Patient-Centered Communication to Improve Health Literacy

This approach focuses on communication between patients and healthcare providers. Improving patient-provider communication and decision-making can improve overall health outcomes. The use of plain language in both spoken and written communication is an important strategy for improving personal health literacy and encouraging understanding. Steps providers and organizations can take to learn how to use plain language include:

• Present important content first.
• Segment hard-to-understand information into comprehensible chunks.
• Use simple terminology and define complex terms.
• Use the active voice.

Two other approaches rural communities can use to improve patient-centered communication are the EDUCATE Model and teach-back method.

EDUCATE Model

The EDUCATE Model is a process-based model that rural organizations can use to enhance communication between patients and providers. The model was developed by the Brigham and Women's Faulkner Hospital Patient/Family Education Committee. The EDUCATE Model allows healthcare providers to guide patient education and focus the conversation to best meet the needs of the patient and family. There are five stages of verbal education, and the model allows educators to choose specific modules that are applicable to a given situation.

The five stages of the model are:

• Enhance comprehension and retention
• Deliver patient-centered education
• Understand the learner
• Communicate clearly and effectively
• Address health literacy and cultural competence

Teach-Back Method

The teach-back method is an approach to educating patients where providers ask individuals to state, in their own words, what health information the provider shared. After the information is repeated, providers can check for comprehension and re-explain if needed. The goal is to confirm patient understanding of health information. The teach-back method is often used in healthcare settings. It can also be implemented in many different community settings to ensure comprehension of health information.

The teach-back method can improve:

• Understanding of treatment regimen
• Medication adherence
• Communication with providers
• Satisfaction
• Health outcomes

Guidelines for effectively implementing the teach-back method include:

• Be empathetic and use a caring attitude.
• Make eye contact and display neutral body language.
• Use plain language.
• Ask the patient to repeat what was said by using their own words.
• Ask open-ended questions.
• Be understanding and motivational to build patient confidence.
• Take the pressure off the patient and put the responsibility on yourself to explain the information clearly.
• If the patient does not repeat the information correctly, explain it in a different way and re-check.
• Use visual or print materials to support comprehension.
• Take notes on what worked and what did not in explaining the information. Practice what works.

Examples of Rural Programs Using the Teach-Back Method to Improve Organizational Health Literacy

• The University of North Carolina at Chapel Hill School of Dentistry is partnering with the Mountain Area Health Education Center to implement the Rural Oral Health Scholars program. Through practice sessions, participants learn to improve readability and plain language of a written patient education handout, and they practice using the teach-back method — a best practice used by healthcare providers to check for understanding by patients and their families.

Program Clearinghouse Examples

• The University of North Carolina, University Libraries – Health Science Library provides a series of videos, tutorials, and guides to help teach the teach-back method and explain how to incorporate the techniques at the organizational level.

Implementation Considerations

Rural organizations can use the EDUCATE Model to enhance patient education delivery and communication. Rural organizations planning to implement patient-centered communication approaches should ensure there is support for these approaches throughout the organization and from leadership. This buy-in will increase the likelihood of implementation and success.

When implementing teach-back methods, it is important to ensure the patient is engaged and responsive. The teach-back technique can be an iterative process if patients must repeat the information multiple times. Staff and healthcare providers can encourage patient participation in teach-back by having open conversations about the health topic and materials.

Resources to Learn More

Always Use Teach-Back!
Website
Toolkit outlining the health literacy principles of using plain language and the teach-back method for healthcare providers working with patients and families. Includes modules on using teach-back effectively and on supporting staff utilization of this method.
Organization(s): Institute for Healthcare Advancement (IHA)

The Impact of Teach-Back as a Patient Education Tool in Women with Inadequate Maternal Health Literacy Seeking Immunizations for their Children
Document
Describes a study of two groups of women in a public health setting receiving patient education information. One group received the information through the teach-back method and one group did not. Results showed an improvement in patient education knowledge scores with the use of the teach-back method.
Author(s): Jared, B.
Organization(s): East Tennessee State University School of Graduate Studies
Date: 5/2017

Plain Language Resources
Website
Offers resources, tools, and guidance on the importance and use of plain language.
Organization(s): Plain Language Action and Information Network

Use the Teach-Back Method
Document
An excerpt from the Health Literacy Universal Precautions Toolkit written for healthcare providers, clinical staff, and others working in the community providing step-by-step instructions to learn the teach-back method.
Organization(s): Agency for Healthcare Research and Quality (AHRQ)
Date: 2015