Teach-back

Teach-back is an easy-to-use technique to check that the health professional has clearly explained information to the patient and that the patient has understood what they have been told.

This technique goes beyond using questions such as “Is that clear?” and “Have you understood everything?” Instead, the health professional asks the patient to explain or demonstrate, using their own words, what has just been discussed with them.

Teach-back does not test the patient’s knowledge but it is an effective technique to check how well the health professional has explained the information in a way that the patient understands.

Download a print versionPDF document

How to do it

  • After each consultation, the health professional will check on the patient’s understanding of what they have been told.
  • The health professional should avoid asking questions such as “Is that clear?” and “Have you understood everything?” and instead they should use questions such as:
    • “To be sure that I have explained everything correctly, could you explain to me
      how you will take your medication?”
    • “We discussed a lot today. Can you tell me what you found most important?”
    • “So that I can be sure I have given you clear instructions, please show me how you will use your asthma inhaler at home?”
  • If the patient is unable to explain what they have been told the health professional should repeat the information or instructions again and rephrase their question using different words.
  • The health professional could draw a diagram or simplify the explanations.
  • The teach-back technique is then repeated and if after two or three attempts the patient is still unable to explain what they have been told then the health professional could seek a colleague’s help or look into whether an interpreter is needed.
  • If the patient fails to explain what they have been told then the health professional has not provided their patient with an adequate explanation and alternative methods should be used in order to provide the relevant information.

Pros

  • Can improve patient safety and communication between the health professional and the patient
  • Not expensive to use
  • Can improve the patient’s understanding and health outcomes.

Cons

  • It requires time and health professionals may need to allocate extra consultation time to encourage the patient to ‘teach-back’ what they have been told
  • This tool could appear as patronising, and deteriorate into an interrogation unless it was used sensitively.

Resources

  • Staff and patient time
  • Publicity
  • Communication support (interpreters, signers for the deaf)

Top Tips

  • Staff should be encouraged to learn the teach-back technique and use it to make sure that their communication is clear.
  • Keep a log of your teach-back experiences.
  • Start with one patient a day. Try the teach-back technique and write down the reflection (how did it go? Is there anything that you would you do differently? Were there any concerns from the patient about using this tool? Did it unearth any communication issues?).
  • If the teach-back technique fails, alternative methods should be used to ensure that the patient is provided with the relevant information.
  • After using teach-back with one person a day, try to increase to two patients a day.
  • Teach-back can be used with everyone whether or not you think the person understands and also when you think someone is struggling to understand what you are telling them.
  • It may be worth allocating sufficient time after a consultation if this tool is to be used to allow you to interact with patients.
  • Depending on how serious a health problem is, a patient may be in a state of shock and likely to be anxious at least. This will not make it easy for the patient to understand what has been said.
  • Teach-back is not a test for the patient. Instead it is to check on how well the health professional provides information to the patient.
  • Practice, practice, practice and soon it will become part of a routine.
  • Many resources suggest using Ask Me 3 in conjunction with the teach-back technique.

Sources and Further Information

  • The Link opens in a new windowAmerican Medical Association’s website provides a number of useful resources to help demonstrate the teach-back technique. Resources also include a 5-minute video of teach-back being used.
  • The North Carolina Program on Health Literacy produced a Link opens in a new windowHealth Literacy Toolkit, which includes a description of the teach-back technique
  • NHSScotland has developed a Teach-back Technique postcard and copies are available from Emailknowledge@nes.scot.nhs.uk
  • Alternatively, a PDF version of the postcard (kindly provided to us by Kate Burton, NHS Lothian) can be downloaded from the Link opens in a new windowNHS Lothian website.