The impact of teach-back on comprehension of discharge instructions and satisfaction among emergency patients with limited health literacy: A randomized, controlled study

Richard T. Griffey, Nicole Shin, Solita Jones, Nnenna Aginam, Maureen Gross, Yonitte Kinsella, Jennifer A. Williams, Christopher R. Carpenter, Melody Goodman, Kimberly A. Kaphingst

Research output: Contribution to journalArticle


Objective: Recommended as a ‘universal precaution’ for improving provider–patient communication, teach-back has a limited evidence base. Discharge from the emergency department (ED) to home is an important high-risk transition of care with potential for miscommunication of critical information. We examined whether teach-back improves: comprehension and perceived comprehension of discharge instructions and satisfaction among patients with limited health literacy (LHL) in the ED. Methods: We performed a randomized, controlled study among adult patients with LHL, randomized to teach-back or standard discharge instructions. Patients completed an audio-recorded structured interview evaluating comprehension and perceived comprehension of (1) diagnosis, (2) ED course, (3) post-ED care, and (4) reasons to return and satisfaction using four Consumer Assessment of Healthcare Providers and Systems questions. Concordance with the medical record was rated using a five-level scale. We analyzed differences between groups using multivariable ordinal logistic regression. Results: Patients randomized to receive teach-back had higher comprehension of post-ED care areas: post-ED medication (P < 0.02), self-care (P < 0.03), and follow-up instructions (P < 0.0001), but no change in patient satisfaction or perceived comprehension. Conclusion: Teach-back appears to improve comprehension of post-ED care instructions but not satisfaction or perceived comprehension. Our data from a randomized, controlled study support the effectiveness of teach-back in a busy clinical setting. Further research is needed to test the utility and feasibility of teach-back for routine use including its impacts on distal outcomes.

Original languageEnglish (US)
Pages (from-to)10-21
Number of pages12
JournalJournal of Communication in Healthcare
Issue number1
StatePublished - Jan 1 2015



  • Emergency department
  • Health literacy
  • Intervention studies
  • Physician–patient relations
  • Teach-back communication

ASJC Scopus subject areas

  • Communication
  • Health Information Management

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