STEP 4 | Re-assess and re-clarify
Repeat Steps 2-3 until any misunderstandings are clarified
Once you have re-explained the information, ask the person to explain back to you in their own words again. Then:
– Provide feedback
– Identify and address any misunderstandings
As with any healthcare encounter, teach-back is not a ‘one size fits all’ approach. You will need to be flexible in applying the technique. Some people will need you to use teach-back just once. Others will require a much gentler, tailored approach. For example, you may need to work out how much information you give the person in one go.
Repeat the process of re-checking and re-clarifying up to three times.
Clarify, re-check and re-clarify
Watch this video
In the video above the doctor explains to the patient what he needs to do.
He realises that the patient didn’t understand him.
Which of the following videos best demonstrates what the doctor should do next?
In Video A the doctor slows down and uses plain language to re-explain what the patient needs to do. However, he uses a closed ‘yes/no’ question to check understanding.
The correct answer is Video B as the doctor slows down and uses plain language to re-explain what the patient needs to do. He also chunks and checks the information and asks the patient to re-explain in his own words so he can be confident the patient has understood.
If you have taken learning styles into account and teach-back doesn’t seem to be working, consider the following approaches.
- Are other factors impacting on the exchange? These might include cultural expectations, health status, ability to hear, or the client’s emotional or cognitive state.
- Are you delivering your information in bite sized pieces (‘Chunking and Checking’)?
- Does another person need to do the teaching?
- Does the person really need to know all the information you are providing?
- What resources does the person already have to help them learn about and manage their health? These could include family, reliable websites, or telephone services. See the role of family members discussed below.
- Is the person from a non-English speaking background and do they need the assistance of an interpreter? See Section 13.
Sometimes teach-back just isn’t appropriate for a person. In these situations, you may need to put other supports in place depending on the circumstances.
The role of family and friends
Frampton, S., Wahl, C, Cappiello, G. 2010. Putting persons first. Partnering with persons’ families: three ways hospitals can enhance family members’ involvement in health care. American Journal of Nursing, 110(7), 53-56.
Agency for Healthcare Research and Quality [AHRQ]. 2015. Health Literacy Universal Precautions Toolkit, 2nd Edition. AHRQ. Accessed Dec 2017.
Amalraj, S., Starkweather, C., Nguyen, C., Naeim, A. 2009. Health literacy, communication, and treatment decision-making in older cancer persons. Oncology. 23(4), 369-375.
Amalraj, S., et al., Health literacy, communication, and treatment decision-making in older cancer persons. Oncology (08909091), 2009. 23(4): p. 369-375.
Labrecque, M., Blanchard, C., Ruckdeschel, J., Blanchard, E. 1991.The impact of family presence on the physician-cancer person interaction. Social Science & Medicine. 33(11), 1253-1261.
Beisecker, A. 1989. The Influence of a Companion on the Doctor-Elderly Person Interaction. Health Communication. 1(1), 55