Barriers and Facilitators for Bystander Cardiopulmonary Resuscitation and Automated External Defibrillator Use in Diverse and Underserved Cities in Los Angeles County, California

BACKGROUND: Few studies have focused on factors contributing to decreased rates of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use after out-of-hospital cardiac arrest in underserved and underrepresented communities, particularly those with Asian populations. We identified factors related to CPR and AED use in 2 cities with low socioeconomic status, majority underrepresented populations, and historically low CPR and AED use rates. METHODS: We conducted semistructured focus groups in English, Spanish, Japanese, and Korean between September 2024 and May 2025. We used purposive and snowball sampling. We developed a grounded theory model to explain the factors influencing learning and performing CPR and AED use. RESULTS: Of 124 participants, 44% identified as Hispanic, 29% as Asian, and 19% as Black. We grouped our findings into 4 main themes: (1) barriers to obtaining CPR/AED education and training, (2) facilitators to obtaining CPR/AED education and training, (3) barriers to providing bystander care, and (4) facilitators to providing bystander care. Barriers to learning included limited public information, low prioritization, training access, and institutional distrust. Barriers to providing care included low confidence, qualification misconceptions, legal and personal welfare concerns, social dynamics, and AED access. Facilitators to learning included self- and family preparedness, training incentives, and training for social roles. Facilitators to providing care included willingness to perform interventions after training and 911 dispatcher instructions. CONCLUSIONS: A complex array of factors influence learning and performing CPR and AED use in underserved and underrepresented communities. These findings should inform the development of community-specific CPR and AED initiatives.