Program evaluators have recognized the gap between the acquisition of knowledge or skills and subsequent changes in attitudes and behavior [26]. In support of the social-cognitive theory of behavior change, a recent study of motivation, self-confidence and skill retention found that gains in these factors were dependent on the method and timing of CPR training

[27]. Therefore, an effective CPR refresher must address not only skill retention, but also confidence and behavioral intention to perform CPR. More research is required to examine the effectiveness of CPR refreshers on skill retention, confidence and motivation, as well as the appropriate Inhibitors,research,lifescience,medical format, timing and frequency Inhibitors,research,lifescience,medical of such refreshers. In order to be effective, CPR refreshers should be easily accessible, available at no or low cost, and likely to be reviewed by trainees in the general population. Thus, the most desirable format would be to deliver the content to a trainee’s home or office, rather than requiring the person to attend a session in a special location. New electronic means of buy FRAX597 communication have expanded the possibilities for delivering CPR refreshers to members of the general public who received training in CPR. Such an approach Inhibitors,research,lifescience,medical does not include renewed CPR practice, which is difficult to

arrange. Our basic assumption Inhibitors,research,lifescience,medical was that various electronic modalities can actively direct the attention of prior trainees to messages designed to help them in recalling correct CPR techniques. Specifically, electronic refreshers are hypothesized to aid in retaining CPR administration skills, confidence in performing CPR and intention to perform CPR when needed. General Inhibitors,research,lifescience,medical population access to and use of electronic communication is already quite extensive, especially among younger people, and is continually

increasing [28-32]. Studies have documented internet access among even more difficult to reach (e.g., low income) populations [33-35]. Based on these trends of increasing access to electronic and mobile communications, the novel CPR others refresher formats selected for this study were: online website, e-mail, and text messaging by cell phone. Recent studies have shown that such electronic communication formats can be effective in increasing confidence and motivation to engage in health promoting behaviors [36-39]. The present study conducted a randomized controlled trial (RCT) of four CPR refreshers – online website, e-mail, text messaging and a mailed brochure – to determine their efficacy in affecting skill retention, confidence in using CPR and intention to use CPR at a one year follow-up after initial CPR training. The first three refreshers, based on electronic communication, can be considered “novel” in that they are not typically used to refresh CPR knowledge and skills.