Self-Study Modules for Effective TB Interviewing
Barriers to Communication
During an interview, various barriers to communication may occur
that can potentially hinder the interview process if not quickly
resolved.† Some of these barriers may occur due to the patientís
actions, while some may occur in part due to the interviewer.† Barriers
can be physical or nonphysical.†
Table 7. Examples of Communication Barriers
- Desk or table between interviewer and patient
- A person wearing sunglasses
- People actively moving about the interview room
- Body language suggestive of insecurity, poor listening,
- Lack of privacy
- Uncomfortable room temperature
- Time pressure
- Judgmental attitude
- Education level
- Selective listening or failure to listen
- Lack of cultural competency
Noting that some barriers are difficult to overcome, an interviewer
can minimize the occurrence of barriers and their effects by
- Scheduling interviews at a time convenient to both the patient
and interviewer, keeping in mind health department interview completion
- Conducting interviews in quiet, private areas, whenever possible;
- Following appropriate verbal and non-verbal cues;
- Engaging in active listening;
- Utilizing an interpreter as needed;
- Using terminology the patient understands; and
- Consistently assessing the need for a proxy (a person who knows
the patient well and is able to provide interview information
when the patient is unwilling, or mentally or physically unable,
to participate in the interview; see Module 4).
Understanding the Patient
Another way to overcome barriers is for the interviewer to ensure
that he or she completely understands the information that the patient
is conveying.† It is also important for the patient to see that
the interviewer is actively listening to what is being stated and
is sincere in addressing the emotions and concerns the patient may
be having throughout the interview.† This can be accomplished through
a combination of three communication techniques: paraphrasing,
reflection, and summarizing.†
Paraphrasing is the rewording of a patientís response in
order to verify information and display that the interviewer is
Patient: †I donít know how I got TB.† I eat well and
I donít smoke.
Paraphrase: †So, you donít understand how you got
TB since you take good care of yourself.†
Patient:† I am feeling very tired these days and the
meds mess up my drug use.† I donít know if itís all worth
Paraphrase:† It sounds like you are considering not
taking your medications anymore.†
Patient:† I have not always been positive for TB.†
I think my first exposure was when I lived in shelters and
a lot of the people who lived there coughed.† That was about
3 or 4 years ago.
Paraphrase:† So you think that you got exposed to
TB about 3 or 4 years ago when you were staying in a shelter.
Reflection is the rewording of a patientís emotional reactions
by acknowledging the displayed feeling(s) and its cause.† A reflection
should be followed by the interviewerís next statement, which should
help resolve what is causing the feeling.
Examples of Reflecting Techniques
Patient:† I donít want to get the HIV test. Whatís
the use anyway, it doesnít make much difference. †I would
rather not know I have AIDS.
Reflection:† It sounds like the HIV-testing process
may be scary for youÖ
Patient:† I donít see any reason why people need to
see me take my medicines. I am not a child anymore.
Reflection:† It seems like you feel unhappy about
being on DOT...
Patient:† (makes statement with a trembling voice)
Sure, Iíll answer your questions.
Reflection:† You seem a bit nervousÖ†
Patient:† You have asked me all sorts of questions
already.† I have answered them all, but Iím not going to give
you the names of my friends.† We donít like snitches.
Reflection:† So youíre feeling like youíve been very
cooperative but feel offended by the request to reveal the
names of your friendsÖ
Patient:† Youíre telling me that I might have given
TB to the people I work with!† Theyíll be so mad at me if
they find out itís me.
Reflection:† It sounds as though you are anxious about
othersí involvement in this contact investigation...
Summarizing is the rephrasing of a series of statements
that have occurred through a dialogue in order to verify information
and display that the interviewer is actively listening.
Examples of Summarizing Techniques
Patient:† Actually, I know very little about TB. Like
I said, I thought I had the virus ícause I started feeling
weak and tired.† I lost my appetite.† I donít know much about
it, thought you could catch it overnight.† I didnít realize
that you had to be exposed for a long time.† I think I got
it from working on ships.† A lot of the workers came from
places where they have a lot of TB so I think I got it from
one of them.
Summary:† So you think that TB is a virus and that
you got it while working with people who came from places
with a lot of TB.† You also know that it takes exposure over
a long time to become infected and that tiredness and loss
of appetite are symptoms of TB.
Patient: Youíll have trouble approaching the people
I use drugs with about TB. They know we never discuss that
Ďcause itís sort of common knowledge. The only reason they
go to take an AIDS test or TB test is because someone is paying
them and a lot of them come out positive and they donít even
bother to do anything about it. Most people have other things
to worry about like money and food.
Summary: You think that the people you use drugs
with do not have to be educated about TB because they already
know about it. But if I would want to get them in for testing,
I would have to offer them money as an incentive.
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