Self-Study Modules for Effective TB Interviewing
All TB interviews should be guided by the same principles and skills.
In all cases, the TB interviewer’s initial introduction and self-identification
is crucial. While being identified as a member of the health department,
the TB interviewer should emphasize protection of the public good
and the health of those the patient knows or has come into contact
with as the reason for initiating the TB interview. Also, reiteration
of confidentiality and provision of education, with many opportunities
for patient questions, should be ongoing.
Patient concerns may surface throughout the interview, necessitating
various approaches to address the unique nature and circumstances
of each patient.
- Patient Reluctance
A patient may hesitate to reveal information about illicit activities
or contacts. The interviewer must emphasize that the interview
is being conducted for the purpose of identifying and evaluating
priority contacts, and not to implicate or pass judgment. It
is important that the interviewer safeguard patient information
and assure the patient that this information will not be shared
with authorities or prevent the patient from receiving services.
This should be reiterated each time a patient shares concerns
or shows evidence of reluctance to provide information.
- Vague or No Contact Information
If a patient cannot give names or addresses of priority contacts,
the patient should be asked for nicknames, physical descriptions,
and descriptions of locations in which exposures have occurred.
However, descriptions can be difficult to specify. When gathering
descriptive information, the interviewer should provide reference
points for the patient to use such as: “How tall is John? Is
he about my height?” The same is true for exposure setting descriptions.
For example, “Where is the diner? What is the nearest store or
landmark? Tell me how to get there from the shelter where you
- Undocumented Immigration Status
Since the goal of the TB interview is to provide education and
identify contacts, the patient’s immigration/visa status and standing
with the law is not relevant. Interviewers should not ask about
immigration/visa status or legal standing. If the patient volunteers
this information or reveals it in an effort to determine how this
may affect the contact investigation, the interviewer should reinforce
that the health department is only concerned about preventing
transmission and medically evaluating exposed contacts.
- Other Pressing Life Concerns
A patient may display disinterest in the interview process as
evidenced by body language or frequent diversions to other topics.
The interviewer should address this to discover what concerns
the patient has and how they can be resolved, if possible, and
should make referrals according to health department policy.
A case manager or other personnel within the health department
can address overwhelming social and medical needs and other concerns.
Discussing patient concerns can assist the patient in completing
TB treatment and provide information for the TB interview process.
- Uncooperative Behavior
Some patients may not want to participate in the contact investigation
process. They may feel that questions about contacts and exposure
sites are too personal. Also, the patient may state a lack of
concern for his or her contacts. While not easy to do, it should
be explained that, in the patient’s case, someone spread TB to
him or her and that the same could happen to others if contacts
are not identified. Or, there may be contacts who have developed
active cases of TB and will spread the germs to others. The patient’s
role is very important in this regard. The patient should also
be reassured about confidentiality, as this may also be a worry
on the patient’s part. If all attempts to engage the patient
fail, another healthcare worker may attempt to conduct the interview.
Often, cues from the patient may be subtle; the interviewer should
look for verbal and nonverbal cues to assess fear, discomfort, hesitance,
and lack of understanding. Use of problem identification and problem-solving
strategies such as patient assessment, review of the interview objectives,
emphasis on confidentiality, and prompting for locating and descriptive
information should be employed as often as necessary. These are
used to educate the patient about the purposes and importance of
the TB interview as well as to inform him or her of how any collected
information will be used.
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