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:

• Health Literacy Out Loud #93: A conversation about the Always Use Teach-back toolkit. Interview with Mary Ann Abrams, Suzanne Rita, and Gail Nielsen. (March 19, 2013). [Podcast]. Osborne H, host.
• Health Literacy Out Loud #129: Teach-back. Interview with Dean Schillinger. (February 3, 2015). [Podcast]. Osborne H, host. 
• Agency for Healthcare Research and Quality. (September 2020). Use the teach-back method: tool #5. Health Literacy Universal Precautions Toolkit. 2nd edition.
• Anderson KM, Leister S, De Rego R. (2020). The 5Ts for teach back: An operational definition for teach-back training. HLRP: Health Literacy Research and Practice, 4(2).  

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