The challenge with teach-back: learning from negative results from the Health Literacy in Pharmacy (HeLP) RCT in Australia

Introduction: Limited health literacy (HL) is highly prevalent in Australia With a consensus that services must adapt to meet patient needs. A dearth of interventions in pharmacy needs to be addressed.\ud \ud Methodology: The HeLP educational programme for pharmacy staff was developed to enhance services and reduce the impact of medicines misadventure, evaluated by a cluster-randomised controlled trial, conducted in 77 pharmacies. HeLP was designed and delivered over 9 111onths by a consortium of 6 universities, Which introduced HL concepts and effects and then strategics to minimise risk. A core HL strategy is using 'teach-back' during counselling to determine and reinforce patient understanding. This, with other behavioural strategies, was assessed by observation, self-report, patient interviews (pre /post intervention) and focus groups with pharmacy staff.\ud \ud Results: Use of teach-back decreased significantly after the intervention. Focus groups described greater awareness of the significance of teach-back and its risks, particularly if appearing to test or judge patients. After the intervention previous, subconscious use of teach-back evolved to a conscious and considered action, which could be withheld. Subsequently only those con1fortable with it used the technique managing impact on patient relationships. Sustainability of behavioural change was not assessed but needs consideration.\ud \ud Conclusion: 'Textbook' examples of teach-back techniques were not well adopted. Participants understood the importance of teach-back to assess patients' understanding following intervention, but recognised it may upset or offend patients. Increased opportunity to explore variations of this strategy would allow staff to develop processes and phrases that suit their confidence level, personality and clientele. Peer feedback is also recommended