Relationship between Teach-back and patient-centered communication in primary care pediatric encounters

Objective We proposed and tested a theoretical framework for how use of Teach-back could influence communication during the pediatric clinical encounter. Methods Audio-taped pediatric primary care encounters with 44 children with asthma were coded using the Roter Interaction Analysis System to measure patient-centered communication and affective engagement of the parent. A newly created Teach-back Loop Score measured the extent to which Teach-back occurred during the clinical encounter; parental health literacy was measured by Newest Vital Sign. Logistic regression was used to test the relationship between Teach-back and features of communication. Focus groups held separately with clinicians and parents elicited perceptions of Teach-back usefulness. Results Teach-back was used in 39% of encounters. Visits with Teach-back had more patient centered communication (p = 0.01). Adjusting for parent health literacy, parent age, and child age, Teach-back increased the odds of both patient centered communication [proportional AOR (95% CI) = 4.97 (4.47–5.53)]and negative affect [AOR (95% CI) = 5.39 (1.68–17.31)]. Focus group themes common to clinicians and parents included: Teach-back is effective, could cause discomfort, should be used with children, and nurses should use it. Conclusions Teach-back was associated with more patient-centered communication and increased affective engagement of parents. Practice implications Standardizing Teach-back use may strengthen patient-centered communication.