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Teach-BackA Tool to Enhance Patient Understanding
OBJECTIVES
After this presentation, you will be able to:
• Define teach-back and its purpose
• Describe the relationship between health literacy and teach-back
• Describe how to use teach-back correctly
• Use teach-back in the clinical setting
What is teach-back?Teach-back is:
• A way to check whether patients comprehend health information you have explained to them.
• A test of whether YOU explained something in a way they could understand.
• NOT a test to see if they understood.
Why is teach-back important?
“It is neither just, nor fair, to expect a patient to make appropriate health decisions and safely manage his/her care without first understanding the information needed to do so.”
−
Reducing Risk, AMA, 2007
“In the absence of teach-back, the only indicator of misunderstanding may be a medication mistake or patient error, which could be harmful.”
−
Dr. Fred Marsh, Iowa Health Study, 2004
What is the goal of teach-back?The goal of teach-back is to create an opportunity for dialogue:
• First, the provider gives the patient information.
• The provider then asks the patient to respond and confirm understanding.
• Based on the patient’s response, the provider either finds another way to present the information, or adds new information as needed.
Steps to Teach-Back1. In a non-shaming way: Ask the patient:
• To tell you in their own words what they need to know or do. Or:
• To demonstrate it.
2. If the patient is able to teach back what they have learned: You may add new information as needed.
If the patient is not able to tell or show you what you have explained: Rephrase the information. Then, ask your patient to teach it back again.
3. If they still do not understand: Consider other teaching strategies.
What is health literacy?Health literacy is the ability to:
• Receive
• Understand
• Act
on health care information.
Teach-back and health literacy are inter-related.
What does health literacy affect?Health literacy affects a patient’s ability to:
• Understand theinformation on:- Prescription bottles
- Patient education handouts
- Appointment slips
- Consent forms
- Other written materials
• Navigate the health care system
• Interpret their test results correctly
Adapted from: North Carolina Program on Health Literacy
Health Literacy Facts• One in five adult Americans are functionally
illiterate. There is a good chance many of your patients will not understand what you tell them, give them to read, or ask them to fill out.
• Patients who are not health literate are more likely to be hospitalized regardless of their socio- economic status and whether or not they have a primary care provider.
• Legal cases show that individuals who are unable to understand consent forms can take legal action in the event of an adverse outcome because they did not truly give “informed” consent.
Health Literacy and Teach-Back
Teach-back is a direct and clear way
to find out if your patients understand
the health information you give
them.
TESTIMONIAL
“I decided to do teach-back on five patients. With one mother and her child, I ended the visit by saying, ‘So tell me what you are going to do when you get home.’ The mother just looked at me without a reply. She could not tell me what instructions I had just given her. I explained again and then she was able to teach them back to me.
“The most amazing thing about this ‘ah ha’ moment was that I had no idea she did not understand until I asked her to teach it back to me. I was so wrapped up in delivering the message that I didn’t realize it was not being received.”
-
Resident physician, pediatric office
Source: North Carolina Program on Health Literacy
How do I know if a patient has low health literacy?
Adapted from: North Carolina Program on Health Literacy
You can’t tell by looking! The patient may:
• Fill out forms incompletely or inaccurately.
• Not take their medications correctly,even though they claim to be doingso. Lab tests or other physiologicalparameters do not reflect this.
• Not follow through with lab tests or referrals to other providers.
• Often miss appointments.
You may hear these responses to receiving written information:
• “I forgot my glasses. I’ll readthis when I get home.”
• “I forgot my glasses. Can you read this to me?”
• “Let me take this home so I can show it to my children (or husband, sister, wife, etc.).”
How do I know if a patient has low health literacy? (continued)
When responding to questions about medications, the patient cannot:
• Give the names of the medications they take.
• Explain the purpose of their medications.
• Explain when and how to take their medications.
How do I know if a patient has low health literacy? (continued)
How can I communicate more clearly?We all benefit from clear communication. People at ALL literacy levels prefer written materials that are easy to read and understand, and spoken information that is free of medical jargon.
When talking with your patients:
• Use plain language.
• Speak slowly.
• Focus on the two or three most important concepts.
• Use teach-back to check for understanding.
Adapted from: North Carolina Program on Health Literacy
How to “Do” Teach-Back
Adapted from: North Carolina Program on Health Literacy
Make teach-back part of every clinic visit. Some ways to work it in are to say things like:
• “I want to be sure I explained how to take this medicine clearly. Can you please explain it back to me so I can be sure I did?”
• “Your husband couldn’t come with you today, like he usually does. What will you tell him about the changes we made to your medicines today?”
• “We’ve gone over a lot of information about adding exercise to your day. In your own words, tell me what we talked about and how you will make it work at home.”
Using Teach-Back Well• Avoid yes/no questions.
Instead of asking, “Do you understand why I’m prescribing this medicine?” ask, “Please tell me why I’m prescribing this medicine for you.”
• When you are explaining more than one concept, “chunk and check.”
Teach two or three main points for the first concept, do a teach-back, then go to the next concept.
• Speak in a caring tone of voice and approach each patient with respect.
A patient’s inability to understand health information may be a reflection of how you have explained it.
Adopted from: North Carolina Program on Health Literacy
When can I use teach-back?Many topics or self-care instructions you commonly discuss with patients are ideal for using the teach-back method. Some ideas:
Adapted from: North Carolina Program on Health Literacy
• Giving insulin injections
• Using an inhaler
• Checking blood glucose
• Preparing for surgery
• Taking a new dose of a medication
• Using a leg bag to collect urine
How can I best word my teach-back questions?
• Think about your area of practice and what you teach patients.
• Discuss this with a person next to you.
• Be prepared to share with the group.
ACKNOWLEDGEMENTS
• IOWA Health System
• North Carolina Program on Health Literacy http://nchealthliteracy.org/toolkit/toollist.pdf
• AHRQ Health Literacy Tool Kit www.ahrq.gov/qual/literacy/
• American Medical Association
TO LEARN MORE
Andrea Dotson, CHES, Health EducatorUWMC Patient and Family Education Services
206-598-7448, [email protected]
Debby Nagusky, MPH, Health EducatorUWMC Patient and Family Education Services
206-598-0073, [email protected]
Sarah Stempski, MPH, Program CoordinatorUWMC Patient and Family Education Services
206-598-4741, [email protected]
© University of Washington Medical Center07/2011
