Australian-first pilot improves health literacy over the phone

An Australian-first pilot of the 'teach-back' technique for stressed parents seeking parenting advice and information over the phone has proven successful in reducing stress and overcoming low health literacy for callers to the Pregnancy, Birth and Baby helpline.

Pregnancy, Birth and Baby provides information, advice and guidance about pregnancy, childbirth and parenting children up to 5 years of age online, over the phone and by video consultation. The service is funded by the Australian Federal Government.

In 2016, the trusted service which is staffed by maternal child health nurses trialled teach-back, a technique where the caller summarises important information and repeats the agreed actions from the advice they have been given.

The pilot was developed to ensure all Australians get the same value from the free service, particularly for those whom English is not their first language, who have difficulty hearing or other disabilities.

“Seeking health advice is often done under distressing situations and by people who may not always understand what the advice means or not feel comfortable asking questions for clarification or more information. This can be especially true of new or expecting parents,” says Dianne Zalitis, clinical lead at Pregnancy, Birth and Baby.

“The teach-back pilot aimed to improve outcomes for all families by ensuring callers have understood the health information provided. Teach-back also helps the caller to remember the advice given by having them say it in their own words.”

Although teach-back is a well-known technique in face-to-face health consultations, this is the first time it has been trialed in a telehealth situation.

“Its potential impact in this service could prove to be instrumental improving the health of young families across Australia. It helps overcome the difficulty in determining the level of understanding - the health literacy - of a patient when the nurse can't take into account visual cues during the conversation,” says Zalitis.

In the evaluation of the trial by The University of Sydney, nurses who participated reported that teach-back was helpful for working with anxious and distressed callers, noting that callers frequently contact the helpline when they are feeling overwhelmed by a situation they're unsure how to manage. Using teach-back gave the nurses tools to clarify with the caller the issue, focus them on a plan of action and what steps to take next.

Nurses felt that using teach-back invited callers to have a say in what happens next rather than being told what to do.

The evaluation also found that teach-back is effective in helping callers feel more confident to know how to act on advice and helps them feel listened to and understood. The report concluded that this may be a way to improve accessibility, quality, and equity of telephone health services.

“Teach-back is a simple, low cost communication technique that can make a world of difference to the effectiveness of telehealth lines such as the Pregnancy, Birth and Baby helpline by reducing anxiety of new parents and helping them clearly understand what they need to do next,” concludes Zalitis.

Research reference

The research was conducted by the University of Sydney, School of Public Health for Healthdirect Australia in July 2016.

Morony S, Weir K, Duncan G, Biggs J, Nutbeam D, McCaffery K: Experiences with Teach-Back in a telephone health service. Health Literacy: Research and Practice 2017, 1(4):e173-e181. DOI 10.3928/24748307-20170724-01