Table 1.

Description of barriers, enablers and intervention components for implementing Teach-Back with reference to the Theoretical Domains Framework

Using a theoretical framework, which barriers and enablers need to be addressed?	Within which theoretical domains do the barriers and enablers operate? (Domain numbering from [45])	Intervention components targeted at overcoming the modifiable barriers and enhancing the enablers
Barriers
Lack of knowledge of how to use the Teach-Back method in this workplace setting	1. Knowledge 2. Skills 9. Goals 12. Social influences 14. Behavioural regulation	Technique: information provision, model/demonstrate the behaviour; rehearsal; encourage problem-solving Mode: Slides and workshop discussion; short (< 90 s) training video (× 2) Content: text and video examples of Teach-Back in practice including familiar scenario in this workplace. Role-play practice with Teach-Back. Facing away from each other to simulate telephone environment, swapping roles between caller/nurse, and changing partners.
Time constraints. Concerns about managing calls within time guidelines (i.e. 10 min)	6. Beliefs about consequences 11. Environmental context and resources	Technique: environmental modification, barrier identification, Mode: relaxing guidelines for maximum call duration for duration of study; workshop discussions Content: Call centre management advised temporary changes to call duration guidelines; workshop facilitators informed nurses of a previous study [36] that found Teach-Back often reduced consultation time (and why)
Difficulty phrasing. Nurse beliefs and attitudes about own communication effectiveness and asking for Teach-Back	2. Skills 3. Social/Professional role and identity 4. Beliefs about capabilities 6. Beliefs about consequences 7. Reinforcement	Technique: information provision, barrier identification Mode: facilitated workshop, guided discussion including discussing barriers to asking Teach-Back; offering a wide range of phrases to try Content: Acknowledging it can be difficult to ask for Teach-Back. Discussing that consumers typically do not mind or do not notice.
Volume and complexity of information discussed, caller needs (incl. Parents’ divided attention)	2. Skills 4. Beliefs about capabilities 6. Beliefs about consequences	Technique: information provision, encourage problem-solving Mode: illustrating situations where Teach-Back can be helpful; introducing “chunk and check” to break down complex information Content: video of distracted caller
Enablers
Self-reflection	10. Memory, attention, and decision processes 11. Environmental context and resources 14. Behavioural regulation	Technique: encouraging self-reflection after each call Mode: online self-reflection surveys, email reminders to complete surveys; Teach-Back phrases on paper and in surveys Content: reflecting on efficacy of explanation and caller understanding (Additional file 1)
Supportive work environment	3. Social/Professional role and identity 4. Beliefs about capabilities 6. Beliefs about consequences 7. Reinforcement	Technique: linking rewards to the activities; encouraging nurses to experiment with different techniques; permission to fail Mode: self-reflection exercise linked to professional development rewards and professional identity as nurses; management support Content: performance is self-assessed with a focus on learning; call duration guidelines relaxed (see above)