Knowledge, Attitudes, Practices Intention, and Barriers Toward Bystander Cardiopulmonary Resuscitation in Resource-Limited Settings: A Multi-National Cross-Sectional Survey

Abstract Background Public cardiopulmonary resuscitation (CPR) knowledge and training rates remain critically low in sub-Saharan Africa, yet multi-country surveys are scarce. This study aimed to assess CPR knowledge, attitudes, practices intention (KAP), and barriers to bystander CPR across six African nations. Methods A community-based cross-sectional survey was conducted from August to October 2024 in South Africa, Angola, the Republic of the Congo, Gabon, Cameroon, and Benin. Participants aged 13–80 years were recruited using convenience sampling and completed a structured questionnaire measuring CPR KAP, and perceived barriers Results Among 1,792 valid respondents (mean age 38.4 ± 12.6 years, 50.6% male), 40.1% had heard of CPR, but only 13.3% had received CPR training. The mean CPR knowledge score was 1.68/4, over 40% answered "not sure" to all items. Attitudes toward performing CPR were most favorable for a child (58.5%), yet only 31.8% reported willingness to perform chest compressions in an emergency scenario. The most frequently mentioned barriers were lack of CPR skills (46.4%), fear of disease transmission (18.6%), and fear of causing harm (18.0%). In multivariable ananlysis, nationality, CPR awareness, prior CPR training, educational attainment, and occupation were independently associated with knowledge score (adjusted R² = 0.338). Conclusion Despite relatively positive attitudes, CPR knowledge and practices intention remain low. Lack of CPR skills and fear of disease transmission were the primary barriers to performing bystander CPR. CPR awareness and prior training were the strongest modifiable determinants of knowledge. Context-adapted education strategies should prioritize underserved groups.