Self-Study Modules for Effective TB Interviewing
Patient Education During the TB Interview
When two individuals communicate, there is a sharing of ideas,
beliefs, values, goals, sincerity, and level of trust. These characteristics
can be conveyed verbally, nonverbally, or both. All verbal and
nonverbal cues provide vital information between the interacting
individuals. For the purposes of TB interviewing, understanding
and utilizing communication skills will assist in establishing trust
and rapport with the patient. Both the interviewer’s and the patient’s
styles of communication can set the groundwork for the success of
the interview process.
Table 1 summarizes communication skills described in this module.
The left side of the table lists each communication skill. The
right side of the table shows the purpose of each skill in the context
of health education about TB.
Table 1. Summary of Effective Communication Skills
- Ask questions and listen
- Encourage the patient to ask questions
Understand the patient’s history
Understand the patient’s current knowledge about TB
Identify and help solve any problems the patient may be facing
- Make the interaction with the patient a positive experience
- Assess and display appropriate verbal and nonverbal language
Motivate the patient by emphasizing his or
her important role in the interview process
Emphasize that a healthcare worker is a partner in working
through the contact investigation process with the patient
- Use the appropriate language level
- Limit the amount of information
- Summarize the information being provided
- Repeat important information, as needed
- Ask additional probing questions and listen
Ensure that the patient understands
and remembers the TB education and contact investigation information
Obtain relevant contact investigation information
The communication skills highlighted in Table 1 are discussed in
further detail in this module.
Make interactions with the patient a positive experience.
How the interviewer expresses himself or herself is as important
as the content of the messages. The interviewer should make the
patient interaction a positive experience by providing encouragement
and support. By demonstrating a caring and respectful attitude,
the patient may be more likely to provide the necessary information
and not hesitate to ask questions. A caring attitude is demonstrated
through the interviewer’s actions, words, body language, tone of
voice, and eye contact.
When an interviewer interacts with a patient, the interviewer should
address the patient by name and respect the patient’s time by attending
to the patient as soon as possible. The interviewer should not
appear judgmental about the patient’s lifestyle, beliefs, and behaviors.
Such judgments might be conveyed through nonverbal body language.
Judgment-laden communication can negatively impact the interviewer’s
relationship with the patient and possibly compromise interview
goals. The interviewer should also acknowledge the patient’s competing
issues and priorities by demonstrating empathy.
The TB interview process involves asking questions about whom
a patient has spent time with and where this time was spent.
It also is based on the fact that the patient may have spread TB
infection to others. In order to motivate a patient’s participation
in the interview process, the interviewer should acknowledge and
thank the patient for providing information despite its personal
nature and the fact that the patient may be quite ill.
Use the appropriate verbal and written language.
Using words that are familiar to patients can make information
relevant and understandable. Prior to imparting any education,
the interviewer should be aware of the patient’s level of TB knowledge.
Some patients may readily ask questions, which may provide some
indication of the patient TB knowledge. Others may require probes
from the interviewer such as
- “Tell me what you know about TB.”
- “What did they tell you in the hospital about this interview?”
- “What do you know about how TB is spread?”
Evaluation of the patient’s knowledge and understanding is a continual
process, since the patient may not understand all aspects of the
information exchanged throughout the interview. It is the interviewer’s
responsibility to look for verbal and nonverbal patient cues to
see how well the information being shared is processed or if the
patient is hesitating to ask questions. The interviewer should
look for any signs in the patient’s body language that may suggest
confusion (see Table 2).
The language used to deliver information is very important. Medical
jargon should be avoided in most cases, but if it is used, it must
be followed by an explanation. Simple, nonmedical terms should
be used in explanations to the patient. For example, when explaining
TB transmission, it is much more helpful to say, “The TB germs are
spread through the air,” than “TB bacilli are transmitted via an
airborne route.” The interviewer should also be aware that TB may
be referred to by different terms such as “consumption” or “weak
Printed materials can also be helpful in providing patient education.
The language used in education materials should match the patient’s
level of comprehension and be culturally appropriate. Effective
educational materials generally assume no more than a sixth-grade
reading level. For patients below that level, the interviewer should
review materials verbally with the patient (See Resource List for
information on patient education materials). Information about
the patient’s level of understanding should be included in the patient’s
interview notes for follow-up.
Limit the amount of information given at any one time.
A patient may not be able to remember the important components of
the interview if too much information is given at one time or if
they are not prepared to receive detailed information. The patient
may be overwhelmed and experiencing fear over the diagnosis of TB
disease. In addition, illness may make it difficult for the patient
to fully participate. The interviewer should be aware of the limits
of the patient’s ability to pay attention and to absorb relevant
information. The duration and intensity of the interview should
be adjusted accordingly.
Provide an overview of the interview at the beginning and upon
People remember information presented at the beginning and at
the end of a session more easily than the information presented
in the middle. The interviewer should inform the patient about
the purpose of the interview, with an emphasis on confidentiality,
and the importance of contact identification at the beginning of
the interview. Important information should be summarized at the
end of the interview.
Repeat important information.
Some people need to hear new information several times before
they remember it. Key messages should be reviewed throughout the
interviews. These messages should include the purpose of the TB
interview and the fact that the collected information will be used
to locate contacts for evaluation and, perhaps, treatment.
Encourage the patient to ask questions.
Patients should feel comfortable asking questions about information
they do not understand. After giving instructions or an explanation,
healthcare workers can pause and ask, “I know we are discussing
a lot of information at once. What questions do you have?”
Patients may be timid and concerned about appearing uneducated
or they may be nervous or not feeling well and simply want to complete
the interview quickly. It may take courage for them to ask questions.
Patients should be praised for asking questions. For example, an
interviewer can say:
- “I’m glad you asked that question.”
- “Good question.”
All questions should be answered thoughtfully and carefully. Interviewers
should also be aware of what questions can be answered within the
scope of their job responsibilities and knowledge. If an interviewer
does not know the answer to a question, it is acceptable for him
or her to say, “I don’t know the answer to that…” or “That isn’t
an area that I have experience with, but I will be glad to find
out the answer and get back to you.”