CPR knowledge among rural grassroots healthcare workers in Xinjiang, China: a cross-sectional analysis

Out-of-hospital cardiac arrest (OHCA) survival depends on rapid recognition, high-quality chest compressions, and early use of an automated external defibrillator (AED). Township household health education instructors in rural China are grassroots healthcare workers and are often the first reachable trained personnel during emergencies; however, their readiness to perform cardiopulmonary resuscitation (CPR) is undercharacterized. We conducted a cross-sectional analysis of a programmatic survey involving 235 instructors in Xinjiang, China. The survey instrument captured demographics, training exposure and its recency, AED awareness, item-level CPR knowledge, rescue willingness, and preferences. We derived a composite readiness score (0-100) and a strict overall accuracy score by averaging seven item-level correctness indicators. Group differences were assessed using chi-squared, Fisher's exact, or Kruskal-Wallis tests, with false discovery rate (FDR)-adjusted post hoc comparisons. Readiness correlates were examined using ordinary least squares (OLS) regression. The participants were predominantly women (97.4%) with a mean age of 37.4 ± 7.1 years; 86.4% were Uyghur, 12.3% Kyrgyz, and 1.3% Han. In total, 87.7% of the participants received CPR training, and 80.4% reported AED awareness. The mean readiness score was 79.4 ± 19.0, and the strict overall accuracy was 62.2 ± 25.6%. Item-level correct rates were as follows: "golden time," 77.4%; compression location, 73.2%; compression rate, 63.4%; indication, 62.1%; compression depth, 56.6%; AED timing, 56.2%; and all respiration steps, 46.8%. The trained participants showed higher readiness (83.7 ± 14.4 vs. 48.4 ± 18.9; p < 0.0001) and accuracy (0.65 vs. 0.42; p < 0.0001) compared to the untrained participants. Readiness varied by ethnicity (p = 0.0096; Uyghur > Kyrgyz, FDR = 0.050) and education (p = 0.00064). In the OLS model, having any prior training (+23.9; p < 0.0001), self-rated "very clear" knowledge (+13.7; p < 0.0001), and AED awareness (+5.0; p = 0.019) independently increased readiness, whereas middle-school education (-9.10; p = 0.0095) and married status (-7.77; p = 0.010) decreased readiness. The findings indicate generally favorable readiness with identifiable gaps, supporting low-dose, high-frequency, bilingual, hands-on refresher training tailored to rural Xinjiang.