Teach-back strategy is in line with the concept of the “learning pyramid” (Masters, 2013). In the process of health education, researchers mobilize the enthusiasm of patients to learn by drawing, video, group discussion, retelling and practical exercise, so that patients can master relevant knowledge through active participation. The results of this study show that teach-back has obvious advantages over conventional health education in improving the hemodialysis related knowledge level of patients receiving MHD. The reasons are as follows: First, it has been reported that 40% ~ 80% of the medical information delivered to patients by conventional health education will be forgotten by them, and 50% of the information saved in patients' memory is wrong (Wasserzug et al., 2016). Teach-back overcomes the disadvantages of simple form and one-way transmission, and pays more attention to two-way communication with patients (Ye, Li, & Gao, 2019). Second, after receiving the knowledge, patients gave feedback, which improved their initiative to participate. Third, the researchers evaluated the patients after their feedback, and the knowledge that the patients did not master was taught again until they fully grasped it. Four, the intervention strategy of centralized learning makes patients discuss with each other, which enhances the efficiency of health education. It suggests that medical staff should translate the professional knowledge of hemodialysis into plain language when conducting health education for patients, so as to stimulate the initiative and interest of patients receiving MHD in learning.
The self-efficacy and self-management level of patients receiving MHD before intervention in this study were similar to the previous study result (X. Wang, Zhang, Yuan, Yang, & Chen, 2019), which suggests that there is still much room for improvement in self-efficacy and self-management level. After six months of teach-back intervention, the self-efficacy and self-management level of patients receiving MHD were significantly improved. It has been reported that the hemodialysis related knowledge level of patients receiving MHD was positively correlated with self-efficacy and self-management (Bao et al., 2019; Ren et al., 2019; Zhu, Mo, Yang, & Zhong, 2015). With the improvement of patients' knowledge level, their confidence and ability to manage their own symptoms are enhanced, so as to improve their self-efficacy and self-management level. The results of this study showed that after 6 months of intervention, the scores of items “1,2,6” in the self-efficacy scale in the observation group were not statistically significant compared with those in the control group. This may be related to the long disease cycle and many dialysis complications in patients receiving MHD, which are difficult to improve in the short term, such as fatigue, physical discomfort, and the impact on daily life. The results of this study showed that after 6 months of intervention, the score of “perform self-care activities” in the self-management scale in the observation group were not statistically significant compared with those in the control group. This may be related to the fact that the study intervention was limited to the education of knowledge and paid less attention to perform self-care activities. It suggests that medical staff should not only give theoretical knowledge education, but also strengthen the mastery of patients' self-care skills when carrying out health education for patients. At the same time, healthcare providers should guide patients on regular dialysis, proper exercise and nutrition to reduce their complications, and give appropriate psychological counseling to improve their confidence and ability, so as to further improve their self-efficacy and self-management level.
In this study, teach-back strategy was applied in health education of patients receiving MHD, which is scientific, effective, low-cost, and has achieved certain effects on improving their self-efficacy and self-management level. The improvement of self-efficacy and self-management level will help to improve the prognosis and quality of life of patients receiving MHD, and prolong the duration of dialysis (Kiajamali et al., 2017; Mahjubian, Bahraminejad, & Kamali, 2018). This study has several limitations. First, the data were collected from single center, which might not be representative of all patients receiving MHD. Second, the intervention time was short, and there was no long-term health education. In the future, it will be interesting to further explore the applicability and intervention effect of teach-back in health education for patients receiving MHD by increasing study samples and extending the intervention time.