title: "Like a dialogue": Teach-back in the emergency department.
abstract: 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.
  
  
  CONCLUSIONS
  Most participants were supportive of teach-back techniques, but many were concerned about perceived judgment from providers.
  
  
  CONCLUSIONS
  Future investigations should focus on feasibility and efficacy of teach-back in the ED and using participant generated wording to introduce teach-back.
authors.affiliation: Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, United States; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, United States. Electronic address: samuelskalowm@email.chop.edu.
authors.forename: Margaret
authors.initials: M
authors.lastname: Samuels-Kalow
authors.affiliation: Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, United States.
authors.forename: Emily
authors.initials: E
authors.lastname: Hardy
authors.affiliation: Hospital of the University of Pennsylvania and Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, United States.
authors.forename: Karin
authors.initials: K
authors.lastname: Rhodes
authors.affiliation: Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, United States; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, United States.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Mollen
mesh_terms: D000328:Adult; D001249:Asthma; D002648:Child; D004636:Emergency Service, Hospital; D005260:Female; D057220:Health Literacy / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010353:Patient Education as Topic / Q000379:methods*; D010372:Pediatrics; D010817:Physician-Patient Relations; D036301:Qualitative Research; D064871:Teach-Back Communication
keywords: Emergency medicine; Health literacy; Teach-back