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Using the teach-back method to improve postpartum maternal-infant health among women with limited maternal health literacy: a randomized controlled study Gui Zhi Cheng 1,#, An Chen 2,3,4,#, Youdi Xin 1, Qian Qian Ni 1,✉ Author information Article notes Copyright and License information PMCID: PMC9827634 PMID: 36624440 Abstract Aim This study aimed to evaluate the effects of using the teach-back method among women with limited maternal health literacy (LMHL) on maternal health literacy(MHL), postpartum health behaviours and maternal-infant health outcomes. Methods A randomized controlled study was conducted in the obstetrics department of Anhui Provincial Hospital, China. A total of 258 pregnant women with LMHL were recruited at the point of admission to the hospital for birth and randomly assigned to the control group (n = 130), where women received routine education sessions, and the teach-back group (n = 128), where women received routine education sessions plus a teach-back intervention. The two groups were assessed in terms of MHL before and after the intervention, breastfeeding execution, uptake of 42-day postpartum check-ups, complete uptake of one-time recommended vaccines, and physical health outcomes. Statistical tests were employed for data analysis. Results There was no significant difference between the two groups in terms of MHL and other social, demographic, and medical status at baseline. After the intervention, the teach-back group had a higher level of MHL (p < 0.001), better postpartum health behaviours in terms of exclusive breastfeeding within 24 hours postpartum (x2 = 22.853, p<0.001), exclusive breastfeeding within 42 days postpartum (x2 = 47.735, p<0.001), uptake of 42-day postpartum check-ups (x2 = 9.050, p = 0.003) and vaccination (x2 = 5.586, p = 0.018) and better maternal-infant health outcomes in terms of the incidence of subinvolution of the uterus (x2 = 6.499, p = 0.011), acute mastitis (x2 = 4.884, p = 0.027), postpartum constipation (x2 = 5.986, p = 0.014), overweight (x2 = 4.531, p = 0.033) and diaper dermatitis (x2 = 10.896, p = 0.001). Conclusions This study shows that the teach-back method is effective for enhancing MHL, leading to positive postpartum health behaviours, and improving postpartum maternal-infant health outcomes among women with LMHL. The teach-back method may play an important role in improving postpartum maternal-infant health and could be considered in maternal health education. Trial registration number Our trial has been prospectively registered at ClinicalTrials.gov (Ref. No.: NCT04858945) and the enrollment date was 26/04/2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05302-w. Keywords: Teach-back, Maternal health literacy, Postpartum maternal-infant health Background The postpartum period (or puerperium), called the "4th trimester", commonly referring to the time from the expulsion of the placenta through the first six to 8 weeks after birth, is a time of convalescence for the mother, impacts on the mother's short-term and long-term health and well-being, and lays the foundation for the newborn's development [1-3]. Most maternal and infant deaths [4, 5], as well as many severe pregnancy- and birth-related complications and child illnesses that may cause lifelong suffering, occur during the postpartum period [6, 7]. Health problems are common among puerperal women. By reviewing relevant studies, Cooklin et al. concluded that approximately 90% of women suffered from at least one physical health problem (e.g., back pain, perineal pain, pain related to caesarean wounds, haemorrhoids, constipation or incontinence) in the first 8 weeks postpartum, over 60% reported two or more physical problems, and between 20 and 80% of puerperal women had breastfeeding problems [8]. According to the World Health Organization (WHO) [9], infections are among the leading causes of newborn deaths, and it is common for newborns to suffer from health problems, e.g., jaundice, which is the most common reason for readmission during the early postpartum period [10]. While maternal and infant health has substantially improved worldwide in recent decades, postpartum-related health issues still need closer attention, especially for mothers and newborns living in low-income and middle-income countries or areas [11, 12]. Considering the epidemiological trend of increasing maternal age, the postpartum period has become more biopsychosocially complex and risky [13]. Promoting overall health and wellbeing for all mothers and infants during the postpartum period, which used to be ignored in many counties, is a rising trend and has been an universal goal included in new national and global health initiatives, strategies, guidelines and recommendations [13-18]. More informed research and evidence-based practices that can prevent postpartum complications and improve puerperal maternal-infant health are needed. Studies have suggested that birth outcomes and postpartum health could be significantly influenced by maternal health literacy (MHL) [19-22]. MHL, a concept derived from health literacy and proposed by Renkert and Nutbeam, refers to "the cognitive and social skills which determine the motivation and ability of women to gain access to, understand, and use information in ways that promote and maintain their health and that of their children" [23]. Women without an adequate level of MHL are more likely to have problems in perceiving the risks of pregnancy and childbirth, have challenges in interpreting and applying key information provided by health care providers, and be less capable in making reproduction-related decisions [24]. This may lead to negative health behaviours or unhealthy lifestyles and ultimately decrease the mother's and child's health statuses. For women during pregnancy and childbirth, especially for the first-time mothers in this life-changing stage, challenges in the acquisition and application of new knowledge and skills for caring for themselves and their child could be demanding and make women stressful [21]. According to the known current studies [25-29], low levels of MHL are quite common among women, and approximately 25-55% of pregnant women have limited health literacy. Mothers with lower incomes, limited resources, low education levels and/or an ethnic minority status usually have lower levels of health literacy [30]. A growing number of studies have shown that limited maternal health literacy (LMHL) is associated with adverse birth outcomes and postpartum health problems, leading to an elevated rate of caesarean section [31], an increased risk of premature birth [32], a higher rate of low birth weight [32], additional risks of postpartum depression [33], a higher risk of maternal overweight [21] and decreased likelihood of breastfeeding [9]. It has also been suggested that LMHL could decrease the likelihood that women have their children immunized [34]. A broad consensus among researchers and practitioners is that better health outcomes for both mothers and children can be achieved by improving MHL [19, 35, 36]. Thus, for improving postpartum maternal and infant health, it is important to provide effective MHL-enhancing support to women, especially to women with LMHL. It has been widely acknowledged that improvement in health literacy is achievable with appropriate communication strategies, techniques or practices, among which the teach-back method has been considered the most recommendable for its simplicity, harmlessness and effectiveness across different medical settings and populations [37-39]. In health care, the teach-back method is used as a process whereby the health care provider (e.g., nurses and doctors) explains the medical situation, presents relevant information and/or provides advice in a simple and understandable way to the patient, who is then asked to use his or her own words to restate what the health care provider has just told them in a shame-free environment. The health care provider then assesses the patient's understanding of the subject, identifies misunderstandings, corrects the mistakes, and provides additional information if required; this process continues until the patient can correctly repeat what he or she has just learned and the health care provider confirms the patient's understanding [38-44]. Studies have found that patient comprehension and recalling of health-related information is limited, as only less than half of the information provided by professionals could be accurately recalled by patients [38, 39, 45, 46]. Patient understanding and memorization of health knowledge and information could be enhanced through these continuous feedback processes. This health literacy-based communication approach has been considered useful in helping patients to better understand their own medical conditions and health information and improving their own abilities to recall and apply medical knowledge in self-care [47, 48]. Studies have shown that the teach-back method is not only effective in improving literacy-related outcomes (e.g., knowledge acquisition, recall and retention) but also helpful in improving patients' health behaviours (e.g., disease management and self-care behaviours) and health-related outcomes (e.g., hospital readmissions, quality of life and patient satisfaction) [38, 39]. While there has been extensive research on the teach-back method and its use in different clinical areas, with the majority of studies focusing on chronic diseases [38, 39, 49], a limited number of studies have investigated the effects of using the teach-back method in the area of pregnancy and childbirth. Previous studies have focused on certain issues, such as immunization [50], breastfeeding [51], communication [41], and the experience of using the teach-back method [52, 53]. To date, the observation of using teach-back methods for postpartum health is still lacking, and especially, the evidence on the impact of the teach-back method on postpartum health outcomes among women with LMHL is largely missing. Among the known studies, only one with the study context in Iran showed that the teach-back method improved postpartum quality of life [42]. The lack of empirical evidence may hinder the effective use of teach-back based tools and practices for postpartum health. Thus, a context-based investigation on the impacts of using the teach-back method on postpartum health is necessary. Answer the following questions based on the article above; A brief description of the author's core thesis. o Identify, critique, and critically analyze two (2) strengths of the article in relation to its application as an evidence-based communication strategy between the nurse and patient/family.. Do not describe any research methodology and/or summarize the author's strengths from the article. o Identify, critique, and critically analyze two (2) limitations of the article in relation to its application as an evidence-based communication strategy between the nurse and patient/family. Do not describe any research methodology and/or summarize the author's limitations from the article. o Identify and discuss the relevance of this article for your nursing practice with respect to the application of the evidence-based communication strategy between the nurse and patient/family. o Identify and explain one (1) key conclusion from the author's perspective on the impact/significance of the evidence-based communication strategy between the nurse and patient/family

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