Health literacy is recognized as a contributor to health outcomes and maternal health literacy is important to the health and wellbeing of children and families. Of particular interest are mothers seeking immunization services for their children. The complexity of the recommended immunization schedule and the care management of children receiving immunizations have the potential to create negative health outcomes in the low health literate population. Assessment of maternal health literacy and provision of effective patient education adapted to the health literacy level of the individual is important for information transfer. The Teach-Back provides an opportunity to both assess understanding and reinforce teaching. This study used an experimental design to study two groups of women for a total of 90 participants in a public health department setting. The control group received the usual immunization patient education using Vaccination Information Sheets. The intervention group also received patient education in this manner plus use of the Teach-Back. Immunization knowledge was assessed prior to and after patient education. Immunization currency was assessed as well. The Newest Vital Sign was used to assess the maternal health literacy for 90 mothers bringing their children for immunizations. A demographic survey addressing both individual characteristics and social determinants of health variables was also administered. Most of the participants were low health literate (84%) and low health literacy was related to lower immunization knowledge and poor immunization currency. Social determinants of health variables were related to maternal health literacy, immunization knowledge and immunization currency. The results demonstrated an improvement of immunization knowledge scores with the use of the Teach-Back method of patient education. Additional research is needed in the area of patient education interventions specific to the low health literate population. The development of instruments to measure interactive and critical health literacy are needed and interventions to promote growth in health literacy are also needed. Clinically, improved patient education interventions for low health literate mothers has the potential to improve health outcomes and decrease health care costs of these women, their children and their families.

The evolution of person-centered healthcare reinforces the need for nursing to provide effective patient education. Literature suggests nurses desire to provide strong discharge education to patients, but are challenged by knowledge gaps and other barriers. This DNP project developed a plan for integrating teach-back on a 30-bed cardiac unit, focusing on heart failure patients. Following a logic model, the process improvement plan to implement teach-back includes education on teach-back, empowerment of unit champions to support the project and evaluation of effectiveness of the education plan and impact on heart failure patients. The sample size of 15 cardiac nurses provides a group representative of other cardiac units and allows for testing and data collection to support spread of the project. Collaboration with the unit leadership to sequence the implementation of the project will direct the timeline for execution and minimize competing priorities that could impede the success. Evaluation of the project takes into account the implementation processes that focus on resources such as education hours needed to implement and heart failure patient outcomes related to readmission rates. Pre- and post-implementation heart failure patient readmission rates as supplied by the site quality improvement team will be analyzed using ttest to correlate the education intervention on heart failure readmission rates. Nursing will drive improved patient outcomes and promote positive social change by using an evidence-based teaching methodology that allows for better patient understanding of how to manage their health. Empowered and better prepared heart failure patients enjoy autonomy with their health management and with reduced readmissions, decrease health care costs.

Class of 2013 Abstract / Specific Aims: The aim of this study was to compare memory retention between two methods (the teach-back method and the standard method) of educating subjects about mock prescription medications during a simulated counseling session. Methods: Men and women ages 18 to 89 years located on the University of Arizona main campus were recruited to participate. Blinded subjects were randomly placed into either the teach-back method or standard counseling method group. The standard method involved telling the subject eight counseling points about two separate fictitious medications while the subject handled mock prescription bottles. The teach-back method added to the standard method by asking three open-ended questions to recall what was taught and correct any misunderstandings. Memory retention was assessed within 5 minutes by a blinded investigator who asked 6 questions concerning the first hypothetical drug. The total score of correct answers between subjects in the two groups were compared using the Mann-Whitney U test. Also, demographic characteristics (age, sex, education, current prescription use) were compared. Main Results: A total of 62 subjects were enrolled in the study. Subjects in the teach-back method remembered one more counseling point on average compared to those in the standard method (median 6 vs 5, mode 6 vs 5, teach-back and standard respectively; Mann-Whitney U test: Z= -3.08, p=0.0021). Conclusion: The teach-back method is a quick and easy counseling method health care providers can use in their daily practice to improve memory retention by patients who receive new medications.

Limited health literacy is a national problem. Nurses are in a position to address patients' limited health literacy skills using a universal precautions approach through the teach-back process. The purpose of this project was to plan a program to educate nurses on best practices in patient education. The theoretical framework informing this work was Bandura's social cognitive theory, which asserts that increases in knowledge and self-efficacy are precursors to affecting behavior change. The logic model was used to guide the project planning processes. Evidentiary sources included literature obtained online and through database searches, input from a team of experts and institutional stakeholders, and surveys from project participants. Ongoing evaluation analyses of team members' feedback allowed for real-time changes to program content and meeting logistics. Team members' agreement about the meaningfulness of the project's goal, activities, and leader effectiveness revealed a mean score of 4.64 out of 5. Team members indicated that teach-back could improve patients' self-management ability and understanding of disease processes. The project outcome was a nurse education toolkit containing easy access to comprehensive learning resources tailored for use at a critical-access hospital. Nurses can positively impact social change by honing skills in the teach-back process as a way to evaluate patients' understanding of self-management and understanding of disease processes. The patients' understanding of educational materials pertinent to their disease process, self-care, and discharge is vital to their well-being and safety in the post hospital environment.

Discharge instructions and medication directions can be overwhelming for older adults, which can lead to potential medication errors, noncompliance, readmissions, and patient safety concerns. At a specialty lung clinic, the goal is to improve patient safety and to decrease the chance of errors by standardizing the discharge process via a Teach-Back education policy and protocol. Without consistency, there is a potential for mistakes and misunderstandings. The Agency for Healthcare Research and Quality (AHRQ) and the Institute for Healthcare Improvement (IHI) considers the Teach-Back discharge method as best practice and should be considered universal practice among health care workers. Using the Always Use Teach-Back Toolkit for education and evaluation provided strategies and resources for the project. Five nurse practitioners and a physician assistant, who are responsible for discharge instructions, participated in the study by viewing an online teaching module and completing written surveys. The Conviction and Confidence Tool revealed 100% of the clinicians agreed that Teach-Back education was '10-Very Important' and were '10-Very Confident' in their abilities to apply the Teach-Back methods using a 1-10 Likert scale. Likewise, the practitioners showed significant improvements when comparing the pre-implementation and one-month, post-policy implementation, as indicated in the paired t test of the second part of the Conviction and Confidence Teach-Back Tool. Nursing plays a pivotal role in positive social change by using an evidence-based education method, which improves patient care through medication compliance and decreased readmission rates, thus showing significant transformation in chronic health management.

Heart failure (HF) readmissions create a financial burden for healthcare nationwide and speak to the lack of effective discharge preparation for patients to be successful with self-care at home. The 183-bed hospital where this DNP quality initiative will take place currently reports an observed-over-expected (O/E) readmission rate for HF patients (Centers for Medicare and Medicaid [CMS]). Core measures on HF developed by the Joint Commission and the Centers for Medicare and Medicaid Services do not appear to be enough to ensure successful transitions of care from hospital to home. Guided by the LOGIC model, the purpose of this quality improvement initiative was to develop a HF educational module to improve patients' readiness to learn in order to promote self-care and prevent readmission to the hospital within 30 days. The design of the educational program was supported by the evidence-based literature and incorporated best practices promoted by the Joint Commission, the Institute for Healthcare Improvement, and the Agency for Healthcare Research and Quality. Content evaluation of the newly developed HF educational program was conducted by 10 experts using a quantitative Likert-type scale and qualitative narrative feedback. Descriptive findings from the Likert scale showed a range of 3.9 to 4.0 in the content, process, and design of the program. Recommendations for improvement included more detail around pathophysiology, as well as how to initiate the process in the outpatient setting. Positive social change can result from the program which offers a relevant strategy to reduce readmissions for HF and has wide-application options for many chronic illnesses that can be better managed through effective discharge teaching.

Low health literacy in parents has been linked to increased obesity risk for their children. When providing information to patients with low health literacy, teach-back (TB) and teach-to-goal (TTG) methods are recommended, but no studies have examined the degree to which TB/TTG strategies can be implemented with fidelity in community-based programs. A study was conducted to determine if type of delivery staff (community or research) is related to implementation fidelity; the degree to which TB/TTG methods are necessary for parent/caregiver understanding of childhood obesity learning objectives; and if baseline parent/caregiver health literacy level is related to support call response. Ninety-four families with overweight/obese children aged 8-12 years were enrolled in a pilot childhood obesity intervention that included 6 bi-weekly parent/caregiver support calls integrating TB/TTG methods into a 5 A's approach. Research partners (n=2) delivered all calls in Wave 1. During Waves 2 and 3, community staff (n=5) delivered a majority of calls with training and support from research staff. ). Average completion rate across calls was 62% and did not differ according to participant health literacy level. Community partners were more likely than research partners to complete calls with participants (68% versus 57%), but this trend was not significant. Both research and community partners adhered to call scripts with high fidelity (97% versus 98%). A significant main effect of health literacy level on TB/TTG performance was found for Call 1 and Call 3 during Wave 1 and for Call 1 during Waves 2 and 3 of iChoose (p<0.05, 0.01, and 0.05). An interaction effect of health literacy level and question number was found for Call 3 during Wave 1 only (p<0.05). For all calls in which TB/TTG performance differed significantly by health literacy level, participants with adequate health literacy were found to have better performance. Following the program, participants expressed they felt satisfied and comfortable with follow-up calls (9.1 (2.0) and 9.5 (1.2) on a 10-point scale), while agreeing that calls helped improve their eating and PA habits (8.1 (2.6) and 7.5 (2.7)) and helped them learn class material better (8.1 (2.7)). Trained community partners were able to deliver the same support call content with similarly high fidelity, completion, and acceptability. Although participant baseline health literacy level had less impact on the need for TB/TTG and on program perception than we anticipated, our findings open up different possibilities to utilize these strategies while using precious resources more efficiently. / Master of Science

Bakgrund: Många studier kan påvisa behovet av kommunikation och information mellan vårdare och patient oavsett profession.Tidsbrist och allt mer slimmade organisationer,med en ökande åldrande befolkning ställer ökade krav på förmåga och kunskap om kommunikation. Andra försvårande omständigheter är språkliga barriärer med en befolkning där alla inte har svenska som sitt modersmål. Teach –back är en metod som säger sig underlätta och stödja en kommunikation för att säkerställa informationen mellan patienter och vårdare. Den syftar också till att öka förutsättningarna för egenvård. Eftersom det är ett viktigt område inom omvårdnad syftar litteraturstudienatt ta reda på vad som finns beskrivet avseende Teach –back. Syfte: Att beskriva användningsområden för metoden Teach –back. Metod: Litteraturstudie baserad på åtta vetenskapliga artiklar. Resultat: Resultatet presenteras i följande teman. Det första temat är hälsolitteracitet och förstå given information och det andra är att säkerställa processen mellan vårdgivare och hemmet. Det tredje temat är att sjuksköterskans insikt om patienters kunskap om den egna hälsan. Analysen visar att inga slutsatser kan dras att Teach-back främjar omvårdnad. Däremot finns det resultat som bekräftar att Teach-back skapar förutsättningar för patient medverkan Diskussion: De delvis motstridiga uppgifterna och att de kan vara olika faktorers som styr resultatet gör att det är svårt att påvisa att Teach-back är lösningen för en kvalitetssäkrad kommunikation. / Background: Academic studies tend to demonstrate the need of communication and exchange of information between the health care provider and the patient, this regardless of the profession and socioeconomic background of the caretaker. Lack of time as well as the increased pressure of trimming the economic costs combined with an aging population creates a higher demand on the skills and knowledge of communication. Moreover our modern sociality is presenting some language barriers because of a growing part of the population whom does not have Swedish as their mother tongue. Teach -back is a method that claims to support a method of communication to ensure the quality of information between patients and care givers. Teach-back as a method also aims to enhance the ability of self-care for the patient. Self-care is regarded as an important area of ​​nursing, therefore the review of the literature in this study intends to map out all of the academic literature there is about the method Teach –back. Aim:To describe the uses for the method Teach-back. Method: A literature study based on eight scientific articles. Results: The result is presented in three following themes. The first theme are healthliteracy and understanding given information and the other is to ensure the process between the healthcare provider and the caretaker. The third theme are nurse’s understanding of the patient’s knowledge about their own health status. The analysis shows that no conclusions can be drawn regarding whether the teach-back method furthers the care or not. However, there are results confirming the fact that Teach-back creates a good environment for patient involvement. Discussion: The partly conflicting results that have emerge from the literature which shows that there may be different factors that have an effect on the outcome, making it difficult to conclude that the Teach-back method is the solution for assuring the quality of the communication.

This paper researches how information in game tutorials can be retained by the player. We use a teach-back framework to see what information the participants’ retained. The purpose of this study is to understand how a video game can communicate vital information about character mechanics and rules with the help of tutorials integrated through level design. This qualitative study was conducted with 15 participants, they played through a Third-Person Action Platformer game which the authors created for this study. The participants were all experienced in this game genre for the sake of the results’ consistency. The results showed that the most effective method is the one that presented most text and restricted player freedom, that being said it is not the preferred method by the participants. This resulted in suggestions that differed from what is presented to them, some of them including demonstrations in the game world and even some audio elements that could be implemented instead of having a text-based tutorial. / I den här studien undersöker vi hur information i spelhandledning kan bibehållas av spelaren, vi använder en undervisningssammanfattning för att se vilken information deltagarna behöll. Syftet med denna studie är att förstå hur ett videospel kan kommunicera viktig information om karaktärsmekaniker och regler med hjälp av handledning integrerad genom nivådesign. Denna kvalitativa studie genomfördes med 15 deltagare, de spelade genom ett Tredje-Person action Platform spel som författarna skapade för denna studie. Alla deltagarna är erfarna i den här spelgenren för att hålla resultaten konsekventa. Den mest effektiva metoden är den som presenterade mest text och begränsade spelarens frihet men det var inte den föredragna metoden bland deltagarna. Det här resulterade i förslag som skilde sig från vad som presenterades för deltagarna, några av de förslagen inkluderade demonstrationer i spelvärlden och vissa ljudelement som kunde ha implementerats istället för att endast ha en textbaserad handledning.

Mise en contexte : Au Canada, environ 600 000 personnes font de l’insuffisance cardiaque (IC) avec une incidence de 50 000 par année. L’insuffisance cardiaque (IC) représente la 2ème cause d’hospitalisation chez les personnes âgées de 65 ans et plus avec une incidence plus élevée chez les hommes. L’IC pourrait être améliorée par les sessions éducatives selon l’approche d’enseignement bidrectionnel (‘teach-back’). Les autosoins sont de meilleure qualité lorsque la conjointe est activement impliquée dans tout le processus de prise en charge du patient. Cette étude a permis d’évaluer l’impact de l’approche d’enseignement bidirectionnel adapté aux couples sur les autosoins des franco-ontariens vivant en situation linguistique minoritaire dans la région d’Ottawa. Méthodologie : Afin de mieux répondre aux questions de recherche en lien avec la rétention des connaissances des couples et l’apport sur la relation conjugale, le devis mixte d’une étude de cas intégrée avec unités d’analyse multiples a été utilisé auprès de six couples franco-ottaviens dont le conjoint était atteint d’IC. Résultats : Les participants ont présenté une augmentation des connaissances des autosoins de l’IC de l’ordre de 27% entre la période avant l’intervention jusqu’à 30 jours après la formation. Il n’y a pas eu de réadmissions hospitalières parmi les participants. L’adaptation de l’approche d’enseignement bidirectionnel à la réalité individuelle des couples participants a eu un effet thérapeutique systémique sur la relation conjugale car cette approche a offert aux partenaires un cadre pour avoir une discussion ouverte sur l’impact réciproque de l’IC sur leur vécu quotidien. En assurant des visites aux domiciles des participants durant une phase post-hospitalisation considérée de grande vulnérabilité chez les patients IC, ce projet a pallié à la faille du système des soins parce qu’elle a permis à une transition sécuritaire des patients (et leurs conjointes) du milieu hospitalier en communauté. Conclusion : L’adaptation de l’approche d’enseignement bidirectionnel en français est une nouveauté pour les infirmières francophones œuvrant auprès des francophones vivant en situation linguistique minoritaire. Cette étude soutient l’importance d’intégrer la gérontandragogie dans les interventions éducatives des personnes âgées en matière de santé.