Tool: Teach-Back

A teach‐back is an evidence‐based health literacy intervention that promotes patient engagement, patient safety, adherence, and quality.¹ In a teach-back, you ask the patient or family caregiver to explain the information they need to know or actions they need to take, in their own words. Teach‐back is a way to confirm that you have explained information clearly and that patients or family caregivers have a clear understanding of what you have told them.

When patients are asked, "Do you understand?" they often indicate they do when they may not—either because they only think they understand a diagnosis or treatment plan or because they are embarrassed to admit they are confused. The only way to know for sure that a patient understood the information communicated is to hear them teach back in their own words. This process also solidifies the information.

This technique is also useful for interpreters, who can use the teach-back to correct any missed communication (or misinformation) with non-English speakers or patients and families with low English proficiency.

Teach‐backs can be used to explain:

• Medication instructions.
• A new diagnosis.
• Next steps for followup testing.
• Recommended behavior changes.
• Treatment options.
• Treatment plan.
• An existing diagnosis to family or caregivers.

Teach‐back may take longer initially as you learn to adopt it into your standard workflow. However, misunderstandings can cause substantial time loss later and also place the patient at risk, making the initial investment of time worthwhile. Examples of effective teach-backs include:

• A home nurse needs to prepare the patient and a family caregiver for the wound care they must perform after a hospital procedure. The nurse shows the patient and family caregiver the process and technique for changing the dressing. This process might include premedicating with pain medicine 30 minutes before wound care, effectively washing hands, and cleaning and dressing the wound. The patient and family caregiver repeat back the process, step by step, and then demonstrate the process prior to discharge.
• In telling a patient how to take a new medication, a pharmacist or other provider would describe how a patient should take the new medication, including the dose and time of administration and responses to side effects. They would then ask the patient or family caregiver to explain the process back to them to verify that it has been carefully listened to and thoroughly understood. Reinforcing this oral message with written instructions is important to ensure the process can be reviewed whenever needed.

Note

1. Health Literacy Universal Precautions Toolkit, 2nd Edition. Use the Teach-Back Method: Tool #5. Content last reviewed September 2020. Agency for Healthcare Research and Quality, Rockville, MD. Accessed April 26, 2023.