Health Literate Communication: Teach-Back Training for First-Year Medical Students

Main Article Content

Iris Feinberg Ali Moradi Michelle Mavreles Ogrodnick Elizabeth Tighe Tricia Reed

Abstract

Abstract


BACKGROUND: Effective physician communication skill requires implementation of basic standards of practice, such as empathy, listening, and close attention to non-verbal indicators. Medical students must learn and understand that enhanced communication skills ensure better patient understanding of diagnosis and prognosis, and compliance to treatment plans.  Health literate communication techniques like Teach-Back must be part of primary skills training for medical students in the early stage of medical education.  The purpose of this study was to measure medical students’ beliefs/knowledge about health literate communication and to evaluate use of Teach-Back skills during patient history taking and examination in the simulation center with standardized patients. METHODS: First-year medical students’ health literacy beliefs/knowledge of health literate communication were measured using pre- and post- Beliefs and Knowledge surveys.  A one-hour health literacy skills training intervention lecture was delivered after pre-testing.  Students were assessed for use of Teach-Back during the standardized patient encounter. RESULTS: 36 students participated in the study.  Median Belief scores increased from 9.25 pre-intervention to 10.00 post-intervention; mean Knowledge scores increased from 8.08 pre-intervention to 10.42 post-intervention with moderate to large effect sizes (beliefs r= .342, knowledge d=1.08).  There was a significant post-intervention increase in both belief and knowledge scores, p>.001 with high power (.954).  Eleven (11) students used Teach-Back successfully in the simulation center.


CONCLUSIONS: Medical students’ beliefs, knowledge, and communication skills may benefit from a one-hour health literacy communication skills training.  Primary care skills courses should incorporate health literacy training as a key competence along with existing curricular foci in order to improve health literate patient communication. 

Article Details

How to Cite
FEINBERG, Iris et al. Health Literate Communication: Teach-Back Training for First-Year Medical Students. Medical Research Archives, [S.l.], v. 8, n. 5, may 2020. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2100>. Date accessed: 17 nov. 2024. doi: https://doi.org/10.18103/mra.v8i5.2100.
Section
Research Articles

References

1. Egbert N, Nanna KM. Health Literacy: Challenges and Strategies. Online Journal of Issues in Nursing. 2009;14(3):5.
2. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. National action plan to improve health literacy. Washington, D.C.: Author, 2010.
3. Nielsen-Bohlman L, Institute of Medicine (U.S.). Committee on Health Literacy. Health literacy: A prescription to end confusion. Washington, D.C.: National Academics Press, 2004.
4. Kutner M, Greenberg E, Jin Y,Paulsen C. (2006). The health literacy of America’s adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006-483). U.S.Department of Education. Washington DC: National Center for Education
5. Paasche-Orlow MK, Wolf MS. The causal pathways linking health literacy to health outcomes. American Journal Of Health Behavior. 2007;31:S19-26. doi:10.5993/AJHB.31.s1.4
6. Berkman N, Sheridan S, Donahue K, Halpern D, Crotty K. Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine. 2011;155(2):97-107. doi:10.7326/0003-4819-155-2-201107190-00005
7. Weiss BD, Mays MZ, Martz W, et al. Quick assessment of literacy in primary care: the newest vital sign. Annals Of Family Medicine. 2005:3(6):514-522. doi:10.1370
8. Kreps GL, Villagran MM, Zhao X, et al. Development and validation of motivational messages to improve prescription medication adherence for patients with chronic health problems. Patient Education and Counseling. 2011;83(3):375-381. doi:10.1016/j.pec.2011.04.029.
9. Han E, Suh D-C, Lee S-M, Jang S. The impact of medication adherence on health outcomes for chronic metabolic diseases: a retrospective cohort study. Research In Social & Administrative Pharmacy: RSAP. 2014;10(6):e87-e98. doi:10.1016/j.sapharm.2014.02.001.
10. Zavala S, Shaffer C. Do patients understand discharge instructions? Journal Of Emergency Nursing: JEN: Official Publication Of The Emergency Department Nurses Association. 2011;37(2):138-140. doi:10.1016/j.jen.2009.11.008.
11. Kessels, RPC. Patients’ memory for medical information. Journal of the Royal Society of Medicine. 2003; 96(5): 219-222. doi:10.1177%2F014107680309600504
12. McCarthy DM, Waite KR, Curtis LM, Engel KG, Baker DW, Wolf MS. What Did the Doctor Say? Health Literacy and Recall of Medical Instructions. Medical Care. 2012;50(4):277. doi:10.1097/MLR.0b013e318241e8e1.
13. Zolnierek KH, DiMatteo MR. Physician communication and patient adherence to treatment: A meta-analysis. Medical Care. 2009; 47(8), 826-834. doi:10.1097/MLR.0b013e31819a5acc
14. Ratanawongsa N, Karter AJ, Parker MM, et al. Communication and medication refill adherence: the diabetes study of Northern California. JAMA Internal Medicine. 2013;173(3):210-218. doi:10.1001/jamainternmed.2013.1216.
15. Safeer R, Keenan J. Health literacy: the gap between physicians and patients. American Family Physician. 2005;72(3):463-468.
16. Ha J, Longnecker N. Doctor-patient communication: A review. The Ochsner Journal On-Line. 2010;10(1): 38-43.
17. Richard C, Glaser E, Lussier M. Communication and patient participation influencing patient recall of treatment discussions. Health Expectations: An International Journal Of Public Participation In Health Care And Health Policy. 2017;20(4):760-770. doi:10.1111/hex.12515
18. Tarn D, Heritage J, Paterniti D, Hays, R, Kravitz R, Wenger, N. Physician communication when prescribing new medications. Archives of Internal Medicine. 2006;166(17):1855-1862. doi:10.1001/archinte.166.17.1855
19. Howard T, Jacobson K, Kripalani S. Doctor Talk: Physicians’ Use of Clear Verbal Communication. Journal of Health Communication. 2013;18(8):991-1001. doi:10.1080/10810730.2012.757398.
20. Nogueira-Martins MCF, Nogueira-Martins LA, Turato LA. Medical students’ perceptions of their learning about the doctor-patient relationship: a qualitative study. Medical Education. 2006;40(4):322-328.
21. Rees CE., Sheard CE., McPherson AC. A qualitative study to explore undergraduate medical students’ attitudes towards communication skills learning. Medical Teacher. 2002;24(3):289-293. doi:10.1080/01421590220134123.
22. Koh H, Gracia J, Alvarez M. Culturally and linguistically appropriate services: Advancing health with CLAS . New England Journal of Medicine. 2014;371(3): 198-201. doi:10.1056/NEJMp1404321
23. Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191-215.
24. Abrams MA, Rita S, Kurtz-Rossi S, Nielsen G. Always Use Teach-back! Toolkit. 2012. www.teachbacktraining.org
25. Liang L, Brach C. Health Literacy Universal Precautions are Still a Distant Dream: Analysis of U.S. Data on Health Literate Practices. Health Literacy Research and Practice. 2014;1(4):e216-e230. http://doi.org/10.3928/24748307-20170929-01
26. (Sperling et al., 2013)
27. Williams, B., Abel, C., Khasawneh, E., Ross, L., & Levett-Jones, T. (2016). Simulation experiences of paramedic students: a cross-cultural examination. Advances in medical education and practice, 7, 181–186. https://doi.org/10.2147/AMEP.S98462
28. Ewid, M. (2019). Medical students accept virtual patients as a helping tool to achieve their study plan objectives. Saudi Journal for Health Sciences, 8(3), 137–140. https://doi.org/10.4103/sjhs.sjhs_155_19
29. Wiggins MN, Coker K, Hicks EK (2009) Patient perceptions of professionalism: implications for residency education. Med Educ 43(1):28–33
30. Author, Author, Author, Author, Czarnonycz C. Teach-Back Training for Nursing Students. Nursing Education Perspectives, in press 2019.
31. Alston C, Paget L, Halvorson G, et al. (2012). Communicating with patients on health care evidence. National Academy of Sciences. 2012. https://nam.edu/wp-content/uploads/2015/06/VSRT-Evidence.pdf Accessed July 1, 2019.
32. Zolnierek KH, DiMatteo MR. Physician communication and patient adherence to treatment: A meta-analysis. Medical Care. 2009; 47(8), 826-834. doi:10.1097/MLR.0b013e31819a5acc
33. Chichirez CM, Purcărea VL. Interpersonal communication in healthcare. Journal of Medicine and Life. 2018;11(2):119-122.
34. Yin, H. S., Jay, M., Maness, L., Zabar, S., & Kalet, A. (2015). Health literacy: An educationally sensitive patient outcome. Journal Of General Internal Medicine, 30(9), 1363-1368. doi:10.1007/s11606-015-3329-z
35. CHoudry
36. Helitzer
37. Green
38. Tran, S., Bennett, G., Richmond, J., Nguyen, T., Ryan, M., Hong, T., Howell, J., Demediuk, B., Desmond, P., Bell, S., & Thompson, A. (2019). “Teach-back” is a simple communication tool that improves disease knowledge in people with chronic hepatitis B - a pilot randomized controlled study. BMC Public Health, 19(1), N.PAG. https://doi.org/10.1186/s12889-019-7658-4
39. Dinh, H. T. T., Bonner, A., Ramsbotham, J., & Clark, R. (2019). Cluster randomized controlled trial testing the effectiveness of a self-management intervention using the teach-back method for people with heart failure. Nursing & Health Sciences, 21(4), 436–444. https://doi.org/10.1111/nhs.12616

40. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. National action plan to improve health literacy. Washington, D.C.: Author, 2010.
41. Author, Author, Author, Czarnonycz C, Zimmerman C. Health literacy training for first-year respiratory therapy students: a mixed-methods pilot study. Respiratory Care. 2019.
42. Author, Author, Hendrick RC, Bates K, Johnson K, Wang B. Perception vs reality: Use of Teach-Back by medical residents. 2019; 3(2):e117-e126.