Teach-back & hepatitis B – A tool for practitioners

it is estimated that there are over two hundred and ten thousand people living in Australia right now with hepatitis B 75% of these come from refugee and migrant backgrounds and indigenous communities and many of those remain undiagnosed as we all recognize there is diversity within the affected communities this can pose some specific challenges for health professionals when working with their clients and patients each individual's level of health literacy their approach to health and illness they're managing diagnosis can vary greatly we all need to acknowledge individual differences when thinking about talking about screening testing and treating people living with hepatitis B teach-back is an effective tool to improve health literacy the other important factor is whether organizations have the capacity to meet the needs of communities that are affected in a way that promotes interagency partnerships and integrates cultural competence and health literate practice for people living with hepatitis B understanding their illness is crucial to the impact on their health and the quality of life I once had a patient who'd have been on treatment for hepatitis B for two years and when it came he came to see me it was evident that he didn't understand the basics of the disease we used the hepatitis B story to go over these details and when he finished he was so relieved because he realized he wasn't going to die of the disease teach makes really useful because it means that what I say to the patient I know they've understood and it's a way of engaging the patient in their own health teach-back is a simple but incredibly effective method of ensuring that the communication that you are having with your client or patient is actually being received by your client or patient in the way that you intend it to be I can think of an example where I used the teach-back method with the patient who had been being seen in our clinic for some months following his diagnosis with chronic hepatitis B although in the medical record it was clearly apparent that discussions regarding the transmission of the hepatitis B virus had been conducted with this patient with the assistance of an interpreter it quickly became apparent that this patient had a lot of very different ideas as to how the hepatitis B virus could be transmitted for example he was no longer allowed to eat with a family or share meals or drinks he was actually moved out of the house and into a unit at the back and it had even gone so far that he had a washing machine bought for him so that his clothes wouldn't contaminate those of the rest of the family it can be a fairly isolating experience to be diagnosed with a chronic communicable diseases like hepatitis B this is really compounded if in your own family unit you're ostracized and felt to be a source of potential infection so this clearly complicated the way that this man was dealing with hepatitis B from not only a social but a psychological perspective so using teach-back I was able to address these beliefs that had been established and to systematically remove them and basically replace what he had taken on board about the transmission of hepatitis B with actual information regarding the transmission of the hepatitis B virus but just as importantly how hepatitis B cannot be transmitted I with the assistance of the interpreter then used teach back to ensure that the messages I had given had been received in exactly the fashion that I hoped and was able to iron out any ongoing misunderstandings with the patient I also invited and he accepted to bring some of his family members in and again with the assistance of interpreter were able to address their concerns as well and again using teach back to ensure that the family members who had really applied this sort of ostracization within his family to allow them to come to an understanding that this really was not an issue and that he could be a full functioning member of the family without any concerns regarding hepatitis B transmission this led to a substantial improvement in the patient's engagement with us and also a psychological approach to his new diagnosis of hepatitis B so teach back in this situation and in many others has been a very effective way of ensuring that the messages that are I'm giving are the ones that are being received by the patient you there's some water for your time thank you so HR we've talked a lot about hepatitis B and we've talked about how most people get it at birth or as a very young child so a child one to check that I've explained everything properly to you can you please explain to me in your own words some of the ways that you can't pass hepatitis B on to others yep by sharing plates eating together holding hands and hugging and I'm going to tell my sister now that it's okay to play with their children without worry yes that's great it's perfectly safe to play with your nieces and nephews and to be affectionate with thurman to share meals so a chai I want to check again that I've explained things properly can you tell me in your own words what tests or checkups you need to have I need to have blood tests over six months to check if my Levi's okay yes that's right that's very important but we talked about some other tests as well if someone in your family asks you what tests you need to have what would you say to them okay do I need more tests you also need to have an ultrasound scan every six months so I need to test every six months yep that's right so the ultrasound scan is a type of photo and we look at that to see if there's any lumps on your liver so on or just sound deceive my liver ace okay that's it so two tests every six months perhaps to help you remember perhaps one lot in wintertime and then one lot in summertime so a child let's just have a look at this book again we had a look at this before and we talked about some of the things that you can do yourself at home to keep your liver well and healthy so I just want to check I've explained properly if someone in your family asked you what you can do yourself to keep well what sort of things would you say to them getting plenty of healthy food no alcohol and exercise mm-hmm good great

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