Keep The Safety Net Intact Through Refresher: Resuscitation Intention In Chinese Lay- Rescuers Decreases With Time Via Mediation Of Theory Of Planned Behaviours Determinants But Not Knowledge—A Cross-Sectional Survey

Abstract Background: Out-of-hospital cardiac arrest (OHCA) threatens thousands of lives each year inHong Kong (HK). While early cardiopulmonary resuscitation (CPR) and automated external defibrillation (AED) are essential to improve OHCA survival, local bystander resuscitation attempt rates were low. To encourage bystander resuscitation and establish a safety net in the community to save lives, the ‘Intention-focused’ training approach based on the Theory of Planned Behaviour (TPB) is advocated, aiming to boost lay-rescuers' willingness to perform Basic Life Support (BLS) by addressing attitude, subjective norms, and perceived behavioural control (PBC). However, refresher courses in Hong Kong still focus on revisiting resuscitation knowledge and skills. This article aimed to investigate the association between time since last training and BLS intention, and the potential mediating role of knowledge and Theory of Planned Behaviour (TPB) determinants. Methods: A cross-sectional online survey of 678 non-healthcare adult lay-rescuerswas 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. Results: Years since the last training were negatively associated with attitude (B=-0.10; P<.001), subjective norms (B=-0.18; P<.001), and PBC (B=-0.31; P<.001). Higher attitude (B=0.36; P<.001), subjective norms (B=0.24; P<.001), and PBC (B=0.45; P<.001) scores were associated with higher BLS intention. Knowledge was negatively associated with time since last training (B=-0.54; P<.001), but not significantly associated with BLS intention (B=0.02; P=.33). Mediation analysis revealed significant indirect effects of years since last training on BLS intention via attitude (B=-0.04; 95%CI, -0.06 to -0.02), subjective norms (B=-0.04; 95%CI, -0.07 to -0.02), and PBC (B=-0.14; 95%CI, -0.18 to -0.10), but insignificant for knowledge (B=-0.01, 95%CI; -0.03 to 0.02). The direct effect was insignificant (B=-0.02; 95%CI, -0.08 to 0.50), suggesting a full mediation. Conclusions: Resuscitation intention decreases with time through TPB determinants, but not knowledge. Comprehensive reviews of the current refresher strategy, focusing on knowledge and skill revisit, are warranted. Future research should focus on developing culturally-adapted 'Intention-focused' refresher pedagogies that address these psychobehavioural factors.