title: The most effective way of delivering a train-the-trainers program: a systematic review.
abstract: BACKGROUND
  Previous literature has shown that multifaceted, interactive interventions may be the most effective way to train health and social care professionals. A Train-the-Trainer (TTT) model could incorporate all these components. We conducted a systematic review to determine the overall effectiveness and optimal delivery of TTT programs.
  
  
  METHODS
  We searched 15 databases. Reference lists and online resources were also screened. Studies with an objective follow-up measure collected over 1 week after the intervention were included. The intervention had to be based on a TTT model for health and social care professionals.
  
  
  RESULTS
  Eighteen studies met the inclusion criteria. TTT interventions varied greatly, ranging from didactic presentations to group discussions and role-plays. The heterogeneity of the studies and limited data prevented meta-analysis. A narrative review found that the TTT programs in 13 studies helped to increase knowledge, improve clinical behavior, or produce better patient outcomes. One study showed no effect. Three studies showed possible effect and one study showed that a CD-ROM training method was more effective than a TTT training method in improving participants' knowledge. Ratings of the studies' methodologies suggested moderate risk of bias, which limits interpretation of the results.
  
  
  CONCLUSIONS
  There is evidence that using a blended learning approach to deliver TTT programs--combining different techniques such as interactive, multifaceted methods and accompanying learning materials--can help to effectively disseminate and implement guidelines and curricula to health and social care professionals. However, further research is needed to determine the optimum "blend" of techniques.
authors.affiliation: Department of Psychological Medicine, Cardiff University, Wales.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pearce
authors.forename: Mala K
authors.initials: MK
authors.lastname: Mann
authors.forename: Caryl
authors.initials: C
authors.lastname: Jones
authors.forename: Susanne
authors.initials: S
authors.lastname: van Buschbach
authors.forename: Miranda
authors.initials: M
authors.lastname: Olff
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Bisson
mesh_terms: D000328:Adult; D057186:Comparative Effectiveness Research; D003695:Delivery of Health Care; D004496:Education, Continuing; D020375:Education, Distance / Q000379:methods*; D006801:Humans