Checking understanding

1. To check if a person understands, ask them to explain or demonstrate what you said. If the person doesn't explain it correctly or misses vital points, re-teach the information.
2. This isn't a test of the consumer's knowledge; it's a test of how well you've communicated.

Teach-back

Teach-back¹ is one of the easiest ways to check you've succeeded in communicating. It involves:

1. Emphasising that it's your responsibility to explain things clearly
2. Asking the consumer to explain in their own words the main points from what you've said.

Teach-back works better than asking 'yes' and 'no' questions like "Do you understand?" Often the answer to that question is 'yes' even if the person does not understand. Many people do not want to take up your time asking for explanations.

Teach-back is an evidence-based method. When used routinely it can improve consumer-provider communication, efficiency and health outcomes, including safety, effectiveness and self-management². Teach-back engages both parties in a conversation and provides feedback about the consumer's understanding and opportunities for you to confirm or correct information you've provided.

Using Teach-back

Step 1

Do what you can to make the person feel comfortable. Use a caring tone and relaxed body language. Make eye contact.

Step 2

'Chunk' your information into small sections.

Step 3

Communicate your first chunk of information, in plain language. Use supporting material (for example, a reader-friendly flier or a demonstration) to support learning.

Step 4

Emphasise that it's your responsibility to explain things in a way that makes sense to them.

Step 5

Ask the person to explain back to you in their own words, or to demonstrate what you've shown them to do. Avoid asking questions that can be answered with a 'yes' or 'no'. Put the focus on how well you've communicated, not their knowledge.

For example:

‘Just checking we are on the same page, what did we decide today?’

• “I want to be sure I explained your tablets correctly. How are you going to take these tablets when you get home?”
• ‘When you get home, what will you tell your family about what we talked about today?’
• ‘Can you show me ….?
• ‘I want to make sure I’ve covered everything, can you tell me in your own words the main points?’

Step 6

If the person does not explain it back correctly, explain again and re-check.

Step 7

When the person explains it back in a way that shows they understand, let them know that this is correct. Then go on to your next chunk of information or message.

Step 8

Document the outcome from using Teach-back, for example, 'Ms X could explain the treatment offered.'

(1) Iowa Health System with Picker Institute, Des Moines University and Health Literacy Iowa, Always Use Teach-back, 2014, viewed August 2018, www.teachbacktraining.org

(2) D Schillinger et al., 'Closing the loop: physician communication with diabetic patients who have low literacy'. Arch Intern Med; 163(1), 2003, pp. 83–90.