Psychological and contextual determinants of public CPR intention in Hubei Province: an extended theory of planned behavior study.

OBJECTIVE: This study examined psychological and contextual determinants of public willingness to perform cardiopulmonary resuscitation (CPR) in Hubei Province using an extended theory of planned behavior (ETPB) framework and explored training-associated changes after standardized first-aid training. METHODS: A theory-driven cross-sectional survey with supplementary within-group pre-post training evaluation was conducted. Adults in Hubei Province were recruited between July 2022 and March 2023. The ETPB model included behavioral attitude, subjective norm, perceived behavioral control, implementation context, and facilitating conditions as predictors of CPR rescue intention. Confirmatory factor analysis and structural equation modeling were used to evaluate the theory-driven model. A supplementary exploratory multi-group SEM and path-by-path critical-ratio comparison were conducted to examine whether previous CPR/AED training experience moderated specific ETPB pathways. Training-associated changes were assessed among participants attending an 8-h Hubei Red Cross first-aider program. RESULTS: A total of 2,156 valid questionnaires were analyzed. The ETPB scale showed acceptable preliminary reliability and validity. The structural model demonstrated acceptable fit and identified facilitating conditions and perceived behavioral control as the strongest predictors of CPR rescue intention, followed by subjective norm and behavioral attitude; implementation context was not significant. In the supplementary training evaluation, 652 participants completed paired assessments. Post-training improvements were observed in CPR/AED knowledge, practical performance, confidence, AED-use willingness, and ETPB domain scores related to CPR rescue intention. The path-by-path critical-ratio comparison identified two moderated pathways: perceived behavioral control to CPR rescue intention was stronger among trained participants, whereas facilitating conditions to CPR rescue intention was stronger among untrained participants. CONCLUSION: Public CPR rescue intention in Hubei Province was shaped mainly by perceived competence and enabling conditions rather than by attitude alone. Previous CPR/AED training experience moderated two key ETPB pathways. CPR promotion strategies should therefore strengthen perceived competence and confidence among trained laypeople, while improving accessible training opportunities and supportive learning conditions among untrained laypeople.