I don't want to put myself in harm's way trying to help somebody: Public knowledge and attitudes towards bystander CPR in North East England - findings from a qualitative interview study

Background: Bystander cardiopulmonary resuscitation (BCPR), and public access defibrillator (PAD) use are essential links in the 'Chain of Survival' for out of hospital cardiac arrest (OHCA). In England, BCPR is delivered in only 40% of cases and population-level studies suggest this may be because of lower socio-economic status (SES). There is little qualitative evidence exploring BCPR and SES in Northern England. The aim of this study was to explore the perceptions and willingness of members of the public to deliver BCPR and use a PAD in communities of varying SES across Northern England.Methods: In-depth interviews between September 2021-January 2022 with 20 participants. Interviews were transcribed verbatim and analysed using reflexive thematic analysis.Findings: Perceptions and attitudes towards BCPR were underpinned by multiple, intersecting factors, contextualised by the individual's unique societal position. A poor understanding of BCPR and very limited knowledge of PAD use was identified, precipitated by language and education marginalisation. Willingness and confidence to attempt BCPR was driven by a sense of social cohesion. Barriers to delivering BCPR initiatives centred upon difficulties with engagement in all communities, particularly closed communities and those not in employment.Conclusions: Willingness and ability to deliver BCPR lie beyond SES alone. Future initiatives to improve rates of BCPR should take an intersectional, place-based approach, and be co-developed in conjunction with local com-munities and delivered in a format that people find convenient. Further research is required to understand how targeted initiatives should be delivered and how these result in improved outcomes from OHCA.