Implementation of the Teach-Back Method into the Care of Patients with Diabetes in Rural Utah

Diabetes mellitus type 2 is a growing health concern throughout the United States. Over the last few decades extensive efforts have been made to improve diabetes care and the health outcomes of individuals with diabetes. However, standards of care and treatment goals, as defined by the American Diabetes Association, are still not being met. Rural individuals, in particular, face numerous barriers when attempting to self-manage the disease. Lower levels of health literacy, poor provider-patient communication, and limited access to providers result in disparities in the health outcomes of rural individuals. The complexity of diabetes mellitus type 2 presents many challenges for providers as they attempt to effectively educate patients on how to self-manage the disease. In order to improve health outcomes for individuals with diabetes in rural communities, patients need to be able to understand and implement the instructions from their health care providers. The teach-back method has been shown to improve patient-provider communication and improve glycemic control of patients with diabetes. The teach-back method allows providers to assess for patient comprehension and gives patients the opportunity to demonstrate their understanding while seeking clarification. Implementing the teach-back method in the rural clinic setting can potentially improve health outcomes among patients with diabetes. The purpose of this project was to improve the quality of education given by providers to patients with diabetes mellitus type 2 in the rural setting through the implementation of the teach-back method. There were 4 main objectives to guide this project: 1) educate providers on the teach-back method, 2) implement the teach-back method into the care of patients with diabetes in a rural clinic, 3) evaluate the effectiveness of the teach-back method in the rural setting, and 4) disseminate the findings. Approval of this project was completed through the University of Utah Institutional Review Board and key stakeholders at the rural clinics. This project utilized a pre-intervention group and a post-intervention group. For a period of three weeks, individuals in the rural clinic received diabetes education from their providers without any modifications. Each patient who agreed to participate in the study received a telephone survey regarding their visit. At the completion of the three weeks, providers in the clinics received training on the teach-back method. Providers then implemented the teach-back method in the care of their patients with diabetes for a period of three weeks. Telephone surveys were again completed and then compared to the reference group to evaluate the effectiveness of the teach-back method. The results of the calculated independent t-test and the non-parametric test of each question in the telephone survey failed to demonstrate significant change in the participants' involvement and confidence in managing diabetes. Despite the statistically insignificant results of the pre- and post-intervention group responses, the teach-back method offers providers one additional method for educating patients with diabetes. Further research on the teach-back method and other educational methods is needed in order to find the most effective educational method to meet the unique needs of rural individuals with diabetes mellitus.