Public Participation Willingness in Out-Of-Hospital Cardiopulmonary Resuscitation: A Meta-Synthesis of Qualitative Research

Background Out-of-Hospital Cardiac Arrest (OHCA) is a significant global public health concern, with survival rates ranging from 2% to 11%. Bystander Cardiopulmonary Resuscitation (CPR) is crucial for improving survival rates. However, public willingness to perform CPR varies widely because of many determinants. This study aims to systematically synthesize qualitative evidence on the determinants of public participation in Out-of-Hospital Cardiopulmonary Resuscitation (OHCPR). It provides insights for enhancing public engagement in emergency response. Methods Following the Joanna Briggs Institute (JBI) methodology for qualitative systematic reviews, a comprehensive search was conducted across six electronic databases (PubMed, Web of Science, Embase, CINAHL, ProQuest, and The Cochrane Library) for studies published up to February 2025. Data extraction and thematic analysis were conducted to identify themes and sub-themes. This study is registered with PROSPERO (CRD42024593820). Results The analysis identified 10 categories and synthesized into 3 themes: (1) The Situational Web, which includes patient characteristics and need for assistance; (2) Knowledge, skills and training, highlighting the impact of first aid knowledge and training on willingness to act; and (3) Inner Self, focusing on intrinsic drive and·psychological distress. These themes collectively shape public decision-making in emergency situations. Conclusions Public participation in OHCPR is determined by a complex interplay of the situational web, knowledge, skills and training, and inner self. Enhancing public training programs, providing clear guidance, and addressing psychological barriers are crucial for improving the willingness of bystander intervention. Future research should focus on optimizing training effectiveness and addressing cultural and regional differences to further enhance public participation in CPR.