Skip to main content

Table 1 Baseline characteristics of the included studies

From: Educating, training, and exercising for infectious disease control with emphasis on cross-border settings: an integrative review

Study Context Input Process Evaluation
Subgroup 1st Author, year, country, reference Training Needs Assessed Target group Recruitment & Autonomy Topic Professional trainers
(content and/or didactics)
Development & Quality of the material Intervention type Duration & number of training moments Train- & testable training objectives Setting & Interaction Pre-test
(RR response / total (%))
(RR response / total (%))
(RR response / total (%))
(evaluation method)
(evaluation method)
(evaluation method)
(evaluation method)
Ablah E., 2007, USA, [21] All employees of local health departments Invitations Infectious disease outbreak response Electronic, simulation exercise. 4 weeks Goals stated at organizational level Multi-county setting; a realistic time frame; participants received feedback to their responses. RR 56/65 (86) RR 48/65 (86) Self-assessed skills
Ablah E., 2008, USA, [22] All employees of local health departments Invitations Infectious disease outbreak response Electronic, simulation exercise 4 weeks, 2–3 injects per day Goals stated at organizational level Multi-county setting; a realistic time frame; injects sent via a web-based system; participants received feedback to their responses. RR - Focus group Focus-group: Self-assessed skills
Aiello A., 2011, Canada, [23] Based on literature review & experience Health professionals of all departments of a hospital Resilience towards pandemics 2 members of the Psychosocial Pandemic Committee -; Materials not tested. Training 1 h Implicitly named on organizational and individual level. Information delivery and discussion. RR 1250/1020 (82) RR 1250/1020 (82) Rating statements Self-assessed skills
Alexander L.K., 2005, USA, [24] Public health nurses Communicable disease surveillance and response Educational course 80 h 4 internet modules and one classroom module with presentations, discussion and technical consultation. RR 55/80 (69) RR 55/80 (69) Rating statements Knowledge test
Alexander L.K., 2008, USA, [25] TNA among target group Public health nurses Communicable disease surveillance, −recognition, −outbreak investigation, and -control; new bioterrorist agents. Professionals with strong teaching credentials State partners provided content, academic partners provided curriculum development and distance-learning technical expertise. Distance-education; face-to-face training and a table-top exercise 14 weeks Clearly stated as competencies Internet-modules with audio lecture, slides and additional readings; and 2 days face-to-face training with presentations and a tabletop on outbreak response RR 177/156 (88) RR 177/156 (88) Rating statements Self-assessed skills
Araz O.M., 2012, USA, [26] University incident command, executive policy group, and emergency operations center. Influenza pandemic preparedness Collaboration between key
university leadership, federal, state and local health officials,
emergency response officials and key community stake
Table top exercise and computer simulation model 1 day Goals clearly stated 4 scenarios presented interactively and graphically; guided discussion; prompted decisionmaking; mixed-groups; feedback from a simulation model RR - Rating statements
Araz O.M. & Jehn M., 2013, USA, [27] Local stakeholders: school administrators; local health officers; school nurses; first responders; parents; large community businesses Invitations pandemic planning Table top exercise 1 day Goals clearly stated Mixed-groups; three scenarios; guided discussion of predefined questions and response in a group-setting; feedback from a simulation model. RR 177/156 (88) RR 177/156 (88) Self-assessed skills
Atack L., 2008, Canada, [28] Healthcare professionals, educators, coordinators and others Infection prevention and control n/a A model of continuing education (Cervero
(1985)) describing the complexity of knowledge transfer. Content
developed by ICP experts
Online course 3 modules using text, graphs, videos, quizzes and games RR 67/76 (88) RR 67/76 (88) Rating statements Knowledge test Naming examples of changed behavior
Atlas R.M., 2005, USA, [29] Medical students, practicing physicians and other healthcare professionals bioterrorism Several goals stated as examples Using standardized patients and patient simulators RR - Self-assessed attitude Self-assessed behavior
Baldwin K., 2005, USA, [30] In target group and on organizational level. Public health personnel multidisciplinary response to bioterrorism n/a Followed the template developed
by Columbia University School of Nursing &
College of Health Policy (2002); Collaboration between public health nursing administration and
faculty at a university school of nursing.
4 e-modules (series) On the intranet of a public health department RR 15/15 (100) Open ended question Knowledge test
CBS Bazeyo K.M., 2015, Uganda, [31] Health workers, immigration officers, customs and media. Selection Ebola surveillance, preparedness and response Professionals with experience in training delivery and on content. Training 5 days Stated specific per discipline, formulated as topics 6 border districts in Uganda; using mixed groups and participatory methods. RR 330/− (−) RR 330/− (−) Knowledge tests
Becker K.M., 2012, Ghana, Uganda, Nigeria, USA, [32] Midlevel public health leaders and frontline public health surveillance workers Recruitment Surveillance and response systems; laboratory networks Universities as host institutions Ministries of agriculture and veterinary schools together with ministries of health and public health training institutions during planning, development, and implementation In-service postgraduate program 2 years competency-based courses, not shown. General study goal stated on regional level. Mix of 25–35% classroom and 65–76% field-based training; interaction between public health and veterinary professionals. RR 43/43 (100) Summing up organizational achievements in two years
TOT Berrian A.M., 2018, USA, [33] Environmental monitor residents Professional skills & one health Study investigators. Based on inquiries from a biosecurity project, supported by theoretical underpinnings in constructivist learning and social cognitive theory; pilot tested first. Training-of-trainers (unclear methods) 4 weeks Objectives clearly stated. ‘workshops with unknown methods; Training delivery directly after the training. RR 10/10 (100) RR 10/10 (100) Knowledge test;
Self-assessed skills
Biddinger P.D., 2010, USA, [34] Health-care organizations
(30%), health departments (17%), emergency
management agencies (12%), fire departments (8%), law enforcement (6%), schools (6%), volunteer organizations
(6%), town administration (3%), federal government (3%), community health centers (2%), and other (7%)
Public health preparedness Conform the
Homeland Security Exercise and Evaluation Program
(HSEEP) and consistent with the principles of the
National Incident Management System.
38 guided, PHEP table-top, functional, drills, and full scale simulation exercises. Generally stated Interactive, multi-disciplinary, regional, and mixed-group methods. “Realistic to the greatest extent possible” Tabletops RR 1145/5892 (19.4); Tabletops RR 1145/5892 (19.4) Rating statements Knowledge tests;
Self-assessed attitude
Cathcart L.A., 2018, USA, [35] All new staff at a CDC State Coordination Task Force Mandatory Zika virus response ‘4 instructors’ The Division of State and Local Readiness
Applied Learning and Development
Team (ALDT) at the Centers for Disease
Control and Prevention (CDC); according to a just-in-time-training template.
Training < 2 days Clearly stated as competencies RR 120/120 (100) RR 120/120 (100) RR 59/120 (49) Rating statement Self-assessed skills Self-assessed behavior
Chandler T., 2008, USA, [36] Employees of local health departments Basic emergency preparedness training Local supervisors The CU-CPHP’s curriculum development; considering the options in blended learning literature. Online distance learning program; on-site agency-specific program. -; + 2 days on-site Competency-based Nationwide, on-site trainings in interaction with local organization & supervisor. RR 817/> 817 (−) RR 817/> 817 (−) Knowledge test;
Self-assessed knowledge;
Skills test
Supervisor’s evaluation
Chiu M., 2011, USA, [37] Public health nurses Disaster surge Competency-based, relies on adult learning principles Online and in-class training 50 h in 12 months Competency based 12 self-learning, online modules and one face-to-face interactive classroom session. RR 41–54/182 (23–30) RR 41–54/182 (23–30) Self-assessed skills
Craig A.T., 2007, Australia, [38] Emergency departments’ (ED) and regional health departments’ staff “required” Regional health departments’ pandemic early response Simulation exercise 3.5 h Stated on an organizational level Very realistic. Mimicking patients suspected for influenza admitted to EDs. RR - RR - Rating statement Self-assessed system performance
Dausey D.J., 2007, USA, [39] State and local health departments Emergency preparedness for manmade and naturally occurring biological threats Materials tested several times 31 Table-top exercises. 2–8 h Limited- active involvement of the facilitator. Shared common elements: evolving hypothetical scenarios, facilitated group discussions, collective decision making. RR 513/− (−) Exercise debriefing; internal team discussion;
open ended evaluating questions; after action reports.
CBS Dausey D.J., 2014, USA, [40] Training objectives were identified in previous exercises Selection by the exercise planning team. Experienced in training delivery and on content. Experienced team, based on the “Day After” methodology 12 Table-top exercise 1.5–4.5 h Objectives remain implicit - not stated. Outside the USA (a.o. Southeast Asia, Middle East, East Africa), in a multi-sectorial, sub-national, national and sub-regional setting.
All exercises included a presentation of the scenario, table-top exercise, guided discussion on 3–6 topics, decision making, and a debriefing.
RR −/558 (−) participants RR −/137 (−) observers Satisfaction & methodology Self-assessed knowledge;
Self-assessed attitude
Self-assessed behavior:
Reporting on ministry level whether learning had changed behavior
Dickmann P., 2016, Hong Kong, Poland, Sweden, Switzerland, UK, [41] Public health and communication
experts working at ECDC and the Commission of the European Union
Risk communication on preventions and control of communicable disease threats Extensive theoretical background on risk communication; team of risk communication experts convened by ECDC. Training program 2 days Clearly stated Input of participants for case-studies reflection sessions, discussions, exploration, testing, working on scenarios, feedback from others in small working groups RR 15/15 (100) RR 15/15 (100) Rating statements Self-assessed knowledge;
Self-assessed attitude
CBS El-Bahnasawy M.M., 2014, Egypt, [42] Young, military nursing staff, mainly unexperienced on the topic Infectious disease disasters at the Eastern Egyptian Border. Training In the Egyptian border region; − RR 125/− (−) RR 125/− (−) RR – (−) Satisfaction & methodology Knowledge tests
TOT Faass J., 2013, USA, [43] Yes Transit personnel Voluntary Training skills & H1N1 prevention in the transit industry Development based on previous trainings, new research and expert consultations. Training Half a day Presentation; 1,5 h webinar or train-the-trainer session; resource book and pamphlet RR 120/231 (52) Satisfaction Self-assessed attitude
Fowkes V., 2007, USA, [44] Educational needs assessment in each area. Health professionals practicing in medically underserved areas. Public health emergency preparedness in medically underserved areas Multi-disciplinary group of a faculty was trained to conduct the educational sessions; trainers were pharmacists, physicians, administrators, family physicians, and other. Based on the needs assessment,
the guidelines for core competencies (U.S. CDC), national guidelines from
the National Incident Management
System; expertise of medical directors, preparedness experts, program director and evaluator with academic experience in medical
Training 4–6 times 1 h Stated as competencies. multi-disciplinary, face-to-face trainings using presentations and case-studies. RR > 6000/9537 (> 62.9) Open ended question;
Rating statement
Self-assessed knowledge;
Self-assessed attitude
Fowkes V., 2010, USA, [45] Health professionals Self-selection & recruitment. Development and application of emergency plans Local health
professionals with interest and expertise in emergency
“Based on California’s guidelines for community clinic
emergency plans and resources from the Hospital Bioterrorism
Preparedness Program; the cal-PEN medical director
developed a scenario for two exercises”
90 table-tops Stated as competencies On-site locations in 18 counties; role play in disaster scenario, enacted, evaluated. RR 1176/1496 (78.6) RR 1176/1496 (78.6) RR 1176/1496 Rating statements Self-assessed knowledge; Observed skills   Check of operation plans in quarterly reports; assessment of the departments’ emergency plans;
reviewed AARs completed by the exercise groups;
Gershon R.R., 2010, USA, [46] Emergency medical services (EMS) personnel Mandatory, department-sponsored. Pandemic preparedness (routes of transmission, PPE use, control practices, seasonal vaccination) Trained EMS station officers Training 30 min Stated Small group-setting with presentation, demonstration and a drill. RR 129/− (−) RR 129/− (−) Rating statements Knowledge test;
Self-assessed knowledge
TOT Grillo M., 2017, [47] Military, medical doctors from developing countries. Military, international HIV Based on behavioral, social and cognitive learning, and international recommendations; in collaboration with military organizations. Training 4 weeks Clinical training, discussions, lectures RR 136/136 (100) RR 136/136 (100) Knowledge test
Hegle J., 2011, USA, [48] Federal, state and local health departments.   Surveillance Different exercises Implicitly stated On-site, with own colleagues; tabletops; seminars; functional exercises; workshops RR −/682 (−) AAR:Observation by at least 2 researchers using an observation guide;
semi-structured interviews with exercise leaders;
review of planning and exercise materials
Hoeppner M.M., 2010, USA, [49] A learning needs assessment Public health professionals at a university Application Emergency preparedness University staff Development by University of Minnesota School of Public Health based on learning needs; grounded in an educational model proposed by Benner. Education curriculum Months-years Stated as competencies “courses” RR 244/387 (63) Rating statements Self-assessed skills; Self-assessed attitude Self-assessed behavior
Horney J.A., 2005, USA, [50] Epidemiologist, public health nurses, health educators, health service manager/ -administrator/ -directors, environmental health employees. Free online Public health preparedness Regional PH
faculty and guest lecturers from PH schools, medicine, pharmacy, and government.
Developed by the lecturers and in line with the competencies E-modules 0.5–1 h Modules based on core competencies Lectures and slides RR 416/3030 (14) Rating statements Knowledge test; Self-assessed attitude
Hueston W.D., 2008, USA, [51] Public health and veterinary medicine schools University students Population health, primary prevention,
disease outbreaks
University staff Universities Joint degree program 2 years Classroom, laboratory, and clinical education. RR - Sharing lessons learned.
Johnson Y.J., 2009, USA, [52] Central, regional and local PH professionals, emergency management-, agricultural-, police-, and industry professionals. Food-borne terrorism outbreak Functional simulation exercise 2 days Clearly stated, on organizational and individual level Mixed groups of health- and non-health responders. Briefing, injects and interaction via a blog website RR - Rating statements Self-reported skills
Kohn S., 2010, USA, [53] Named as relevant; not performed Local public health departments Incident management system use “selected trainers” of the John Hopkins-Center for Public Health Preparedness By the Johns Hopkins Center for Public Health Preparedness very extensively described: out of quite sec NIMS, content was made PH specific. training 3–7 h From an organizational perspective. Face-to-face modules with presentations, slides, open book exam, interactive lecture materials, specific and attractive for the target group RR 213/− (−) Rating statements
Informal conversations with participants and trainers
TOT Livet M. 2005, USA, [54] Public health staff and community partners Development & implementation of a table-top exercise & emergency preparedness for local community capacity Academic experts & sponsors of the program. Training-of-trainers Three times a 2-day session. Testable & trainable goals 1) Presentations, interaction, exercises, motivational presentations; 2) lectures, case-studies, discussions; 2–3) delivery of own TTX; 3) active presenting and discussion. RR 67–70/80 (84–88) RR 67–70/80 (84–88) Self-assessed networking/ relationship building Self-assessed competence
Macario E., 2007, USA, [55] On an organizational level; not among participants Public health nurses and other health professionals Pandemic influenza Presenters: CDHS
Communicable Disease Control and Immunization
Branch public health medical officers and laboratory
research scientists, public affairs professionals. Local facilitator of the tabletop.
California Department
of Health Services and the California
Distance Learning Health Network
Table-top exercise 3,5 h divided over two sessions at the same day Stated as SMART goals derived from competencies Online lectures and tabletop exercise at the same day; on-site and with local partners. RR: broadcast 821/25000 (3.3)
RR: tabletop 164/− (−)
RR knowledge test: 735/25000 (2.9)
RR teleconference: 21/− (−)
Rating statements;
Telecall interviews after table-top
Knowledge test;
Telecall interviews after table-top on skills and confidence
CBS Martin G., 2018, Ireland, [56] Airport- &PH personnel, fire officers, police, health service responders Response to a plane with MERS-suspection on board. Exercise material reflected the WHO Simulation Guide. Simulation exercise   Organizational level Several areas on a local airport available: operation control center, passenger reception, real plane and runaway. RR - /> 200 observers (−) Satisfaction & Methodology
Mitka M., 2003, USA, [57] National, state and local health and safety officials Bioterrorism event in the metro Simulation exercise 5 days Implicitly stated City-wide exercise, on-site and with many partners RR - Participants’ comments
Morris J.G., 2012, USA, [58] 4 federal agencies, 9
state agencies, 6 universities, 1 nonprofit organization, and 1 private corporation
Invited Foodborne toxoplasmosis outbreak on college campuses Ad hoc planning
committee within a regional partnership of universities, public health agencies, affiliates, and foundations dedicated
to combating biologic threats
Tabletop exercise 2 days Stated as competencies 5 modules representing phases of the outbreak, multimedia depiction of simulated conditions, guided small-group discussions, plenary discussions. RR 22/− (−) Rating statements Self-assessed knowledge
Olson D., 2008, USA, [59] Yes, using a Delphi method Current and future public health workers ‘admitted’ bioterrorism and emergency readiness at a school of PH UMNSPH’s lifelong-learning model based on the Dreyfus model (Benner), and Spross & Lawson Education curriculum 17 h Competency-based curriculum RR −/1680 (−) RR - Testimonials Self-assessed knowledge (testimonials) Self-assessed behavior (testimonials)
TOT Orfaly R.A., Frances J.C., 2005, USA, [60] Community needs assessment Recruited based on their interest and experience in capacity building and public speaking. Delivery of
educational programs & public health preparedness
Public health directors for training. Based on a community needs assessment, and adult learning principles. Training   Objectives generally stated. 2-days training in training and monthly lectures thereafter on preparedness. Participants had to perform 3 own trainings of which 1 < 90 days after RR 21/21 (100) Satisfaction through interviews # Delivered trainings & # participants
Orfaly R.A., Biddinger P.D., 2005a, USA, [61] Students of the Master of Public Health Self-registered Bioterrorism preparedness and response Practicing emergency physicians +experts in disaster medicine or emergency preparedness and response. Based upon previously existing course, further adapted to serve as training. Course in the master of PH 7-weeks: 30 in class hours Core competencies stated during evaluation of the course, not as course goals Series of lectures (30 h) and a 2-day tabletop exercise RR 24/24 (100) Rating statements
TOT Otto J.L., 2010, USA, [62] Military PH emergency officers Influenza response Facilitators were “trained”. Based on organizational needs and policy, not tested. Table-top exercises Training objectives clearly stated. Table-tops with prepared questions, guided discussion, and a hot wash. Own table-top was expected afterwards RR 65/85 (76) RR 50/85 (59) Satisfaction & methodology through Likert scale questions and open questions Self-assessed new/revised planning; whether exercises were performed
Peddecord K.M., 2007, USA, [63] PH professionals Freely available online Mass vaccination service Produced by department of health services, a distance learning network and the center for disease control Online training 90 min 90 min online lecture, more specific methods unknown RR 520/> 1658 (< 31) RR 520/> 1658 (< 31) RR 291/> 1658 (< 18) Knowledge test;
Rating statements on attitude
Self-assessment of behavior with open ended questions
Potter M.A., 2005, USA, [64] Yes, unknown method Public health workforce of several counties Recruited Leadership in emergency preparedness and counter terrorism Based on an existing leadership curriculum Training curriculum A Year Stated on the organizational level Three conferences and a real-life project RR 28/28(100) Rating statements Self-assessed knowledge & skills
Quiram B.J., 2005, USA, [65] Physicians, veterinarians, epidemiologists, nurses, law enforcement personnel, emergency medical technicians, hospital safety officers, port authority personnel, bioterrorism planners and coordinators. 50% serves rural populations Emergency preparedness & response Experts on the topic from a variety of organizations. School of Rural Public health at Texas A&M University, CDC. Training 3 modules of 4,5; 2; 2 days, spread over several weeks Stated as competencies or concrete SMART tasks. Multi-methods, including presentations, simulation, table-top exercise, technical consultation and discussion RR −/167 (−) RR −/167 (−) Knowledge test
Qureshi K.A., 2004, USA, [66] PH nurses Recruited Emergency preparedness Columbia University faculty
members and School Health Program
staff, senior leadership from the
Developed in consultation
with the NYC–DOHMH School Health
Program administration; based on CDC’s
Emergency Preparedness Core Competencies
for All Public Health Workers.
Training 4 h Based on the basic public health emergency preparedness competencies Presentations and readables RR 678/764 (89) RR 678/764 (89) RR 230/764 (30) Rating statements Knowledge tests;
Self-assessed knowledge; Self-assessed attitude
Rega P.P., 2013, USA, [67] Students in the master of PH Pandemic preparedness and response Education & a table-top exercise Semester 1) education, 2) audio materials mimicking a growing pandemic. 3) Tabletop exercise, groups representing counties, group response. Second table-top was adapted based on feedback. RR - RR - Rating statements Self-assessed knowledge
CBS Richter J., 2005, USA, [68] Recruited per e-mail and telephone. Bioterrorism Selected on experience & responsibility. Newly developed by parties experienced on content Table-top exercise 2 days Training goals: interagency networking while assessing their training and research needs. At a cruise ship. Using presentations, guided-group discussion, small-group guided discussions, plenary presentations, networking. RR 32/50 (64) Satisfaction, Methodology Self-assessed knowledge
Rottman S.J., 2005, USA, [69] Inquiry of agency’s disaster plan and local emergency management policies are inquired. All levels of health department personnel. Disaster preparedness & response The Center for Public Health and Disasters as organizing company. Applied preparations per location: an interview at the department and profiling the community and the environment. Training & exercise 2 days Clearly stated competencies are used Interactive, scenario-based training sessions, Location & agency-specific training and 4 table-top exercises RR 403/− (−) RR 403/− (−) Knowledge test;
Self-reported knowledge
Sandstrom B.E., 2014, Sweden, [70] Emergency board personnel from a wide range of functions, PH personnel CBRN emergencies Adequate emergency
management experience, fully prepared and
comfortable in their position
Iterative process of application and adaptation to a local homogeneous, national mixed and international mixed setting. Table-top exercise Using exercise cards to walk participant through the scenario. Led to different possible outcomes of the scenario. RR n/a Observation of the exercises;
Evaluation seminars
Sarpy S.A., 2005, USA, [71] A needs analysis Representatives from the Arkansas department of health and external partner agencies Response to a SARS event Local physician with an advanced degree
in PH, expertise in facilitating
small group discussion, knowledge of the
local healthcare system. The expert in SARS presented
the pre-tabletop lecture, is an international authority on SARS, with hands-on experience.
to the SCCPHP training systems model; Centers for Disease Control and
Prevention core competencies for emergency preparedness
and response and input from practice partners
Tabletop exercise Half a day Objectives based on competencies which were identified in the needs assessment 1) Lecture; 2) 3.5-h tabletop in 7–10 p groups where 3 scenarios were discussed (first individually, then discussion of answers, group decision, plenary presentation and discussion). Tricks to enhance realism: first ambiguity in case, participants became infected, authentic contextual factors integrated, 30-day time frame, info on a day-to-day basis. RR 49/49 (100) RR 44/49 (90) Rating statements;
Open ended questions
Self-assessed skills;
Self-assessed knowledge;
Self-assessed attitude
Savoia E., 2009, USA, [72] Local-, regional-, and state-level professionals
from a variety of disciplines such as public health, law,
health care, public safety, and emergency management.
Legal preparedness An expert
knowledgeable on PH infrastructure
of the geographical area being tested
program guidance provided by the Association of State and
Territorial Health Officials
Tabletop exercise Stated as competencies within the text Presentations, three exercise modules, guided small-group discussions, mixed groups from same/ neighboring communities RR 56/89 (63) RR 56/89 (63) Knowledge test;
Self-assessed attitude
Savoia E., 2013, USA, [73] Public health officials and emergency responders with experience in emergency preparedness exercises A convenience sample PHEP&R Opinions from 61 public health officials and emergency responders were systematically gathered and analyzed Consensus method on the use of exercises and AARs. Clearly stated questions Consensus method RR - Group discussion developing lists of recommendations
TOT Soeters H.M., 2018, Guinea & USA, [74] Infection prevention and control trainers; frontline healthcare workers at health centers. Conducting needs assessments & Regional infection prevention; PH ministry, WHO and CDC. Training 3–4 days training-of-trainers; subsequent 2 days training delivery Training objectives stated During the Ebola epidemic, at an health center, training delivery directly after the TOT. Program: 55% didactic methods, 45% hands-on training with practice, demonstration and technical assistance. RR 1625/1625 (100) RR 1625/1625 (100) Knowledge test;
demonstration of skills
Taylor J.L., 2005, USA, [75] A broad selection of public health staff and emergency services Recruited during two conferences Pandemic influenza preparedness Collaborative effort between
DHMH, the Maryland Partnership for Prevention,
and a group of outside consultants.
Tabletop exercise 4 h Stated on an organizational level. 1) two introductory presentations, 2) 9 scripts on 1 outbreak were presented, 3) individual response 4) group discussion 5) joint action.
Each participant was allowed
to bring up to two additional experts for consultation
on an as-needed basis.
RR 69/150 (46) Self-assessed attitude by comments and written evaluations
Umble K.E., 2000, USA, [76] Trained in nursing, clinical or managerial duties, and worked for a state, city, or
county public health agency
Vaccine-preventable diseases With the help of instructional and graphic
Traditional classroom vs. distance education 14 h Stated as a single course goal RR 196/470 (41.7) for classroom
RR 116/251 (46.2) for broadcast
RR 196/470 (41.7) for classroom
RR 116/251 (46.2) for broadcast
RR 196/470 (41.7) for classroom
RR 116/251 (46.2) for broadcast
Knowledge test;
Self-assessed attitude;
Self-assessed skills;
Waltz E.C., 2010, USA, [77] PH professionals in New York State Differed among and within used methodologies Preparedness training University of Arkansas center for public health preparedness staff members 3 education technologies: audience response systems, satellite broadcast and interactive web-based continuing education courses in public health. Audience response systems, satellite broadcast and interactive web-based continuing education courses in public health. ARS RR 93/93 (100);
Satellite broadcast RR none;
Web-based education RR 20.000/44.000 (48)
# views
Wang C., 2008, China, [78] On individual and organizational level; TNA is part of the public health leadership model referred to. Public health leaders Emergency response Selected on their expertise in the field of PH emergency response, related training programs and involvement in continuous consultations on health service programs. Training developed according to the public health leadership model on development, delivering and evaluating training. Mixed-methods leadership training 14 days Clearly stated as competencies Mixed-methods RR 41/43 (95) RR 41/43 (95) RR 41/43 (95) Rating statements Knowledge test;
Self-assessed skills
Wang C., 2008a, China, [79] Public health staff at centers for disease control and prevention in 18 cities Emergency preparedness Based
on their expertise, from the MOH,
WHO, Chinese CDC, Health Department of Hubei
Province, Fudan University, Wuhan University and
Huazhong University of Science and Technology
Based on the aims Training Aims designed
by experts, based on competencies, stated as topics
Case-studies, workshops, tutorials, seminars, group discussions, role playing, drilling and fieldwork. Least used method was formal lecture. RR 76/78 (97) RR 76/78 (97) RR - Rating statements Knowledge test;
Self-assessed skills
Wang C., 2010, China, [80] Yes Public health staff in rural centers for disease control Emergency preparedness From MOH, WHO, Chinese CDC, Wuhan
University and Huazhong University of Science and Technology.
selected based on expertise in the field of
Public health emergency response
According to an integrated instructional design system
model (Fig. 1), which emphasizes the major components of
instructional design, including assessing, designing, delivering and evaluating training.
Training Using core competencies, Case-studies, workshops, tutorials, seminars, group discussions, role playing, drilling and fieldwork. Least used method was formal lecture. RR 226/237 (95) RR 226/237 (95) RR - Rating statements Knowledge test;
Self-assessed skills
Yamada S., 2007, Hawaii, [81] Physicians, nurses, public health workers, hospital administrators, lab workers, radiology technicians, medical records clerks, pharmacy workers, cancer registrars and dental assistant, and other. Response to unknown agents Trained in-country personnel on PBL
in PBL tutoring skills,
education and training.
At the University of Hawai‘i, by the Pacific Bioterrorism
Curriculum Development Project,
Based on the
principles of and experience with PBL,
community-based, and interdisciplinary training.
Education Several meetings/ working groups Interdisciplinary problem-based, guided discussion of a case, lists of problem, discovery learning in groups, presentations and discussion. RR 85/− (−) Rating statements;
Interviews with participants
Yellowlees P., 2007, USA, [82] State and county health officials Mass prophylaxis delivery n/a Based on an assessment of normal work flows and surroundings, by authors and the help of a graphical artist Virtual reality training 2 h -, each participant had their own objectives Virtual reality pilot: the SecondLife game environment with participants for introduction/guided tour and taking up virtual tasks like reception, screening, examination, and dispensing. RR 13/25 (52) Rating statements;
Open ended questions
  1. Variables include characteristics of context, input, process and eveluation. RR = response rate; TOT = training-of-trainers; CBS = cross-border setting; − = no information available; EMS = emergency medical service, PPE = personal protective equipment; PH = public health; # = ‘the number of’