The Effect of the 5T Teach-Back Method on Respiratory Exercise and Incentive Spirometer Training (TEACH-BREATHE)

The Effect of the 5T Teach-Back Method in Respiratory Exercise and Incentive Spirometer Training on Knowledge Level, Practical Skills, Respiratory Parameters, and Patient Satisfaction: A Randomized Controlled Study

Breathing problems after surgery are common and can lead to serious complications such as low oxygen levels, lung collapse, or pulmonary embolism. These problems increase patient risk and place an additional burden on the healthcare system. Breathing exercises and incentive spirometer use are important methods to prevent these complications. However, many patients have difficulty understanding and correctly performing these exercises when education is limited to standard verbal instructions. This randomized controlled study aims to evaluate whether the 5T Teach-Back education method improves patients' understanding, practical skills, respiratory outcomes, and satisfaction compared with standard verbal education. The study will be conducted in a university hospital and will include 76 adult patients undergoing abdominal surgery under general anesthesia. Participants will be randomly assigned to either an intervention group or a control group.

Patients in the intervention group will receive preoperative breathing exercise and incentive spirometer training using the 5T Teach-Back method, which encourages patients to explain the information back in their own words and repeat the skills until they are correctly understood. Patients in the control group will receive routine verbal education provided by clinical nurses. Outcomes will be measured before surgery and again within 24-72 hours after surgery. These outcomes include patients' knowledge level, correct performance of breathing exercises and spirometer use, respiratory rate, oxygen saturation, lung function test results, and patient satisfaction with nursing care. The results of this study are expected to show whether the 5T Teach-Back method is more effective than standard education in improving postoperative respiratory care and patient satisfaction. The findings may help standardize patient education practices and support nurses in delivering more effective respiratory training before surgery.

Study Overview

• Status: Not yet recruiting
• Conditions: Patient Education; Atelectasis; Postoperative Pulmonary Complications; Incentive Spirometry; Respiratory Exercises
• Intervention / Treatment: Behavioral: 5T Teach-Back-Based Respiratory Exercise and Incentive Spirometer Education; Behavioral: Standard Verbal Respiratory Education

• Study Type: Interventional
• Enrollment (Estimated): 76
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Cigdem Erdem, Assistant Professor; Phone Number: +095075011397; Email: cgdmctn07@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Adults aged 18 years or older
• Scheduled for abdominal surgery under general anesthesia
• Postoperative use of respiratory exercises and incentive spirometry is recommended
• Expected postoperative hospital stay of more than 3 days
• Able to read and write and able to communicate effectively
• Conscious, cooperative, and oriented
• Willing to participate voluntarily and able to provide written informed consent

Exclusion Criteria:

• Severe neurological or cognitive impairment
• Unstable vital signs or hemodynamic instability
• Anticipated or required postoperative intensive care unit admission
• Severe pain that prevents participation in education or assessments
• Visual or communication impairments that limit participation in education

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: 5T Teach-Back Education Group; Participants receive preoperative respiratory exercise and incentive spirometer training using the 5T Teach-Back method.	Behavioral: 5T Teach-Back-Based Respiratory Exercise and Incentive Spirometer Education; This intervention involves preoperative respiratory exercise and incentive spirometer education delivered using the structured 5T Teach-Back method. Education is provided individually by a trained nurse and includes demonstration, patient return demonstration, and repeated instruction until correct understanding and performance are achieved. The five steps of the 5T Teach-Back approach (Triage, Tools, Take Responsibility, Tell Me, and Try Again) are systematically applied to ensure patient comprehension and skill mastery. Sessions last approximately 20-30 minutes and are completed before surgery. Unlike routine verbal education, this intervention actively engages patients in explaining and performing the exercises in their own words, allowing immediate correction of misunderstandings and reinforcing correct technique
Active Comparator: Standard Education Group; Participants receive routine verbal education on respiratory exercises and incentive spirometer use provided by clinical nurses.	Behavioral: Standard Verbal Respiratory Education; This intervention consists of routine verbal education on respiratory exercises and incentive spirometer use provided by clinical nurses as part of standard preoperative care. Education is delivered according to usual clinical practice without a structured teaching framework, return demonstration, or formal assessment of patient understanding. No standardized duration, repetition, or feedback process is applied. This intervention reflects typical routine care and differs from structured educational approaches by relying solely on conventional verbal instruction.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient Knowledge and Correct Performance of Respiratory Exercises and Incentive Spirometer Use	Patient knowledge and correct performance of respiratory exercises and incentive spirometer use will be assessed using a structured knowledge test and observation-based checklists. Knowledge level will be evaluated with a short multiple-item test, and performance accuracy will be assessed by direct observation of breathing exercises and incentive spirometer use. Higher scores indicate better understanding and correct application of the techniques.	From baseline (preoperative period) to 24-72 hours postoperatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pulmonary Function Test	Pulmonary function will be assessed postoperatively using spirometry. The primary parameter will be the FEV1/FVC ratio (%), where higher values indicate better pulmonary function.	24-72 hours postoperatively
Patient Satisfaction	Patient satisfaction will be assessed using the Newcastle Satisfaction with Nursing Scales (NSNS). The NSNS was originally developed by Thomas et al. (1996) to evaluate patients' experiences and satisfaction with nursing care and was adapted and validated in Turkish by Akın and Erdoğan (2007). The scale consists of 19 items rated on a 5-point Likert scale. Item scores are summed and transformed to yield a total satisfaction score ranging from 0 to 100. Higher scores indicate greater satisfaction with nursing care, with a score of 100 representing the highest possible level of satisfaction.	24-72 hours postoperatively
Respiratory Parameter (SpO₂)	Peripheral oxygen saturation (SpO₂, %) will be measured pulse oximetry. Changes between baseline (preoperative) and postoperative assessment will be compared between study group	From baseline (preoperative period) to 24-72 hours postoperatively
Respiratory Rate	Respiratory rate (breaths/min) will be measured using routine clinical assessment. Changes between baseline (preoperative period) and postoperative assessment will be compared between study groups.	From baseline (preoperative period) to 24-72 hours postoperatively

Collaborators and Investigators

• Sponsor: Suleyman Demirel University

Publications and helpful links

General Publications

• Wang J, Hu H, Sun J, Zhang Q, Chen Z, Wang Q, Zhu M, Yao J, Yuan H, Zhang X. The effectiveness of health education based on the 5Ts for teach-back on oral nutritional supplements compliance of post-discharge patients after surgery for gastric cancer: a randomized controlled trial. Support Care Cancer. 2023 Feb 11;31(3):157. doi: 10.1007/s00520-023-07581-1.
• Anderson KM, Leister S, De Rego R. The 5Ts for Teach Back: An Operational Definition for Teach-Back Training. Health Lit Res Pract. 2020 Apr 9;4(2):e94-e103. doi: 10.3928/24748307-20200318-01.

Study record dates

Study Major Dates

• Study Start (Estimated): January 15, 2026
• Primary Completion (Estimated): January 15, 2027
• Study Completion (Estimated): January 15, 2027

Study Registration Dates

• First Submitted: December 28, 2025
• First Submitted That Met QC Criteria: January 10, 2026
• First Posted (Actual): January 20, 2026

Study Record Updates

• Last Update Posted (Actual): January 20, 2026
• Last Update Submitted That Met QC Criteria: January 10, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Lung Diseases; Pulmonary Atelectasis
• Other Study ID Numbers: 973-973-11

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No