Impact of Primary Spoken Language as a Social Determinant of Health on Cardiopulmonary Education and Use: Pilot Study

Over 350,000 out-of-hospital cardiac arrests occur annually in the United States, with neurologically intact survival below 10%. Recent literature demonstrates that survival is lower in communities of color and non-English speakers. Social determinants of health, such as healthcare access, language, and literacy, may serve as barriers to receiving cardiopulmonary resuscitation (CPR) education and using the skills learned. Current research is sparse on identifying barriers contributing to the lack of CPR education and use in non-English speaking communities. We hypothesized that barriers to CPR education and use differ between English- and Spanish-speaking learners. This study provides insights into how classes could be tailored to address disparities in CPR education and use.

In this cross-sectional study we used survey-based research to assess the knowledge, comfort, and perceived barriers to activating the 9-1-1 system and performing bystander CPR. Participants were recruited using convenience sampling at community-based events in Roanoke, Virginia. We directly compared responses between language groups using Fisher tests within R, adjusting for various demographic factors.

We collected 367 surveys from the 550 participants (estimated 50 attendees each for 11 events) for a response rate of 66.7%. Of the surveys collected, 231 (63%) were in English and 136 (37%) in Spanish. Spanish-speakers were more concerned with immigration status (7% vs 1%), doing something wrong (14% vs 7%), and language barrier (31% vs 1%) compared to English-speakers when asked why they may not call 9-1-1. We found that 72% of English-speakers would have no problem calling 9-1-1, compared to only 16% of Spanish-speakers. Regardless of language, the most prevalent barrier to initiating CPR was the "fear of doing something wrong" with 49% of Spanish-speakers and 28% of English-speakers endorsing this as a barrier. Only 10% of Spanish speakers would have no concerns starting CPR, compared to 54% of English-speakers. Language was reported by 21% of Spanish-speakers vs 2% of English-speakers as a barrier to administering CPR.

Results of this pilot study highlight that Spanish-speaking respondents were less comfortable calling 9-1-1 and initiating CPR compared to English-speaking respondents. While there were some shared barriers between the groups, Spanish-speaking respondents were more likely to identify a barrier overall. These results suggest that marginalized communities would benefit from tailored educational models that address their unique challenges. Further research is necessary to better understand how social determinants of health serve as barriers to CPR education/use in specific communities.