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      Enhancing communication skills for telehealth: development and implementation of a Teach-Back intervention for a national maternal and child health helpline in Australia

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          Abstract

          Background

          Telehealth professionals require advanced communication skills, in part to compensate for lack of visual cues. Teach-Back is a best practice communication technique that has been recommended but not previously evaluated for consumer telehealth. We aimed to implement Teach-Back at a national maternal and child health telephone helpline. We describe the intervention and report telenurse experiences learning to use Teach-Back.

          Methods

          We identified barriers (time, knowledge, skills, beliefs) and enablers (self-reflection) to using Teach-Back, and developed a novel training program to address these, guided by the Theoretical Domains Framework. We engaged maternal and child health telenurses to participate in a “communication skills” study. The intervention had two key components: guided self-reflection and a Teach-Back skills workshop. For the duration of the 7-week study nurses completed brief online surveys following each call, reflecting on both the effectiveness of their communication and perceived caller understanding. At the end of each shift they reflected on what worked well. Teach-Back knowledge, skills, and beliefs were addressed in a 2-h workshop using videos, discussion, and role play. We explored nurses’ experiences of the intervention in focus groups and interviews; and analysed transcripts and comments from the self-reflection surveys using the Framework method. This study forms part of a larger evaluation conducted in 2016.

          Results

          In total 16 nurses participated: 15 were trained in Teach-Back, and 13 participated in focus groups or interviews. All engaged with both self-reflection and Teach-Back, although to differing extents. Those who reported acquiring Teach-Back skills easily limited themselves to one or two Teach-Back phrases. Nurses reported that actively self-reflecting (including on what they did well) was useful both for developing Teach-Back skills and analysing effectiveness of the techniques. Most wanted more opportunity to learn how their colleagues manage Teach-Back in different situations, and more visual reminders to use Teach-Back.

          Conclusions

          Our theory-informed intervention successfully enabled nurses to use Teach-Back. Guided self-reflection is a low-resource method aligned with nurse professional identity that can facilitate Teach-Back skills learning, and could also be applied to other advanced communication skills for telehealth. Listening to multiple workplace-specific examples of Teach-Back is recommended for future training.

          Trial registration

          ACTRN12616000623493 Registered 15 May 2016. Retrospectively registered.

          Electronic supplementary material

          The online version of this article (10.1186/s12913-018-2956-6) contains supplementary material, which is available to authorized users.

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          Most cited references35

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          Patients' memory for medical information.

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            Education and training to support the use of clinical telehealth: A review of the literature.

            Introduction Despite a growing literature base, substantial investment, and policy changes within governments, the integration of telehealth into routine clinical care has been limited. The availability of appropriate systematic education and training for practitioners has been highlighted as necessary for strong adoption. However, the availability and nature of telehealth-related education and training for practitioners is not understood. By reviewing the literature, we aimed to describe the delivery of education and training in telehealth, with particular focus on content, modes of delivery, types of institutions, and target clinician groups. Methods We performed searches using PubMed, Scopus, Embase, Web of Science, PsycINFO, the Cochrane Library, and ERIC. We included studies that were focused on the delivery of telehealth-related academic or vocational education and training. We extracted information pertaining to country, programs and their participants, and tabulated the results. Results Altogether 388 articles were identified, of which nine studies were selected for final review. Programs from five countries were represented and articles were spread across telemedicine and clinically oriented journals. Education and training in telehealth has been provided as both university level and vocational courses using conventional classroom based delivery methods and e-learning. Reported curriculum items included terminology, clinical applications, the evidence-base, and technological aspects. Conclusions Published evidence in peer-reviewed literature on telehealth education and training is limited. According to this review, a number of topics relating to telehealth have been covered by existing education programs both within tertiary and professional development levels.
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              Interventions to Improve Care for Patients with Limited Health Literacy.

              OBJECTIVE: To propose a framework and describe best practices for improving care for patients with limited health literacy (LHL). METHODS: Review of the literature. RESULTS: Approximately half of the U.S. adult population has LHL. Because LHL is associated with poor health outcomes and contributes to health disparities, the adoption of evidence-based best practices is imperative. Feasible interventions at the clinician-patient level (eg, patient-centered communication, clear communication techniques, teach-to-goal methods, and reinforcement), at the system-patient level (eg, clear health education materials, visual aids, clear medication labeling, self-management support programs, and shame-free clinical environments), and at the community-patient level (eg, adult education referrals, lay health educators, and harnessing the mass media) can improve health outcomes for patients with LHL. CONCLUSION: Because LHL is prevalent, and because the recommended communication strategies can benefit patients of all literacy levels, clinicians, health system planners, and health policy leaders should promote the uptake of these strategies into routine care.
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                Author and article information

                Contributors
                suzanne.morony@sydney.edu.au , smorony@gmail.com
                kristie.weir@sydney.edu.au
                gregory.duncan@monash.edu
                Janice.Biggs@digitalhealth.gov.au
                don.nutbeam@sydney.edu.au
                kirsten.mccaffery@sydney.edu.au
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                7 March 2018
                7 March 2018
                2018
                : 18
                : 162
                Affiliations
                [1 ]ISNI 0000 0004 1936 834X, GRID grid.1013.3, The University of Sydney, Sydney School of Public Health, ; Sydney, NSW Australia
                [2 ]ISNI 0000 0004 1936 834X, GRID grid.1013.3, The University of Sydney, Wiser Healthcare, Sydney School of Public Health, ; Sydney, NSW Australia
                [3 ]ISNI 0000 0004 1936 7857, GRID grid.1002.3, Eastern Health Clinical School, Medicine, Nursing and Health Sciences, Monash University, ; Box Hill, Melbourne, VIC Australia
                [4 ]Healthdirect Australia, Sydney, NSW Australia
                [5 ]ISNI 0000 0004 1936 834X, GRID grid.1013.3, The University of Sydney, Sydney Health Literacy Lab, Sydney School of Public Health, ; Sydney, NSW Australia
                Author information
                http://orcid.org/0000-0002-4534-0899
                Article
                2956
                10.1186/s12913-018-2956-6
                5842621
                29514642
                d41172bc-033f-4577-a920-445ab54ba7f8
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 15 October 2017
                : 21 February 2018
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Health & Social care
                teach-back communication,training,self-reflection,self-directed learning,metacognition,communication skills training,professional development,telenursing,health-line,teleadvice,theoretical domains framework,tdf,health literacy

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