title: Barriers to calling 911 and learning and performing cardiopulmonary resuscitation for residents of primarily Latino, high-risk neighborhoods in Denver, Colorado.
abstract: OBJECTIVE
  Individuals in neighborhoods composed of minority and lower socioeconomic status populations are more likely to have an out-of-hospital cardiac arrest event, less likely to have bystander cardiopulmonary resuscitation (CPR) performed, and less likely to survive. Latino cardiac arrest victims are 30% less likely than whites to have bystander CPR performed. The goal of this study is to identify barriers and facilitators to calling 911, and learning and performing CPR in 5 low-income, Latino neighborhoods in Denver, CO.
  
  
  METHODS
  Six focus groups and 9 key informant interviews were conducted in Denver during the summer of 2012. Purposeful and snowball sampling, conducted by community liaisons, was used to recruit participants. Two reviewers analyzed the data to identify recurrent and unifying themes. A qualitative content analysis was used with a 5-stage iterative process to analyze each transcript.
  
  
  RESULTS
  Six key barriers to calling 911 were identified: fear of becoming involved because of distrust of law enforcement, financial, immigration status, lack of recognition of cardiac arrest event, language, and violence. Seven cultural barriers were identified that may preclude performance of bystander CPR: age, sex, immigration status, language, racism, strangers, and fear of touching someone. Participants suggested that increasing availability of tailored education in Spanish, increasing the number of bilingual 911 dispatchers, and policy-level changes, including CPR as a requirement for graduation and strengthening Good Samaritan laws, may serve as potential facilitators in increasing the provision of bystander CPR.
  
  
  CONCLUSIONS
  Distrust of law enforcement, language concerns, lack of recognition of cardiac arrest, and financial issues must be addressed when community-based CPR educational programs for Latinos are implemented.
authors.affiliation: American Heart Association, Dallas, TX; University of Colorado School of Medicine, Aurora, CO; Colorado School of Public Health, Aurora, CO. Electronic address: comilla.sasson@heart.org.
authors.forename: Comilla
authors.initials: C
authors.lastname: Sasson
authors.affiliation: University of Colorado School of Medicine, Aurora, CO; Colorado School of Public Health, Aurora, CO; Denver Health Medical Center, Denver, CO.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Haukoos
authors.affiliation: Department of Emergency Medicine, Alameda County Hospital, Oakland, CA.
authors.forename: Leila
authors.initials: L
authors.lastname: Ben-Youssef
authors.affiliation: Denver Health Medical Center, Denver, CO.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Ramirez
authors.affiliation: Colorado School of Public Health, Aurora, CO.
authors.forename: Sheana
authors.initials: S
authors.lastname: Bull
authors.affiliation: American Heart Association, Dallas, TX.
authors.forename: Brian
authors.initials: B
authors.lastname: Eigel
authors.affiliation: Institute for Healthcare Research, Kaiser Permanente, Denver, CO.
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
authors.affiliation: Denver Health Medical Center, Denver, CO.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Padilla
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health / Q000208:ethnology*; D016887:Cardiopulmonary Resuscitation / Q000193:education*; D003120:Colorado; D003144:Communication Barriers; D055812:Community-Based Participatory Research; D004631:Emergency Medical Service Communication Systems / Q000706:statistics & numerical data*; D005260:Female; D017144:Focus Groups; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000208:ethnology / Q000628:therapy*; D011204:Poverty Areas; D036301:Qualitative Research; D012306:Risk