Pandemic ready or playing catch-up? A scoping review of public health training programs for pandemic preparedness and response efforts

Abstract

Background

The COVID-19 pandemic underscored the urgent need for scalable, adaptable training programs to support public health preparedness and response. While many training initiatives emerged globally, their effectiveness, sustainability, and relevance to community needs remain uneven. This scoping review characterizes the landscape of pandemic-related training programs and identifies barriers, facilitators, and gaps in preparedness education for public health professionals, community-based organizations (CBOs), and frontline responders.

Methods

We conducted a scoping review of English-language peer-reviewed articles published between 2005 and 2023. Using the Consolidated Framework for Implementation Research (CFIR) to guide data extraction and thematic synthesis, we examined training programs focused on pandemic preparedness, including design, delivery, implementation processes, and evaluation strategies.

Results

Thirty-eight studies met inclusion criteria. Training programs varied in scope, format, and target populations, with most focused on COVID-19 and conducted in low- and middle-income countries. Programs commonly emphasized contact tracing, epidemiology, surveillance, and community engagement. While virtual formats increased accessibility, participants often preferred in-person, interactive learning. Facilitators were associated with perceived success included strong partnerships, culturally tailored materials, and improvement through feedback, while barriers were associated with program challenges included limited infrastructure, unclear learning objectives, lack of sustained funding, and inadequate evaluation. Most programs were reactive and short-term, with minimal input from community stakeholders. Trust, equity, and cultural responsiveness emerged as central themes.

Conclusions

Preparedness training programs remain fragmented and overly reliant on crisis-driven implementation. Future programs would benefit from prioritizing sustained investment, co-design with community partners, and use of validated frameworks like CFIR to guide development and evaluation. Strengthening the capacity of CBOs and embedding preparedness within trusted community networks are essential to building equitable and resilient public health systems.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-026-27090-0.

Introduction

The COVID-19 pandemic revealed significant shortcomings in public health preparedness and response, particularly in the ability to rapidly train and activate a skilled and adaptable workforce. Across the United States and globally, health departments struggled to scale core public health functions due to burdensome employment onboarding processes, insufficient training infrastructure, inconsistent protocols, and workforce shortages [1, 2]. One highly visible example was the implementation of contact tracing and case investigation (CT/CI), a cornerstone of infectious disease control [3]. Although CT/CI was already embedded in most response frameworks, agencies were often unprepared to train or manage the surge in personnel required to control viral spread [1, 4, 5, 6]. These challenges underscored a broader issue: the need for robust, context-sensitive training programs that can be quickly adapted and scaled during public health emergencies.

As the pandemic evolved, local health departments (LHDs) and regional health ministries reassigned personnel, partnered with academic institutions, and enlisted volunteers, including school nurses and students, to support CT/CI efforts. Some states outsourced workforce expansion to private vendors. National training initiatives emerged to support onboarding, including online courses from Johns Hopkins University and the “Making Contact” program launched by the Association of State and Territorial Health Officials (ASTHO). While these efforts reached tens of thousands of learners, they were often hampered by shifting public health guidelines, evolving scientific understanding, a lack of standardized curricula or evidence-based best practices, and the limited availability of multilingual informational materials and staff [1, 4, 5, 6, 7–9, 10]. The transition to remote learning formats, prompted by stay-at-home orders, introduced further challenges for oversight, supervision, and staff coordination [7]. Taken together, these challenges, along with many others, may have worked synergistically to undermine trust and reduce participation in public health efforts [10].

Beyond CT/CI, the pandemic highlighted the importance of a wide array of training domains, including risk communication, outbreak surveillance, data analysis, and public health leadership [4, 11, 12]. Many of the revealed gaps hindered timely responses to the immense threat posed by SARS-CoV-2, which thwarted efforts to prevent the viral outbreak from reaching pandemic status. Recent experiences from the COVID-19 pandemic underscore the need for sustainable workforce readiness. To better equip communities and LHDs to handle future public health emergencies, we must evaluate existing training programs and identify opportunities for improvement. To support this effort, our team conducted a scoping review of pandemic-related training programs and curricula. The purpose of this review is to characterize the types of training documented in the literature and to identify gaps in the education of public health professionals and community members. These insights may inform future efforts to prepare for, respond to, and recover from pandemics and viral outbreaks via more resilient and equitable training systems.

The Consolidated Framework for Implementation Research (CFIR) [13] guided our analysis. CFIR is a widely used model for examining the implementation of complex interventions. The framework includes five domains: Intervention Characteristics, Outer Setting, Inner Setting, Characteristics of Individuals, and Implementation Process. Applying the CFIR allowed us to assess how training programs were designed, delivered, and adapted across different contexts. By mapping findings to this framework, we identify factors that facilitated or hindered training program implementation, thereby informing future workforce development and pandemic preparedness strategies.

Methods

The methodological process for conducting this scoping review was guided by the six-step framework outlined by Mak and Thomas [14], which builds on the foundational work of Arksey and O’Malley [15] and subsequent enhancements by the Joanna Briggs Institute (JBI) [16]. The six steps include: (1) identifying a research question; (2) identifying relevant studies; (3) selecting studies for inclusion in the review; (4) charting the data; (5) collating, summarizing, and reporting the results; and (6) consulting stakeholders [17]. The stakeholder consultation was completed as part of individual interviews for an earlier phase of the study, where community members and representatives from LHDs answered questions on contact tracing and case investigation, with a particular focus on training community-based organizations to lead the process. Results from those interviews informed the direction of the scoping review, including the framework selection. To ensure transparent and comprehensive reporting, we also adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. PRISMA-ScR served as a reporting framework rather than a methodological guide, allowing us to structure the review process and findings clearly and consistently.

This scoping review was guided by two research questions: (1) What types of training programs have been developed, implemented, and evaluated to support public health preparedness and response to pandemics? And (2) What are the common barriers to and facilitators of the development and implementation of pandemic public health training programs?

The first question informed study selection by focusing on literature describing training programs or curricula for outbreak and pandemic preparedness and response. It also guided data extraction by identifying key elements such as program type, training setting, target audience, and mode of delivery. The second question guided the inclusion of implementation constructs, including barriers, facilitators, and contextual factors, in data extraction. Together, these questions ensured that both the scope of included studies and the extracted data addressed important program characteristics and implementation considerations.

Identifying relevant studies

Articles included in the review were published between 2005 and 2023. This time frame captures training programs developed across multiple major infectious disease outbreaks, including those preceding and during the COVID-19 pandemic. The team collaborated with a librarian to devise a search strategy to identify articles for the review. Electronic searches were performed using PubMed, Google Scholar, and EBSCOhost. The following keywords and phrases were used to develop a search string to identify articles within the databases: pandemic, outbreak, COVID-19, curriculum, program, training, and contact tracing. Articles for this review were also sourced through reference lists and MeSH terms to ensure comprehensive literature coverage. Additionally, our team searched for training programs within CDC TRAIN, a national learning network offering training opportunities to public health professionals. More information regarding the search strategy, including keywords, phrases, and MeSH Terms used in PubMed, is provided in Supplementary File A. Public health programs refer to population level, preventive, and community-oriented efforts aimed at disease prevention, surveillance, health promotion, and emergency response, distinct from individualized, curative, or hospital-based care. Covidence, a web-based software platform, was used to streamline the scoping review process and remove duplicates.

Inclusion criteria/exclusion criteria

The inclusion and exclusion criteria for this scoping review were structured using the PCC (Population, Concept, Context) framework.

Population

We included studies describing or evaluating training programs targeting public health professionals, community-based organizations (CBOs), frontline health workers (e.g., nurses, physicians, community health workers), or students preparing for public health roles. Studies without a public health preparedness component were excluded.

Concept

We included articles that described, implemented, or evaluated training programs or curricula related to infectious disease outbreak preparedness and response. This included training in contact tracing, case investigation, epidemiology, surveillance, risk communication, vaccine education, and emergency response. Articles were excluded if they did not describe or evaluate a formal training program, or if the focus was on policy, healthcare infrastructure, or clinical treatment without a training component.

Context

We included studies conducted in the context of pandemic or epidemic preparedness and response across all global regions. The training programs could be delivered in-person, virtually, or via hybrid models. Only peer-reviewed articles published in English between 2005 and 2023 were included. Editorials, commentaries, conference abstracts, and non-English publications were excluded.

Articles were eligible for inclusion in the scoping review if they focused on the development, implementation, evaluation, or refinement of a training program or curriculum responding to or addressing viral outbreaks. In addition to formal training programs, articles could also focus on toolkits, webinars, seminars, or workshops providing strategies for pandemic response or viral outbreaks. Articles were excluded if they were editorials, letters, commentaries, or not published in English.

Selecting articles for the scoping review (screening process)

The screening process consisted of three consecutive phases: title review, abstract review, and full text screening. During each phase, articles were evaluated by two members of the team. If both team members agreed, articles either advanced to the next phase or were excluded from the review. If the team members disagreed, a resolution was obtained through discussion. A third reviewer was brought in to resolve disagreements when needed.

Charting data

After the final articles for inclusion were identified, the team developed a data extraction form in the web-based platform, Covidence [18], based on the five domains of the CFIR Framework. Innovation Characteristics captured attributes of the training or curriculum. This included the training title, the article’s primary focus (e.g., development, implementation, evaluation, adaptation, update, or descriptive overview), the training’s purpose (preparedness, response, or recovery), disease focus, format, and topics covered. The Outer Setting focused on external factors influencing implementation, such as the timing of training, location of training, and whether the training was conducted virtually. Inner Setting addressed organizational features related to training implementation. This included the organizations or agencies responsible for the training, collaborators and partners, training facilitators, in-person training locations, the presence of steering committees, and training cost. Individual Characteristics captured information about the participants in the training program. Lastly, The Implementation Process captured activities used for implementing training, such as prerequisites, training duration, number of modules or sessions, inclusion of skill-building exercises, certificate issuance, and whether the training was evaluated. To ensure reliability, the extraction form was piloted by two team members who independently reviewed 10 eligible articles. After discussing challenges and resolving discrepancies, they refined the form used to extract information from the remaining articles.

We selected CFIR because it is a widely used and comprehensive framework that facilitates the structured analysis of complex interventions across multiple contexts. Additionally, findings from stakeholder interviews suggested that some of the greatest challenges with successfully implementing programs focused on containing viral outbreaks could be well captured and articulated using CFIR. Compared to alternative frameworks that focus narrowly on process or outcomes, CFIR provides flexibility to examine intervention characteristics, organizational context, and individual-level factors. The five domains provide a useful organizing structure for analyzing implementation factors across diverse training programs. In particular, CFIR enabled us to systematically identify and categorize barriers and facilitators related to program design (Intervention Characteristics), setting (Outer and Inner Setting), participant characteristics, and implementation processes.

Collating, summarizing, and reporting results

We undertook an iterative multi-stage process to organize, synthesize, and interpret extracted data. Following completion of data charting, two reviewers independently reviewed the extracted material to identify consistencies, divergences, and patterns across studies. We applied both deductive coding (guided by the CFIR framework) and inductive coding to capture concepts that emerged organically from the dataset. Codes were compared, reconciled, and refined through team discussion. Related codes were then grouped into analytic categories, which were subsequently organized within the CFIR domains to support conceptual clarity and comparability across studies.

The analytic process is summarized in Table 1, which outlines each procedural step, its purpose, and its outputs.

Table 1.

Analytic process and coding workflow

Step	Purpose	Activities Conducted	Outputs Produced
Familiarization With Extracted Data	To understand the full breadth of extracted information	Reviewers independently read all extracted data fields, made initial notes, and discussed overall impressions	Reviewer memos; shared understanding of dataset
Development of Initial Code Set	To generate a structured coding system aligned with the review purpose	Applied CFIR-aligned deductive codes; added inductive codes to capture emergent concepts not represented in CFIR categories	Preliminary codebook with deductive and inductive codes
Independent Coding of Extracted Data	To ensure systematic and consistent application of the coding framework	Two reviewers independently coded all extracted items using the preliminary codebook	Coded dataset; documentation of discrepancies
Code Reconciliation & Refinement	To improve code clarity, reduce redundancy, and resolve discrepancies	Reviewers compared coding decisions, resolved inconsistencies, merged overlapping codes, and refined definitions	Finalized codebook; updated coding structure
Collation of Codes into Higher-Level Categories	To identify meaningful clusters of related concepts	Codes were grouped into categories aligned with CFIR domains (Intervention Characteristics, Outer Setting, Inner Setting, Individual Characteristics, Implementation Process)	Analytic categories mapped to CFIR
Thematic Pattern Identification	To derive analytic insights and patterns across findings	Team reviewed category clusters to note patterns, relationships, and conceptual gaps	Thematic scaffolding (fully developed in Results section)

Results

We initially identified 695 articles through the literature search. Of these, 484 were excluded during title screening, leaving 210 articles. During abstract screening, three articles were excluded for not being available in English, and 168 were excluded for not meeting the inclusion criteria. Ultimately, 38 articles were included in the scoping review (Fig. 1).

Fig. 1.

PRISMA flow diagram of study selection

Although the results are organized thematically for clarity, each theme is explicitly aligned with its corresponding CFIR domain, as mapped in Table 2, to link our findings with the implementation science framework.

Table 2.

Training barriers and facilitators organized by CFIR domains

Domains	Barriers	Facilitators
Intervention Characteristics	• Facilitators struggled to clearly define the curriculum and learning objectives • Training was lecture style rather than hands on and interactive • Participants preferred in person training rather than virtual formats	• Virtual training formats improved accessibility and broadened participant reach • Interactive elements like role-playing enhanced engagement • Training courses were offered in multiple languages • Supplemental materials, such as toolkits and visual aids, supported learning • Flexibility of training
Outer Setting	• Large-scale unanticipated events such as war-impacted training delivery • Public health recommendations were evolving impacting policies and laws • Frequently changing information impacted the accuracy and relevance of training materials • Limited access to essential health services hindered ability to support training participants	• Community partnerships supported participant recruitment, training expansion, and health information dissemination • Collaboration among academic institutions, public health agencies, and community organizations guided training topic selection and development • Connections with government and health agencies provided access to resources, including training locations and funding
Inner Setting	• Staffing shortages made it difficult to train large numbers of people quickly • Technology related barriers included a lack of stable internet and malfunctioning equipment • Organizations lacked sufficient funding to implement and sustain the training	• Use an implementation checklist to ensure training accuracy • Streamline onboarding to improve training efficiency • Deliver in-person training at convenient locations • Fostered collaboration by establishing a safe and engaging environment • Engagement with partners and stakeholders allows for clear communication surrounding the development and implementation of training
Individual Characteristics	• Participants reported visual impairments, language barriers, and limited technological literacy • There were also barriers related to participant capacity including training fatigue, low motivation, limited time and competing responsibilities • Participants were hesitant to perform clinical tasks during training given they were only authorized due to the urgency of virus mitigation • There was also disbelief in the virus and vaccine hesitancy which was fueled by media • Cultural stigma and mistrust of research institutions impacted receptiveness to the training	• Leveraged senior staff champions to support implementation
Implementation Process	• Lack of robust data collection and systematic evaluation of participant behavior change • Challenges around adapting and modifying training for better integration into work processes • Scalability and effectiveness were limited because of the reliance on classroom-based instruction	• Collaborate with partners to brainstorm and assess training needs • Incorporating evaluation tools and feedback mechanisms throughout the training process supported skill retention and helped to identify implementation challenges • Require participants to create presentations, policy briefs, or publications for community knowledge translation

Barriers and facilitators to training implementation

The thematic analysis yielded a cross-cutting set of barriers and facilitators within each CFIR domain. These are summarized in Table 2, which provides an overview of barriers and facilitators mapped to the five CFIR domains (Intervention Characteristics, Outer Setting, Inner Setting, Individual Characteristics, and Implementation Process). These determinants emerged consistently across the included studies and informed the structure of the Results narrative that follows.

Characteristics of the studies

The characteristics of the public health preparedness training programs and exercises identified in the review are presented in Table 3. While most focused on COVID-19, other infectious diseases were also represented, including Ebola, Zika, Influenza, Hepatitis, SARS, and sexually transmitted infections, including HIV. Additionally, six articles described training programs aimed at broadly addressing viral or disease outbreaks without focusing on a specific pathogen. Additional information can be found in the supplemental file (Supplemental File A).

Table 3.

Summary of training/curriculum characteristics

	Frequency	References
Innovation: Focuses on attributes of the training/curriculums in the articles
How many articles in the scoping review focused on the following  Note: Some articles focused on more than one
Development of a training/curriculum	13	[11, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30]
Implementation of a training/curriculum	17	[2, 11, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36]
Evaluation of a training/curriculum	22	[6, 11, 21, 25, 26, 27, 28, 29, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47]
Description of a training/curriculum	21	[2, 6, 10, 11, 20, 21, 23, 24, 27, 31, 33, 36, 43, 44, 45, 46, 47, 48, 49, 50, 51]
Update of a training/curriculum	3	[30, 48, 52]
Adaption of a training/curriculum	6	[10, 32, 36, 47, 48, 49]
Disease focus:
COVID-19	21	[6, 10, 11, 21, 22, 24, 26, 27, 29, 32, 34, 35, 37, 38, 40, 41, 44, 48, 49, 51, 52]
Ebola	4	[2, 19, 25, 45]
HIV	2	[23, 42]
Zika	2	[20, 31]
Hepatitis	1	[39]
SARS	1	[28]
Not Disease Specific	7	[30, 33, 36, 43, 46, 47, 50]
Training Formats:  Note: Some training included more than one training format
In-Person	20	[2, 22, 23, 25, 26, 28, 29, 31, 32, 33, 34, 36, 39, 40, 42, 43, 46, 47, 48, 50]
Virtual Workshops	12	[6, 10, 11, 19, 21, 27, 29, 41, 44, 47, 48,52]
Online Module	12	[10, 11, 19, 20, 21, 24, 26, 29, 41, 44, 45, 47]
Hybrid	7	[29, 30, 32, 35, 37, 38, 49]
Delivery mode:  Note: Some training courses conducted in real-time and include recording from previous training.
Conducted in real-time	37	[2, 6, 10, 11, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36,37, 38, 39, 40, 41, 42, 43, 44, 46, 47, 48, 49, 50, 51, 52]
Conducted in real-time and includes recording from previous training.	4	[24, 41, 44, 47]
Unclear	1	[45]
Training Topics
Contact Tracing only	4	[2, 21, 37, 38]
Case Investigation only	1	[49]
Both CT & CI	10	[6, 10, 11, 24, 25, 30, 40, 44, 47, 51]
Additional Topics	36	[2, 6, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52]
Outer Settings: Factors external to the program that influenced implementation
Country or City of Implementation:  *2 had multiple regions
USA	12	[6, 10, 11, 20, 21, 24, 27, 28, 40, 43, 44, 52]
Sub-Sharan Africa	11	[2, 19, 25, 29, 30, 32, 33, 35, 45, 46, 50]
South and Southeast Asia	9	[22, 27, 36, 37, 38, 39, 42, 48, 49]
Caribbean and Latin America	3	[23, 31, 34]
Portugal	1	[51]
Australia	1	[26]
Yemen	1	[47]
Year training was created
Before COVID-19 pandemic	18	[2, 10, 19, 20, 23, 25 ,28, 30, 31, 33, 38, 39, 42, 43, 45, 46, 47, 50]
After COVID-19 was determined a pandemic	16	[6, 11, 21, 22, 24, 26, 27, 29, 34, 35, 41, 44, 48, 49, 51, 52]
Creation date not specified	4	[32, 36, 37, 40]
Inner Settings: Organizational features related to implementation
Training created by:
Public Health Department/Health Ministry	12	[21, 25, 26, 32, 33, 40, 41, 43, 46, 47, 49, 50]
Academic Institution or Research Team	13	[2, 10, 11, 19, 22, 27, 29, 30, 36, 39, 44, 51, 52]
Non-profit organization	3	[24, 34, 48]
Collaborations between multiple groups and agencies	9	[20, 23, 28, 31, 35, 37, 39, 42, 45]
Training implemented by:
Health experts/staff	14	[2, 10, 11, 21, 25, 27, 31, 33, 34, 46, 47, 48, 51, 52]
Medical professionals	6	[22, 23, 28, 37, 43, 49]
Self-guided	6	[19, 20, 35, 39, 41, 45]
Not specified	12	[6, 24, 26, 29, 30, 32, 36, 38, 40, 42, 44, 50]
Training Cost
Training/curriculums with an associated cost	3	[30, 33, 49]
Steering Committee
Steering committee involved in development of the training	7	[11, 23, 26, 28, 47, 49, 50]
Individual Characteristics: Target Audience
Target audience:  Note: Some studies targeted more than one audience
Frontline health workers/Public Health Professional	27	[19, 20, 21, 22, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 39, 41, 42, 43, 45, 46, 47, 49, 51, 52]
Students	7	[6, 10, 23, 37, 38, 44, 50]
Civil servants/community members	6	[2, 11, 24, 40, 48, 52]
Process: Implementation Steps and logistics
Pre-requisites required	17	[2, 10, 23, 26, 33, 34, 35, 36, 38, 39, 40, 42, 43, 45, 46, 49, 50]
Average number of training units’/modules/ sessions	4/5 modules
Training/curriculums evaluated	30	[6, 11, 19, 20, 21, 23, 24, 25, 26, 27, 28, 29, 30, 32, 33, 35, 36, 37, 38, 39, 40, 41, 42, 43, 45, 46, 47, 50, 51, 52]
Number of articles that incorporated skills exercises in training	26	[6, 10, 11, 19, 20, 21, 22, 23, 24, 25, 27, 28, 29, 30, 32, 33, 35, 37, 38, 39, 42, 43, 45, 47, 48, 51]
Barriers
Number of articles that reported barriers to implementation	28	[2, 6, 11, 21, 22, 23, 24, 26, 27, 29, 30, 31, 32, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 45, 47, 48, 49, 50]

Scope and distribution of training programs

Findings in this subsection reflect influences consistent with both the Outer Setting (community context, environmental conditions) and Inner Setting (organizational structures supporting or constraining implementation).

Most articles focused on trainings conducted outside the USA with geographic coverage spanning across Africa, Southeast Asia, the Caribbean, South America, and Oceania. Notably, most of the articles were published after the onset of the COVID-19 pandemic. Articles predominantly focused on the development, implementation, or evaluation of a training program or exercise. Some articles provided an update or adaptation of an existing training, while the remainder provided a description of a completed training.

Training programs and exercises were developed by national health departments or ministries of health, state and local public health agencies and centers, academic institutions and researchers, nonprofit organizations, or through collaborations between government agencies, international public health organizations, and academic institutions.

Most training programs were reactive and developed in response to acute crises, often without mechanisms for long-term sustainability. A smaller number represented institutionalized training models integrated into broader workforce development. While many programs focused on workforce training, only a few incorporated community members or leaders.

Training content and delivery approaches

The findings in this section correspond to the Innovation domain, which captures features of training format, content, and modality as well as Individual Characteristics relating to the target audience for the training.

The training programs primarily targeted frontline healthcare workers (e.g., nurses, physicians, and pharmacists), public health professionals (e.g., community health workers, health inspectors, staff within health departments and health ministries), and students enrolled in medical or public health academic programs. Only five articles described programs that included participants with little to no public health or healthcare background.

The training programs and exercises covered a wide range of topics related to viral outbreaks. A substantial portion reported training programs focusing on CT/CI. These programs typically included educating participants on interviewing techniques and the processes of CT/CI. Some trainings also addressed topics such as epidemiology and disease surveillance. Field epidemiology training programs expanded on these areas by incorporating research methods, data collection, and scientific writing.

Most trainings included components aimed at educating participants about specific infectious diseases (e.g., HIV, COVID-19, Ebola, Zika), their modes of transmission, and prevention strategies. Several programs focused on vaccine-related knowledge, specifically vaccine development and their risks and benefits. Other trainings emphasized community engagement and effective communication with community members. Some trainings focused on disaster preparedness and emergency response more generally. These trainings often covered how to develop emergency plans, collaborate with other agencies, and build organizational capacity for preparedness.

The majority of trainings were in-person, with smaller numbers implemented in virtual formats or using hybrid approaches. The virtual formats included online modules, virtual reality simulations, and asynchronous delivery methods [11, 24, 27, 29, 32, 41]. When examining the facilitating factors related to the training programs, participants reported these formats were user-friendly and flexible, which contributed to their effectiveness. Virtual formats also enabled broad reach, allowing participation across diverse geographical locations.

Hands-on experiences and interactive elements, such as role-playing, were also found to be engaging, helpful, and enjoyable [37]. Supplemental resources, such as toolkits, visual aids, and videos, were also highlighted as valuable components that enhanced the training experience [43, 45]. One study noted the ability to adapt and customize training to meet the specific needs of clinic staff and participants as a key factor in making the training relevant and impactful [43]. Ensuring that materials were available in the languages spoken by both trainers and participants was identified as an important facilitator of successful implementation [21]. Several trainings also demonstrated the value of flexible delivery formats, and some provided materials in multiple languages, both of which facilitated learner engagement and accessibility.

Partnerships and system level influences

Themes described here align with the Outer Setting domain, reflecting community partnerships, inter-organizational relationships, and challenges within the broader community context. Community factors also influenced training implementation. Strong partnerships and collaborations were key facilitators of the development and implementation of training programs [19, 20, 27, 28, 34, 35, 36, 45, 47, 48]. Authors emphasized the importance of connections with academic institutions, government health agencies and ministries, and international health networks. These partnerships were essential for identifying relevant training topics, promoting training within communities, securing funding for development and implementation, and ensuring the training was responsive to community needs. Community partnerships also facilitated participant recruitment, training expansion, and dissemination.

Several barriers emerged at the community level. One major challenge was the occurrence of critical incidents: large-scale, unanticipated events that disrupted training delivery. Armed conflict sometimes created instability and safety risks, complicating implementation and participation [47]. Barriers also arose from policies and laws, particularly those tied to evolving public health recommendations [21]. Frequently changing information about the pandemic led to constant revisions in guidance, compromising the accuracy and relevance of training materials [21, 24, 31, 34]. In response, facilitators and participants had to adapt to meet community needs amid shifting conditions [31]. Finally, local and environmental conditions posed additional challenges. Limited access to essential health services within the broader community hindered the ability to support training participants who lacked needed treatment and support [31].

Participant engagement and individual-level factors

The findings below correspond to the Individual Characteristics domain, including trainee motivation, personal capacity, beliefs, and individual barriers. Training recipients reported a range of challenges that affected participation and engagement. These challenges included visual impairments, language barriers, and limited technological literacy [26, 27, 41]. Many participants experienced training fatigue, low motivation, limited time, and competing responsibilities, all of which negatively impacted engagement. [6, 21, 22, 27, 36, 37, 38, 40, 41, 45, 48]. Some participants expressed hesitation about performing clinical tasks introduced in the training, knowing they were only temporarily authorized due to the urgency of virus mitigation [26]. Beyond these practical concerns, disbelief in the virus and vaccine hesitancy, often fueled by media narratives, further hindered participation [26, 34]. Cultural stigma and mistrust of research institutions also reduced receptiveness to the training [31, 34, 40].

On the positive side, several studies found programs that leveraged senior staff champions to support implementation observed improved trainee confidence, motivation, and engagement.

Implementation strategies and organizational context

The facilitators and challenges described in this subsection map onto both the Inner Setting domain (organizational capacity, resources, staffing, communication, training infrastructure) and the Implementation Process domain (execution, evaluation, adaptation).

Facilitating factors related to the implementation of training included intensive brainstorming during curriculum design, which helped ensure relevance and clarity [37]. A strong onboarding process for participants supported engagement and reduced challenges during implementation [10, 21]. The inclusion of evaluation tools and opportunities for revision allowed facilitators to identify areas for improvement and make timely adjustments [11, 21, 52, 53]. In one study, participants were required to develop a presentation, policy brief, or publication following the training, which supported knowledge translation [36].

Barriers to implementation were also evident. There was a lack of infrastructure related to evaluation, and time constraints often limited opportunities for reflection and assessment. Many training sessions lacked robust data collection, with low response rates to post-training surveys and limited systematic evaluation of participant behavior change [2, 21, 22, 26, 29]. In some cases, assessments were viewed as inappropriate or insufficient [2, 22, 29, 39]. Challenges also emerged around adapting and modifying the training for better integration into work processes [21]. The reliance on classroom-based instruction proved resource intensive and less flexible than field-based or e-learning approaches, ultimately limiting scalability and effectiveness [35].

Several additional barriers were related to the credibility and reputation of the group providing the training. Many facilitators struggled to clearly define the curriculum and articulate specific learning objectives, which led to inconsistent instruction and participant confusion [23]. This lack of clarity undermined trust, with participants questioning both the facilitators’ expertise and the legitimacy of the training itself. Other barriers were tied to the quality and structure of the training [27, 36, 48]. Participants across several studies reported poor training quality and limited opportunities for active engagement [36, 48]. Many expressed a preference for hands-on activities and skill practice over passive, lecture-style instruction. As a result, in-person training was preferred over virtual formats, as it better supported interactive learning and participant engagement.

Facilitating factors related to organizational context included training location, specifically the physical space where the training was held. For training that included an in-person component, conducting sessions in convenient and safe locations for participants and the training team fostered positive interactions among participants, facilitators, and leadership, which supported collaboration and improved implementation [43]. The use of standardized checklists improved training quality and increased preparedness [30]. Having human resources embedded within the existing organizational infrastructure was valuable, as it supported strong recruitment and the effective rollout of new hires participating in the training [10, 21, 29]. Furthermore, clear and consistent communication among partners and leadership teams contributed to successful implementation [30]. Additionally, requiring participants to create presentations, policy briefs, or written products promoted knowledge translation [36].

Barriers related to workforce infrastructure were prominent. Staffing shortages made it difficult to conduct quality trainings, which were important for skill development [11, 21, 49, 50]. Organizations often faced pressure to train large numbers of individuals quickly, making small-group formats infeasible [43]. There were also technical barriers, such as having unstable internet access or malfunctioning equipment [35, 38, 41, 43, 45]. Many organizations lacked sufficient funding to implement and sustain the training [30, 43, 47, 50]. These financial constraints affected health workers’ engagement, ultimately limiting the reach and effectiveness of the intervention.

Evaluation and evidence gap

Evaluation findings align with the Implementation Process, which includes assessment, monitoring, and iterative improvement.

Most articles evaluated the training program or curricula. Most evaluations measured participants’ knowledge, skills, and overall training experience. Several studies also assessed participant satisfaction and confidence in applying learned skills. In addition, some trainings gathered participants’ perspectives and recommendations for improving training content, accessibility, and relevance.

Some programs tracked participant activities to evaluate whether they applied the knowledge and skills they gained after the training. This included task logs, action reports, completed conference presentations, and assignments completed throughout the course. Training programs designed for disaster response also assessed trainees after an outbreak or disaster to identify additional training and support needs.

Articles in the scoping review used various methods to assess trainings, including pre-test and post-test surveys, feedback questionnaires with closed and open-ended questions, and qualitative interviews. A few studies conducted follow-up surveys 6 to 18 months after the training.

Discussion

This scoping review identified 38 studies that described or evaluated training programs supporting pandemic preparedness and response. While contact tracing and case investigation (CT/CI) were a central focus of many programs, the review revealed a wider range of training initiatives addressing epidemiology, surveillance, vaccine education, emergency response, and community engagement. Most trainings were designed for frontline healthcare workers, public health professionals, and students, with fewer targeting community members without health-provider backgrounds. Training programs were developed and activated across a wide range of global contexts, particularly in low- and middle-income countries.

Our synthesis aligns with frequent critiques of public health infrastructure, which describe cyclical patterns of preparedness investment wherein training capacity ramps up during crises and contracts during interpandemic periods, limiting institutional learning and workforce retention. This review indicates that the absence of stable financing, standardized competencies, and embedded evaluation systems constrained program quality and long-term sustainability. Additionally, most programs were developed with limited or no meaningful community input, likely contributing to persistent challenges in cultural relevance, trust, and community uptake which are patterns that echo the implementation barriers observed across studies in this review. This review similarly highlights how online formats can extend reach during acute phases while revealing gaps in standardized competencies, equity of access (e.g., bandwidth, language), and systematic follow-up further reinforcing our conclusion that sustained infrastructure and design standards are required beyond the emergency window [54].

Training modality consistently shaped participant engagement and perceived effectiveness across studies. Virtual formats including asynchronous modules, online platforms, and simulated environments expanded accessibility and were especially valuable when in-person instruction was not feasible [27, 48]. However, learners frequently preferred hands-on, face-to-face training, which they associated with stronger interaction, confidence, and skill acquisition [37]. Interactive strategies, including role-playing, case-based learning, and supplemental tools such as visual aids and checklists, improved engagement and knowledge retention [43, 45]. Hybrid approaches, though less commonly implemented, appeared to offer an effective balance by pairing scalable online content with structured opportunities for supervised practice. Consistent with our findings, more recent work has suggested that online training improves reach but that meaningful skill transfer depends on built-in interactivity, follow-up assessment, and scenario-based exercises [54]. Moreover, challenges such as inconsistent connectivity, the need for bilingual materials, and the absence of standardized curricula or clearly defined learning objectives often undermined training credibility and participant confidence [23]. Collectively, these results highlight the need for validated, adaptable training models that combine flexibility with structured, interactive components responsive to LMIC implementation contexts. Strong onboarding, iterative curriculum design, and continuous feedback were identified as critical facilitators [11, 21, 52, 53]. Some programs incorporated participant deliverables, such as presentations or policy briefs, that promoted knowledge translation and practical application [36]. However, these strengths were offset by limited evaluation infrastructure, low post-training survey response rates, and inadequate measurement of behavior change [2, 29]. At the organizational level, barriers such as limited funding, staffing shortages, and unclear coordination were widespread [21, 50]. Many training programs emerged in response to immediate crises and were discontinued once the threat diminished. This reactive approach restricted opportunities for sustained capacity building. The need for ongoing investment in evaluation systems, facilitator development, and institutional learning emerged as a recurring theme.

Across studies, trust emerged as an important determinant of training success. Programs that fostered trust through transparent communication, cultural responsiveness, and participatory methods reported greater engagement [26]. In contrast, language barriers and limited community engagement appeared to hinder trust and reduce the willingness of some community members to participate in CT/CI efforts [10]. Training programs involving ministries of health, universities, and community-based organizations (CBOs) were better able to adapt to local needs and earn community by-in. However, many programs designed by academic or governmental institutions had minimal input from intended beneficiaries. Few programs explicitly operationalized equity beyond broad statements of intent. Only a small subset implemented concrete strategies such as co-design with community partners, cultural tailoring of scenarios or examples, translation of materials, or delivery by trusted local facilitators. These practices, though limited, were associated with greater trust, cultural relevance, and engagement.

CBOs and community leaders played varied roles across programs. Where CBOs participated in co-design or delivery, trust, receptiveness, and program uptake improved. Co-design can include compensated community advisory boards with decision-making authority, “train-the-community-trainer” models that create paid local trainer roles, use of plain-language and multilingual materials developed through iterative testing with participants, and formal agreements (e.g., memorandums of understanding) helping CBOs to deploy community trainers rapidly during surge.

Discernible structural and resource-driven differences emerged across the reviewed studies. Programs in low- and middle-income countries more often faced infrastructural constraints (e.g., unstable connectivity, limited devices) and inconsistent funding, which shaped training design (reduced reliance on fully virtual formats), supervision, and opportunities for longitudinal evaluation. Conversely, programs in high-income countries more frequently incorporated digital tools, online platforms, and structured assessments, although sustainability challenges persisted across settings.

Despite the breadth of literature reviewed, several critical gaps remain. First, few studies employed theoretical or implementation frameworks to guide program design or evaluation. CFIR and similar models can provide a structured approach to identifying contextual barriers, facilitators, and sustainability strategies [13]. Second, standardized tools for assessing organizational readiness are lacking, which may leave CBOs and health departments with unclear and subjective metrics of their capacity to respond to emerging outbreaks. Third, few studies examined training cost, sustainability, or long-term outcomes such as knowledge retention and behavioral change. Given the limited use of validated outcome measures and the scarcity of longitudinal evaluations, the overall strength of evidence across studies should be interpreted as moderate. Because many outcomes relied on self-reported or short-term assessments, readers should interpret claims of training effectiveness with caution and recognize the need for validated, long-term indicators of workforce performance and preparedness.

Addressing the gaps identified in this review requires linking documented needs to actionable policy and funding solutions, while also strengthening evaluation plans that extend beyond immediate post-tests to capture behavior change and performance in real-world response settings. Such an approach ensures that training programs go beyond conferring short-term knowledge to supporting measurable improvements in workforce readiness, institutional capacity, and community engagement over time.

The present study has several important strengths. First, it synthesizes training efforts across multiple pathogens and regions, enabling cross-cutting insights that are not limited to COVID-19. Second, it applies the CFIR to systematically map barriers and facilitators across intervention characteristics, inner and outer settings, individual attributes, and implementation processes. Third, it foregrounds the role of community-based organizations and equity considerations such as language access and cultural tailoring that are frequently underrepresented in preparedness research. Finally, it integrates implementation-relevant themes, including onboarding, evaluation, and sustainability, that can inform future program design and long-term strategic planning.

This study also has limitations that warrant careful consideration. Limiting the review to English-language, peer-reviewed articles may have excluded relevant non-English literature. Additionally, many programs did not employ rigorous assessments, such as validated indicators of behavior change or organizational readiness, making it difficult to determine the true effectiveness of the training. Finally, this scoping review did not include formal assessments of study quality or risk of bias.

Despite these limitations, our findings have several practical implications for policymakers, funders, and public health leaders. Sustained financing is essential, including multi-year preparedness grants tied to competency benchmarks and funding mechanisms that integrate preparedness, workforce development, and community health allocations. Establishing standing surge-readiness contracts with community-based organizations and academic partners including pre-approved scopes of work, compensation structures, and rapid-activation clauses can shorten onboarding and support rapid mobilization during emergencies. Standardizing curricula across jurisdictions, supported by role-specific modules and regularly scheduled simulations, can enhance workforce consistency. Strengthening onboarding through streamlined credentialing and digital access systems can further accelerate deployment. It is equally important to develop co-design processes by establishing compensated community advisory bodies, co-developing culturally tailored materials, investing in “train-the-community-trainer” pathways, and incorporating lived-experience metrics such as trust, perceived respect, and burden into quality-improvement systems. Evaluation infrastructure also requires significant investment, including the use of pretest and post-test assessments linked to skill demonstrations, long-term follow-ups, and field performance indicators. Dashboards tracking coverage, language access, and retention can support continuous program improvement. Preparedness training must be treated as an enduring organizational function that is adequately financed, staffed, evaluated, and co-governed with communities rather than a temporary or crisis-driven undertaking. Implementing the practice and research priorities outlined above can help shift public health preparedness from reactive cycles to systems of sustained, equitable readiness.

The findings likewise point to several directions for future research. There is a need to develop and validate organizational readiness indices and evaluation tools that incorporate equity considerations and are feasible for both health departments and community-based organizations. Longitudinal studies are needed to measure knowledge retention, behavior change, workforce performance, and community trust over time. Comparative evaluations of hybrid, simulation-based, and community-delivered training models, including their effectiveness in resource-limited and rural settings, would support decisions about scale and investment. Researchers should also test co-design implementation strategies, such as compensated advisory boards and community-trainer models, using mixed-methods and realist evaluation to identify contextual mechanisms that advance or inhibit success. Finally, future studies should examine how training can address misinformation and stigma through strategies such as motivational interviewing and narrative communication, and how these approaches influence participation in preparedness training, vaccine acceptance, and public health behaviors.

Conclusion

This scoping review highlights the urgent need for sustained, community-centered pandemic preparedness systems that combine evidence-based training with local leadership possessing local knowledge and lived experience. Although training programs varied widely in content and delivery, most were short-lived, under-resourced, and lacked mechanisms for evaluation and sustainability. The most persistent barriers were organizational including limited funding, staffing shortages, and inadequate coordination. This suggests that effective preparedness depends as much on infrastructure and trust as on individual knowledge [13, 21, 43].

To build resilient public health systems, policy and practice must prioritize investment in relevant curricula, culturally tailored training, and community-led implementation strategies. CBOs, often the first to act during crises, should be recognized as essential partners in pandemic response. Equipping them with the tools, authority, and resources needed to act swiftly can enhance local trust and improve outcomes, particularly in historically marginalized communities [10, 26, 31].

Future research should focus on co-developing and testing readiness assessments and rapid response toolkits reflecting the lived experiences of community members. These tools will help organizations evaluate their strengths, coordinate with public health agencies, and respond effectively to future emergencies. By embedding preparedness within trusted community networks, we can move beyond reactive models toward a more equitable, sustainable approach to public health readiness, one that protects health and well-being during, before, and after a crisis [27, 37, 48].

Authors’ contributions

KB and JB conducted the data analysis and drafted the manuscript under supervision. JD provided supervision and direction for manuscript drafting, and substantive input throughout the analysis and manuscript development, including critical revisions of all drafts. TDR conceptualized the study, secured funding, and provided substantive direction, guidance, and feedback on manuscript drafts. All authors read and approved the final manuscript.

Funding

This work was supported by a New Innovator’s Award (DP2MD017444), which is supported by the National Institute on Minority Health and Health Disparities and the NIH Office of the Directorate. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Data availability

All data generated or analyzed during this study are included in this published article and/or within the original published article.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.