Improving IBD Management: Teach-Back and Apps Support Patient Adherence

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Self-care education through teach-back and smartphone apps improved treatment adherence in patients with inflammatory bowel disease (IBD), suggesting apps can be a cost-effective alternative for patient education.

Treatment adherence encompasses taking medications, attending appointments, following up on treatments, taking tests and maintaining a healthy lifestyle. Poor adherence has been linked to decreased quality of life, increased risk of recurrence, colorectal cancer, increased economic burden and mortality. Previous research has shown nonadherence rates among patients with IBD range between 40% and 72%, which in turn can exacerbate their condition.

The teach-back method is an effective tool to improve a patient’s learning and understanding of the educational materials during an office visit and has been shown to benefit a wide range of populations, including those with chronic diseases. Smartphone applications are another method that has shown positive results for patients as well as health-care systems. These apps not only improve knowledge and skills, they are also cheap, versatile and available both online and offline at any time or in any place.

“Considering that patient education plays a key role in improving patients’ adherence to treatment, it is necessary to adopt the best educational method for them,” wrote a team of investigators led by Zahra Sadat Manzari, PhD, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. “A comparison done between the best traditional educational methods (teach-back) and new methods (app) can help health-care systems in allocating human and financial resources to develop an effective educational method.”

Investigators aimed to compare the effects of the two methods on treatment adherence in patients with IBD. Conducted using a cohort of 80 patients in Mashhad, Iran, between 2021 and 2022, self-care education was provided through either teach-back or a smartphone app, with a control group receiving routine education. The education included information on diet, medications, sleep, exercise, sexual relationships, personal relationships and social relationships. A group of controls only received routine education. Demographics and treatment adherence information were collected through a questionnaire.

In the teach-back group, subjects underwent two individual teaching sessions on two different days, with a maximum length of 60 minutes for each session. The sessions, which were held between three and five days apart, were conducted virtually via video calls and patients received a copy of the information by email.

Patients in the app group were given information on the features of the app, which was also sent via email and/or social networks. They were ordered to use the app for the next 30 days, with a check-in with investigators on a weekly basis, and could answer any questions they had about the disease within the application.

The mean age of patients was 38.73 years, 81% had ulcerative colitis and 67% were married. Treatment adherence were the same across groups at baseline.

Results demonstrated that both the teach-back and app groups had significantly higher post-test adherence scores compared to the control group (170.04, 167.99 and 159.60, respectively), but there was no significant difference between the teach-back and app groups.

As both methods were equally effective in improving adherence, investigators recommended either option for clinical staff to educate patients. However, smartphone apps offer an economical alternative for patient education.

“It seems that benefits such as distance education, interesting and multimedia content, saving manpower, the possibility of updating the educational content, availability at any time and in any place, and lower expenses make apps more prominent than teach-back,” they concluded.