Patient Education

Abstract

Most patients, especially after being examined with complex health conditions, have difficulty comprehending or recalling the information their healthcare providers gave them regarding their health. However, the use of teach-back methodology has proven to improve this scenario since it provides guidance that could help deliver health services most effectively. Besides, with diabetes mellitus being a major pandemic in most nations, this review aims to comprehend the information about teach-back methodology in the institutions offering healthcare services and implement strategic ways of proper insulin administration as one of the treatment plans for diabetes. Therefore, the research utilized a qualitative approach because it was the most convenient way of extracting information and assessing the methodological quality. Furthermore, the use of teach-back was found to be the most effective since it is not limited to the surrounding population and the outcomes of the measure. Also, its mode of delivery is easy to comprehend and administer with practical training from stakeholders in healthcare institutions. Thus, proper support to the nurses during its implementation will help sustain the uptake of the teach-back methodology to help achieve positive outcomes between patients and healthcare providers.

Significance and background

Numerous studies indicate that most patients remain confused about their health care plans after being discharged from the hospital. Besides, most patients are unaware of their lack of comprehension; when they are discharged, a substantial portion of the information is forgotten immediately. This often happens when a large amount of information is presented, leading to less information being recalled and 50% of the information being wrong (Farahaninia et al., 2020). However, some research indicated that health information focused on an individual increase how they comprehend information on their health, which supports healthy self-management, thus promoting health outcomes for individuals with chronic illness.

Therefore, this has rapidly increased unnecessary hospitalization and readmission of patients. Based on some reports, it constitutes one-third of the national total health expenditure in the United States. But studies indicated that if the medication could have been administered promptly and effectively, it could have helped lower the number of unnecessary hospitalizations (Hong et al., 2019). But the techniques used in bringing this intervention have had little success in the clinical setting, which led to the promotion of a technique called the teach-back, advocated mainly by the national agencies that it will help improve the state of health outcomes. The teach-back method works because it enhances and assesses patient engagement and knowledge when assessing their health condition. It creates an interactive loop between the healthcare worker and the patient. Through the method, the health worker asks the patients to describe what they are feeling and what the health worker needs to know about the patients' health conditions. This allows the doctor to assess the patient's understanding and intervene with education. The approach mainly aims at the patient's understanding of their health conditions which is vital in promoting adherence. This interactive approach has proven to be much more effective and linked with healthier outcomes for diabetic patients. It is an effective method, and research has shown that it can reduce hospital readmission by 4-12% for those patients with extreme risk of acute conditions.

Purpose of this literature review

The healthcare system's responsibility is to ensure patients are also involved in their treatment plan through decision-making; however, this is becoming extremely complicated. This self-management approach requires the patient to comprehend the complex health information and to apply it effectively to their lives daily. However, in most healthcare institutions, there has been a poor communication mechanism between healthcare workers and patients. Some studies indicate that health workers could be working on the assumption that they have the capabilities and requirements to communicate effectively with their patients. A recent survey showed that 75% of healthcare workers were working on pure assumptions that they could communicate effectively with their patients; however, 21% of the patients that responded were the only ones who reported being satisfied with that communication (Talevski et al., 2020). Also, another report indicated that 77% of healthcare workers assumed their patients understood the medical conditions they were diagnosed with; however, only 55% of the patients could comprehend that. Even though it might look like a minor thing, that communication gap could lead to adverse outcomes for the patient, including compromising their safety, thus increasing their economic burden. Many patients have reported not comprehending the medication terminology used by the healthcare workers, and therefore they are demanding more precise explanations to avoid misunderstanding and confusion during medical consultation. Also, another major challenge that patients with Diabetes Mellitus condition encounter are recalling the information provided by the doctors since remembering is among the vital mediators for treatment adherence and improved healthcare outcome. Therefore, this paper aims to utilize the most recent evidence on the translation of teach-back in the healthcare setting by depicting how it works and the strategies used in supporting its implementation and effectiveness across different healthcare settings and populations in the United States and other nations.

Results

During patients' interactions with healthcare providers in the hospital, a few reported conversing with the teach-back notion. In contrast, most of them reported having never experienced it before.

Study #1: Nursing research Study (Non-USA)

In the United States, diabetes mellitus has been a major public concern, just like in any other country in the world. In 2009, nearly 9.4% of the United States population, which encompasses almost 30.3 million people, were perceived to be diabetic (Mathew et al., 2022). Diabetes not only results in specific complications but also paves the way for other chronic diseases, and this disease has eaten the economic burden in the United States. There are numerous treatment plans for diabetes, but they are mostly affected by the teach-back method in the healthcare institution since it is among the most common practices that determine its success or failure. However, research has shown that teach-back has not been fully implemented in most hospitals, and most healthcare workers were not well trained to use it in their daily care. Therefore, they need to implement a strategical system that will enable them to optimize the routine uptake and sustainability of delivering this technique in their daily practices. For instance, in Singapore, statistics indicated that in 2018 it was 8.6%, with an estimate of over 19,000 people being dragonized yearly, and one out of 9 people aged between 18 to 69 had diabetes (Mathew et al., 2022). However, many people suffering from this chronic disease must be treated with insulin therapy. It is the most approved and effective method of treatment for this condition which helped in preventing the onset and progression of other diabetic-related problems. But because of, poor communication between the health workers and patients and most patients not understanding the teach-back has resulted in most of them refusing the treatment plan.

Even though most patients understood the importance of insulin in helping their health status, they still declined it to be administered to them because of the communication gap between them and doctors. For instance, a local survey in 2011 depicted that 70.6% of the patients refused to use insulin after it had been recommended to them (Talevski et al., 2020). This was the same scenario in Malaysia, where 74.2% of the patients declined, and comparatively lower in Korea since it indicated only 35.7% of patients declined insulin use. Teach-back plays a crucial role in the self-management practice of the patient; once insulin has been initiated, they encounter an issue with treatment adherence which has been affecting glycemic control. Refusal of insulin and non-adherence to treatment has been greatly contributed by the lack of teach-back in healthcare institutions. This level of poor communication has led to difficulty administering insulin to patients, among other factors like needle pain, social stigma, and discrimination among patients.

The most significant factor that slowed the treatment of diabetes was patients' fear of being judged by their healthcare providers, especially the outpatient who visit the hospitals irregularly. Sometimes, the patient might have forgotten to take their insulin injection, and their situation worsens to the point that they will have to visit their doctor (Mathew et al., 2022). But because of their poor relationship, the patient might hide vital information from the doctor to avoid being told the condition is severe due to the bad behavior of absconding to take their medication.

Study #2: Nursing Research Study (USA)

Teach-back is a valuable tool required in healthcare institutions to improve patient safety and their understanding of their health conditions. This is vital as proper utilization can help provide the healthcare worker with potent insight into how their patients comprehend their medical results and can effectively communicate their feelings (Seely et al., 2022). If they feel something is not going as their expectation or how they wanted it to be, they can freely open a dialogue with their healthcare provider to resolve and clarify all the details. Besides teach-back being less known in the healthcare sector, it has proven to be the most significant methodology in providing a shared decision-making process and improving health literacy and outcomes. However, most patients fail to listen to what their health workers say and recommend. For instance, if the doctor has prescribed them a particular medication plan, they might fail to do so because of trust issues without them understanding that all their doctors are wishing them good health. This has made them develop trust issues regarding their doctor's knowledge, thus neglecting their instructions. However, they never question themselves why they still visit them when their health condition worsens.

Study #3: Nursing Research Study (Non-USA)

The most depicted problem for both United States and other nations was trust issues which significantly impacted the delivery mode of services. Thus, if the patients have doubts about the mode of treatment the health worker is administering, it will significantly impact accepting the insulin therapy (Hong et al., 2019). Besides, some patients also feared the medical treatment plan. For instance, some feared treatment plans that needed injection as they feared the pain induced by the syringe. Also, some could not comprehend that particular treatment plan as they feared the side effects.

Furthermore, many were unaware of their health status, and developing complex regime were among the most common reasons for non-adherence to insulin therapy (Farahaninia et al., 2020). Therefore, the harm of these complex interactions between health workers and patients has been a significant challenge in implementing the teach-back mechanism in hospitals, affecting insulin adherence. Also, most health workers have shown little interest in understanding the aspect that affects insulin acceptance and compliance. Furthermore, patients overcoming the fear of needles and pain was also a significant factor among the psychological fears that patients develop while undertaking their treatment. Some experience needle phobia, which is the barrier to insulin initiation. Without the teach-back mechanism and doctors' understanding of their patient's well-being, it might become difficult to address such incidents because they might go unnoticed (Farahaninia et al., 2020). However, if doctors truly understand their patients well, they could even advise them to use pen devices and shorter needles to ensure they follow their treatment plan.

Study #4: Nursing Research Study (Non-USA)

Poor communication skills between health workers and patients. Most doctors don't know how to communicate with their patients effectively. They administer medication without notifying their patients of its importance and the impact that it would have on their bodies (Burmeister & Nickasch, 2022). When doctors learn the aspect of effective communication, it will help patients to undertake their medication without any doubts. For instance, some patients might prefer taking their medication as the most appropriate treatment plan; however, there are some medical conditions where the treatment plan could not effectively require them to undertake injection. But because of ineffective communication, patients might neglect because they don't understand why they are being subjected to the intensive pain of injection while they can take their medication. Therefore, doctors need to learn the art of good communication skills (Eloi, 2021). If the diabetic Mellitus condition is high, they should educate their patients that taking the insulin injection will help to manage and keep it under control more easily than taking medication for a while. Besides, when there is good communication, it will be easy for healthcare workers to encourage and motivate their patients to recover and get well soon.

Recommendations

The paper advocates for efforts to enhance patient and healthcare provider effective interaction. This could be done through proper administration that would best treat diabetes mellitus. Several shortcomings have affected this mode of treatment, like trust issues and poor communication that has interfered with the patients' acceptance and adherence to insulin therapy (Talevski et al., 2020). However, proper utilization of the teach-back will help create a safer environment that will result in good communication, which will help address the barriers to insulin adherence. Also, the healthcare workers can opt to train and offer motivational support to their patients in handling and using the medical equipment for injecting insulin. Furthermore, healthcare can opt for team-based care to ensure continuity of care, proper communication, and follow-up on how the patient is coping with their medication. This will require healthcare to have well-trained nurses and other medical workers.