1. Farris, Cindy PhD(C), MSN, MPH, CNE

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Q: At our home healthcare agency, we are supposed to document that the teach-back method was used when we teach patients. Can you describe this method of teaching?


Health literacy issues are very prevalent in the United States. It is estimated that 14% (30 million) of people in the United States are unable to perform even lower-level literacy tasks (U.S. Department of Health and Human Services, 2010). Effective health education is critical in all settings including the home healthcare arena. Often patients are discharged from facilities without proper evaluation of learned material. As much as 40% to 80% of medical information that a patient receives is forgotten immediately, and nearly half of the retained information is incorrect (Kessels, 2003). Closing the gap between clinician teaching and patient understanding could be accomplished through the use of the teach-back method of instruction (Schillinger et al., 2003).


Definition and Uses of the Teach-Back Method

Teach-back is a way to confirm that the educator has explained to the patient what is important and in a manner that the patient understands (Health Literacy, 2014). Patient understanding is confirmed when the patient explains it back in their own words to the educator. It can also help the clinician identify explanations and communication strategies that are most commonly misunderstood by patients (Health Literacy).


There are several ways to begin using the teach-back concept in home healthcare. Remember the teach-back method is not about testing the client's knowledge but rather how well the concept was explained. In home healthcare, assessing how well clinicians from other facilities explained instructions prior to discharge would be key during the initial visit. Ask the patient what instructions they received prior to discharge. Use the teach-back method when the patient is struggling with directions. All members of the home healthcare agency can use the teach-back method to ensure communication to the patient is clear and concise (Health Literacy, 2014; North Carolina Program for Health Literacy, 2014).


Steps to Using the Teach-Back Method

A staff in-service on the concepts of the teach-back method should be scheduled prior to putting this policy in place. Emphasize to the staff to start slowly and gain confidence in the method. A plan of when the teach-back method of evaluation should be used needs to be carefully detailed. Not all situations are appropriate for using the teach-back method. Reviewing written materials to reinforce the teaching points can be very helpful for patient understanding. Make sure the literacy reading level has been determined for the patient prior to written handouts. Ask the patient how they best learn. Do they prefer written materials, oral instruction, or videos? If patients cannot remember or accurately repeat what was asked, clarify the information or directions and allow them to teach the information back again. Reinforce the teach-back method until the patients are able to correctly describe in their own words what they are going to do, without parroting back what the staff said. The teach-back method may take some time getting used to, but studies show that once established as part of a routine, it does not take longer to perform (Health Literacy, 2014; North Carolina Program for Health Literacy, 2014).



Always Use Teach-back (2015), Health Literacy (2014), and North Carolina Program for Health Literacy (2014) have wonderful Web sites and tools containing an overview of the method, purpose, handouts, and videos for both the educator and the client regarding the teach-back method. These tools and Web sites include an introduction to the Teach-BackToolkit, an interactive teach-back learning module that enables learners to identify and use key aspects of plain language and teach-back throughout the care continuum by following a patient's experience during hospital discharge through the home healthcare and primary care settings. Videos demonstrating clinicians using the teach-back method are available. The module also includes tips and tools to help managers and supervisors empower staff to use teach-back, and another area with readings, resources, and videos.


Evaluation of Process

Allow staff to share teach-back strategies that worked best. In addition, when in the home, it is important to ask patients about the teach-back interaction. Assess how often the teach-back is utilized and during what situations. A few weeks after first trying the teach-back, track how many clinicians or staff members are using it. Have each individual keep a log of when and how it was used over the course of a few days and evaluate its effectiveness.



The teach-back method of instruction is a great way to evaluate the learning outcomes of patients and the success of teaching. There are many resources to assist clinicians in the home healthcare arena to utilize the teach-back concept. Improving communication between the patient and the staff is important for effective health learning, and the teach-back method is one way to improve communication. A key goal of home healthcare is the reduction of rehospitalizations. The teach-back method is an integral component of that goal (Sevin et al., 2013).




Always Use Teach-back. (2015). Teach-back training kit. Retrieved from[Context Link]


Health Literacy. (2014). Teaching aids: Teach-back method. Retrieved from[Context Link]


Kessels R. P. (2003). Patients' memory for medical information. Journal of the Royal Society of Medicine, 96(5), 219-222. [Context Link]


North Carolina Program for Health Literacy. (2014). The teach-back method. Retrieved from[Context Link]


Schillinger D., Piette J., Grumbach K., Wang F., Wilson C., Daher C., ..., Bindman A. B. (2003). Closing the loop: Physician communication with diabetic patients who have low health literacy. Archives of Internal Medicine, 163(1), 83-90. [Context Link]


Sevin C., Evdokimoff M., Sobolewski S., Taylor J., Rutherford P., Coleman E. A. (2013). How-to guide: Improving transitions from the hospital to home health care to reduce avoidable rehospitalizations. Cambridge, MA: Institute for Healthcare Improvement. Retrieved from[Context Link]


U.S. Department of Health and Human Services (HHS). (2010). National health plan to improve health literacy. Retrieved from[Context Link]