A stepped wedge cluster randomised trial of nurse-delivered Teach-Back in a consumer telehealth service

Abstract

ObjectiveTo evaluate the impact of Teach-Back on communication quality in a national telephone-based telehealth service, for callers varying in health literacy.DesignCross-sectional stepped wedge cluster randomised trial with continuous recruitment, short (fixed) exposure and blinded outcome assessors. Nurses were stratified by hours worked and randomised into training groups using a computer generated sequence.SettingAn Australian national pregnancy and parenting telephone helpline.InterventionComplex intervention involving a single 2-hour group Teach-Back training session, combined with ongoing nurse self-reflection on their communication following each call and each shift.ParticipantsParticipants were 637 callers to the telephone helpline aged 18–75 (87% female), of whom 127 (13%) had inadequate health literacy (measured with the Single Item Literacy Screener); and 15 maternal and child health nurses with 15 years’ experience on average.MeasuresPrimary outcome was a modified subscale of the Health Literacy Questionnaire, ‘having sufficient information to manage health’. Secondary caller outcomes included caller confidence, perceived actionability of information and nurse effort to listen and understand. Nurse outcomes were perceptions of their communication effectiveness.ResultsOver a 7 week period, 376 surveyed callers received usual care and 261 Teach-Back. Ratings on the primary outcome increased over time (OR 1.17, CI 1.01 to 1.32, p = 0.03) but no independent Teach-Back effect was observed. A consistent pattern suggests that, compared with usual care, Teach-Back helps callers with inadequate health literacy feel listened to (OR 2.3, CI 0.98 to 5.42, p = 0.06), confident to act (OR 2.44, CI 1.00 to 5.98, p = 0.06), and know what steps to take (OR 2.68, CI 1.00 to 7.17, p = 0.06). Nurse perceptions of both their own communication effectiveness (OR = 2.31; CI 1.38 to 3.86, p<0.0001), and caller understanding (OR = 2.56; CI 1.52 to 4.30, p<0.001) both increased with Teach-Back. No harms were reported.ConclusionsTeach-Back appears to benefit telephone health service users with inadequate health literacy, but the extent of this is unclear due to smaller numbers of lower literacy participants. Improving caller ratings over time are likely due to increasing nurse communication competence.

Disparities in COVID-19 related knowledge, attitudes, beliefs and behaviours by health literacy

“…Future surveys need to target these groups as we were unable to do so with limited time and funds for this project. Our sample of adults with low health literacy is similar to other studies we have conducted (∼15%)(18). The single item measure of health literacy used for assessment is simple and non-stigmatising to administer, however it under-reports problems with health literacy, identifying only those with very low health literacy levels (19).…”

Interventions to Improve Health among Reproductive-Age Women of Low Health Literacy: A Systematic Review

“…The study of Morony et al [ 31 ] aimed to implement the “teach-back” technique (wherein patients are asked to repeat, in their own words, the information they had just received) in a telephone service providing information and advice for pregnancy and parenting of young children, and evaluate the impact on caller ratings of information they received as well as the overall experience of the call (Australian national pregnancy and parenting telephone helpline). This study aimed to mitigate the service gaps experienced by persons with low HL when accessing telephone-based health services in view of their difficulties to ask questions or indicate when they do not understand.…”

Health literacy and disparities in COVID-19–related knowledge, attitudes, beliefs and behaviours in Australia

“…The proportion of adults with low health literacy in our sample is similar to other studies we have conducted (~15%). 22 The single item measure of health literacy (SILS) used for assessment is simple and nonstigmatising to administer; however, it under-reports problems with health literacy, identifying only those with very low health literacy levels. 23 It was correlated with our additional related measure of numeracy, e-health literacy and graphical literacy (all p values <0.001).…”