Joanne Ramsbotham

The effectiveness of the teach-back method on adherence and self-management in health education for people with chronic disease: a systematic review.

Background Chronic diseases are increasing worldwide and have become a significant burden to those affected by those diseases. Disease‐specific education programs have demonstrated improved outcomes, although people do forget information quickly or memorize it incorrectly. The teach‐back method was introduced in an attempt to reinforce education to patients. To date, the evidence regarding the effectiveness of health education employing the teach‐back method in improved care has not yet been reviewed systematically. Objectives This systematic review examined the evidence on using the teach‐back method in health education programs for improving adherence and self‐management of people with chronic disease. Inclusion criteria Types of participants Adults aged 18 years and over with one or more than one chronic disease. Types of intervention All types of interventions which included the teach‐back method in an education program for people with chronic diseases. The comparator was chronic disease education programs that did not involve the teach‐back method. Types of studies Randomized and non‐randomized controlled trials, cohort studies, before‐after studies and case‐control studies. Types of outcomes The outcomes of interest were adherence, self‐management, disease‐specific knowledge, readmission, knowledge retention, self‐efficacy and quality of life. Search strategy Searches were conducted in CINAHL, MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, ProQuest Nursing and Allied Health Source, and Google Scholar databases. Search terms were combined by AND or OR in search strings. Reference lists of included articles were also searched for further potential references. Methodological quality Two reviewers conducted quality appraisal of papers using the Joanna Briggs Institute Meta‐Analysis of Statistics Assessment and Review Instrument. Data extraction Data were extracted using the Joanna Briggs Institute Meta‐Analysis of Statistics Assessment and Review Instrument data extraction instruments. Data synthesis There was significant heterogeneity in selected studies, hence a meta‐analysis was not possible and the results were presented in narrative form. Results Of the 21 articles retrieved in full, 12 on the use of the teach‐back method met the inclusion criteria and were selected for analysis. Four studies confirmed improved disease‐specific knowledge in intervention participants. One study showed a statistically significant improvement in adherence to medication and diet among type 2 diabetics patients in the intervention group compared to the control group (p < 0.001). Two studies found statistically significant improvements in self‐efficacy (p = 0.0026 and p < 0.001) in the intervention groups. One study examined quality of life in heart failure patients but the results did not improve from the intervention (p = 0.59). Five studies found a reduction in readmission rates and hospitalization but these were not always statistically significant. Two studies showed improvement in daily weighing among heart failure participants, and in adherence to diet, exercise and foot care among those with type 2 diabetes. Conclusions Overall, the teach‐back method showed positive effects in a wide range of health care outcomes although these were not always statistically significant. Studies in this systematic review revealed improved outcomes in disease‐specific knowledge, adherence, self‐efficacy and the inhaler technique. There was a positive but inconsistent trend also seen in improved self‐care and reduction of hospital readmission rates. There was limited evidence on improvement in quality of life or disease related knowledge retention. Implications for practice Evidence from the systematic review supports the use of the teach‐back method in educating people with chronic disease to maximize their disease understanding and promote knowledge, adherence, self‐efficacy and self‐care skills. Implications for research Future studies are required to strengthen the evidence on effects of the teach‐back method. Larger randomized controlled trials will be needed to determine the effectiveness of the teach‐back method in quality of life, reduction of readmission, and hospitalizations.

The Effectiveness of Interventions for Improving the Research Literacy of Nurses: A Systematic Review.

Background Internationally, a considerable body of research exists examining why nurses do not use evidence in practice. Consistently, the research finds that lack of knowledge about research or discomfort with understanding research terminology are among the chief reasons given. Research education is commonly included in undergraduate nursing degree programs, but this does not seem to translate into a strong understanding of research following graduation, or an ability to use it in practice. Aim The objective of this review was to identify the effectiveness of workplace, tertiary-level educational, or other interventions designed to improve or increase postregistration nurses’ understanding of research literature and ability to critically interact with research literature with the aim of promoting the use of research evidence in practice in comparison to no intervention, other intervention, or usual practice. Methods A wide range of databases were searched for quantitative studies of registered nurses receiving educational interventions designed to increase or improve their understanding of research literature in tertiary or workplace settings. Two reviewers working independently critically appraised the relevant papers and extracted the data using Joanna Briggs Institute instruments. Data are presented as a narrative summary as no meta-analysis was possible. Results Searching identified 4,545 potentially relevant papers, and after the sifting of titles and abstracts, 96 papers were selected for retrieval. On examination of full-text versions, 10 of the 96 retrieved papers were found to meet the inclusion criteria. Included studies were low to moderate quality. Interactive or activity-based learning seems to be effective in terms of improving research knowledge, critical appraisal ability, and research self-efficacy. Utilizing a program with a strong base in an appropriate theory also seems to be associated with greater effectiveness, particularly for workplace interventions. Linking Evidence to Action The included studies strongly favored interactive interventions, and those utilizing theory in their construction. Therefore, these types of interventions should be implemented to improve the effectiveness of research education for nurses as well as their research literacy.

Interventions for improving the research literacy of nurses: a systematic review

Background Despite the importance of research literacy for nurses, many nurses report feeling unable to effectively read and understand research, which in turn results in lower research utilization in practice. Nurses themselves identify poor experiences with trying to understand and use research as factors that contribute to a reluctance to utilize research. This reluctance often leads nurses to seek other sources of information, such as colleagues, instead. Objectives The objective of this review was to identify the effectiveness of research literacy interventions on the research literacy of registered nurses. Inclusion criteria Types of participants Registered nurses. Types of interventions Interventions of interest were those that evaluated the effectiveness of workplace educational programs or interventions conducted in a healthcare organization or tertiary‐level educational facility aiming to improve or increase registered nurses’ understanding of research literature. Type of outcome measures Outcomes of interest were research literacy, measured explicitly or as research knowledge, research understanding, use of research evidence in practice, and/or ability to critically appraise research. Type of studies We considered experimental study designs such as randomized controlled trials, nonrandomized controlled trials, quasi‐experimental, and before and after studies. Search strategy A wide range of databases were searched in order to provide the most complete possible review of the evidence. Initial keywords used were: “research litera*”, “research education”, “research knowledge”, “evidence‐based practice education”. Methodological quality Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta‐Analysis of Statistics Assessment and Review Instrument (JBI‐MAStARI). Data extraction Data were extracted from papers included in the review using the standardized data extraction tool from JBI‐MAStARI. Data synthesis Quantitative data would have been, if possible, pooled in statistical meta‐analysis using the Cochrane Collaborations Review Manager 5.2 software. As statistical pooling was not possible, the findings are presented in narrative form including tables and figures where appropriate to aid in data presentation. Results The majority of included studies were single‐group pre‐test/post‐test designs (n=7). One was a post‐test only two‐group comparison and two were two‐group quasi‐experimental studies. Included studies were conducted in Taiwan, Japan, Hong Kong, Australia, United Kingdom and United States. The total number of registered nurses in the included studies was 453. The educational interventions were conducted in universities (n=6) and healthcare facilities (n=4). Most included studies were published (n=9), with one unpublished study. Conclusions The evidence on educational interventions, while not strong, is indicative of the types of interventions which are likely to be effective. Online or face‐to‐face interventions using interactive teaching strategies, such as activities, role‐play and discussions, and which are underpinned by an appropriate behavioral or education theory, are likely to increase research literacy. Implications for practice Educational interventions for nurses’ research literacy should be designed to be as interactive as possible. Interactive research education can have effects on improving nurses’ critical appraisal skills and research knowledge. The use of an appropriate educational or behavioral theory may improve the effectiveness of the intervention. The platform for the education (in‐person or online) is less important than the design of the activities and the amount of interaction. The length of the intervention appears to have little impact on its effectiveness. Implications for research More rigorous experimental studies of educational interventions for nurses’ research literacy are warranted, in order to demonstrate the effectiveness of different course and program designs. Future studies should consider longer periods of follow‐up to test the longevity of the effect, as education needs to have lasting effects to be beneficial to the recipients.

Consistent and collaborative approaches to reduce preventable deaths: a Safe Infant Sleeping educational resource designed for health professionals

Objective: To identify knowledge, attitudes and practices of child health nurses relating to infant wrapping as an effective settling/sleep strategy. Methods: A pre-test/post-test intervention design was used to explore knowledge, attitudes and practices relating to wrapping in a sample of child health nurses (n=182): a) pre-test survey; b) educational intervention incorporating evidence relating to infant wrapping; SIDSK Safe Sleeping recommendations. Emphasis was placed on infant wrapping as an effective settling strategy for parents to use as an alternative to prone positioning; c) post-test survey to evaluate intervention effectiveness. Results: Pretest results identified wide variation in nurses’ knowledge, attitudes and practices of infant wrapping as a settling/sleep strategy. The intervention increased awareness of wrapping guidelines and self-reported practices relating to parent advice. Significant positive changes in nurses’ awareness of wrapping guidelines (p<0.001); to wrap in supine position only (p<0.001); and parental advice to use wrapping as an alternative strategy to prone positioning to assist settling/sleep (p<0.01), were achieved post-test. Conclusions: Managing unsettled infants and promoting safe sleeping practices are issues routinely addressed by child health nurses working with parents of young infants. Queensland has a high incidence of prone sleeping. Infant wrapping is an evidence-based strategy to improve settling and promote supine sleep consistent with public health recommendations. Infant wrapping guidelines are now included in Queensland Health’s state policy and Australian SIDSandKids information relating to safe infant sleeping. In communicating complex health messages to parents, health professionals have a key role in reinforcing safe sleeping recommendations and offering safe, effective settling/sleep strategies to address the non-recommended use of prone positioning for unsettled infants.

Self-management intervention using teach-back for people with heart failure in Vietnam: A cluster randomized controlled trial protocol

Globally, the increasing prevalence of heart failure is a burden on health-care systems, especially in under-resourced countries, such as Vietnam. We describe a prospective single-site, cluster randomized controlled trial of an intervention designed to teach adult patients about heart failure and how to undertake self-care activities. The intervention, delivered by a nurse, comprises of an individual teaching session using teach-back, a heart failure booklet, weighing scales, a diary to document daily weight, and a follow-up phone call 2 weeks after hospital discharge. Teach-back is a process of asking patients to repeat information and for the nurse to fill any gaps or misunderstanding until adequate understanding is demonstrated. The control group will receive usual education plus the heart failure (HF) booklet. A total of 140 participants will be allocated into two study groups. The level of randomization is at the ward level. The primary outcome (HF knowledge) and secondary outcomes (self-care behaviors and all-cause hospitalizations) will be measured at 1 and 3 months. This study will make an important contribution regarding a protocol of teach-back and chronic disease self-management.