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Regardless of a patient's health literacy level, it is important that staff ensure that patients understand the information they have been given. The teach-back method is a way of checking understanding by asking patients to state in their own words what they need to know or do about their health. It is a way to confirm that you have explained things in a manner your patients understand. The related show-me method allows staff to confirm that patients are able to follow specific instructions (e.g., how to use an inhaler).

• The teach-back and show-me methods are valuable tools for everyone to use with each patient and for all clinic staff to use. These methods can help you:
• Improve patient understanding and adherence.
• Decrease call backs and cancelled appointments.
• Improve patient satisfaction and outcomes.

Fact
Studies have shown that 40-80% of the medical information patients are told during office visits is forgotten immediately, and nearly half of the information retained is incorrect.

Action

Learn the teach-back method.

• The Always Use Teach-Back! Toolkit describes principles of plain language, teach-back, coaching, and system changes necessary to promote consistent use of teach-back. Its 45-minute Interactive Teach-Back Learning Module includes key content and videos of clinicians using teach-back. The module can be used by clinicians, staff members, in a group setting, or as a self-directed tutorial.
• 5-Minute Teach-Back Video. This 5-minute video gives two examples for clinicians of how to use teach-back with medicine changes.
• Health Literacy and Patient Safety: Help Patients Understand is a 23-minute video from the American Medical Association that includes an example of a clinician using teach-back (see the last 5 minutes of the video).

Practice Experiences
"I decided to do teach-back on five patients. With one mother and her child, I concluded the visit by saying 'so tell me what you are going to do when you get home.'...She could not tell me what instructions I had just given her. I explained the instructions again and then she was able to teach them back to me… I had no idea she did not understand… I was so wrapped up in delivering the message that I did not realize it wasn't being received".

—Pediatric office

Try the teach-back method.

• Keep in mind this is not a test of the patient's knowledge. It is a test of how well you explained the concept.
• Plan your approach. Think about how you will ask your patients to teach back the information. For example:
  • "We covered a lot today and I want to make sure that I explained things clearly. So let's review what we discussed. Can you please describe the 3 things you agreed to do to help you control your diabetes?"
• "Chunk and Check." Don't wait until the end of the visit to initiate teach-back. Chunk out information into small segments and have your patient teach it back. Repeat several times during a visit.
• Clarify and check again. If teach-back uncovers a misunderstanding, explain things again using a different approach. Ask patients to teach-back again until they are able to correctly describe the information in their own words. If they parrot your words back to you, they may not have understood.
• Start slowly and use consistently. At first, you may want to try teach-back with the last patient of the day. Once you are comfortable with the technique, use teach-back with everyone, every time!
• Practice. It will take a little time, but once it is part of your routine, teach-back can be done without awkwardness and does not lengthen a visit.
• Use the show-me method. When prescribing new medicines or changing a dose, research shows that even when patients correctly say when and how much medicine they'll take, many will make mistakes when asked to demonstrate the dose. You could say, for example:
  • "I've noticed that many people have trouble remembering how to take their blood thinner. Can you show me how you are going to take it?"
• Use handouts along with teach-back. Write down key information to help patients remember instructions at home. Point out important information by reviewing written materials to reinforce your patients' understanding. You can allow patients to refer to handouts when using teach-back, but make sure they use their own words and are not reading the material back verbatim. Refer to Tool 12: Use Health Education Material Effectively for more information.

Promote the use of teach-back.

• Train non-clinical staff. Non-clinical staff members who interact with patients should also use teach-back. For example, staff making appointments may use it to ensure the patients understand what is required of them at the next visit such as arrival time, insurance documentation, bringing medicines, fasting, and details about referrals to other clinicians.
• Share teach-back stories. Ask one person at each staff meeting to share a teach-back "Aha!" moment. This serves as a reminder of the importance of using teach-back consistently.

Track Your Progress

The Conviction and Confidence Scale should be filled out before you start using teach-back and then 2, 6, and 12 months later to track your progress. Calculate the percentage of staff who have completed the scale at least twice in the past 12 months. The results can help you identify ways to build conviction and confidence in using teach-back.

The Teach-Back Observation Tool should be used by a designated observer as clinicians build their skills and confidence with teach-back. Use the findings to guide evaluation, coaching, additional learning, and establishment of consistent habits.

If you field questions from the Health Literacy Patient Survey, calculate what percentage of patients responded "Always" to question #12.

What is the most important goal in patient education?

What are three ways in which a patient information packet can be helpful to the medical office?

What is the purpose of the patient information packet?

When teaching a patient how to lift a heavy object properly which of the following instructions would be included?