Abstract
Patients often have difficulty comprehending or recalling information given to them by their healthcare providers. Use of ‘teach-back’ has been shown to improve patients’ knowledge and self-care abilities, however there is little guidance for healthcare services seeking to embed teach-back in their setting. This review aims to synthesize evidence about the translation of teach-back into practice including mode of delivery, use of implementation strategies and effectiveness. We searched Ovid Medline, CINAHL, Embase and The Cochrane Central Register of Controlled Trials for studies reporting the use of teach-back as an educational intervention, published up to July 2019. Two reviewers independently extracted study data and assessed methodologic quality. Implementation strategies were extracted into distinct categories established in the Implementation Expert Recommendations for Implementing Change (ERIC) project. Overall, 20 studies of moderate quality were included in this review (four rated high, nine rated moderate, seven rated weak). Studies were heterogeneous in terms of setting, population and outcomes. In most studies (n = 15), teach-back was delivered as part of a simple and structured educational approach. Implementation strategies were infrequently reported (n = 10 studies). The most used implementation strategies were training and education of stakeholders (n = 8), support for clinicians (n = 6) and use of audits and provider feedback (n = 4). Use of teach-back proved effective in 19 of the 20 studies, ranging from learning-related outcomes (e.g. knowledge recall and retention) to objective health-related outcomes (e.g. hospital re-admissions, quality of life). Teach-back was found to be effective across a wide range of settings, populations and outcome measures. While its mode of delivery is well-defined, strategies to support its translation into practice are not often described. Use of implementation strategies such as training and education of stakeholders and supporting clinicians during implementation may improve the uptake and sustainability of teach-back and achieve positive outcomes.
Highlights
The healthcare system places a significant burden on patients to participate in their own care such as shared decision-making, providing informed consent or adhering to therapeutic regimens [1, 2]
The ability to understand and use health information is a core component of health literacy, a concept which is consistently associated with health outcomes [4] and identified by the World Health Organization as key to achieving the Sustainable Development Goals [5]
A frequently observed barrier to patient understanding is the continued use of medical terminology by doctors [12,13,14], with one systematic review reporting that patients want clearer explanations about their condition as they frequently misunderstand terms used in medical consultations [14]
Summary
The healthcare system places a significant burden on patients to participate in their own care such as shared decision-making, providing informed consent or adhering to therapeutic regimens [1, 2]. A frequently observed barrier to patient understanding is the continued use of medical terminology by doctors [12,13,14], with one systematic review reporting that patients want clearer explanations about their condition as they frequently misunderstand terms used in medical consultations [14]. Another major challenge in healthcare communication is patients’ ability to recall the information provided to them. Interventions to improve communication at the patient-clinician interface are warranted; with one approach being the use of education and recall communication strategies such as ‘teach-back’ [17]
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