Theory of planned behaviour determinants mediate association between time since last training and resuscitation intention in Chinese lay-rescuers: a cross-sectional survey

Abstract Bystander cardiopulmonary resuscitation (CPR) and automated external defibrillation (AED) rates remain low in out-of-hospital cardiac arrest (OHCA) crises in Hong Kong. Despite the Theory of Planned Behaviour (TPB) based ‘Intention-focused’ training approach being advocated to boost lay-rescuers’ willingness to perform Basic Life Support (BLS), local refresher courses still focus on revisiting resuscitation knowledge and skills. Few studies have explored the underlying mechanisms by which refresher training boosts resuscitation willingness. This article aimed to investigate the association between time since last training and BLS intention, and the potential mediating role of knowledge and the three TPB determinants, namely, attitude, subjective norms (SN), and perceived behavioural control (PBC). A cross-sectional online survey of 678 non-healthcare adult lay-rescuers was conducted in 2022 using snowball sampling. Participants were categorised by years since last training: trained within 1 year (n = 289), 1–2 years (n = 141), 3–5 years (n = 129), and > 5 years (n = 119). The Intention to Deliver BLS scale was used. Mediation analysis was conducted using SPSS PROCESS Macro (Model 81). Controlling for demographics, years since the last training were negatively associated with knowledge (B = − 0.54, P < 0.001), attitude (B = − 0.07, P = 0.001), SN (B = − 0.14, P < 0.001) and PBC (B = − 0.24, P < 0.001). Higher BLS intentions were associated with attitude (B = 0.36; P < 0.001), SN (B = 0.24; P < 0.001), and PBC (B = 0.45; P < 0.001), but not knowledge (B = 0.02, P = 0.328). Mediation analysis revealed significant indirect effects of years since last training on BLS intention via attitude (B = − 0.02, 95%CI − 0.04 to − 0.01), SN (B = − 0.04, 95% CI − 0.06 to − 0.02), and PBC (B = − 0.11, 95% CI − 0.15 to − 0.08). Knowledge alone was not a significant mediator (B = − 0.01, 95% CI − 0.04 to 0.01), but the three serial mediation paths through knowledge and the TPB determinants were significant (B ranged from − 0.01 to − 0.03). The direct effect was insignificant (B = − 0.02, P = 0.502). Resuscitation intention was negatively associated with time since the last training through TPB determinants, but not knowledge. Comprehensive reviews of the current knowledge- and skill-focused refresher strategy are warranted. Future research should focus on developing culturally-adapted ‘Intention-focused’ refresher pedagogies that address these psychobehavioural factors.