Table 1 Baseline characteristics of the included studies

–

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

holders.

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

education.

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

preparedness.

“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

NYC–DOHMH

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.

According

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

Using

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

designers

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)

–

Survey;

# 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

–

–

–