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.


METHODS
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.


METHODS
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.


METHODS
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.
Centre for Intervention Research, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
Line
http://orcid.org/0000-0002-0141-4374
L
Zinckernagel
Department of Cardiology, Copenhagen University Hospital Gentofte, Gentofte, Denmark.
Carolina
C
Malta Hansen
Centre for Intervention Research, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
Morten Hulvej
MH
Rod
Department of Cardiology, Copenhagen University Hospital Gentofte, Gentofte, Denmark Emergency Medical Services, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark.
Fredrik
F
Folke
Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark.
Christian
C
Torp-Pedersen
Centre for Intervention Research, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
Tine
T
Tjørnhøj-Thomsen
D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000193:education*; D002648:Child; D003718:Denmark; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D036301:Qualitative Research; D000070777:School Teachers; D012574:Schools / Q000458:organization & administration*; D013334:Students
CARDIOPULMONARY RESUSCITATION; EDUCATION & TRAINING (see Medical Education & Training); PUBLIC HEALTH; QUALITATIVE RESEARCH; SCHOOLS