Award Title: Facilitating Bystander Cardiopulmonary Resuscitation Training in high-risk areas (FACT)
Funder: Department of Health and Social Care

Abstract: Cardiac arrest is when someone’s heart stops beating and they stop breathing.  People who see cardiac arrests are called bystanders. They can help save the person’s life by doing cardiopulmonary resuscitation (CPR) and using a heart restarter machine before an ambulance arrives.  The heart restarter machines are also known as publicly accessible defibrillators (PADs)._x000D_
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In some areas people are more likely to have a cardiac arrest. In some of these areas not many bystanders do CPR either. We are calling these high-risk areas. High-risk areas are usually deprived areas with a higher number of people from diverse communities living there. The study from the University of Warwick will work with people from high—risk areas in different parts of England. We want to find out what stops people from helping someone having a cardiac arrest. We want to come up with some activities to help people overcome the things that stop them doing CPR or using a heart restarter. _x000D_
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The study is in 3 parts_x000D_
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1.	The study team will look at information from other studies that have looked this problem in similar areas. We will discuss the problem with people from high—risk areas at about 4 workshops in the West Midlands. We want to see what they think about the problem.  We will see if what the other studies say is similar to or different from their own experiences. We will then discuss ideas about activities that might help make things better._x000D_
2.	The study team will look at all the information from the discussions and work out what sort of activities might work to improve things. They will also work out what it is about the activities that seems to make a difference.  At another workshop, the researchers will discuss their ideas with local people and people from organisations interested in improving the numbers of bystanders doing CPR, like the Resuscitation Council UK.  The people taking part will decide which activities could work in the local high-risk areas and decide which are the best ones to try out in the next part of the study._x000D_
3.	These activities, will be tried out in two places in the West Midlands to see how they work.  Information will be collected from people taking part in the test activities to see what they thought.  This information will be used to decide if any changes need to be made to the activities before trying them out in a few other areas in England. People taking part will be asked for their thoughts on the activities to see if the activities work for most people or don’t work for most people in the way they should._x000D_
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Members of the public will take part in this study in different ways. Two will be members of the study team and two more will be on the committee that makes sure the project is going as planned on behalf of the funder. We will have a public advisory group that will meet several times a year to hear how things are getting on with the project and to advise the study team. Other people will take part in the workshops in part 1 and part 2 of the study. Others will take part in the events run to test out the chosen activities._x000D_
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This study will help organisations trying to improve the numbers of bystanders doing CPR in the areas that need it the most to know what activities could help improve things.

Lay Abstract: Background_x000D_
Improved survival from out-of-hospital cardiac arrest (OHCA) is associated with early cardiopulmonary resuscitation (CPR) and use of defibrillation, often by members of the public before emergency medical services arrive. Although bystander interventions (CPR and use of publicly accessible defibrillators (PAD)) have been improving over recent years there is variation between areas. High risk areas have been identified in England where there is a higher incidence of cardiac arrest combined with lower than average bystander CPR rates. These areas are characterised by deprivation, higher than average minority group populations and populations in manual occupations. There is little international evidence and only one ongoing study in the UK in Scotland, to inform initiatives to improve the situation. Understanding reasons for lower bystander intervention rates and developing interventions to tackle them is urgently needed to provide stakeholders with evidence and tools to help towards their efforts to meet NHS England Long Term Plan aims to reduce health inequalities and to improve survival from OHCA by 4,000 people a year by 2028._x000D_
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Aims_x000D_
To identify reasons for low bystander resuscitation rates in high-risk communities through literature and primary evidence synthesis and to develop, implement and evaluate theoretically informed interventions. _x000D_
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Objectives_x000D_
1.    To establish a community based public involvement advisory group to co-produce key aspects of the study. _x000D_
2.	To identify barriers and facilitators to performing CPR or publicly accessible defibrillator use in high-risk areas through realist evidence synthesis and develop theoretically informed interventions._x000D_
3.	Prioritise interventions with community partners and other stakeholders for evaluation._x000D_
4.	Develop a realist informed evaluation framework and associated data collection tools, including assessment of locally made intervention changes. _x000D_
5.	Conduct an implementation evaluation with embedded feasibility study. _x000D_
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Design and methods_x000D_
A collaborative realist enquiry, informed by the Theoretical Domains Framework (TDF) and associated Behaviour Change Wheel (BCW), consisting of a realist evidence synthesis, intervention development and implementation evaluation with embedded feasibility in three work packages (WPs)._x000D_
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WP 1 is a realist synthesis, informed by the Theoretical Domains Framework, of published and primary evidence on facilitators, barriers and associated interventions relevant to improving bystander CPR. It will use cross-disciplinary literature and data from workshops with people from communities with characteristics of high-risk areas. The synthesis will produce conjectured context, mechanism and outcome theories which will inform intervention design and prioritisation in WP2. In WP3 we will implement interventions and conduct a theoretically informed realist evaluation in up to six English high-risk areas._x000D_
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Timelines_x000D_
WP1 and WP 2 will be complete in 18 months and WP3 and dissemination by 36 months._x000D_
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Anticipated impact and dissemination_x000D_
The evaluated interventions will be available for use by training providers and promotion by campaigning organisations to help increase participation in CPR and defibrillation training.  Planned dissemination to stakeholders will be strengthened through their engagement in intervention development in WP2. Findings will contribute much needed knowledge to the subject.

Research Activity Codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health Categories: CARDIOVASCULAR