Research Article: A mediation analysis of the effect of practical training on the relationship between demographic factors, and bystanders’ self-efficacy in CPR performance

Date Published: April 29, 2019

Publisher: Public Library of Science

Author(s): Wonjeong Yoon, Young Sun Ro, Sung-il Cho, Abraham Salinas-Miranda.


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.

Partial Text

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].

This study systematically unraveled the relationship of demographic characteristics and CPR practical training with self-efficacy in CPR performance using a mediation analysis. We discovered two things through the analysis: 1) CPR practical training acted as mediator in the pathway from particular demographic characteristics (e.g., gender, age, education level, occupation, and residential area) to self-efficacy in CPR performance, and 2) there was a difference in the magnitude of the mediation effect (e.g., non, partial, or complete) of CPR practical training depending on demographic characteristic.

Self-efficacy in CPR performance for educated bystanders is determined by the combined effect of their demographic characteristics and practical training experience. This finding suggests that the gradual and systematic educational strategy centered on high quality, individualized CPR practice for the adult population should be prioritized. Providing practice-based CPR training programs optimized for trainees’ demographic characteristics will improve the effectiveness of CPR training and will ultimately contribute to increasing bystander CPR and the survival rate of patients who undergo OHCA.




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