Building a health education team, developing protocols and training staff
Two obstetric care specialists, eight registered nursing supervisors (RNSs) and two master’s-level research nurses comprised a health education team for this study. Obstetric care specialists were primarily responsible for guiding and monitoring the execution of the intervention. Registered supervisor nurses organized education sessions for the participating women and communicated with the women in the education sessions. Research nurses designed the study, collected the data and conducted the analysis, but to avoid critical biases in data analysis and interpretation, they did not participate in any education sessions set in the trial.Before commencing the trial, a one-day team workshop was organized. The workshop was organized with the following programmes:One research psychologist who was experienced with nurse-patient communication and one education specialist who was experienced in using the teach-back method were invited to introduce the teach-back method to the team.Two research nurses introduced the trial and its process, demonstrated the intervention, and explained the guidelines for communicating with the women in the education sessions. The materials of the education sessions for both teach-back group and control group were developed in accordance with the 55 knowledge and skill items defined in “Maternal and child health literacy - basic knowledge and skills”, a national guidebook issued by the China Ministry of Health in 2012 [The research nurses hosted a team discussion to develop work protocols used in the teach-back group and control group and agreed on the contents, timing, processes and communication methods for each education session offered to the participating women. The research psychologist and education specialist commented during the discussion.Teach-back training was organized for 8 RNSs. Laptops and paper copies of the team-agreed education materials, together with communication guidelines and protocols planned to be used during the trial, were distributed to the RNSs. The RNSs were divided into four pairs and practised teach-back education sessions and conventional education sessions in simulated scenarios. The research psychologist, education specialist and two research nurses provided supports to each pair during the training.The workshop closed after one research nurse provided a summary and expressed gratitude to all the participants.Before the trial started, each RNS was asked to complete a test that consisted of a theoretical examination and practices. The research psychologist, education specialist and two research nurses evaluated each RNS’s performance and gave comments and suggestions for improvements. In the theoretical examination, the RNSs had to answer questions regarding the theory of teach-back and its application. In the practice session, each RNS was asked to communicate with a “patient”, played by a research nurse, and organize one teach-back education session and one conventional education session. Only after passing the test, the RNSs could start to provide education sessions to the women. All RNSs passed the test.