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Effective TB Interviewing for Contact Investigation: Facilitator Led Training Guide 2006

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10. Course Activities

Facilitator

Activity 5:  Active Listening Exercise

Objective

 

To practice the following skills:

  • Asking open-ended, closed-ended, and focused questions
  • Paraphrasing
  • Reflecting
  • Summarizing

 

Time Allotted

60 minutes total

 

Materials Needed

Copies of “Active Listening Exercise” on pages 46-50 (one for each participant and for the facilitators).

 

Pre-Course Tasks

  1. This exercise is best carried out with small groups.  If possible, arrange for group leaders who have experience in interviewing or teaching communication skills.  If not possible, this exercise can be done as a large group with one leader or you in that role. 
  2. Prior to the course, give the leader(s) a copy of the exercise prior to the course with which to become familiar.

 

Procedure
  1. The leader should keep a copy of the exercise (pages 46-50) from which to read during the course.  This sheet should not be given to the participants until the end of the activity.
  2. The leader should read the description of each communication technique (e.g., open-ended question, reflection, focused question).  The facilitator should read and ask each member of the group to respond to the “Leader/ Patient” statement.  The possible participant response is directly underneath the Leader/Patient statement and is underlined.
  3. Participants should take turns responding to each selection.  The participants will obviously not reiterate the answers exactly as they are written on the sheet.  The answers on the sheet are examples of several possible ways of responding.  The leader should use his or her knowledge of communication skills to assess the correctness of the participants’ responses.
  4. After the entire activity is over, hand each participant copies of the answer sheet from which the leader(s) read.

 

Tips

  • The exercise may seem unnatural, as pieces of dialogue are being used without the benefit of surrounding discussion.  Explain this to the participants ahead of time so that they feel comfortable with their role.  They should treat all interactions as if talking to an actual patient (with the exception of the first section on open-ended questions). 
  • As each section of the exercise progresses, the leader should ask other participants how they would make the same statements and if they agree with the way in which their classmates responded.  This will give rise to a discussion of different approaches to patients and what communication techniques may or may not work well.

 

 


Leader

Activity 5:  Active Listening Exercise

Group Leader’s Sheet, p. 1

This exercise should be completed orally, as it involves listening skills.  Please ask each person in the group to work on a different question.  The underlined answers given below are only suggestions.  Please use your own experience to provide feedback to the participants and initiate discussion.  Prior to beginning each section, read the definitions of each concept to refresh the participants’ memories from their reading of the material, Effective TB Interviewing for Contact Investigation: Self-Study Modules. 

Open-Ended Question

Requires more than a one-word answer

Ask each member of the group to change one of the following closed-ended questions to an open-ended question.  You, the leader, will ask the closed-ended question to be changed.

 

  1. Leader/Closed-Ended Question: Do you live with somebody?
    Open-ended: With whom do you live?  Tell me about your living situation.
     
  2. Leader/Closed-Ended Question: Do you have a telephone?
    Open-ended: What is your telephone number?
     
  3. Leader/Closed-Ended Question: Do you cough a lot?
    Open-ended: How are you feeling?  What kinds of symptoms are you having?
     
  4. Leader/Closed-Ended Question: Do you work?
    Open-ended: How do you support yourself?  What kind of work do you do?  What are your sources of income?  Tell me what kind of work you do?  What do you do for a living?
     
  5. Leader/Closed-Ended Question: Are you using drugs?
    Open-ended: What kind of drug use have you experienced?
     
  6. Leader/Closed-Ended Question: Is your name spelled J-O-H-N D-O-E?
    Open-ended: What is the correct spelling of your name?

     
  7. Leader/Closed-Ended Question: Do you have any side effects from the medicines you take?
    Open-ended: How do your medicines make you feel?  What side effects are you having from the medications?
     
  8. Leader/Closed-Ended Question: Did the doctor talk to you about TB?
    Open-ended: What did the doctor tell you about TB?  Tell me what you know about TB.

     
  9. Leader/Closed-Ended Question: Can you get to the clinic for DOT?
    Open-ended: How will you get to the clinic for your DOT?
     

Focused Question

Used if respondent makes a vague statement or one requiring more specific information.  A focused question may provide limits or boundaries (e.g., time, example) to direct an answer. This is not a closed-ended question.

Read the following exchanges below and ask each participant to respond with a focused question.

 

  1. Leader/Patient: You know, it’s really hard to say where I spend most of my time.

    Focused question: Okay, let’s take yesterday.  Was it a regular day for you?  What did you do in the morning?
     
  2. Leader/Patient: I guess I spent most of my time with some people over at the shelter and then some people I meet for a drink now and then. 

    Focused question: Whom do you mostly spend time with at the shelter?  Whom do you mostly drink with?
     
  3. Leader/Patient: My brother doesn’t really have an address.  He lives all over the place.

    Focused Question:
    Where are the places that I am most likely to find your brother?
     
  4. Leader/Patient: Taking these medications is just too much trouble.  I don’t think they will do any good anyway.

    Focused Question: at is it that makes it so difficult for you to take the medications?  Why do you think the medications won’t help?
     
  5. Leader/Patient: Well, I think only certain kinds of people get HIV and I’m not one of those people.

    Focused Question: What types of people do you think get HIV?
     
  6. Leader/Patient: For fun, I like to shoot heroin and trip around the city.

Focused Question: What is involved in tripping around the city?
 

Paraphrasing

Rewording of a response in order to verify information and display that the interviewer is actively listening. 

Read the following patient response statements and ask each participant to respond by paraphrasing.

 

  1. Leader/Patient: I don’t know anyone who has TB.  It bugs me that someone just came near me and didn’t bother to tell me they were sick.

    Paraphrase: So, you aren’t sure from whom you got TB, and you think that your TB came from someone who just came near you.
     
  2. Leader/Patient: I don’t know a whole lot about TB.  Just like I said, you can die from it.  It can make you really sick.  If you come down with it, it can be cured.  You can take medication for a year or so, and that just doesn’t sound like fun. 

    Paraphrase: All right.  So you know that TB is a serious disease that can kill you, but that it can be cured by taking medicine for a long period of time.  

     
  3. Leader/Patient: I don’t really talk about my problems with anyone.  Mostly everyone I’m around has the same problems and I’m not sure they want to hear mine when they have the same ones, like housing and feeling sick all the time. 

    Paraphrase: You don’t talk to anyone around you about your problems because they have enough of their own.  

     
  4. Leader/Patient: I don’t know how I’m going to tell my wife that I have TB.  She worries about other things like the kids and her mom.  This will be a big blow to her.

    Paraphrase:  You’re concerned about telling your wife that you have TB because she has so much on her mind.

     
  5. Leader/Patient: I can’t really tell you the names of all of my contacts.  Honestly, I don’t even know who some of them are.  We just hang out at the pool hall.  I know their names…let’s see, there’s John, Al, Frank…

    Paraphrase: So you don’t know the full names of many of your contacts. 

     

Reflection

Rewords a respondent’s emotional reactions through acknowledging the displayed feeling and its cause.

Read the following statements below to each participant and ask them to follow each with a reflection. 

 

  1. Leader/Patient: The doctor told me so many things and I just didn’t understand everything she said.  It’s all too confusing.

    Reflection:  It sounds like you feel overwhelmed by all of the information you have been receiving.

     
  2. Leader/Patient: I can’t let people know I have TB, especially my boyfriend.  He’d be really mad at me. 

    Reflection: You seem to be feeling anxious over people finding out about your illness.

     
  3. Leader/Patient: You mean once I leave the hospital someone’s going to watch me take my medications?  I’m a pretty busy person with a lot of friends.  How will this person give me the medications without all of those people knowing my business?

    Reflection: You seem to have some concerns about keeping your privacy while on DOT. 
     
  4. Leader/Patient: I’m feeling really tired and this whole interview is making me nervous.  It doesn’t help to have you asking me all of these personal questions.

    Reflection: I know that this interviewing process can be overwhelming under the circumstances. 
     
  5. Leader/Patient: Some guy is going to come to my house and watch me take my medications and now you’re going to come back to my house and interview me and talk to me again?  Why?  Don’t you people trust me?

    Reflection:  It sounds as though you are uncomfortable with the health department’s continuing involvement with your health.

     
  6. Leader/Patient: I can’t remember all of the people that I was in contact with in the past 3 months.  What if I infected a whole bunch of people and they get really sick?  I couldn’t live with myself then.

    Reflection: So, you’re feeling bad about possibly infecting your contacts.

     

Summarizing

Rephrasing a series of statements that may have occurred throughout a dialogue in order to verify information and display that the interviewer is actively listening.

Read the following interactions to each participant and ask them to summarize.

 

  1. Leader/Patient: I don’t know a lot about TB, but I do know that if you get it, there are places you can go where they will check you out.  If you got it, they will treat you and give you the right medications and you will be cured, I don’t know how it starts though.

    Summary: Okay, so you don’t know how TB starts, but you know that it can be cured with medications.

     
  2. Leader/Patient: So, let me get this straight.  If I tell you whom I’ve been around, you’ll go and tell them that they’ve been exposed to someone with TB but you won’t tell them my name.  I think they’ll figure it out, but I guess you know what you’re doing.

    Summary: You understand that I will keep your identity confidential, but that your contacts may figure out that it is you anyway.

     
  3. Leader/Patient: My workplace is pretty big with a lot of people crowded into a big room separated by cubicle walls.  You asked about windows…we have windows but they’re sealed shut.  The temperature is way too hot all the time.  At least I get to sit near a window and see the trees outside.

    Summary: So you work in a big, crowded area without much ventilation.

     
  4. Leader/Patient: I don’t really have a set routine.  Sometimes I sleep late or take my little sister out to the park. I lost my job a while ago, so I’ve been hanging out at home without much cash to do much of anything.  I don’t ask anyone to come over since my parents will get mad and ask me to get a job. 

    Summary: So you don’t go out much or hang out with many people besides your family and don’t have a job at this time.

 
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