1. Holman, Carita K. DNP, FNP-C
  2. Weed, L. Diane PhD, FNP-BC
  3. Kelley, Sabrina P. DNP, FNP


The purpose of this pilot study was to improve patient health literacy by teaching acute care nurses the teach-back method. The study involved administration of an evaluation tool to assess knowledge, attitudes, and use of teach-back prior to and 30 days after an education session. Nursing professional development practitioners can use the findings from this study to develop an education program to improve patient health literacy.


Article Content

A high prevalence of admissions and readmissions to a small hospital in the Southern United States led to the initiation of the pilot study discussed in this article. The causes of these admissions and readmissions were uncontrolled diabetes, kidney disease, and heart failure. In 2011, all-cause hospital readmissions in the United States contributed approximately $41.3 billion of the hospital cost (Hines, Barrett, Jiang, & Steiner, 2014). What factors contribute to uncontrolled chronic diseases? Are patients intentionally noncompliant or unlearned? If the answer is unlearned, how should one bridge the gap? The required resources to answer these questions and complete the pilot were time and finances for incentives. Key stakeholders included the organization's leaders, nurses, and patients. Although the results of the study were essentially positive, lack of finances may have contributed to the low postintervention participation.


Teach-back is a research-supported practice that asks patients to recall health information in their own words to confirm understanding and enhance communication (Fidyk, Ventura, & Green, 2014). An essential element of effective communication in health care is evaluating patient understanding, and healthcare providers are critical components of all healthcare systems, including patient education (Al Sayah, Williams, Pederson, Majumdar, & Johnson, 2014). Teach-back provides the opportunity to assess patients' understanding and correct any misunderstandings during the patient encounter (Abrams, Rita, Kurtz-Rossi, & Nielsen, 2012). This ensures patients' understanding and increases the opportunity for successful disease management (Al Sayah et al., 2014). The purpose of this article is to report the findings of a pilot study designed to improve patient health literacy by teaching nurses the teach-back method.



Low health literacy and chronic disease may result in adverse outcomes, and studies indicate that providers are inadequately addressing health literacy. Through an educational coaching session of teach-back, the primary investigator (PI) intended to impact health literacy in the hospital setting. The question the PI sought to answer is as follows: In acute care nurses, does an education training session on teach-back improve the provider's use of teach-back? The sample included 1 male and 19 female acute care nurses over the age 19 years.


A 300-bed inpatient facility served as the setting of the pilot study. The PI focused on nurses, including license practical nurses, registered nurses, nurse case managers, and nurse practitioners on two medical-surgical nursing units.


The intervention for the project was several coaching sessions on teach-back for the day and evening nursing staff. The topic focused on the teach-back technique using information from the Agency for Healthcare Research and Quality'sHealth Literacy Universal Precautions Toolkit and the Always Use Teach-Back! Toolkit (Abrams et al., 2012). The data tool used was the Conviction and Confidence Scale from the Always Use Teach-Back! Toolkit (Abrams et al., 2012).


This project included first recruiting participants by distributing flyers that advertised the study. The nurse manager for the unit recruited staff on the day of the intervention. Next, the PI explained the project and allowed time for questions, then participants gave written informed consent. For the third step, the PI administered a presurvey. After completion of this questionnaire, which was returned in the folder given to them at the beginning of the session, the PI would begin a 10-20-minute group lunch and learn educational session on the use of teach-back. Finally, a month after the intervention, the posttest was repeated. The follow-up surveys were administered using Survey Monkey to the e-mails provided at the initial session. Finally, results were analyzed.



IBM Statistical Package for the Social Science (SPSS) version 24 was used for all statistical analyses. The sample consisted of 20 participants, with 35% falling within the range of 19 to 30 years of age. The sample (N = 20) consisted of 95% females and 5% males. Nine participants participated postintervention. The majority of the participants' highest degree was 4 years of college (65%), followed by those with 1-3 years of college (30%). Descriptive statistical analyses were performed to examine the preintervention and postintervention Conviction and Confidence Scale. The questionnaire measures conviction in the importance of teach-back, the confidence in the participants' ability to use teach-back, and the frequency in which participants use the elements of teach-back. Compared to preintervention surveys, there was an improvement in scores among the nine who answered postintervention surveys. When asked the about the importance of using teach-back, 78% of those who responded reported the highest level of conviction compared to 75% of presurvey respondents. Seventy-eight percent of postsurvey respondents indicated the highest level of confidence in their ability to use teach-back, compared to 50% of presurvey participants. Postintervention respondents also consistently indicated an increased frequency of use of the elements of teach-back. The greatest improvement was noted in reteaching to patients who were unable to teach-back. Based on the Likert scale used for the project, postintervention data suggest that teaching teach-back to providers could be effective in improving its use.



One of the major findings of this project was the increase in nurses reexplaining when patients were unable to explain in their own words their patient education. Other findings included an overall increase in nurses' conviction in the importance of teach-back and an increase in confidence in using teach-back. Based on the results of this project, the education intervention was helpful in encouraging nurses to use teach-back more frequently and to include all elements of the method, especially reteaching information that the patient appears to misunderstand. The third question on the Conviction and Confidence Scale assessed use of teach-back. The preintervention results showed that 60% of the participants had been using the elements of teach-back for 6 months or more. The final results of the project indicated that although nurses already know and practice teach-back, continuing education and evaluation in this area would be beneficial in improving patient health literacy.


Limitations of this study include the small sample size and low postintervention participation. As a result, this study cannot be generalized. Voluntary participation, lack of a control group, and the self-assessment tool used during this project increase the opportunity for bias.



Patient education is an essential function of healthcare and teach-back is a research supported practice that asks patients to recall health information in their own words to confirm understanding and enhance communication. The results of the pilot study showed that, after an educational session, there was an overall increase in use of the elements of teach-back, especially in the area of re-explaining information when patients are unable to explain in their own words what was taught. Although the results of this study cannot be generalized due to the small sample size there is an indication that a professional development program with a similar design could be beneficial in creating health literate healthcare providers as well as health literate organizations, thereby improving overall patient health literacy.




Abrams M. A., Rita S., Kurtz-Rossi S., & Nielsen G. (2012). Always Use Teach-back! Toolkit. Retrieved from[Context Link]


Agency for Healthcare Research and Quality (2015). Health Literacy Universal Precautions Toolkit. Rockville, MD: Author. [Context Link]


Al Sayah F., Williams B., Pederson J. L., Majumdar S. R., & Johnson J. A. (2014). Health literacy and nurses' communication with type 2 diabetes patients in primary care settings. Nursing Research, 63(6), 408-417. doi:10.1097/NNR.0000000000000055 [Context Link]


Fidyk L., Ventura K., & Green K. (2014). Teaching nurses how to teach: strategies to enhance the quality of patient education. Journal for Nurses in Professional Development, 30(5), 248-253. doi:10.1097/NND.0000000000000074 [Context Link]


Hines A., Barrett M., Jiang H. J., & Steiner C. (2014). Conditions with the largest number of adult hospital readmissions by Payer, 2011. Healthcare Cost and Utilization Project: Statistical Brief No. 172. Retrieved from[Context Link]