Experiences of Teach-Back in a Telephone Health Service

BACKGROUND: Asking patients to “Teach-Back” information during a health care consultation is widely recommended, yet little is known about patient and provider experiences using this method. Teach-Back has not previously been evaluated in a consumer telephone health service, a situation in which low health literacy can be especially difficult to identify. OBJECTIVE: This study sought to explore telenurse experiences using Teach-Back at a maternal and child health helpline, supplemented with caller experiences. METHOD: After training maternal and child health nurses to use Teach-Back (n = 15), we interviewed nurses and callers to the helpline service. We used semi-structured guides to conduct focus groups and telephone interviews and analyzed transcripts of nurse and caller data using the Framework method. This qualitative study forms part of a randomized controlled trial of Teach-Back involving 637 callers. KEY RESULTS: Nurses (n = 13) reported Teach-Back was helpful to invite questions from callers, summarize information, review action plans, and close calls. Some found it helpful to empower and calm (anxious) callers. Nurses reported they did not always use Teach-Back, either because it was not appropriate or they felt uncomfortable with phrasing. Comfort with using Teach-Back tended to improve with practice. Perceived effect on call duration was mixed. We report sample Teach-Back strategies used by nurses, including the lead-in phrase “just before you go…,” which was considered helpful for initiating Teach-Back at close of a call. Caller reports of Teach-Back were limited (n = 8) but mostly positive. CONCLUSIONS: Teach-Back is a simple communication technique that can be used in a consumer telehealth service to confirm caller understanding and actions to take, and in some cases it may also reduce caller anxiety. Further research on caller experiences and objective impact on call duration is needed. [Health Literacy Research and Practice. 2017;1(4):e173–e181.] PLAIN LANGUAGE SUMMARY: Low health literacy can be difficult to identify, especially over the telephone. Asking callers to summarize important information and agreed actions (known as Teach-Back) could help telehealth providers confirm understanding. We interviewed nurses operating a maternal and child health helpline and callers about their experiences with Teach-Back. Findings support Teach-Back for telehealth and suggest Teach-Back can also reduce caller anxiety.