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Overview

It is important to confirm that you have explained things in a manner your patients understand. The teach-back method is a way of checking understanding by asking patients to state in their own words what they need to know or do about their health. The related show-me method allows you to confirm that patients are able to follow specific instructions, such as how to use an inhaler.

The teach-back and show-me methods are valuable tools for everyone in the practice to use with all patients. These methods can help you:

• Improve patient understanding and adherence.
• Decrease call backs and cancelled appointments.
• Improve patient satisfaction and outcomes.

Action

Learn the teach-back method.

• AHRQ's Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families has resources for learning and teaching the teach-back method, including Implementation Guidance and a Teach-Back Training Toolkit with a PowerPoint slide deck, role play scenarios, and a 10-minute interactive training module.
• The  describes principles of plain language, teach-back, coaching, and system changes necessary to promote consistent use of teach-back. Its Interactive Teach-Back Learning Module and supporting materials include key content and videos of clinicians and others using teach-back. The module can be used by clinicians and other staff members, in a group setting or as a self-directed tutorial, and by nonclinical health organizations like public health agencies.

Try the teach-back method.

• Plan how you will ask non-shaming questions. Remember, you are checking how well you explained something, not testing the patient. For example, you could say, 
  • "We've gone over a lot of information, and I want to make sure I explained things clearly. So tell me, what do you think are the three most important things to know about diabetes?"
  • "When you get home, what will you tell your partner about this visit?"
  • "I want to make sure I've done my job well and explained things clearly. If you will tell me back the plan we've made, I'll type it up and send it home with you."

• Use the show-me method. When prescribing new medicines or changing a dose, research shows that even when patients correctly say when and how much medicine they will take, many will make mistakes when asked to demonstrate the dose. You could say, for example: "I've noticed that many people have trouble remembering how to take their blood thinner. Using these pills, can you show me how you are going to take them?"
• Remember teach-back is not a test of patients' memory. You can allow patients to refer to handouts when asking for a teach-back, but make sure they use their own words and are not reading the material back verbatim. Refer to Tool 12: Use Health Education Material Effectively for more information on reviewing written materials to reinforcing patients' understanding.
• Clarify and check again. If teach-back uncovers a misunderstanding, explain things using a different approach, and ask patients to teach-back again. Repeat the cycle of reteaching and asking for a teach-back until they are able to describe the information in their own words correctly. If they parrot your words back to you, they may not have understood.
• "Chunk and Check." Do not wait until the end of the visit to initiate teach-back. Chunk out information into small segments and have your patient teach it back. Then move on to the next segment and repeat as needed throughout the visit.
• Start slowly and use consistently. At first, you may want to try teach-back with the last patient of the day. Once you are comfortable with the technique, use teach-back with everyone, every time.
• Practice. It will take a little time, but once it is part of your routine, teach-back can be done without awkwardness and does not lengthen a visit.

Promote the use of teach-back.

• Train clinical and nonclinical staff. All staff who interact with patients should use teach-back. For example, staff making appointments may use it to ensure that patients understand what is required of them at the next visit, such as arrival time, insurance documentation, bringing medicines, fasting, and details about referrals to other clinicians. 
• Share teach-back stories. Ask one person at each staff meeting to share a teach-back "Aha!" moment. This serves as a reminder of the importance of using teach-back consistently.
• Post the Teach-Back Poster from the appendix where clinicians and staff can see it.
• Make teach-back a required part of obtaining informed consent. The National Quality Forum, the Joint Commission, and the Leapfrog Group all recommend using teach-back during informed consent discussions as a safety practice. You can use the teach-back questions that were developed as part of AHRQ's Making Informed Consent and Informed Choice: Training Module for Health Care Professionals.
• Recruit teach-back champions. Get people who use teach-back consistently to coach those who are not asking patients to teach back.

Track Your Progress

Ask staff to fill out anonymously the before you start using teach-back and then 1 and 3 months later. Track changes in the responses to see if people increasingly believe that teach-back is important and have confidence in using the method.

The should be used by a designated observer as clinicians build their skills and confidence with teach-back. There is also a teach-back question on the Communication Observation Form. Use the findings to guide evaluation, coaching, and additional learning to establish consistent habits.

Before implementing this tool and 2, 6, and 12 months later, collect patient feedback on a selection of questions about this tool from the Health Literacy Patient Feedback Questions. 

Go to Tool 2: Assess Organizational Health Literacy and Create an Improvement Plan to learn how to use data in the improvement process.