Do patients understand all, or even most, of the information their doctors provide them about their health and treatment? The sobering answer is that not enough patients do. Most patient education materials are written at or above a 10th grade reading level, yet nearly half of U.S. adults have trouble understanding and acting on information that is written above an 8th grade level, and only 12 percent have proficient health literacy.

According to the National Assessment of Adult Literacy (NAAL), that means over a third of U.S. adults — 77 million people — would have difficulty with common health tasks, such as following directions on a prescription drug label. This contributes to poor patient compliance, leading to increased hospitalizations and chronic illness and costing the economy up to $238 billion each year, according to research from The George Washington University Himmelfarb Health Sciences Library.

To address these concerns, the American Academy of Ophthalmology recently redesigned new patient education materials to meet the health literacy standards used by the Centers for Disease Control, Centers for Medicare & Medicaid Services, and National Institutes of Health, which require materials to be between fifth and eighth grade reading levels. But reading level alone is not enough to ensure that patients have processed and understood a doctor’s instructions – studies show that a particular technique may make all the difference.

The “teach-back” technique
Authors of the 1996 book, Teaching Patients with Low Literacy Skills, Ceci and Len Doak are often considered “the grandparents of health literacy.” While the book is now out of print (though the full text is available here), its popularity has grown amongst health educators, health communication specialists, and health care providers as the need for clear communication principles in medicine becomes ever more apparent.

The book pioneers the “teach-back technique,” a method of ensuring that your teaching is effective by asking for the learner to teach it back to you in his or her own words. “Teach-back is not a test of the learner’s knowledge, but a way for you to find out if your teaching was clear, or if you need to present the information in a different way,” states health education specialist Fran London, MS, RN, on her website, NoTimetoTeach.com. She also perfectly illustrates her point with a clip from the TV show “House,” showing a patient’s understanding – or rather, misunderstanding – of how to use her inhaler.

Doctors need not worry that “teach-back” will take more time. In fact, it saves time by catching and clearing up confusion up front. And, the simple technique can potentially cut costs as well, say clinicians who have used it.

“Teach back” do’s and don’ts
“Teach back” is useful for all levels of literacy because it gives you the information you need to individualize teaching, states London. To try it with your patients, she offers examples of the right types of questions to ask. For instance, don’t ask, “Do you have any questions?” but, “What could I have explained more clearly?” Do not say, “Are you sure you’re using it right?” but ask the patient to show you how she is using her medical equipment or taking her medication.

The following statements and questions can help you evaluate patients’ understanding:

  • “I want to make sure I clearly explained that and didn’t leave out anything important. Could you tell me, in your own words . . .”
  • “Tell me what you know about . . .”
  • “How would you explain that to . . .”
  • “How would you know if . . .”
  • “Show me how you would . . .”
  • “What would you do if . . .”
  • “Who would you call if . . .”

Of course, listening and eye contact are important to fully gauge patients’ responses, so avoid the temptation to immerse yourself in recording their answers on your computer or EHR.

To correct misunderstandings, consider saying:

  • “I’m glad you brought that up. Many people were taught that in the past, but now we know . . .”
  • “That used to be the case, but now research has shown . . .”


The use of visuals in “teach-back”

We know from research that the majority of people – perhaps as many as 85 percent – are visual learners who retain information better by seeing pictures or videos rather than by hearing it or reading it. We also know that the retina delivers data to the brain at the rapid speed of 10 million bits per second. So it makes sense for doctors to incorporate pictures and videos into their teach-back strategy.

An Australian study on the use of animations and the teach-back technique to facilitate an understanding of health literacy levels within the general community found that participants not only responded positively to the animations, but survey data showed an increase in their knowledge of key health concepts as a result.

Animations that can be shared with family members and other caregivers outside the doctor’s office offer even more benefits. Patients then have the opportunity to teach others what they learned, with the accompaniment of medically accurate, high-quality videos provided by their doctor.

To find out more, or for a look at Rendia, our interactive patient-education platform, get in touch today.