PROJECT SUMMARY Survival of out-of-hospital cardiac arrest (OHCA) depends on the prompt delivery of bystander cardiopulmonary resuscitation (B-CPR), which is often administered by layperson community members until the arrival of emergency medical services personnel. There is wide variability in both B-CPR participation rates and survival of OHCA throughout the United States, particularly in neighborhoods of low socioeconomic status. Our central hypothesis is that unique modifiable barriers to B-CPR participation exist in high-risk neighborhoods in Birmingham, Alabama, which can be used to inform a targeted community B-CPR intervention to increase B- CPR rates and ultimately improve OHCA survival. We will test our hypothesis through the following specific aims: In Aim 1 we will utilize geospatial mapping of local cardiac arrest and census tract data to identify and characterize high-risk OHCA neighborhoods in Birmingham, AL. For our study, high-risk neighborhoods are defined as those with a high incidence of OHCA and low B-CPR participation rates. In Aim 2 we will utilize qualitative methods to understand barriers to B-CPR participation in high-risk neighborhoods and elicit community feedback on the current American Heart Association CPR Anytimeâ training kit. Focus group interviews with members of the Bystander Support Network will provide critical insights into the real-life bystander experience, which will help inform local focus group discussions. Stakeholder interviews and focus group discussions with community members residing in a high-risk Birmingham neighborhood will identify neighborhood-specific barriers to B-CPR participation and provide feedback regarding the usability of the CPR Anytimeâ training kit. Finally, in Aim 3 we will adapt the CPR Anytimeâ training kit using the feedback received from community focus groups; and then pilot a prototype targeted community intervention specifically designed to overcome modifiable barriers to B-CPR with the goal of increasing layperson OHCA awareness, CPR education, and willingness to perform B-CPR in at-risk neighborhoods. This project is complemented by a structured career development plan that has been designed with the input of an expert multidisciplinary mentorship team that is committed to provide guidance throughout this award. During the 5 years of this award, Dr. Ryan Coute, an early investigator committed to reducing OHCA treatment and outcome disparities, will learn geospatial mapping, multimethod qualitative research, community intervention design, and implementation science. This K23 award will ultimately support Dr. Coute’s transition to lead an independent research portfolio and will provide the training and preliminary data needed for future R-level proposals; such as (1) evaluating the impact of a targeted community-level B-CPR intervention on OHCA survival, (2) a multi-site trial to determine the impact of the intervention on other communities, or (3) exploring the dynamics of neighborhood make-up and social determinants of health on cardiac arrest survivorship for residents of at-risk communities.

PROJECT NARRATIVE—RELEVANCE TO HEALTH Bystander cardiopulmonary resuscitation (B-CPR) is the most effective treatment for out-of-hospital cardiac arrest (OHCA); however, the likelihood of receiving B-CPR and surviving OHCA varies significantly based on neighborhood demographics. Our research is designed to identify modifiable barriers to B-CPR participation in at-risk neighborhoods, and adapt a targeted, culturally sensitive, community-level intervention designed to improve B-CPR participation and OHCA survival in underserved populations.