Examining training and attitudes to basic life support in multi-ethnic communities residing in New South Wales, Australia: A mixed-methods investigation

Sonali Munot*, Emily J. Rugel, Janet Bray, Julie Redfern, Guoyan Yang, Linh Ngo, Adrian Bauman, Quan Minh Dang, Zoe Rock, Simone Marschner, Andrew Coggins, Christopher Semsarian, Paul M. Middleton, Garry Jennings, Blake Angell, Saurabh Kumar, Pramesh Kovoor, Clara K. Chow

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

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Bystander response, including cardiopulmonary resuscitation (CPR), is critical to out-of-hospital cardiac arrest (OHCA) survival. Nearly 30% of Australian residents were born overseas, and little is known about their preparedness to perform CPR. In this mixed-methods study, we examined rates of training and willingness and barriers to performing CPR among immigrants in Australia. 


First, we surveyed residents in New South Wales, Australia, using purposeful sampling to enrich immigrant populations. Multivariate logistic regression was used to examine the association between place of birth and willingness to perform CPR. Next, we conducted focus-group discussions with members of the region's largest migrant groups to explore barriers and relevant societal or cultural factors. 


Of the 1267 survey participants (average age 49.6 years, 52% female), 60% were born outside Australia, most in Asia and 73% had lived in Australia for more than 10 years. Higher rates of previous CPR training were reported among Australian-born participants compared with South Asian-born and East Asian-born (77%, 35%, 48%, respectively, p <0.001). In adjusted models, the odds of willingness to perform CPR on a stranger were significantly lower among migrants than Australian-born (adjusted OR: 0.64; 95% CI 0.49 to 0.83); however, this association was mediated by history of training. Themes emerging from the focus-group discussions included concerns about causing harm, fear of liability, and birthplace-specific social and cultural barriers. 


Targeted awareness and training interventions, which address common and culture-specific barriers to response and improved access to training, may improve confidence and willingness to respond to OHCA in multi-ethnic communities.

Original languageEnglish
Article numbere073481
Pages (from-to)1-13
Number of pages13
JournalBMJ Open
Issue number7
Publication statusPublished - 25 Jul 2023
Externally publishedYes


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