"Like a dialogue": Teach-back in the emergency department.

Objective: Teach-back may improve communication, but has not been well studied in the emergency setting. The goal of this study was to characterize perceptions of teach-back in the emergency department (ED) by health literacy.

Methods: We conducted an in-depth interview study on the ED discharge process examining teach-back techniques in two tertiary care centers (adult and pediatric), using asthma as a model system for health communication. Participants were screened for health literacy, and purposive sampling was used to balance the sample between literacy groups. Interviews were conducted until thematic saturation was reached for each literacy group at each site; audiotaped, transcribed, coded, and analyzed using a modified grounded theory approach.

Results: Fifty-one interviews were completed (31 parents; 20 patients). Across all groups, participants felt that teach-back would help them confirm learning, avoid forgetting key information, and improve doctor-patient communication. Participants with limited health literacy raised concerns about teach-back being condescending, but suggested techniques for introducing the technique to avoid this perception.

Conclusion: Most participants were supportive of teach-back techniques, but many were concerned about perceived judgment from providers.

Practice Implications: Future investigations should focus on feasibility and efficacy of teach-back in the ED and using participant generated wording to introduce teach-back.