change attitudes towards, and improve confidence to administer, bystander CPR. This systematic review will inform a research study that seeks to develop a tailored and targeted strategy to improve the rate of bystander CPR in deprived communities. Its primary purpose is to explore the facilitators and barriers in deprived communities to deliver bystander CPR. The secondary objective is to map existing bystander OHCA social marketing and social network intervention campaigns that could inform future activities to improve the rate of bystander CPR in deprived communities.

Methods: Systematic review searching the following databases: CINAHL, MEDLINE,
PsycINFO, Web of Science Core Collection Citation Indexes. Unpublished ‘grey’ literature will also be sourced through web searches, stakeholder interviews (from the wider study), and the advisory group. The reference lists of any relevant reviews will also be checked for additional studies. References will be restricted to those published in 2000 onwards. Authors will independently screen, assess data quality and extract data for synthesis. A narrative synthesis of study findings will be conducted, with findings presented thematically.

Discussion: This review will focus on all studies that seek to examine the barriers and facilitators to the delivery of bystander CPR in deprived communities and identify examples of previous interventions or activities that could inform the design of a future theory-based intervention to improve the rate of bystander CPR in deprived communities.