Original Data

The Teach-Back Effect on Self-Efficacy in Patients with Type 2 Diabetes

Marhamat Farahaninia¹, Tahere Sarboozi Hoseinabadi^2,3, Rasool Raznahan^2,3, Shima Haghani⁴

Manuscript submitted September 13, 2020; resubmitted September 25, 2020; accepted October 2, 2020.

Keywords: teach-back, self-efficacy, self-management, training, type 2 diabetes, disease management

Abstract

BACKGROUND: Diabetes is a chronic, metabolic disease, which is commonly associated with increased blood glucose levels caused by impaired secretion or function of insulin. Therefore, daily blood glucose control, adherence to a dietary and pharmaceutical regimen, regular physical activity, and foot care are fundamental components of disease management. In order to optimize effective self-management, patients need to be trained. Teach-back is a method which aims to improve patients' understanding and perception of treatment regimens based on the interaction between patient and caregiver. AIM: This study was conducted to investigate the impact of the teach-back method on the effectiveness of self-management in patients with type 2 diabetes (T2D). METHODS: A total of 74 patients with T2D were included in the study by convenience sampling at the Endocrine and Metabolism Clinic. The subjects were assigned to control or intervention group. Data collection was performed by using a demographic data form and a self-efficacy questionnaire that were provided to the patients before and 1 month after training. The patients in the intervention group received a 5-session training program using the teach-back method. The control group received only routine programs. One month after completion of the training sessions, the questionnaires were completed by the subjects in the 2 groups, and the data obtained were analyzed. RESULTS: In contrast to the control group, mean and standard deviation of self-efficacy were significantly higher in the intervention group one month after training by the teach-back method than before training. The two groups did not significantly differ regarding mean score of self-efficacy before training, but there was a significant difference one month after training: the mean score of self-efficacy in the intervention group was significantly higher than in the control group (p < 0.001). CONCLUSIONS: Teach-back is a training procedure aimed at improving patients' understanding of treatment regimens. This study showed that teach-back significantly improved patients' self-efficacy even over as short a period as one month. It may be interesting to study the long-term effects of this simple but effective training method.

1. Introduction

Chronic diseases are among the main causes of mortality and disability in the world today [1]. Decline in physical activity, increase in obesity and tobacco use, and increasingly aging populations have led to considerable growth rates in the prevalence of chronic diseases in societies [2]. Diabetes is one of the most common chronic metabolic diseases [3, 4]. According to reports by the World Health Organization (WHO), about 422 million individuals were affected by diabetes in 2014, with greater prevalence in low and moderate income countries. The global prevalence of diabetes is estimated to be 8.5% among adults aged above 18 years. It was the seventh leading cause of mortality in 2016 (1.6 million individuals died from consequences of diabetes) [5].

Diabetes may cause short-term complications, including as hypoglycemia and diabetic ketoacidosis, and long-term complications, including retinopathy, nephropathy, neuropathy, and cardiovascular disease [6]. It may also lead to disability and a multi-year decline in life expectancy [7, 8]. Therefore, daily blood glucose control, adherence to a dietary and pharmaceutical regimen, physical activity, and regular foot care are essential factors in disease management [9, 10]. About 95% of diabetes treatment consists of self-management criteria [11, 12]. Application of effective self-management behavior is thus decisive in diabetes treatment; therefore, its effectiveness needs to be optimized by training people with diabetes, which should result in improved self-efficacy [13].

Self-efficacy means self-confidence and the individual's ability to conduct self-management in various situations [14]. Perceived self-efficacy is an important factor for successful performance of self-management and a fundamentally required skill to perform it [15]. Bandura described self-efficacy as an individual's belief in his ability to achieve a specific goal [16]. The WHO describes self-efficacy as a measure of health promotion at an individual level to achieve control over one's own life [17]. Improvement of self-efficacy is an important prerequisite for behavioral changes and may result in an increase in life-expectancy [18, 19].

Training is a proper tool to increase awareness in patients, so that active and informed cooperation for the self-management of their disease is improved [20]. Also, training should be based on patients' needs and emphasize the key aspects of the teach-back method [21]. Teach-back is an evidence-based training method based on the interaction between patient and physician; it is helpful to assess patients' understanding and perception of treatment regimens through interviewing patients; its aim is to increase patients' knowledge and perception and improve their self-management. This method provides valuable information for patient and healthcare givers and helps to improve the treatment process and outcome [22]. It aims to provide effective learning and decrease memory errors and mistakes [23].

Teach-back is considered one of the most effective methods to improve training perception [24, 25]. In teach-back, the trainer teaches content in simple and understandable language without using medical terms, and after finishing the training, the clients are asked to explain the content as they perceived it. If the client did not understand the content properly, the trainer should repeat it to clients until complete understanding is reached [26]. The nurse trainer may access the needs of the patients involved by communication skills, and has the ability to design and present individualized training to meet these needs [27]. Since training is important for patients to ensure individuals' perception, recall, and maintenance of training information, the aim of this study was to determine the effect of the teach-back method on self-efficacy in patients with T2D over a short one-month period to determine whether immediate success can be obtained by introducing this method.

2. Materials and methods

2.1 Patients

References

1. Rodriguez F, Blum MR, Falasinnu T, Hastings KG, Hu J, Cullen MR, Palaniappan LP. Diabetes-attributable mortality in the United States from 2003 to 2016 using a multiple-cause-of-death approach. Diabetes Res Clin Pract 2019. 148:169-178. [DOD] [CrossRef]
2. Forbes AW. The nursing contribution to chronic disease management: a discussion paper. Int J Nurs Stud 2009. 46(1):120-131. [DOD] [CrossRef]
3. Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, Zinman B. Medical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy. Diabetologia 2009. 52(1):17. [DOD] [CrossRef]
4. Caughey GE, Roughead EE, Vitry AI, McDermott RA, Shakib S, Gilbert AL. Comorbidity in the elderly with diabetes: Identification of areas of potential treatment conflicts. Diabetes Res Clin Pract 2010. 87(3):385-393. [DOD] [CrossRef]
5. World Health Organization. The top 10 causes of death, the context of primary health care. 2016. [DOD] 
6. Brunner LS, Smeltzer SC, Bare BG, Hinkle JL, Cheever KH. Brunner and Suddarth’s textbook of medical-surgical nursing. Lippincott Williams and Wilkins, 2014. [DOD] 
7. Seclen SN, Rosas ME, Arias AJ, Huayta E, Medina CA. Prevalence of diabetes and impaired fasting glucose in Peru: report from perudiab, a national urban population-based longitudinal study. BMJ Open Diabetes Res Care 2015. 3(1):e000110. [DOD] [CrossRef]
8. Khalkhali HR. The effect of conseling on health promotion behaviors in diabetic mothers referred to Motahhari Hospital of Urmia at 2016. J Urmia Nurs Midwif Facul 2016. 14(9):757-766. [DOD] 
9. McDowell J, Courtney M, Edwards H, Shortridge-Baggett L. Validation of the Australian/English version of the diabetes management self-efficacy scale. Int J Nurs Pract 2005. 11(4):177-184. [DOD] [CrossRef]
10. Shakibazadeh E, Rashidian A, Larijani B, Shojaeezadeh D, Forouzanfar M, Karimi Shahanjarini A. Perceived barriers and self-efficacy: Impact on self-care behaviors in adults with type 2 diabetes. J Hayat 2010. 15(4):69-78. [DOD] 
11. Fischer J, Koszewski W, Jones G, Stanek-Krogstrand K. The use of interviewing to assess dietetic internship preceptors needs and perceptions. J Am Diet Assoc 2006. 106(8):A48. [DOD] [CrossRef]
12. Bazzazian S, Besharat M, Ehsan BH, Rajab A. The moderating role of coping strategies in relationship between illness perception, quality of life and HbA1c in patients with type I diabetes. Iran J Endocrinol Metab 2010. 12(3):213-221. [DOD] 
13. Wu SF, Courtney M, Edwards H, McDowell J, Shortridge-Baggett LM, Chang PJ. Self-efficacy, outcome expectations and self‐care behaviour in people with type 2 diabetes in Taiwan. J Clin Nurs 2007. 16(11c):250-257. [DOD] [CrossRef]
14. Keough LA. Self-management of type 1 diabetes across adolescence: a dissertation. 2009. [DOD] 
15. Lau-Walker M. Importance of illness beliefs and self‐efficacy for patients with coronary heart disease. J Adv Nurs 2007. 60(2):187-198. [DOD] [CrossRef]
16. Bandura A. Adolescent development from an agentic perspective. In: Pajares F, Urdan T (eds.): Self-efficacy beliefs of adolescents (pp. 1-43). Greenwich, Connecticut, Information Age Publishing, 2006. [DOD] 
17. Naidoo J, Wills J. Health promotion functions for practice. London, Toronto, second ed., 2005, p. 98-99. [DOD] 
18. Bentsen SB, Wentzel-Larsen T, Henriksen AH, Rokne B, Wahl AK. Self-efficacy as a predictor of improvement in health status and overall quality of life in pulmonary rehabilitation - an exploratory study. Patient Educ Couns 2010. 81(1):5-13. [DOD] [CrossRef]
19. Baljani E, Rahimi J, Amanpour E, Salimi S, Parkhashjoo M. Effects of a nursing intervention on improving self-efficacy and reducing cardiovascular risk factors in patients with cardiovascular diseases. J Hayat 2011. 17(1):45-54. [DOD] 
20. Wilson FL, Baker LM, Nordstrom CK, Legwand C. Using the teach-back and Orem's Self-care Deficit Nursing theory to increase childhood immunization communication among low-income mothers. Issues Compr Pediatr Nurs 2008. 31(1):7-22. [DOD] [CrossRef]
21. Esquivel J, White M, Carroll M, Brinker E. Teach-back is an effective strategy for educating older heart failure patients. J Card Fail 2011. 17(8):S103. [DOD] [CrossRef]
22. Kripalani S, Bengtzen R, Henderson LE, Jacobson TA. Clinical research in low-literacy populations: using teach-back to assess comprehension of informed consent and privacy information. IRB 2008. 30(2):13-19. [DOD] 
23. Dalir Z. Teach back method in patient education. Strides in Development of Medical Education 2017. 13:640-643. [DOD] 
24. Kornburger C, Gibson C, Sadowski S, Maletta K, Klingbeil C. Using "teach-back" to promote a safe transition from hospital to home: an evidence-based approach to improving the discharge process. J Pediatr Nurs 2013. 28(3):282-291. [DOD] [CrossRef]
25. White M, Garbez R, Carroll M, Brinker E, Howie-Esquivel J. Is "teach-back" associated with knowledge retention and hospital readmission in hospitalized heart failure patients? J Cardiovasc Nurs 2013. 28(2):137-146. [DOD] 
26. Pistoria M, Peter D, Robinson P, Jordan K, Lawrence S. Using teach back to reduce readmission rates in hospitalized heart failure patients. Lehigh Valley Health Network Scholarly Works, Paper no. 62, 2011. [DOD] 
27. Seaman S. The role of the nurse specialist in the care of patients with diabetic foot ulcers. Foot Ankle Int 2005. 26(1):19-26. [DOD] [CrossRef]
28. Khavasi M, Masroor D, Varai S, Joudaki K, Rezaei M, Mehr BR, Shamsizadeh M. The effect of peer education on diabetes self-efficacy in patients with type 2 diabetes: a randomized clinical trial. J Knowledge Health 2016. 11(2):67-74. [DOD] 
29. Tang T, Sohal P, Garg A. Evaluating a diabetes self-management support peer leader training programme for the English- and Punjabi-speaking South-Asian community in Vancouver. Diabet Med 2013. 30(6):746-752. [DOD] [CrossRef]
30. Nelson K, Drain N, Robinson J, Kapp J, Hebert P, Taylor L, Silverman J, Kiefer M, Lessler D, Krieger J. Peer Support for Achieving Independence in Diabetes (Peer-AID): design, methods and baseline characteristics of a randomized controlled trial of community health worker assisted diabetes self-management support. Contemp Clin Trials 2014. 38(2):361-369. [DOD] [CrossRef]
31. Rashidi K, Safavi M, Yahyavi S, Farahani H. Effects of peer support on self-efficacy of patients with type II diabetes. Sci J Hamadan Nurs Midwife Facul 2015. 3(50):15-26. [DOD] 
32. Lachini A, Amirsardari L, Zaman M. Efficacy of education of self-efficacy on controlling HbA1c in the Diabetes II. J Res Psychol Health 2014 8(2):61-70. [DOD] 
33. Hejazi S, Peyman N, Tajfard M, Esmaily H. The impact of education based on self-efficacy theory on health literacy, self-efficacy and self-care behaviors in patients with type 2 diabetes. Iran J Health Educ Health Promo 2017. 5(4):296-303. [DOD] [CrossRef]
34. Naghibi SA, Asghari M, Rostami F. Investigation the effect of education on self-care promotion in type 2 diabetic patients in Noor Health Centers in 2015. J Health Res Commun 2015. 1(2):22-28. [DOD] 
35. Masoodi R, Alhani F, Rabiei L, Majdinasab N, Moghaddasi J, Esmaeili S, Noorian C. The effect of family-centered empowerment model on quality of life and self-efficacy of multiple sclerosis patients family care givers. Iran J Nurs Res 2013. 7(27):32-43. [DOD] 
36. Mohsenikhah M, Esmaili R, Tavakolizadeh J, Khavasi M, Jaras M, Delshad Noghabi A. Effects of peer-education on quality of life in adults with type 2 diabetes. Q Horizon Med Sci 2018. 24(1):17-22. [DOD]