Relationship between Teach-back and patient-centered communication in primary care pediatric encounters

• DOI: 10.1016/j.pec.2017.02.022
• Publication Date: 2017-02-25T03:18:48Z
• Authors: Adam Badaczewski; Laurie J. Bauman; Arthur E. Blank; Benard Dreyer; Mary Ann Abrams; Ruth E.K. Stein; Debra L. Roter; Jobayer Hossain; Hal Byck; Iman Sharif
• Keywords: Health Literacy; Odds; Affect

We proposed and tested a theoretical framework for how use of Teach-back could influence communication during the pediatric clinical encounter.Audio-taped pediatric primary care encounters with 44 children with asthma were coded using the Roter Interaction Analysis System to measure patient-centered communication and affective engagement of the parent. A newly created Teach-back Loop Score measured the extent to which Teach-back occurred during the clinical encounter; parental health literacy was measured by Newest Vital Sign. Logistic regression was used to test the relationship between Teach-back and features of communication. Focus groups held separately with clinicians and parents elicited perceptions of Teach-back usefulness.Teach-back was used in 39% of encounters. Visits with Teach-back had more patient centered communication (p=0.01). Adjusting for parent health literacy, parent age, and child age, Teach-back increased the odds of both patient centered communication [proportional AOR (95% CI)=4.97 (4.47-5.53)]and negative affect [AOR (95% CI)=5.39 (1.68-17.31)]. Focus group themes common to clinicians and parents included: Teach-back is effective, could cause discomfort, should be used with children, and nurses should use it.Teach-back was associated with more patient-centered communication and increased affective engagement of parents.Standardizing Teach-back use may strengthen patient-centered communication.