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

Suzanne Morony, Kristie Weir, Gregory Duncan, Janice Biggs, Don Nutbeam, Kirsten J. McCaffery

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15 Citations (Scopus)


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.

Original languageEnglish
Article number162
Number of pages9
JournalBMC Health Services Research
Issue number1
Publication statusPublished - 7 Mar 2018


  • Communication skills training
  • Health literacy
  • Health-line
  • Metacognition
  • Professional development
  • Self-directed learning
  • Self-reflection
  • TDF
  • Teach-back communication
  • Teleadvice
  • Telenursing
  • Theoretical domains framework
  • Training

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