How-To Tips

Health Literacy

Using Teach-Back to Confirm Understanding

Feb 1, 2022

It is vital that we as health communicators confirm that our messages are truly understood. Two important ways to do this are with teach-back (for the spoken word) and feedback (for print and web information). 

This month’s How-To Tip looks at teach-back. This is a back-and-forth verbal exchange used to assess whether both sides of a conversation (the person communicating the message and the person receiving it) correctly understand each other.

Here are some tips about using teach-back:

  • Prioritize topics. Patients and providers likely discuss many topics. This often includes context such as what a symptom is and why, or why not, it is worrisome. Topics might also be about follow-up, such as when and where to schedule the next appointment. It’s likely that much of the patient-provider conversation is on “how-to” information such as directions for taking medicine, using a medical device, or recognizing side effects. While all topics can be helpful, use teach-back only for a few important ones. 
  • Set a tone of partnership. Teach-back is a way to confirm that you, as the communicator, are clear. It is not to test how smart or savvy the other person is. Start by setting a tone of partnership such as “I want to make sure that I explained this clearly.” Then ask open-ended questions in a conversational manner. For instance, “When you go home today, what will you tell your [spouse, adult child, or caregiver] about [key points we just discussed]?” Or focus on important actions, like saying “we talked about the importance of eating high fiber foods. What will you look for the next time you buy cereal?”
  • Follow up to their response. Say a bit more after the other person replies. If it’s evident that they correctly understood, acknowledge that and perhaps add a bit more, such as, “It’s great that you know about [topic]. I look forward to hearing how that helps.” But if the patient does not seem to correctly or completely understand, reword the message to be more clear. Then use teach-back again to assess the patient’s level of understanding. If despite your best efforts the patient still does not understand, adapt your teaching accordingly. This might be by showing a video on that topic or recommending they invite someone to come with them to the next appointment.
  • Allow sufficient time. Admittedly, teach-back takes some time. But perhaps not as long as you fear, especially once teach-back becomes a routine part of your clinical care. Consider, too, the extra time it might later take if patients do not understand and cannot correctly follow instructions. 

Next month’s How-To Tip will focus on getting feedback.

To learn more:

This How-To Tip is adapted from Helen Osborne’s soon-to-be published book, Health Literacy from A to Z: Practical Ways to Communicate Your Health Message, Third Edition.