Health Literacy and use of Teach-Back for patient education Listen Learn Speak Health Literacy and use of Teach-Back for patient education Improving the engagement of the patient in their own care.

Hidden Barriers to Communicating with Patients Clients/Patients: Education/ Literacy/ Language Health Literacy: Capacity to: Obtain, process, understand basic health information and services Make appropriate healthcare decisions (act on information) Access/ navigate healthcare system

Red Flags for Low Literacy in patients Frequently missed appointments Incomplete registration forms Non-compliance with medication Unable to name medications, explain purpose or dosing Identifies pills by looking at them, not reading label Unable to give coherent, sequential history Ask fewer questions Lack of follow-through on tests or referrals

Strategies to Improve Patient Understanding Focus on ‘need-to-know’ & ‘need-to-do’ What specifically do they need to do for themselves at home? Limit instructions to most important Cover more at next appointment Use “Teach Back” (examples to follow in this presentation) Demonstrate/ draw pictures - Use clearly written education materials Take 2 pills each morning

8 tips for Clinicians Use plain language Limit information (2-4 key points) Be specific and concrete, not general Demonstrate, draw pictures, use models Repeat/Summarize Avoid questions with YES/NO responses – use open ended questions. Teach-Back (Confirm Understanding) Be positive, hopeful, empowering

Focus on “Need-to-know” & “Need-to-do” What do patients need to know/do…? When they leave the exam room When they check out What do they need to know about going home? Taking medicines Self-care Referrals and follow-ups Filling out forms

Examples of Plain Language Commonly used terms Plain Language Terms Annually Arthritis Cardiovascular Dermatologist Diabetes Hypertension Yearly or every year Pain in joints Having to do with the heart Skin doctor Elevated sugar in the blood High blood pressure

Teach-back is… Asking patients to repeat in their own words what they need to know or do, in a non-shaming way. ● NOT a test of the patient, but of how well YOU explained a concept. A chance to check for understanding and, if necessary, re-teach the information.

“Teach-back” Ensuring agreement and understanding about the care plan is essential to achieving adherence Some evidence that use of “teach-back” is associated with improved patient engagement in their own care. Example script: “I want to make sure I explained it correctly. Can you tell me in your words how you understand the plan?”

A means to know if patient is really understanding instructions.

Ask patients to demonstrate understanding, using their own words: ● “I want to be sure I explained everything clearly. Can you please explain it back to me so I can be sure I did?” ● “What will you tell your husband about the changes we made to your blood pressure medicines today?” ● “We’ve gone over a lot of information about getting more exercise in your day. In your own words, tell me some of the ways you can get more exercise. How will you make it work at home?”

TEACHBACK Scripting: Can you tell me how you take each medicine TEACHBACK Scripting: Can you tell me how you take each medicine? When do you take these medicines? How much or how many do you take?

Show me how many pills you would take in 1 day.

In Summary: Plain Language How much will you take in the morning? Opportunity to re-teach if needed. When do you call your doctor?

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