This held for all three outcomes examined: CPR skill retention, confidence for CPR, or intent to help in a cardiac emergency. However, interpreting this “intent to treat” result is difficult because many

subjects did not actually review the electronic refreshers that were sent. Comparing outcomes for those exposed to the electronic refreshers vs. those not exposed indicated a significant effect for one of the three outcomes, confidence in performing CPR. According to social-cognitive theory, because increased confidence in being able to perform a behavior should increase the likelihood of performing Inhibitors,research,lifescience,medical that behavior, there is at least a potential that the novel refreshers can influence whether the subjects would conduct CPR in an emergency. The study identified a significant effect of refresher website exposure specifically on increased behavioral

Inhibitors,research,lifescience,medical intent. The website refresher can be considered more interactive than the other novel refreshers. The algorithm-based web program engaged the subject in critical thinking, leading them to appropriate responses in contrast to the other refreshers Inhibitors,research,lifescience,medical which were more didactic in their approach to reviewing CPR technique. The greater degree of active engagement in reviewing the principal CPR skills made possible by the website format may be responsible for the more positive outcome Inhibitors,research,lifescience,medical of this refresher compared with the others. This result bears more investigation, although of course it may be a chance finding, given the multiple comparisons made in the exploratory analyses. The number of refresher episodes (one vs. two) did not show a significant effect on any outcomes. This indicates that repeating the refreshers during a one year post-training period is not an effective strategy for retaining CPR capability. Examining the pattern of the satisfaction data, highest satisfaction occurred for the e-mails, Inhibitors,research,lifescience,medical second highest for the brochure, third highest for the website, and lowest for the text messaging. Those who received

e-mails also had the highest rate of exposure to any of the novel refreshers, measured by whether they opened any refresher e-mails. From these data, we might conclude that e-mail was the most successful of the novel CPR refreshers, about at least in terms of subject acceptance of and reactions to the refresher. It is possible, however, that a higher proportion looked at the mailed brochure than viewed any of the novel refreshers, although the data are ambiguous on this point, because of possible confusion with the CPR reminder “card” received at the initial training. One predictor model determined that age (younger), education (higher) and race (White) were significant predictors of skill retention, although these Roscovitine mouse variables only accounted for 19% of the variation in skill.