Ask the person to demonstrate understanding in their own words about what they need to know or do.
Teach-back is not a test of the person but of how well you explained the topic. How you ask questions is also important. What you say, along with your tone of voice and body language, conveys whether you are working with the person or they feel like they are being tested. Don’t ask yes/no questions such as “do you understand?” because most times people just say ‘yes’ or ‘no’ – even if they haven’t understood. You as the healthcare worker need to take responsibility for their understanding. A key is to be genuine, which means you will need to find your own way and words to genuinely engage with each individual.
Here are some examples of specific questions you could adapt:
“Would you just mind explaining that back to me so I can check I’ve covered everything?”
“I want to check how well I explained your treatment options, their benefits and possible problems. Please tell me, in your own words, about what options you have for treating your lower back pain.”
“We’ve gone over a lot of things…..just so I make sure I have explained things clearly, can you please tell me in your own words what you heard me say?”
“I want to make sure I was clear about the side effects of taking this medicine. Can you please explain to me in your own words the things you need to watch out for?”
“Now that we’ve covered everything could you run through what you are going to do if this happens again for you?”
Pick three ways to ask someone to repeat back in their own words:
D, F, H and I are closed yes/no questions which don’t check understanding.
J is also incorrect as it might make the person feel like they are being tested. The onus is on you to explain clearly. So you might say, "I need to check I have explained this clearly, can you explain back to me what you need to do when you go home?"
Using open-ended, non-shaming questions
Creating a shame-free environment where questions are encouraged is essential.
In which video does the nurse use a non-shaming, open-ended question to check understanding?
In Video A the nurse assumes the burden of communicating clearly by asking the question “To make sure I have given you the right information can you tell me what I have told you in simple words.”
In Video B the nurse does not check if understanding has taken place but looks for a simple un-tested affirmation.