The report is a product of the VA/HSR Evidence Synthesis Program.

Effectiveness and Implementation of Teach-Back as an Approach to Patient Education: A Systematic Review

Takeaway: This systematic review provides updated evidence on the effectiveness of teach-back as a health education strategy for individual clinical encounters. It finds improvements in patient self-efficacy and adherence to recommended health behaviors after exposure to teach-back interventions. Uncertainty remains regarding teach-back’s impact on health knowledge and skill acquisition, how to successfully implement routine use of teach-back, duration of effect, and the populations or settings in which teach-back is most useful. Despite the limitations of this review’s findings, the potential benefit of this low-risk intervention supports its continued use in clinical practice.

Patients often forget or misremember a significant proportion of health information conveyed during medical encounters. Teach-back is a strategy that is intended to promote patient and family understanding of health information and enhance patient adherence and adoption of health behaviors. During teach-back, a healthcare professional provides information verbally or by demonstration, and then asks the patient to fully repeat this information in their own words or redemonstrate the skill shown. Prior systematic reviews suggested a beneficial impact from teach-back on multiple outcomes, although findings were limited by lack of comparators and risk of bias.

To inform efforts of VA’s National Center for Health Promotion and Disease Prevention, HSR’s Evidence Synthesis Program (ESP) Center in Durham, NC, conducted a systematic review to provide updated evidence on the effectiveness of teach-back for individual clinical encounters, as well as strategies employed to support clinician use of teach-back. To identify relevant articles, the ESP team searched MEDLINE, Embase, and CINAHL for studies published January 1, 2018, to July 9, 2024, and hand-searched reference lists from eight prior systematic reviews.

Summary of Findings

• Sixteen randomized trials addressed the effectiveness of teach-back. The trials were set within inpatient and outpatient settings across a range of clinical contexts.
• Seven pre-post, single site studies evaluated the effect of efforts to increase clinician use of teach-back.
• Eight of the identified trials evaluated the effect of teach-back on short-term patient knowledge acquisition. All had substantial methodologic limitations that limited the ESP team’s ability to draw meaningful conclusions about the effect of teach-back on knowledge acquisition.
• Teach-back led to a moderate increase in short-term health behavior adherence in six trials, which primarily used self-reported assessments.
• Teach-back led to a large increase in self-efficacy in four trials, all with substantial methodologic limitations.
• Minimal data explored differences in the effect of teach-back across different clinical settings, methods of delivering teach-back, or patient-level characteristics.
• Limited evidence on the implementation of teach-back suggests that most sites used staff training along with additional strategies to encourage clinicians to use teach-back.

Implications

Teach-back is a low-risk health education strategy that improves patient self-efficacy and adherence to recommended health behaviors, including self-care. Despite the limitations of this review’s findings and residual uncertainty regarding teach-back’s impact on health knowledge and skill acquisition, the potential benefit of this low-risk intervention on patient self-efficacy and adherence to recommended health behaviors may support its continued use in clinical practice. It remains unknown how best to ensure that clinical team members use teach-back consistently and appropriately in order to achieve the desired effect.

Limitations

Limitations of the relevant literature included the small size of individual studies, few detailed descriptions of comparator arms, and variations in how outcomes were conceptualized, measured, and reported. In addition, the identified literature did not provide data needed to identify differences in teach-back effects by patient-level characteristics (e.g., literacy level, health status, age). None of the identified studies were conducted in VA, which may limit the applicability of findings to the VHA population.

Future Research

Future studies of teach-back should continue to evaluate its short- and long-term effectiveness using validated measures and should determine which strategies are most effective at increasing the routine use of teach-back in real-world clinical settings.

Citation:

Vick JB, Pace R, Klimek-Johnson P, et al. Effectiveness and Implementation of Teach-Back as an Approach to Patient Education: A Systematic Review. Washington, DC: Evidence Synthesis Program, Health Systems Research, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #9-010; 2025.

To view the full report, go to vaww.hsrd.research.va.gov/publications/esp/teach-back.cfm . (This report is available via Intranet only.)

How can VA leadership work with the ESP? Nominations for systematic review topics may be submitted to the program at any time. When you submit a topic nomination form, ESP Coordinating Center staff will work with you to determine the appropriate research approach and ESP product to address your questions of interest. Topics are selected and assigned to an ESP Center based on program capacity and alignment with VA national goals.

This Management Brief is provided to inform you about recent HSR findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR Resource Center charged with disseminating important HSR findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.

This report is a product of VA/HSR's Evidence Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers; and to disseminate these reports throughout VA.

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