Using Teach Back to Evaluate the Efficacy of a Pediatric Headache Program: A DNP Project

Background: Only 40%-80% of health information is retained during an office visit due to ineffective communication. Caregivers, and patients, are unable to remember how to manage their health care needs. Teach back is an effective tool that encourages a conversation between the caregiver/patient and provider. The purpose of this project is to increase knowledge retention and self-management behaviors using a headache teach back tool.

Methods: The quality department at a large children’s hospital in the southwestern United States approved the project as a practice change and parent consent was not required. The project design was a randomized controlled group: pretest-posttest design, quality improvement method. Participants were chosen by convenience sample. Required diagnoses were headache or migraine. Each group had 18 participants, for a total of 36 participants. Ages ranged from four to 18 years of age, with legal guardians present for the intervention group only. New and follow-up patients were included in the project. Demographics for each group were statistically similar. Questionnaires were used to assess knowledge pre and post implementation of teach back tool. Self-management was measured by a follow-up phone call after their appointment to inquire regarding implementation of the headache diary. Charts were reviewed for both groups regarding the number and type of phone calls received by the office.

Outcomes: Paired sample t-test was used to evaluate mean differences in knowledge from pre and post questions of teach back tool. Data analysis concluded a statistical increase in knowledge of triggers and prevention techniques. Cohen’s d for triggers was 2.21 and 1.87 for prevention. Self-management of behavior was measured by use of headache diary and determined by a percentage. Sixty-seven individuals started to use the headache diary. Independent t-test was used to compare number of phone calls from each group. Data concluded a decrease in phone calls. However, due to a small sample size, statistical significance could not be established.

Conclusion: Teach back encourages caregiver/patient and provider interaction, which increases health literacy retention and increases self-management behaviors. Future research should focus on patients with headaches with unknown triggers for their headaches.