Using Teach-Back to Understand Participant Behavioral Self-Monitoring Skills Across Health Literacy Level and Behavioral Condition

J Nutr Educ Behav. 2016 Jan;48(1):20-26.e1. doi: 10.1016/j.jneb.2015.08.012. Epub 2015 Dec 10.


Objective: To assess differences, by health literacy status and behavioral condition, in participants' abilities to self-monitor behaviors accurately and recall key behavioral messages using data from a teach-back call.

Design: Cross-sectional.

Setting: Rural, southwestern Virginia.

Participants: Adults (n = 301). The majority were female (81.1%), 31.9% had a high school education or less, 66.1% earned < $25,000/y, and 32.9% were low health literate.

Intervention: First class session of 2 community-based behavioral interventions: SIPsmartER (reduce sugar-sweetened beverage intake) or MoveMore (increase physical activity).

Main outcome measures: Reported accuracy of behavioral diary completion, proportion of behavioral messages recalled during the first round of teach-back, and rounds of teach-back.

Analysis: Descriptive statistics and generalized linear model.

Results: Low health literate participants were significantly less accurate in diary completion (P < .001), recalled fewer behavioral messages correctly (P < .001), and needed more rounds of teach-back (P < .001) than high health literate participants. Compared with SIPsmartER participants, MoveMore participants more accurately completed diaries (P = .001) but recalled a lower proportion of behavioral messages correctly (P < .001) and required more rounds of teach-back (P < .001).

Conclusions and implications: Health literacy status and behavioral target affect the ability to self-monitor and recall key concepts. Researchers should consider using teach-back early in the intervention to assess and reinforce participants' ability to self-monitor.

Keywords: beverages; health literacy; physical activity; self-report.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Beverages / statistics & numerical data
  • Female
  • Health Behavior*
  • Health Knowledge, Attitudes, Practice*
  • Health Literacy / methods*
  • Humans
  • Male
  • Middle Aged
  • Motor Activity
  • Virginia