A nod and a smile are not understanding: Why teach-back matters in audiology

Have you ever had a patient nod along as you explain how to use their new hearing aids, only to discover at their next visit that they misunderstood your instructions?

Imagine being back at school, sitting in the principal’s office. She has just asked you to deliver a message to your teacher, but you did not quite understand what she meant. Embarrassed, you nod anyway. After all, she seemed confident and in a hurry, and you did not want to look foolish by asking again.

That moment of uncertainty, of pretending to understand when you do not, is something many of our patients experience in clinic. They see us as the experts, assume that if they did not grasp something it must be their fault, and leave feeling unsure but unwilling to ask for clarification.

Why this matters for patient outcomes

Understanding is not the same as agreement or compliance. Patients often say “yes” or nod politely to avoid embarrassment or to signal respect, not necessarily comprehension. In hearing care, where technology, settings, and daily maintenance can be complex, this misunderstanding can lead to frustration, poor device use, and lower satisfaction.

Research consistently shows that people remember only part of what is explained during medical appointments.¹ In audiology, that means a patient who nods at the fitting may later forget how to change wax filters or pair their hearing aids to a phone.

What is the teach-back technique?

The teach-back technique is a simple but powerful way to ensure patients have truly understood key information. After explaining something, the clinician invites the patient to restate it in their own words.

For example:

“Just so I can check I explained it clearly, can you show me how you would clean the hearing aid at home?”

This small shift changes the dynamic. It removes the burden of understanding from the patient and reframes comprehension as the clinician’s responsibility.

Evidence behind teach-back

A systematic review by Talevski et al. (2020) found that teach-back improves patient knowledge, self-efficacy, and adherence to care plans across healthcare settings.² It enhances recall and supports confidence in self-management, both critical for hearing aid success. When patients can demonstrate or explain what they have learned, it not only confirms understanding but also reinforces memory and confidence.

Putting teach-back into practice

Incorporating teach-back does not need to add time to appointments. It can be integrated naturally into existing workflows.

Try these small adjustments:

• After demonstrating a new feature, ask the patient to show you how they would use it.

• Avoid yes/no questions and replace them with open-ended ones like “What would you do if the hearing aid stopped working?”

• Encourage family members to observe or even participate in the explanation, since they often provide day-to-day support.

Over time, these interactions build trust and make patients feel more capable and engaged in their care.

From information to empowerment

The purpose of teach-back is not just accuracy but empowerment. It tells patients, “Your understanding matters.” When people feel capable of managing their hearing health, they are more likely to wear their devices consistently and experience better outcomes.

Person-centered care begins with empathy, and empathy begins with understanding how it feels to be uncertain. By using teach-back, we ensure that no one leaves our clinic smiling and nodding, but secretly confused.

Every meaningful change starts with a small step. The updated BSA Guiding Principles for Person-Centred Care in Adult Hearing Rehabilitation offer more ideas to help you strengthen communication, empathy, and collaboration in your clinic.
Explore the full document here.

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References

1. Kessels, R. P. C. (2003). Patients’ memory for medical information. Journal of the Royal Society of Medicine, 96(5), 219–222. https://doi.org/10.1258/jrsm.96.5.219
   
2. Talevski, J., Wong Shee, A., Rasmussen, B., Kemp, G., & Beauchamp, A. (2020). Teach-back: A systematic review of implementation and impacts. PLOS ONE, 15(4), e0231350. https://doi.org/10.1371/journal.pone.0231350