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Self-Study Modules for Effective TB Interviewing

Patient Education During the TB Interview

Verbal and Nonverbal Communication

How something is said conveys meaning in addition to what is actually said.† Characteristics of how something is said can convey many meanings particularly when viewed in conjunction with nonverbal cues.† Nonverbal communication, or ďbody language,Ē can provide more additional meaning than speech alone.†

The key to effective communication is to be aware of verbal and nonverbal cues.† The interviewer should be observant of how the patient portrays these cues.† In turn, the interviewer should display the appropriate body language indicated in Tables 2 and 3 while speaking to or listening to the patient.

Table 2.† Building Rapport through Nonverbal Communication

Communication Through Body Language

Builds Rapport

Does Not Build Rapport

Eye Contact

  • Meeting the patientís eye without aggressively forcing eye contact
  • Looking at other objects
  • Looking down
  • Looking defiantly
  • Shifting eyes from object to object
  • Looking away when the client looks at you or verbally responds to you

Facial Expressions

  • Pleasant expression
  • Brow relaxed
  • Sincerity
  • Frown
  • Scowl
  • Grin
  • Pained look


  • Leaning slightly toward the client
  • Sitting in a relaxed but attentive manner
  • Facing the client
  • Consideration of personal space
  • Sitting sideways or away from the client
  • Slouching
  • Crossing arms in front as if to protect self
  • Taking an aggressive stance
  • Standing over the client


  • Demonstrating with hands to show sizes
  • Nodding in recognition or agreement
  • Flailing arms
  • Tapping feet
  • Fidgeting
  • Shrugging shoulders noting disapproval
  • Winking
  • Tending to other tasks during the interview


  • In most cultures, touching someone you have not developed a rapport with is not acceptable.† However, a handshake is usually acceptable upon greeting.

Table 2. Building Rapport through Nonverbal Communication, continued

Nonverbal Behavior Using the Environment
Builds Rapport Does Not Build Rapport
  • Interviewer moves in relation to movement initiated by client
  • Interviewer moves away from client as client moves toward interviewer

  • Interviewer takes the initiative in establishing distance instead of client taking the initiative

Arrangement of Physcial Setting
Builds Rapport Does Not Build Rapport
  • Tidy, organized
  • Warm, soft
  • Casual, cheerful
  • Quiet
  • Well lit
  • Private
  • Untidy, disorganized
  • Cold, formal
  • Cheerless, no color
  • Filled with distractions
  • Dark
  • Crowded with other patients, healthcare workers, or others

Table 3.† Interviewer Verbal and Nonverbal Cues



Eye contact

Consistent eye contact; eyes should not move around, as this may indicate disinterest and distraction


Natural and comfortable, not overly rigid or slouching


Natural volume and tone; if voice is loud, the patient may be intimidated and if too soft, the message may be inaudible or sound hesitant


Regular pace; excess speed can indicate a feeling of being rushed, while slow speech can sound tentative

Hand motion

Although quite common and acceptable, it should not be distracting to the patient


Kept to a minimum; however, they can be used to move the conversation back into a useful direction if it diverts from the topic


Not crossed during an interview; use relaxed, open posture


While uncomfortable, may be an indication of a thought process occurring; silence may reflect thinking both on the part of the interviewer and patient, particularly if there is an unexpected question or statement


Done while offering eye contact in conjunction with affirmative head nodding or reactive emotions (e.g., smile or empathy); this displays engagement in and acknowledges the value of what is being communicated

Although the cues described in Table 3 pertain to the interviewer, these cues can also pertain to the patient and indicate similar meaning to what is mentioned above.† Signs of problems occurring with communication, as indicated from the patient, are included in Table 4.

Table 4.† Patientís Nonverbal Language

Nonverbal Cue

Possible Meaning

Faltering eye contact

Boredom, fatigue, disengagement

Intense eye contact

Fear, surprise, confrontation or anger


Fear, nervousness, preoccupation

Stiff posture

Discomfort, nervousness

Elevated voice tone


Prolonged and frequent periods of silence

Disinterest, loss of train of thought, inability to understand, fatigue


Discomfort, disinterest, nervousness, possible drug use

Distress on the patientís part needs to be addressed immediately or the interview will be unproductive.† When communication becomes strained, the interviewer should ask how the patient feels and if it is permissible to continue.† Acknowledging the amount of information being exchanged and its personal nature may put the patient at ease.† The patient may simply not feel well and may need to take a break or continue the interview at another time. †Making an appointment for the next day, if possible, may be the best intervention if an interviewer perceives distress.† The interviewer should attempt to obtain as much information as possible, as there is a chance that the interviewer may not see the patient again.† However, an interviewer should recognize a patientís limits.†


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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CDC/Division of Tuberculosis Elimination
Communications, Education, and Behavioral Studies Branch
1600 Clifton Rd., NE - Mailstop E-10, Atlanta, GA 30333