Lack of confidence in CPR skills, concerns about psychological fear, medical litigation, and sanitary issues when the victim is a stranger, and poorer performance among those aged ≥50 years, with lower educational levels, and rural residents are the primary factors limiting bystander CPR action in Shaanxi Province, China.
Nearly three-quarters of participants could recognize when CPR was needed, but recognition ability was poorer in certain subgroups.
Over 94% of participants reported willingness to perform CPR on both relatives and strangers, but willingness was significantly stronger for relatives than for strangers.
A high proportion of participants reported internal concerns about initiating CPR, with concerns more pronounced when the victim was a stranger.
Rural residents and those with primary education or below demonstrated poorer actual CPR knowledge scores.
Individuals aged ≥50 years, those with lower educational levels, and rural residents showed a tendency toward poorer performance across all assessed domains.
The study assessed bystander CPR barriers using a researcher-developed questionnaire across four distinct domains in a sample of 572 participants.
This research examined why bystanders in China's Shaanxi Province hesitate to perform CPR when someone goes into cardiac arrest outside of a hospital. Researchers surveyed 572 people using a questionnaire that measured four things: whether people could recognize when CPR was needed, how willing they were to perform it, what internal worries they had about doing it, and how much they actually knew about CPR technique. They found that while most people (about 74%) could identify when CPR was needed and over 94% said they were willing to try, nearly all participants—over 91%—reported significant internal concerns that could prevent them from acting. The biggest barrier was a lack of confidence in their own CPR skills, which likely reflects gaps in actual training and competence. The study also found important differences depending on who the potential victim was. People were notably more willing to help a relative than a stranger, and they reported greater fears about psychological distress, physical strain, potential lawsuits, and hygiene when the victim was someone unknown to them. These concerns about helping strangers are particularly important because bystander CPR situations often involve people who do not know each other. Additionally, certain groups consistently performed worse across all measures: people aged 50 and older, those living in rural areas, and those with lower levels of education showed weaker recognition ability, lower willingness, and poorer CPR knowledge. This research suggests that CPR training programs in China need to address not just technical skills but also the psychological and social barriers that prevent people from acting in an emergency. Special outreach efforts may be needed for older adults, rural communities, and those with less formal education. Reducing fears around legal liability and improving public confidence in CPR skills could help increase the rate of bystander CPR and potentially save more lives from out-of-hospital cardiac arrest.
Li D, Wang K, Fu Q, Li Y, Guo W, Guo X, et al.. (2026). What limits a bystander's action to perform cardiopulmonary resuscitation in China? Insights from a cross-sectional study conducted in Shaanxi Province.. Frontiers in public health. https://doi.org/10.3389/fpubh.2026.1902076