A qualitative study to identify barriers to deployment and student training in the use of automated external defibrillators in schools

BACKGROUND: Student training in use of automated external defibrillators and deployment of such defibrillators in schools is recommended to increase survival after out-of-hospital cardiac arrest. Low implementation rates have been observed, and even at schools with a defibrillator, challenges such as delayed access have been reported. The purpose of this study was to identify barriers to the implementation of defibrillator training of students and deployment of defibrillators in schools. METHODS: A qualitative study based on semi-structured individual interviews and focus groups with a total of 25 participants, nine school leaders, and 16 teachers at eight different secondary schools in Denmark (2012–2013). Thematic analysis was used to identify regular patterns of meaning using the technology acceptance model and focusing on the concepts of perceived usefulness and perceived ease of use. RESULTS: School leaders and teachers are concerned that automated external defibrillators are potentially dangerous, overly technical, and difficult to use, which was related to their limited familiarity with them. They were ambiguous about whether or not students are the right target group or which grade is suitable for defibrillator training. They were also ambiguous about deployment of defibrillators at schools. Those only accounting for the risk of students, considering their schools to be small, and that time for professional help was limited, found the relevance to be low. Due to safety concerns, some recommended that defibrillators at schools should be inaccessible to students. They lacked knowledge about how they work and are operated, and about the defibrillators already placed at their campuses (e.g., how to access them). Prior training and even a little knowledge about defibrillators were crucial to their perception of student training but not for their considerations on the relevance of their placement at schools. CONCLUSIONS: It is crucial for implementation of automated external defibrillators in schools to inform staff about how they work and are operated and that students are an appropriate target group for defibrillator training. Furthermore, it is important to provide schools with a basis for decision making about when to install defibrillators, and to ensure that school staff and students are informed about their placement

What are the barriers to implementation of cardiopulmonary resuscitation training in secondary schools?:A qualitative study

OBJECTIVE: Cardiopulmonary resuscitation (CPR) training in schools is recommended to increase bystander CPR and thereby survival of out-of-hospital cardiac arrest, but despite mandating legislation, low rates of implementation have been observed in several countries, including Denmark. The purpose of the study was to explore barriers to implementation of CPR training in Danish secondary schools. DESIGN: A qualitative study based on individual interviews and focus groups with school leadership and teachers. Thematic analysis was used to identify regular patterns of meaning both within and across the interviews. SETTING: 8 secondary schools in Denmark. Schools were selected using strategic sampling to reach maximum variation, including schools with/without recent experience in CPR training of students, public/private schools and schools near to and far from hospitals. PARTICIPANTS: The study population comprised 25 participants, 9 school leadership members and 16 teachers. RESULTS: School leadership and teachers considered it important for implementation and sustainability of CPR training that teachers conduct CPR training of students. However, they preferred external instructors to train students, unless teachers acquired the CPR skills which they considered were needed. They considered CPR training to differ substantially from other teaching subjects because it is a matter of life and death, and they therefore believed extraordinary skills were required for conducting the training. This was mainly rooted in their insecurity about their own CPR skills. CPR training kits seemed to lower expectations of skill requirements to conduct CPR training, but only among those who were familiar with such kits. CONCLUSIONS: To facilitate implementation of CPR training in schools, it is necessary to have clear guidelines regarding the required proficiency level to train students in CPR, to provide teachers with these skills, and to underscore that extensive skills are not required to provide CPR. Further, it is important to familiarise teachers with CPR training kits

Perception of pharmacological prevention and subsequent non-adherence to medication in patients with ischaemic heart disease:a population-based cohort study

OBJECTIVE: A patient-focused approach is advocated to embody risk of non-adherence to medication and subsequent adverse clinical outcomes following ischaemic heart disease (IHD). This study aimed to explore how patient perceived information on pharmacological prevention was associated with subsequent non-adherence to medication (measured by non-initiation, non-implementation and non-persistence) in patients with incident IHD. DESIGN: Cohort study. SETTING: Denmark. PARTICIPANTS: Register-based cohort of 829 patients with incident IHD in 2013. MEASURES: Perception covered whether patients’ experienced being adequately informed about their pharmacological prevention. Information on such was obtained from a survey and divided into ‘Well informed’, ‘Moderately informed’ and ‘Poorly informed’. Information on baseline characteristics, and reimbursed prescriptions of medication (antiplatelets, statins, ACE-inhibitors/angiotensin receptor blockers and β-blockers) during follow-up were obtained by linkage to nationwide public registers. Non-initiation and non-implementation of medication, measured as proportion of days covered, were analysed by Poisson regression. Non-persistence to medication, measured as risk of discontinuation, was analysed by multivariable Cox proportional hazard regression. PRIMARY AND SECONDARY OUTCOME MEASURES: Non-implementation and non-persistence to medication up to 365 days of follow-up were primary outcomes. Secondary outcomes included non-initiation as well as non-implementation and non-persistence to medication at 180 days of follow-up. RESULTS: A dose–response association was in general found between perception of pharmacological prevention and risk of non-implementation and non-persistence. For example, the hazard of non-persistence to antiplatelets was 1.18 (95% CI 0.71 to 1.96) times higher for patients reporting 'Moderately informed' and 1.89 (95% CI 1.10 to 3.25) times higher for patients reporting 'Poorly informed', compared with patients reporting 'Well informed of perception of pharmacological prevention' up to 365 days of follow-up. CONCLUSION: Lower levels of perception of pharmacological prevention were associated with subsequent non-implementation and non-persistence to medication in patients with incident IHD

Lay Bystanders' Perspectives on What Facilitates Cardiopulmonary Resuscitation and Use of Automated External Defibrillators in Real Cardiac Arrests

Background Many patients who suffer an out‐of‐hospital cardiac arrest will fail to receive bystander intervention (cardiopulmonary resuscitation [CPR] or defibrillation) despite widespread CPR training and the dissemination of automated external defibrillators (AEDs). We sought to investigate what factors encourage lay bystanders to initiate CPR and AED use in a cohort of bystanders previously trained in CPR techniques who were present at an out‐of‐hospital cardiac arrest. Methods and Results One‐hundred and twenty‐eight semistructured qualitative interviews with CPR‐trained lay bystanders to consecutive out‐of‐hospital cardiac arrest, where an AED was present were conducted (from January 2012 to April 2015, in Denmark). Purposive maximum variation sampling was used to establish the breadth of the bystander perspective. Twenty‐six of the 128 interviews were chosen for further in‐depth analyses, until data saturation. We used cross‐sectional indexing (using software), and inductive in‐depth thematic analyses, to identify those factors that facilitated CPR and AED use. In addition to prior hands‐on CPR training, the following were described as facilitators: prior knowledge that intervention is crucial in improving survival, cannot cause substantial harm, and that the AED will provide guidance through CPR; prior hands‐on training in AED use; during CPR performance, teamwork (ie, support), using the AED voice prompt and a ventilation mask, as well as demonstrating leadership and feeling a moral obligation to act. Conclusions Several factors other than previous hands‐on CPR training facilitate lay bystander instigation of CPR and AED use. The recognition and modification of these factors may increase lay bystander CPR rates and patient survival following an out‐of‐hospital cardiac arrest. </jats:sec

Cardiopulmonary Resuscitation Training in Schools Following 8 Years of Mandating Legislation in Denmark:A Nationwide Survey

Background School cardiopulmonary resuscitation ( CPR ) training has become mandatory in many countries, but whether legislation has translated into implementation of CPR training is largely unknown. We assessed CPR training of students following 8 years of legislative mandates in Denmark. Methods and Results A nationwide cross‐sectional survey of Danish school leadership (n=1240) and ninth‐grade homeroom teachers (n=1381) was carried out for school year 2013‐2014. Qualitative interviews and the Theory of Planned Behavior were used to construct the survey. Logistic regression models were employed to identify factors associated with completed CPR training. Information from 63.1% of eligible schools was collected: 49.3% (n=611) of leadership and 48.2% (n=665) of teachers responded. According to teachers, 28.4% (95% CI 25.0% to 32.0%) and 10.3% (95% CI 8.1% to 12.8%) of eligible classes had completed CPR and automated external defibrillator training, respectively. Among leadership, 60.2% (95% CI 56.2% to 64.1%) reported CPR training had occurred during the 3 years prior to the survey. Factors associated with completed CPR training included believing other schools were conducting training (odds ratio [ OR ] 9.68 [95% CI 4.65‐20.1]), awareness of mandating legislation ( OR 4.19 [95% CI 2.65‐6.62]), presence of a school CPR training coordinator ( OR 3.01 [95% CI 1.84‐4.92]), teacher feeling competent to conduct training ( OR 2.78 [95% CI 1.74‐4.45]), and having easy access to training material ( OR 2.08 [95% CI 1.57‐2.76]). Conclusions Despite mandating legislation, school CPR training has not been successfully implemented. Completed CPR training was associated with believing other schools were conducting training, awareness of mandating legislation, presence of a school CPR training coordinator, teachers teacher feeling competent to conduct training, and having easy access to training material. Facilitating these factors may increase rates of school CPR training. </jats:sec

Alternative Models of Cardiac Rehabilitation Delivery Urgently Needed to Improve Access for Heart Failure Patients

No abstract available