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Table 1 Description of barriers, enablers and intervention components for implementing Teach-Back with reference to the Theoretical Domains Framework

From: Enhancing communication skills for telehealth: development and implementation of a Teach-Back intervention for a national maternal and child health helpline in Australia

Using a theoretical framework, which barriers and enablers need to be addressed? Within which theoretical domains do the barriers and enablers operate? (Domain numbering from [45]) Intervention components targeted at overcoming the modifiable barriers and enhancing the enablers
Lack of knowledge of how to use the Teach-Back method in this workplace setting 1. Knowledge
2. Skills
9. Goals
12. Social influences
14. Behavioural regulation
Technique: information provision, model/demonstrate the behaviour; rehearsal; encourage problem-solving
Mode: Slides and workshop discussion; short (< 90 s) training video (× 2)
Content: text and video examples of Teach-Back in practice including familiar scenario in this workplace. Role-play practice with Teach-Back. Facing away from each other to simulate telephone environment, swapping roles between caller/nurse, and changing partners.
Time constraints. Concerns about managing calls within time guidelines (i.e. 10 min) 6. Beliefs about consequences
11. Environmental context and resources
Technique: environmental modification, barrier identification,
Mode: relaxing guidelines for maximum call duration for duration of study; workshop discussions
Content: Call centre management advised temporary changes to call duration guidelines; workshop facilitators informed nurses of a previous study [36] that found Teach-Back often reduced consultation time (and why)
Difficulty phrasing. Nurse beliefs and attitudes about own communication effectiveness and asking for Teach-Back 2. Skills
3. Social/Professional role and identity 4. Beliefs about capabilities
6. Beliefs about consequences
7. Reinforcement
Technique: information provision, barrier identification
Mode: facilitated workshop, guided discussion including discussing barriers to asking Teach-Back; offering a wide range of phrases to try
Content: Acknowledging it can be difficult to ask for Teach-Back. Discussing that consumers typically do not mind or do not notice.
Volume and complexity of information discussed, caller needs (incl. Parents’ divided attention) 2. Skills
4. Beliefs about capabilities
6. Beliefs about consequences
Technique: information provision, encourage problem-solving
Mode: illustrating situations where Teach-Back can be helpful; introducing “chunk and check” to break down complex information
Content: video of distracted caller
Self-reflection 10. Memory, attention, and decision processes
11. Environmental context and resources
14. Behavioural regulation
Technique: encouraging self-reflection after each call
Mode: online self-reflection surveys, email reminders to complete surveys; Teach-Back phrases on paper and in surveys
Content: reflecting on efficacy of explanation and caller understanding (Additional file 1)
Supportive work environment 3. Social/Professional role and identity
4. Beliefs about capabilities
6. Beliefs about consequences
7. Reinforcement
Technique: linking rewards to the activities; encouraging nurses to experiment with different techniques; permission to fail
Mode: self-reflection exercise linked to professional development rewards and professional identity as nurses; management support
Content: performance is self-assessed with a focus on learning; call duration guidelines relaxed (see above)