title: The effectiveness of the teach-back method on adherence and self-management in health education for people with chronic disease: a systematic review.
abstract: Chronic diseases are increasing worldwide and have become a significant burden to those affected by those diseases. Disease-specific education programs have demonstrated improved outcomes, although people do forget information quickly or memorize it incorrectly. The teach-back method was introduced in an attempt to reinforce education to patients. To date, the evidence regarding the effectiveness of health education employing the teach-back method in improved care has not yet been reviewed systematically.
  
  
  
  This systematic review examined the evidence on using the teach-back method in health education programs for improving adherence and self-management of people with chronic disease.
  
  
  
  Adults aged 18 years and over with one or more than one chronic disease.All types of interventions which included the teach-back method in an education program for people with chronic diseases. The comparator was chronic disease education programs that did not involve the teach-back method.Randomized and non-randomized controlled trials, cohort studies, before-after studies and case-control studies.The outcomes of interest were adherence, self-management, disease-specific knowledge, readmission, knowledge retention, self-efficacy and quality of life.
  
  
  
  Searches were conducted in CINAHL, MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, ProQuest Nursing and Allied Health Source, and Google Scholar databases. Search terms were combined by AND or OR in search strings. Reference lists of included articles were also searched for further potential references.
  
  
  
  Two reviewers conducted quality appraisal of papers using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument.
  
  
  
  Data were extracted using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument data extraction instruments.
  
  
  
  There was significant heterogeneity in selected studies, hence a meta-analysis was not possible and the results were presented in narrative form.
  
  
  
  Of the 21 articles retrieved in full, 12 on the use of the teach-back method met the inclusion criteria and were selected for analysis. Four studies confirmed improved disease-specific knowledge in intervention participants. One study showed a statistically significant improvement in adherence to medication and diet among type 2 diabetics patients in the intervention group compared to the control group (p < 0.001). Two studies found statistically significant improvements in self-efficacy (p = 0.0026 and p < 0.001) in the intervention groups. One study examined quality of life in heart failure patients but the results did not improve from the intervention (p = 0.59). Five studies found a reduction in readmission rates and hospitalization but these were not always statistically significant. Two studies showed improvement in daily weighing among heart failure participants, and in adherence to diet, exercise and foot care among those with type 2 diabetes.
  
  
  
  Overall, the teach-back method showed positive effects in a wide range of health care outcomes although these were not always statistically significant. Studies in this systematic review revealed improved outcomes in disease-specific knowledge, adherence, self-efficacy and the inhaler technique. There was a positive but inconsistent trend also seen in improved self-care and reduction of hospital readmission rates. There was limited evidence on improvement in quality of life or disease related knowledge retention.Evidence from the systematic review supports the use of the teach-back method in educating people with chronic disease to maximize their disease understanding and promote knowledge, adherence, self-efficacy and self-care skills.Future studies are required to strengthen the evidence on effects of the teach-back method. Larger randomized controlled trials will be needed to determine the effectiveness of the teach-back method in quality of life, reduction of readmission, and hospitalizations.
authors.affiliation: 1. The Hanoi Medical University Nursing Research Center for Evidence Based Healthcare: an Affiliate Centre of the Joanna Briggs Institute2. School of Nursing, Queensland University of Technology, Australia3. Kidney Health Service, Royal Brisbane, Australia4. QUT Centre for Evidence Based Healthy Ageing (CEBHA): an Affiliate Centre of the Joanna Briggs Institute5. Flinders University and School of Nursing, South Australia, Australia6. The Queensland Centre for Evidence-Based Nursing and Midwifery: Collaborating Centre of the Joanna Briggs Institute7. Nursing Research Centre, Mater Health Services, Queensland, Australia.
authors.forename: Thi Thuy
authors.initials: TT
authors.lastname: Ha Dinh
authors.forename: Ann
authors.initials: A
authors.lastname: Bonner
authors.forename: Robyn
authors.initials: R
authors.lastname: Clark
authors.forename: Joanne
authors.initials: J
authors.lastname: Ramsbotham
authors.forename: Sonia
authors.initials: S
authors.lastname: Hines
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002908:Chronic Disease / Q000453:epidemiology* / Q000523:psychology; D015331:Cohort Studies; D017281:Cost of Illness; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology; D006266:Health Education / Q000379:methods*; D006333:Heart Failure / Q000523:psychology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D065228:Non-Randomized Controlled Trials as Topic; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012648:Self Care / Q000379:methods; D020377:Self Efficacy; D000073278:Self-Management / Q000379:methods*; D064871:Teach-Back Communication / Q000379:methods*