Suzanne Morony|Kristie Rebecca Weir|Katy Bell|Janice Biggs|Gregory Duncan|Don Nutbeam|Kirsten McCaffery
A stepped wedge cluster randomised trial of nurse-delivered Teach-Back in a consumer telehealth service
University of Sydney|University of Sydney|University of Sydney|Eastern Health|Monash University|University of Sydney|University of Sydney
objective evaluate impact teachback communication quality national telephonebased telehealth service callers varying health literacy design crosssectional stepped wedge cluster randomised trial continuous recruitment short fixed exposure blinded outcome assessors nurses stratified hours worked randomised training groups using computer generated sequence setting australian national pregnancy parenting telephone helpline intervention complex intervention involving single 2hour group teachback training session combined ongoing nurse selfreflection communication following call shift participants participants 637 callers telephone helpline aged 1875 87 female 127 13 inadequate health literacy measured single item literacy screener 15 maternal child health nurses 15 years experience average measures primary outcome modified subscale health literacy questionnaire sufficient information manage health secondary caller outcomes included caller confidence perceived actionability information nurse effort listen understand nurse outcomes perceptions communication effectiveness results 7 week period 376 surveyed callers received usual care 261 teachback ratings primary outcome increased time 117 ci 101 132 p 003 independent teachback effect observed consistent pattern suggests compared usual care teachback helps callers inadequate health literacy feel listened 23 ci 098 542 p 006 confident act 244 ci 100 598 p 006 know steps take 268 ci 100 717 p 006 nurse perceptions communication effectiveness 231 ci 138 386 p00001 caller understanding 256 ci 152 430 p0001 increased teachback harms reported conclusions teachback appears benefit telephone health service users inadequate health literacy extent unclear due smaller numbers lower literacy participants improving caller ratings time likely due increasing nurse communication competence