San Antonio, Texas — Health care workers want patients and clients to leave an appointment recalling the conversation and knowing what steps to take next.
Unfortunately, that isn’t always the case. For some, an appointment can be an anxiety-filled experience, especially if there are language barriers, or a use of technical words that may make things hard to follow.
Health literacy experts support the use of an evidence-based method — Teach Back — during conversations between health care workers and clients that can help improve recall, understanding and adherence to treatment plans.
The Teach Back method is defined as asking patients, in a non-shaming way, to repeat, in their own words, what they need to know or do. For instance, understanding when and how to take their insulin, or how to properly use an inhaler to control asthma symptoms.
An effective way to learn how to use this strategy is a program called the 5Ts for Teach Back. Health literacy expert Kathryn Anderson and a team at the University of New Mexico Hospitals created the 5Ts method, which breaks Teach Back into five skills that can help health care workers do it well with every patient or client conversation.
The 5Ts are specific, observable steps: Triage, Tools, Take Responsibility, Tell Me, and Try Again.
Health care workers of various roles, from nurses and physicians to pharmacists and community health workers, rely on this method to get important information across to their audiences.
The following definitions of the 5Ts are excerpts from the original academic paper with some entries edited for brevity. Read the academic article (linked below) for a more in-depth explanation of each step.
- Triage – In the first triage step, a health worker determines which one to three topics are most important and will be the focus for education and Teach Back. Research has shown that the more information a clinician delivers, the less information the patient will remember correctly. The authors encourage a “chunk and check,” meaning you deliver one chunk of information and then check back to make sure it is understood. During the teaching step, the provider must use plain language and consider the patient’s cultural and linguistic background context.
- Tools — A tool is broadly defined as any aid that can assist the clinician with providing a clear explanation. Reader-friendly handouts, simple pen-and-paper drawings, models or diagrams, use of the health care workers’ own body (such as using the fist to represent the heart pumping), or even a relatable story are possible tools.
- Take responsibility — The Take Responsibility step is critical for the non-shaming aspect of the Teach-Back definition. This step happens once the health care worker has delivered a chunk of information. The health care worker may state, “That was a lot of information, and it can be hard to remember all that at once, so I want to make sure I did a good job explaining it.”
- Tell me — During the Tell Me step, the health care worker invites patients to state, in their own words, what they understood. The ask needs to be specific, such as, “How will you use your glucose meter when you go home?” This allows the patient and the health care worker to focus on one specific piece of information so they are both on the same page. In some cases, the provider may ask the patient to show, rather than tell, such as demonstrating the use of an inhaler.
- Try again — If the patient does not tell back correctly, the health care worker must explain the information again, modifying the explanation to make it clearer. This may mean using plainer words or using a different tool like a drawing or an analogy, to teach in a way that makes sense to the patient. Another round of Teach Back must be done to ensure correct understanding.
How effective is the Teach Back method?
Teach back is recommended by The Joint Commission, a nonprofit organization that accredits and certifies health care organization and programs in the United States. It is the number one ranked health literacy practice to teach trainees. There is a growing body of evidence that supports the effectiveness of Teach Back. It is associated with increased knowledge, better adherence to medical regimens, improved patient outcomes like glycemic control, and improved patient safety.
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