Use the teach-back method of communication to help support minority health

Editor's note: This blog was revised on 4/4/2024

Written by Kimberly Tchang, Medical Editor, Digital Content, Krames; and Daphne Pierce-Smith, RN, MSN-FNC/P, Accreditation, Certification, and Regulatory Manager, Krames 

April marks Minority Health Month, a time to raise awareness about the importance of improving the health of racial and ethnic minorities and reducing the health disparities these communities face disproportionally. The Minority Health Month theme for 2024 is Be the Source for Better Health: Improving Health Outcomes Through Our Cultures, Communities, and Connections. The focus here is to understand how the unique environments, cultures, histories, and social determinants of health affect minority groups, and how healthcare professionals can address health literacy, language access, and more. 

It’s a well-known problem that patients often leave healthcare visits unsure and confused about their condition, treatment, and care plans. Research has shown that most patients have trouble understanding instructions after a hospital discharge.¹ The Agency for Healthcare Research and Quality (AHRQ) notes that studies show that patients forget between 40-80% of the medical information they are given at an office visit – and nearly half of what they do recall is wrong.² 

When patients don’t fully understand key health information, the consequences can be serious. They include reduced patient safety and negative health outcomes.³ These concerns are true for all patients, but especially for racial and ethnic minorities who are disproportionately affected by low health literacy or may have low English proficiency. 

For example, according to the Survey of Adult Skills, published by the Organisation for Economic Co-operation and Development (OECD), 59% of black and 56% of Hispanic adults score below Level 2, compared to 19% of white adults. 

As a provider, is it your responsibility to make sure you are giving your patients clear information, and being certain they understand and can apply the information in a way that benefits their health outcomes. Fortunately, the teach-back method is a communication tool that helps improve health literacy. 

The teach-back method 

Also known as “closing the loop,” this simple yet effective communication strategy has been shown to greatly improve patient recall of healthcare information.⁴ It is an evidence-based, patient-centered approach that checks patients' understanding by asking them to state in their own words what you have told them. It helps to confirm that you have explained things clearly to your patients. And it immediately alerts you to any information that is not clearly understood. 

The teach-back method has been demonstrated to increase understanding, skills, and self-care in people with chronic disease.⁵ It has been advised as a health literacy-based communication tool in policy statements from organizations such as the American Diabetes Association and the American Heart Association.^6,7 And it is recommended by both the AHRQ and the Institute for Healthcare Improvement.⁸ 

Steps to the teach-back method 

Here is an example of how to use the teach-back method: ^{9, 10} 

Explain. 
Start by explaining the key points or instructions to the patient.Use simple, plain words. Don’t use medical jargon or technical terms. Speak with a friendly, caring tone. Make eye contact. 

Check. 
After explaining, ask the patient to repeat the information back to you. This is not a test of the patient. It’s a test of how well you explained the information. Ask them, "I want to be sure that I explained things clearly. Can you please tell me in your own words what you heard me say?” 

Listen. 
Listen to their response. Note any information they may have left out or misunderstood. 

Clarify. 
If the patient doesn’t fully understand what you said, explain it again in a different way. Always speak with kindness. Do not blame the patient if they don’t understand something. Tell them that it is your job to make the information clear to them. Say, “I’m sorry, I don’t think I explained that very well. Let me try again.” 

Check again. 
Repeat these steps as needed. Break the information down into very simple terms or steps as needed. Be sure the person can tell you the information in their own words. If they only repeat your exact words, they may not really understand. Using printed patient materials written in plain, simple language can also help reinforce the information. 
 

Using the teach-back method gives providers the chance to re-explain anything that isn’t clear, right in the moment. This is a valuable tool for checking patient recall. Once the person can tell you the information accurately in their own words, then you know they have a good grasp of it. 

In addition, this method can be done in virtually any healthcare setting–emergency room, hospital, provider’s office, outpatient clinic, community health center, pharmacy, or telehealth portal. 

The teach-back method does require some practice and training on the part of providers. For example, it’s essential to use a friendly tone and simple language when talking with your patients. It’s also helpful to use this method to check on key pieces of information throughout a patient visit, rather than covering everything right at the end. 

Resources to help providers 

Fortunately, there are many provider resources available online. These include helpful tools from the AHRQ and interactive learning modules at Always Use Teach-back! 

In addition, you can supplement the teach-back method with patient education content that’s written in plain language. These may be printed materials written at lower reading levels so they are easier to understand—and that are offered in multiple languages. You can also point your patients to digital or video materials, if they prefer. 

When it is implemented consistently, the teach-back method — as well as these additional resources — can be key tools for you to ensure your patients’ level of understanding, and ultimately improve their outcomes. 

Sources 

1. Ha Dinh TT, Bonner A, Clark R, Ramsbotham J, Hines S. The effectiveness of the teach‐back method on adherence and self‐management in health education for people with chronic disease: a systematic review. JBI Database of Systematic Reviews and Implementation Reports. 2016;14(1):210–47. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6590951/#b1-fp-36-06-284&n…;
2. Health Literacy Universal Precautions Toolkit, 2nd Edition. Use the Teach-Back Method: Tool #5. Agency for Healthcare Research and Quality https://www.ahrq.gov/health-literacy/improve/precautions/tool5.html 
3. Talevski J, Wong Shee A, Rasmussen B, Kemp G, Beauchamp A. Teach-back: A systematic review of implementation and impacts. PLoS One. 2020 Apr 14;15(4):e0231350.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7156054/ 
4. Health Literacy Universal Precautions Toolkit, 2nd Edition. Use the Teach-Back Method: Tool #5. Agency for Healthcare Research and Quality https://www.ahrq.gov/health-literacy/improve/precautions/tool5.html 
5. Hong Y-R, Jo A, Huo J, Cardel MI, Mainous AG. Pathways of Teach-Back Communication to Health Outcomes Among Individuals With Diabetes: A Pathway Modeling. Journal of Primary Care & Community Health. 2022;13. https://journals.sagepub.com/doi/full/10.1177/21501319211066658#con2&nb…;
6. Ha Dinh TT, Bonner A, Clark R, Ramsbotham J, Hines S. The effectiveness of the teach‐back method on adherence and self‐management in health education for people with chronic disease: a systematic review. JBI Database of Systematic Reviews and Implementation Reports. 2016;14(1):210–47. 10.11124/jbisrir-2016-2296 
7. Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Hess Fischl A, et al. Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Diabetes Care. 2015;38(7):1372–82. 10.2337/dc15-0730 https://diabetesjournals.org/care/article/38/7/1372/30767/Diabetes-Self…;
8. Rasmusson K, Flattery M, Baas LS. American Association of Heart Failure Nurses Position Paper on Educating Patients with Heart Failure. Heart & Lung: The Journal of Acute and Critical Care. 2015;44(2):173–7. https://www.heartandlung.org/article/S0147-9563(15)00002-3/fulltext 
9. 10 Elements of Competence for Using Teach-Back Effectively. Institute for Healthcare Advancement. http://higherlogicdownload.s3.amazonaws.com/HEALTHLITERACYSOLUTIONS/b33…;
10. Anderson KM, Leister S, De Rego R. The 5Ts for Teach Back: An Operational Definition for Teach-Back Training. Health Lit Res Pract. 2020 Apr 9;4(2):e94-e103. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7156258/#:~:text=The%205Ts….