{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:50:44Z","timestamp":1791827444487,"version":"4.3.4"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Background<\/jats:title>\n Out-of-hospital cardiac arrest remains a major public health concern, and early cardiopulmonary resuscitation (CPR) by bystanders is crucial for improving survival outcomes. University students represent an important target population for CPR education because they are socially active, highly accessible, and capable of disseminating lifesaving knowledge within the wider community. However, inadequate CPR knowledge, low willingness to perform CPR, and poor self-efficacy remain common among university students in Malaysia.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n This two-phase study aims to determine the prevalence of self-reported CPR-related knowledge, willingness, and self-efficacy among students in a Malaysian tertiary institution (Phase 1) and to explore the preliminary changes in these outcomes following a peer-led CPR workshop (Phase 2).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In Phase 1, a cross-sectional survey was conducted at a tertiary institute in Selangor, Malaysia using a validated questionnaire on knowledge, attitudes, behavioral intention, and self-efficacy (KABSE) (N\u2009=\u2009431). In Phase 2, a two-hour peer-led workshop, delivered by medical students, targeted students without CPR training in the past two years, and pre\u2013post KABSE changes were measured (N\u2009=\u200933).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Phase 1 baseline findings revealed CPR knowledge and self-efficacy levels were relatively lower than attitudes and willingness to perform CPR. Females showed higher knowledge and attitudes, while males reported greater self-efficacy. Older and married participants demonstrated better attitudes, and those with a healthcare-related background had higher knowledge, attitudes, and self-efficacy, though similar behavioral intention. Higher scores were also linked to AED awareness, AED usage capability, and recent CPR training. Statistical analysis revealed significant associations among the KABSE domains. Following the peer-led workshop, the participants showed significant gains in self-reported knowledge (p\u2009<\u20090.001), attitude (p\u2009<\u20090.001), behavioral intention (p\u2009<\u20090.01), and self-efficacy (p\u2009<\u20090.001).<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Although participants displayed positive attitudes toward CPR, baseline knowledge and self-efficacy were limited. The peer-led workshop demonstrated feasibility as a proof-of-concept intervention, generating significant short-term gains in self-reported knowledge and confidence.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0360510","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:25:41Z","timestamp":1791825941000},"page":"e0360510","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Knowledge, willingness, and self-efficacy in CPR: A two-phase study of prevalence and preliminary peer-led workshop in a Malaysian tertiary institution"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9299-6842","authenticated-orcid":true,"given":"Siew-Keah","family":"Lee","sequence":"first","affiliation":[{"name":"Universiti Tunku Abdul Rahman","place":["Selangor, Malaysia"],"department":["M. Kandiah Faculty of Medicine and Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei Jie","family":"Hoo","sequence":"additional","affiliation":[{"name":"Universiti Tunku Abdul Rahman","place":["Selangor, Malaysia"],"department":["M. Kandiah Faculty of Medicine and Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel Zoe","family":"Koh Raj","sequence":"additional","affiliation":[{"name":"Universiti Tunku Abdul Rahman","place":["Selangor, Malaysia"],"department":["M. Kandiah Faculty of Medicine and Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irvin Ken Lym","family":"Yeo","sequence":"additional","affiliation":[{"name":"Universiti Tunku Abdul Rahman","place":["Selangor, Malaysia"],"department":["M. Kandiah Faculty of Medicine and Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9124-3289","authenticated-orcid":true,"given":"Yu Wen","family":"Beh","sequence":"additional","affiliation":[{"name":"Universiti Tunku Abdul Rahman","place":["Selangor, Malaysia"],"department":["M. Kandiah Faculty of Medicine and Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosidah","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Universiti Tunku Abdul Rahman","place":["Selangor, Malaysia"],"department":["M. Kandiah Faculty of Medicine and Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai Bin","family":"Liew","sequence":"additional","affiliation":[{"name":"University of Cyberjaya","place":["Selangor, Malaysia"],"department":["Faculty of Pharmacy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6733-5759","authenticated-orcid":true,"given":"Yik-Ling","family":"Chew","sequence":"additional","affiliation":[{"name":"UCSI University","place":["Negeri Sembilan, Malaysia"],"department":["Faculty of Pharmaceutical Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenie Sin Sing","family":"Tan","sequence":"additional","affiliation":[{"name":"UCSI University","place":["Kuala Lumpur, Malaysia"],"department":["School of Healthy Aging, Medical Aesthetics and Regenerative Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ang-Lim","family":"Chua","sequence":"additional","affiliation":[{"name":"Universiti Teknologi MARA","place":["Selangor, Malaysia"],"department":["Faculty of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"issue":"4","key":"pone.0360510.ref001","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1017\/S1049023X23006088","article-title":"Prehospital emergency care in low- and middle-income countries: A systematic review","volume":"38","author":"HK Bhattarai","year":"2023","journal-title":"Prehospital and Disaster Med"},{"issue":"2","key":"pone.0360510.ref002","first-page":"192","article-title":"Public participation willingness in out-of-hospital cardiopulmonary resuscitation: A systematic review and meta-analysis","volume":"12","author":"Y Cheng","year":"2025","journal-title":"Int J Nurs Sci"},{"issue":"1","key":"pone.0360510.ref003","doi-asserted-by":"crossref","first-page":"46","DOI":"10.5334\/gh.1255","article-title":"Factors and barriers on cardiopulmonary resuscitation and automated external defibrillator willingness to use among the community: A 2016-2021 systematic review and data synthesis","volume":"18","author":"A Daud","year":"2023","journal-title":"Glob Heart"},{"issue":"1","key":"pone.0360510.ref004","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1177\/17579139211055497","article-title":"Barriers and facilitators to delivering bystander cardiopulmonary resuscitation in deprived communities: a systematic review","volume":"143","author":"I Uny","year":"2023","journal-title":"Perspect Public Health"},{"issue":"2","key":"pone.0360510.ref005","first-page":"191","article-title":"Impact of bystander cardiopulmonary resuscitation on out-of-hospital cardiac arrest survival in Saudi Arabia: A retrospective multiregional analysis","volume":"21","author":"TH Alshahrani","year":"2025","journal-title":"Postepy Kardiol Interwencyjnej"},{"issue":"1","key":"pone.0360510.ref006","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.annemergmed.2023.08.006","article-title":"Sudden Cardiac Death at Home: Potential Lives Saved With Fully Automated External Defibrillators","volume":"83","author":"LJ Gessman","year":"2024","journal-title":"Ann Emerg Med"},{"issue":"1","key":"pone.0360510.ref007","doi-asserted-by":"crossref","first-page":"36","DOI":"10.5334\/aogh.3624","article-title":"Globally, GDP per capita correlates strongly with rates of bystander CPR","volume":"88","author":"A Shekhar","year":"2022","journal-title":"Ann Glob Health"},{"key":"pone.0360510.ref008","doi-asserted-by":"crossref","DOI":"10.1016\/j.resuscitation.2025.110733","article-title":"European resuscitation council guidelines 2025 epidemiology in resuscitation","volume":"215","author":"E Baldi","year":"2025","journal-title":"Resuscitation"},{"key":"pone.0360510.ref009","doi-asserted-by":"crossref","first-page":"110445","DOI":"10.1016\/j.resuscitation.2024.110445","article-title":"The \u201cinvisible ceiling\u201d of bystander CPR in three Asian countries: Descriptive study of national OHCA registry","volume":"206","author":"Y Okada","year":"2025","journal-title":"Resuscitation"},{"issue":"2","key":"pone.0360510.ref010","first-page":"147","article-title":"Characteristics and outcomes of out-of-hospital cardiac arrest cases responded by emergency medical services across three states in Malaysia","volume":"80","author":"AK Sarah","year":"2025","journal-title":"Med J Malaysia"},{"issue":"2","key":"pone.0360510.ref011","first-page":"218","article-title":"Factors contributing to delayed ambulance response time using ambulance vehicle locator and global integrating system (AVL- GIS) at hospital universiti sains Malaysia","volume":"21","author":"Asri Zulaili","year":"2021","journal-title":"Malay J Pub Health Med"},{"issue":"1","key":"pone.0360510.ref012","first-page":"49","article-title":"Cardiopulmonary resuscitation\u2005: The short comings in Malaysia","volume":"15","author":"CK Sheng","year":"2008","journal-title":"Malays J Med Sci"},{"key":"pone.0360510.ref013","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2024.1459590","article-title":"Training experience is an important factor affecting willingness for bystander CPR and awareness of AED: A survey of residents from a province in Central China in 2023","volume":"12","author":"X Tian","year":"2024","journal-title":"Front Public Health"},{"key":"pone.0360510.ref014","doi-asserted-by":"crossref","first-page":"1444970","DOI":"10.3389\/fpubh.2024.1444970","article-title":"The knowledge, training, and willingness of first year students in Xuzhou, China to perform bystander cardiopulmonary resuscitation: A cross-sectional study","volume":"12","author":"Z Qin","year":"2024","journal-title":"Front Public Health"},{"key":"pone.0360510.ref015","doi-asserted-by":"crossref","first-page":"100518","DOI":"10.1016\/j.clinsp.2024.100518","article-title":"Willingness and skills among students from non-health academic fields in providing efficient basic life support","volume":"79","author":"PN Sugimoto","year":"2024","journal-title":"Clinics (Sao Paulo)"},{"key":"pone.0360510.ref016","doi-asserted-by":"crossref","first-page":"1341851","DOI":"10.3389\/fpubh.2024.1341851","article-title":"Knowledge, attitudes, practices, and self-efficacy of the Chinese public regarding cardiopulmonary resuscitation: An online cross-sectional survey","volume":"12","author":"H Gao","year":"2024","journal-title":"Front Public Health"},{"key":"pone.0360510.ref017","unstructured":"Parametric measures of effect size. 1994."},{"issue":"7","key":"pone.0360510.ref018","doi-asserted-by":"crossref","first-page":"1184","DOI":"10.1097\/CCM.0000000000002375","article-title":"Influence of gender on the performance of cardiopulmonary rescue teams: A randomized, prospective simulator study","volume":"45","author":"SA Amacher","year":"2017","journal-title":"Crit Care Med"},{"issue":"12","key":"pone.0360510.ref019","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0244104","article-title":"Correction: Barriers to bystander CPR in deprived communities: Findings from a qualitative study","volume":"15","author":"F Dobbie","year":"2020","journal-title":"PLoS One"},{"issue":"5","key":"pone.0360510.ref020","article-title":"Knowledge, attitude, and willingness to perform on-site Cardiopulmonary Resuscitation among individuals trained in public CPR: A cross-sectional survey","volume":"20","author":"S Cui","year":"2025","journal-title":"PLoS One"},{"key":"pone.0360510.ref021","doi-asserted-by":"crossref","first-page":"4","DOI":"10.31436\/ijcs.v4iSupp1.188","article-title":"Knowledge, attitude and awareness of basic life support among health sciences university students","volume":"4","author":"N Zainul Azlan","year":"2021","journal-title":"Int J Care Scholars"},{"issue":"51","key":"pone.0360510.ref022","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000018466","article-title":"Knowledge of and willingness to perform Hands-Only cardiopulmonary resuscitation among college students in Malaysia","volume":"98","author":"SR Karuthan","year":"2019","journal-title":"Medicine (Baltimore)"},{"issue":"1","key":"pone.0360510.ref023","doi-asserted-by":"crossref","first-page":"2944","DOI":"10.1186\/s12889-025-24412-6","article-title":"Factors influencing willingness to perform cardiopulmonary resuscitation (CPR) and use an automated external defibrillator (AED) among non-healthcare community participants in a CPR fun run","volume":"25","author":"NI Mohd Hashim","year":"2025","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0360510.ref024","doi-asserted-by":"crossref","first-page":"12","DOI":"10.47836\/mjmhs.20.1.3","article-title":"Readiness and challenges in cardiopulmonary resuscitation teaching: A preliminary perspective amongst malaysian secondary school principles","volume":"20","author":"MH Haiqal","year":"2024","journal-title":"Malaysian J Med Health Sci"},{"issue":"5","key":"pone.0360510.ref025","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1161\/CIRCOUTCOMES.111.000097","article-title":"Barriers and facilitators to learning and performing cardiopulmonary resuscitation in neighborhoods with low bystander cardiopulmonary resuscitation prevalence and high rates of cardiac arrest in Columbus, OH","volume":"6","author":"C Sasson","year":"2013","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"17","key":"pone.0360510.ref026","doi-asserted-by":"crossref","DOI":"10.1161\/CIR.0000000000001054","article-title":"Understanding the importance of the lay responder experience in out-of-hospital cardiac arrest: A scientific statement from the American Heart Association","volume":"145","author":"KN Dainty","year":"2022","journal-title":"Circulation"},{"key":"pone.0360510.ref027","first-page":"187","article-title":"Comparison of peer-led versus professional-led training in basic life support for medical students","volume":"2","author":"T Fujiwara","year":"2011","journal-title":"Adv Med Educ Pract"},{"issue":"6","key":"pone.0360510.ref028","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-075961","article-title":"Effects of peer-education training on cardiopulmonary resuscitation knowledge and skill retention of secondary school students: A feasibility study","volume":"14","author":"A Spartinou","year":"2024","journal-title":"BMJ Open"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0360510","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:25:48Z","timestamp":1791825948000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0360510"}},"subtitle":[],"editor":[{"given":"Nik Hisamuddin","family":"Nik Ab. Rahman","sequence":"first","affiliation":[{"name":"Universiti Sains Malaysia","place":["MALAYSIA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,12]]},"references-count":28,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0360510","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,12]]}}}