Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Susan Dean-Baar, PhD, RN, CENP, FARN, FAAN


Nancy Magnuson, DSN, APRN, PCNS, FNP-BC

Chaney Bell, MSN, APRN, FNP-C


Implementation of an Educational Teach-back Program for Patients with Hypertension


Problem: To improve health literacy and provide adequate health care to patients and their family, clear and effective dialogue is essential. The teach-back method is a technique utilized to confirm a patient’s level of understanding of care instructions done by relaying patient directions, and then confirming the patient understands by asking the patient to reiterate those directions. The purpose of this quality improvement project was to assess the effectiveness of using the teach-back method by health care professionals with their patients who have a diagnosis of hypertension or high blood pressure.

Methods: A descriptive design was used to evaluate the effectiveness of the teach-back method ii n an urban, midwestern primary care clinic setting. Education about the teach-back method was provided to staff over two sessions. Seven staff completed the entire Teach-Back Conviction and Confidence Scale before the education and six weeks after the education, completing the two items on conviction and confidence immediately after the education. Data from initial and follow-up visits for 42 patients with a diagnosis of hypertension was also collected.

Results: Staff report of how often they asked patients to explain in their own words increased significantly (p=.001). A significant increase was seen in the five of the eleven teach-back elements. Results from the staff survey showed a significant increase in staff conviction (F(s,18)=4.44, p=.027) and confidence (F(2,18)=7.21, p=.005) in use of the teach-back method from pre-education to immediately after the education. Patient response to taking prescribed medications increased (p=.002), and there was a significant decrease in reported symptoms related to hypertension from initial visit to follow up visit.

Implications for Practice: The use of teach-back to improve health literacy and patient’s self-management of hypertension was supported by this project. Strategies to reinforce the use of teach-back by healthcare providers should be encouraged. The Agency for Health Care Policy and Research Teach-Back Toolkit is a resource that should be used by healthcare settings to support staff in using this technique.