Self-Study Modules for Effective TB Interviewing

Physical

Nonphysical

• Desk or table between interviewer and patient
• A person wearing sunglasses
• Noise
• People actively moving about the interview room
• Body language suggestive of insecurity, poor listening, or disinterest
• Lack of privacy
• Uncomfortable room temperature

• Time pressure
• Language
• Interruptions
• Judgmental attitude
• Education level
• Insecurity
• Selective listening or failure to listen
• Lack of cultural competency

Example 1

Patient:  I don’t know how I got TB.  I eat well and I don’t smoke.

Paraphrase:  So, you don’t understand how you got TB since you take good care of yourself. 

Example 2

Patient:  I am feeling very tired these days and the meds mess up my drug use.  I don’t know if it’s all worth it.

Paraphrase:  It sounds like you are considering not taking your medications anymore. 

Example 3

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.

Example 1

Patient:  I don’t want to get the HIV test. What’s the use anyway, it doesn’t make much difference.  I would rather not know I have AIDS.

Reflection:  It sounds like the HIV-testing process may be scary for you…

Example 2

Patient:  I don’t 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...

Example 3

Patient:  (makes statement with a trembling voice) Sure, I’ll answer your questions.

Reflection:  You seem a bit nervous… 

Example 4

Patient:  You have asked me all sorts of questions already.  I have answered them all, but I’m not going to give you the names of my friends.  We don’t like snitches.

Reflection:  So you’re feeling like you’ve been very cooperative but feel offended by the request to reveal the names of your friends…

Example 5

Patient:  You’re telling me that I might have given TB to the people I work with!  They’ll be so mad at me if they find out it’s me.

Reflection:  It sounds as though you are anxious about others’ involvement in this contact investigation...

Example 1

Patient:  Actually, I know very little about TB. Like I said, I thought I had the virus ’cause I started feeling weak and tired.  I lost my appetite.  I don’t know much about it, thought you could catch it overnight.  I didn’t 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.

Example 2

Patient: You’ll have trouble approaching the people I use drugs with about TB. They know we never discuss that ‘cause it’s 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 don’t 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.