Review by Lesley Rushton, Journal of the Royal Statistical Society Series A, 167: 3 , p 571, August 2004

The ActivEpi CD-ROM together with the Companion Textbook have been designed for self-study or for a course in the concepts of epidemiology.

They offer a range of learning approaches including video, animation, narration, text and interactive question-and-answer sessions. Topics that are covered include the following: design methodology; measure of disease frequency, effect and impact; validity, biases and confounding; analytical methods ranging from simple risk estimate calculations through to the use of mathematical models to control for extraneous factors and to carry out stratified analysis. The book and the compact disc (CD) are not completely identical as some of the narration on the CD was altered for the book and I found the order also different, making it difficult to use the two concurrently.

The CD is straightforward to install and the introduction and explanations and hints on using the package are useful. A glossary of terms is provided which can be accessed at any time during use. The package is constructed in a series of lesson books in which a few key concepts are introduced, followed by viewing and interacting with three types of activities:
(a) 'narrated expositions', which are accessed through clicking on an icon and give a short animation, similar to a PowerPoint-based lecture which uses slides together with an audio presentation;
(b) 'drag and drop quizzes', which are self-completion exercises in which one fills in the blanks by choosing from a range of options;
(c) 'data desk', which provides access to a statistics software program which enables the user to be guided through a statistical analysis.

In addition templates are provided in data desk which are focused on specific epidemiological analysis.

The lesson book includes features such as changing the colour of text or putting a tick in an icon box when an activity has been completed and the ability to use a stop-watch to time an activity. It is not clear what the advantages of the stop-watch feature are unless it is to give students practice for preparing for an examination. There is also the use of prominent green asterisks. The program states that clicking on these leads to additional and important information or comments. If the material is so essential one wonders why the user is left to decide whether to access this rather than making it an essential part of the package. The package has a table of contents index and a bookmark facility.

There is the suggestion that the user could manage without the audio facility. However, I felt that this was absolutely essential for obtaining a real understanding of the narrated expositions and that important information would be missed without it. In fact the section on learning effectively with the package suggests that the user should take notes. It ispossible to copy text to a clipboard but not the text that is used in animations, i.e. the lecture studies. The advantage over a lecture is that one can stop the animation at any point in time or go back and repeat it.

One would expect any epidemiology text-book to illustrate the theory with examples from public health. ActivEpi addresses every issue through a practical example. In addition, the CD media enables this aspect to be exploited to the full so that not only are a large number of different relevant and topical examples used but also the use of pictures and cartoons adds to the interest. The animations also make an intelligent use of colour and movement. One area, on which much of the course focuses, is the effect on the risk estimates of various biases and confounding. The worked examples and the study exercises are particularly helpful here.

In general the drag-and-drop quizzes are easy to carry out, although the jingles and other vo- cals that occur when correct or incorrect answers are given lead me to advise users to turn off the sound at these points. The most disappointing aspect of ActivEpi was the data desk statistical package. Unlike the rest it is unattractively presented as several black-and-white subscreens, and, at least on the computer that I was using, there was a danger of so many of these subscreens being open and overlaid at once that it became difficult to find the one required. The computational process is fairly easy to follow through the use of templates and various calculation and graphical options. However, it has a very old-fashioned feel to it. One wonders why the authors did not address this aspect by providing a linkage to one of the many well-known statistical computing packages which would have the advantages of providing transferable expertise in the use of a computing package.

The ActivEpi CD and text-book are designed to be worked through sequentially and at a steady pace. They will not replace the need for a good epidemiological text-book for reference use. However, the thoroughness of the coverage and the many interesting practical examples, together with an attractive use of animation and audio, provide a very useful addition to the teaching material that is currently available.

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