Effective TB Interviewing for Contact Investigation:
Facilitator Led Training Guide
10. Course Activities
Activity 5: Active Listening Exercise
To practice the following skills:
- Asking open-ended, closed-ended, and focused questions
60 minutes total
Copies of “Active Listening Exercise”
on pages 46-50 (one for each participant and for the facilitators).
- This exercise is best carried out with small groups.
If possible, arrange for group leaders who have experience
in interviewing or teaching communication skills.
If not possible, this exercise can be done as a large group
with one leader or you in that role.
- Prior to the course, give the leader(s) a copy of the
exercise prior to the course with which to become familiar.
- The leader should keep a copy of the exercise (pages 46-50)
from which to read during the course. This sheet should
not be given to the participants until the end of the activity.
- The leader should read the description of each communication
technique (e.g., open-ended question, reflection, focused
question). The facilitator should read and ask each
member of the group to respond to the “Leader/ Patient”
statement. The possible participant response is directly
underneath the Leader/Patient statement and is underlined.
- Participants should take turns responding to each selection.
The participants will obviously not reiterate the answers
exactly as they are written on the sheet. The answers
on the sheet are examples of several possible ways of responding.
The leader should use his or her knowledge of communication
skills to assess the correctness of the participants’
- After the entire activity is over, hand each participant
copies of the answer sheet from which the leader(s) read.
- The exercise may seem unnatural, as pieces of dialogue
are being used without the benefit of surrounding discussion.
Explain this to the participants ahead of time so that they
feel comfortable with their role. They should treat
all interactions as if talking to an actual patient (with
the exception of the first section on open-ended questions).
- As each section of the exercise progresses, the leader
should ask other participants how they would make the same
statements and if they agree with the way in which their
classmates responded. This will give rise to a discussion
of different approaches to patients and what communication
techniques may or may not work well.
Activity 5: Active Listening Exercise
Sheet, p. 1
This exercise should be completed orally, as it involves listening
skills. Please ask each person in the group to work on a different
question. The underlined answers given below are only suggestions.
Please use your own experience to provide feedback to the participants
and initiate discussion. Prior to beginning each section,
read the definitions of each concept to refresh the participants’
memories from their reading of the material, Effective TB Interviewing
for Contact Investigation: Self-Study Modules.
Requires more than a one-word answer
Ask each member of the group to change one of the following
closed-ended questions to an open-ended question. You,
the leader, will ask the closed-ended question to be changed.
- Leader/Closed-Ended Question: Do you live with somebody?
Open-ended: With whom do you live? Tell me about
your living situation.
- Leader/Closed-Ended Question: Do you have a telephone?
Open-ended: What is your telephone number?
- Leader/Closed-Ended Question: Do you cough a lot?
Open-ended: How are you feeling? What kinds of
symptoms are you having?
- Leader/Closed-Ended Question: Do you work?
Open-ended: How do you support yourself? What
kind of work do you do? What are your sources of income?
Tell me what kind of work you do? What do you do for a living?
- Leader/Closed-Ended Question: Are you using drugs?
Open-ended: What kind of drug use have you experienced?
- Leader/Closed-Ended Question: Is your name spelled J-O-H-N D-O-E?
Open-ended: What is the correct spelling of your name?
- Leader/Closed-Ended Question: Do you have any side effects from
the medicines you take?
Open-ended: How do your medicines make you feel?
What side effects are you having from the medications?
- Leader/Closed-Ended Question: Did the doctor talk to you about
Open-ended: What did the doctor tell you about TB?
Tell me what you know about TB.
- Leader/Closed-Ended Question: Can you get to the clinic for
Open-ended: How will you get to the clinic for your
Used if respondent makes a vague
statement or one requiring more specific information.
A focused question may provide limits or boundaries (e.g.,
time, example) to direct an answer. This is not a closed-ended
Read the following exchanges below and ask each participant
to respond with a focused question.
- Leader/Patient: You know, it’s really hard to say where
I spend most of my time.
Focused question:Okay, let’s take yesterday. Was it
a regular day for you? What did you do in the morning?
- Leader/Patient: I guess I spent most of my time with some people
over at the shelter and then some people I meet for a drink now
Focused question: Whom do you mostly spend time with at the
shelter? Whom do you mostly drink with?
- Leader/Patient: My brother doesn’t really have an address.
He lives all over the place.
Focused Question: Where are the places that I am most likely
to find your brother?
- Leader/Patient: Taking these medications is just too much trouble.
I don’t think they will do any good anyway.
Focused Question:at is it that makes it so difficult for you to
take the medications? Why do you think the medications won’t
- Leader/Patient: Well, I think only certain kinds of people get
HIV and I’m not one of those people.
Focused Question: What types of people do you think get HIV?
- Leader/Patient: For fun, I like to shoot heroin and trip around
Focused Question: What is involved in tripping around
Rewording of a response in order to verify
information and display that the interviewer is actively listening.
Read the following patient response statements and ask each
participant to respond by paraphrasing.
- Leader/Patient: I don’t know anyone who has TB.
It bugs me that someone just came near me and didn’t bother
to tell me they were sick.
Paraphrase: So, you aren’t sure from whom you got TB,
and you think that your TB came from someone who just came near
- Leader/Patient: I don’t know a whole lot about TB.
Just like I said, you can die from it. It can make you really
sick. If you come down with it, it can be cured. You
can take medication for a year or so, and that just doesn’t
sound like fun.
Paraphrase: All right. So you know that TB is a serious
disease that can kill you, but that it can be cured by taking
medicine for a long period of time.
- Leader/Patient: I don’t really talk about my problems
with anyone. Mostly everyone I’m around has the same
problems and I’m not sure they want to hear mine when they
have the same ones, like housing and feeling sick all the time.
Paraphrase: You don’t talk to anyone around you about
your problems because they have enough of their own.
- Leader/Patient: I don’t know how I’m going to tell
my wife that I have TB. She worries about other things like
the kids and her mom. This will be a big blow to her.
Paraphrase: You’re concerned about telling your
wife that you have TB because she has so much on her mind.
- Leader/Patient: I can’t really tell you the names of all
of my contacts. Honestly, I don’t even know who some
of them are. We just hang out at the pool hall. I
know their names…let’s see, there’s John, Al,
Paraphrase: So you don’t know the full names of many
of your contacts.
Rewords a respondent’s emotional reactions
through acknowledging the displayed feeling and its cause.
Read the following statements below to each participant and
ask them to follow each with a reflection.
- Leader/Patient: The doctor told me so many things and I just
didn’t understand everything she said. It’s
all too confusing.
Reflection: It sounds like you feel overwhelmed by all
of the information you have been receiving.
- Leader/Patient: I can’t let people know I have TB, especially
my boyfriend. He’d be really mad at me.
Reflection: You seem to be feeling anxious over people finding
out about your illness.
- Leader/Patient: You mean once I leave the hospital someone’s
going to watch me take my medications? I’m a pretty
busy person with a lot of friends. How will this person
give me the medications without all of those people knowing my
Reflection: You seem to have some concerns about keeping
your privacy while on DOT.
- Leader/Patient: I’m feeling really tired and this whole
interview is making me nervous. It doesn’t help to
have you asking me all of these personal questions.
Reflection: I know that this interviewing process can
be overwhelming under the circumstances.
- Leader/Patient: Some guy is going to come to my house and watch
me take my medications and now you’re going to come back
to my house and interview me and talk to me again? Why?
Don’t you people trust me?
Reflection: It sounds as though you are uncomfortable
with the health department’s continuing involvement with
- Leader/Patient: I can’t remember all of the people that
I was in contact with in the past 3 months. What if I infected
a whole bunch of people and they get really sick? I couldn’t
live with myself then.
Reflection: So, you’re feeling bad about possibly
infecting your contacts.
Rephrasing a series of statements that may
have occurred throughout a dialogue in order to verify information
and display that the interviewer is actively listening.
Read the following interactions to each participant and ask
them to summarize.
- Leader/Patient: I don’t know a lot about TB, but I do
know that if you get it, there are places you can go where they
will check you out. If you got it, they will treat you and
give you the right medications and you will be cured, I don’t
know how it starts though.
Summary: Okay, so you don’t know how TB starts,
but you know that it can be cured with medications.
- Leader/Patient: So, let me get this straight. If I tell
you whom I’ve been around, you’ll go and tell them
that they’ve been exposed to someone with TB but you won’t
tell them my name. I think they’ll figure it out,
but I guess you know what you’re doing.
Summary: You understand that I will keep your identity
confidential, but that your contacts may figure out that it is
- Leader/Patient: My workplace is pretty big with a lot of people
crowded into a big room separated by cubicle walls. You
asked about windows…we have windows but they’re sealed
shut. The temperature is way too hot all the time.
At least I get to sit near a window and see the trees outside.
Summary: So you work in a big, crowded area without
- Leader/Patient: I don’t really have a set routine.
Sometimes I sleep late or take my little sister out to the park.
I lost my job a while ago, so I’ve been hanging out at home
without much cash to do much of anything. I don’t
ask anyone to come over since my parents will get mad and ask
me to get a job.
Summary: So you don’t go out much or hang out with many
people besides your family and don’t have a job at this
Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination - http://www.cdc.gov/tb
Please send comments/suggestions/requests
CDC/Division of Tuberculosis Elimination
Communications, Education, and Behavioral Studies Branch
1600 Clifton Rd., NE - Mailstop E-10, Atlanta, GA 30333