Teach-back: A systematic review of implementation and impacts

Abstract

Patients often have difficulty comprehending or recalling information given to them by their healthcare providers. Use of 'teach-back' has been shown to improve patients' knowledge and self-care abilities, however there is little guidance for healthcare services seeking to embed teach-back in their setting. This review aims to synthesize evidence about the translation of teach-back into practice including mode of delivery, use of implementation strategies and effectiveness. We searched Ovid Medline, CINAHL, Embase and The Cochrane Central Register of Controlled Trials for studies reporting the use of teach-back as an educational intervention, published up to July 2019. Two reviewers independently extracted study data and assessed methodologic quality. Implementation strategies were extracted into distinct categories established in the Implementation Expert Recommendations for Implementing Change (ERIC) project. Overall, 20 studies of moderate quality were included in this review (four rated high, nine rated moderate, seven rated weak). Studies were heterogeneous in terms of setting, population and outcomes. In most studies (n = 15), teach-back was delivered as part of a simple and structured educational approach. Implementation strategies were infrequently reported (n = 10 studies). The most used implementation strategies were training and education of stakeholders (n = 8), support for clinicians (n = 6) and use of audits and provider feedback (n = 4). Use of teach-back proved effective in 19 of the 20 studies, ranging from learning-related outcomes (e.g. knowledge recall and retention) to objective health-related outcomes (e.g. hospital re-admissions, quality of life). Teach-back was found to be effective across a wide range of settings, populations and outcome measures. While its mode of delivery is well-defined, strategies to support its translation into practice are not often described. Use of implementation strategies such as training and education of stakeholders and supporting clinicians during implementation may improve the uptake and sustainability of teach-back and achieve positive outcomes.

Improving adult coping with social isolation during COVID‐19 in the community through nurse‐led patient‐centered telehealth teaching and listening interventions

“…Have you been connecting with social groups? 35 (80) 9 (20) Are you considered higher risk due to a vulnerable condition? Vulnerable means > 60 years old, immunocompromised (weakened immune system due to certain conditions or medications), has lung disease (asthma or COPD), or has chronic health conditions (diabetes, heart disease, and hypertension).…”

“…Have you talked to that person or anyone else about your wishes and preferences for end-of-life care? 16 (80) 4 (20) Note: N = 44, all cycles; N = 24, cycles 1-2; N = 20, cycles 3-4.…”

Implementation of an electronic care pathway for hip fracture patients: a pilot before and after study

“…Finally, although clinicians and nurses involved in the study were trained in the use of the e-pathway, which is an essential implementation strategy when introducing a new intervention, training alone is not sufficient to effect ongoing change and uptake into clinical practice [ 38 ]. Successful implementation normally requires an implementation plan and a multifaceted approach that includes collaboration between stakeholders and health services, staff flexibility, and a culture receptive to change [ 39 ]. A recent implementation study identified five strategies which may contribute to the successful implementation of an electronic care pathway: a strong national policy context for the rationalization of processes and data collection of efficiency indicator targets; financial and organisational resources; multidisciplinary engagement; guidelines and documentation for the standardisation and implementation; and development of an implementation protocol based on national guidelines and clinical expertise [ 40 ].…”

A Virtual Training Program for the Tandem t:slim X2 Insulin Pump: Implementation and Outcomes

“…The virtual training program was designed specifically for remote sessions and involved more than performing standard pump training over a video call. Structured training specifically tailored to remote learning included (1) practice of pump-related features while showing competency related to specific tasks with use of the t:simulatorÔ smartphone app, (2) standardized instruction and feedback using the teach-back method, [6][7][8] and (3) followup review with the pump trainer and health care providers. Key aspects of the newly designed virtual training program, including preparation, in-session, and follow-up visits, are shown in Table 1.…”