Reducing Racial Disparities in Bystander CPR: Psychological and Environmental Determinants of Hands-Only CPR Willingness in African American Communities

Racial disparities in out-of-hospital cardiac arrest (OHCA) survival remain a persistent public health equity concern in the United States. African Americans are less likely to receive bystander cardiopulmonary resuscitation (CPR) and experience lower survival to hospital discharge compared to White individuals. While structural inequities contribute to these disparities, less is known about modifiable psychological, informational, and environmental determinants of CPR willingness within community-based African American populations. This study examined predictors of Hands-Only CPR comfort and response confidence among participants in a culturally tailored cardiovascular health program. A cross-sectional analysis was conducted using survey data from 372 adults who completed a Hands-Only CPR educational module within the HeartSmarts Community Health Education Program; 64.5% identified as Black or African American. Binary logistic regression was used to assess predictors of comfort performing CPR on family members and strangers, and confidence in responding to sudden cardiac arrest. Perceived informational sufficiency emerged as the most consistent predictor across outcomes. Participants reporting sufficient information were significantly more likely to report comfort performing CPR on family members (OR = 5.36, p < .001) and strangers (OR = 6.79, p < .001). Uncertainty regarding CPR technique was a strong negative predictor across models. Absence of concerns, workplace defibrillator presence, and defibrillator training were also independently associated with greater willingness and response confidence. Findings highlight modifiable pathways linking perceived capability, environmental preparedness, and intervention readiness. Community-based, culturally responsive strategies that strengthen informational sufficiency and address fear-related barriers may reduce racial disparities in bystander CPR and improve OHCA survival equity.