Enhancing communication skills for telehealth: development and implementation of a Teach-Back intervention for a national maternal and child health helpline in Australia

Abstract

BackgroundTelehealth professionals require advanced communication skills, in part to compensate for lack of visual cues. Teach-Back is a best practice communication technique that has been recommended but not previously evaluated for consumer telehealth. We aimed to implement Teach-Back at a national maternal and child health telephone helpline. We describe the intervention and report telenurse experiences learning to use Teach-Back.MethodsWe identified barriers (time, knowledge, skills, beliefs) and enablers (self-reflection) to using Teach-Back, and developed a novel training program to address these, guided by the Theoretical Domains Framework. We engaged maternal and child health telenurses to participate in a “communication skills” study. The intervention had two key components: guided self-reflection and a Teach-Back skills workshop. For the duration of the 7-week study nurses completed brief online surveys following each call, reflecting on both the effectiveness of their communication and perceived caller understanding. At the end of each shift they reflected on what worked well. Teach-Back knowledge, skills, and beliefs were addressed in a 2-h workshop using videos, discussion, and role play. We explored nurses’ experiences of the intervention in focus groups and interviews; and analysed transcripts and comments from the self-reflection surveys using the Framework method. This study forms part of a larger evaluation conducted in 2016.ResultsIn total 16 nurses participated: 15 were trained in Teach-Back, and 13 participated in focus groups or interviews. All engaged with both self-reflection and Teach-Back, although to differing extents. Those who reported acquiring Teach-Back skills easily limited themselves to one or two Teach-Back phrases. Nurses reported that actively self-reflecting (including on what they did well) was useful both for developing Teach-Back skills and analysing effectiveness of the techniques. Most wanted more opportunity to learn how their colleagues manage Teach-Back in different situations, and more visual reminders to use Teach-Back.ConclusionsOur theory-informed intervention successfully enabled nurses to use Teach-Back. Guided self-reflection is a low-resource method aligned with nurse professional identity that can facilitate Teach-Back skills learning, and could also be applied to other advanced communication skills for telehealth. Listening to multiple workplace-specific examples of Teach-Back is recommended for future training.Trial registrationACTRN12616000623493 Registered 15 May 2016. Retrospectively registered.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-2956-6) contains supplementary material, which is available to authorized users.

Telephone advice nursing : communication, patient satisfaction and tool development

“…This action is described as a communication technique called "Teach back" and has recently been tested in a TAN context. The results from that study support our decision to emphasize this in the TSAT (Morony et al 2018).…”

The 5Ts for Teach Back: An Operational Definition for Teach-Back Training

“…Ninety-three percent of participants achieved competence in the use of Teach Back by the end of the training (measured by direct observation), and 96% reported using Teach Back in a 3-month follow-up survey (Mahramus et al, 2014). In a small qualitative study, a 2-hour training that combined video demonstration, handouts, role play, and peer learning was effective for Teach-Back training (Morony et al, 2018). Participants felt that follow-up with the trainers, providing cues in the workplace, and more peer interaction would have increased competence.…”

“…The second is a statement implying that the HCW is the one being tested rather than the patient. This element also reduces the burden on the patient and reflects the impact of Teach Back on the HCW's communication skill development (Morony et al, 2018).…”

“…Included in many definitions is the concept that Teach Back is a measure of the HCW's ability to clearly communicate information (Institute for Healthcare Advancement, 2012; Kornburger, Gibson, Sadowski, Maletta, & Klingbeil, 2013;Morony et al, 2018). It is not a test of the patient's ability (Institute for Healthcare Advancement, 2012).…”

“…Several definitions of Teach Back explicitly indicate that if the patient is not able to accurately restate the information, the HCW should reteach the information (Institute for Healthcare Advancement, 2012; Bogue & Mohr, 2017;Griffey et al, 2015;Ha Dinh, Bonner, Clark, Ramsbotham, & Hines, 2016;Kornburger et al, 2013;Morony et al, 2018). After reteaching the information, the HCW should perform Teach Back again and continue the cycle until patient understanding is achieved (Ha Dinh et al, 2016;Kornberger et al, 2013).…”