Skip directly to search Skip directly to A to Z list Skip directly to navigation Skip directly to site content Skip directly to page options
CDC Home
Share
Compartir

Effective TB Interviewing for Contact Investigation: Facilitator Led Training Guide

2006

Return to Table of Contents

10. Course Activities

Facilitator

Activity 8:  Effective TB Interviewing DVD

Objectives
  • To review the basic elements of TB interviewing for contact investigation
  • To understand the skills necessary for an effective TB interview
  • To learn techniques for conducting contact investigations in a variety of settings with a variety of patients
     
Time Allotted

35 – 105 minutes

22 minutes’ viewing and 13 minutes’ discussion for each scenario
 

Materials Needed Effective TB Interviewing for Contact Investigation (available from CDC), DVD player
 
Procedure There are several different ways to use this DVD during training on effective TB interviewing.  The DVD was initially developed as a stand-alone training tool.  However, the list of questions for discussion in this activity can be used to explore the concepts raised in the DVD in more detail and discuss how they relate to local conditions.

The DVD consists of excerpts of three TB interviewing scenarios interspersed with comments by contact investigation and other TB control experts.  There is also a narrator who appears at the beginning and end of each segment to highlight the main challenges presented in the contact investigation and major teaching points from the interview. 

You can view the DVD in its entirety and then have a general discussion after it is over.  Alternatively, it may be useful to have a discussion after each section in the DVD.  This will break the viewing time into shorter segments and will ensure the scenarios are fresher in participants’ minds.  The scenarios are as follows:

  1. A clinic interview with Jerry, an HIV-infected homeless man
  2. A home reinterview with Javier, a 37-year-old Mexican-born night shift factory supervisor
  3. A home interview with Sheila, a 38-year-old stay-at-home mother in home isolation; she is a private patient in a rural area

If you have a limited amount of time, you may wish to select one or two scenarios to show and discuss, based on the demographics of the population served in your area.

  1. Briefly describe the format of the DVD and the exercise.

  2. Play the DVD.  If you are showing a selected segment, cue the DVD to that segment in advance.

  3. Start at the beginning of the DVD (or at the beginning of the segment where the narrator describes the scenario).

  4. If you are discussing each segment as it concludes, pause the tape after the interviewer reviews the follow-up plan (just after the follow-up plan bulleted list appears on screen).

  5. Use the list of attached questions to discuss each scenario or the whole DVD, if you are showing it in its entirety.

  6. If you are showing the DVD in segments, continue the tape after the group discussion is concluded and view the narrator’s summary of the scenario.

  7. Continue the tape to view the next scenario, if desired, and then pause again after the interviewer reviews the follow-up plan and the bulleted list appears on screen.

  8. Discuss the scenario using the attached list and repeat the process until the DVD ends or desired segments have been shown.
     

Tips The questions starting on page 73 can be used to guide the discussion.  You may read each question aloud to elicit responses.  Some potential answers have been listed.  Participants may have other answers that are not listed here.  Encourage participants to discuss ideas with one another and use your expertise to assess and respond to additional answers or comments.  Some questions ask for opinions from participants; these questions do not have answers listed.  Other questions ask participants to compare the scenarios in the DVD to the participants’ local situations.  Use your knowledge of the specific state and local situations and health department standards of practice to facilitate this part of the discussion.

 

 

Facilitator

Activity 8:  Effective TB Interviewing DVD: Questions for Discussion

Jerry

1. How do Jerry’s lifestyle and life circumstances affect the course of the interview?

  • Because he was hungry and frustrated, he left the clinic before the interview could start
  • He was suspicious and fearful of being asked to leave the shelter and, therefore, did not reveal information easily
  • Because of his transient lifestyle, he did not know specific information about and locating information for some of his contacts
  • His circumstances may make it difficult for him to adhere to medication, as evidenced by his comment about not taking his HIV medication.  As noted in the comments, this should have served as a “red flag” to the interviewer to discuss the importance of taking anti-TB medications

2. Pete (the outreach worker) observed the soup kitchen prior to the interview. How did this assist him in the interview?

  • He was able to assess physical space
  • He saw persons with whom Jerry spent time

3. Comment on Pete’s verbal communication skills as an interviewer.

  • Spoke slowly and clearly
  • Used appropriate terminology for the patient
  • Had a tone of sincerity in his voice

4. Comment on Pete’s body language.

  • Good eye contact
  • Open posture
  • No physical barriers between him and the patient

5. What patient education techniques did Pete use?

  • Used layperson’s terminology, e.g., “an actual hole in your lungs”
  • Emphasized that TB is curable, but gave Jerry sense of urgency regarding his treatment
  • Discussed transmission in an understandable way

6. How could Pete have formulated an infectious period?  Why was it important that he do this?

  • The infectious period could have been formulated using the time of symptom onset, as per health department standards
  • This is important as it provides the patient and interviewer some direction on the time frame from which to elicit contacts

7. Why is physical description and location information of contacts important?

  • If the patient does not know the contacts’ names, or only nicknames or aliases, the description can help to identify the patient, once located
  • Physical descriptions can help to verify the identity of contacts, even if named, once located

Questions on Opinions and Relevance to Local Situations

8. Do you agree with the way Pete pushed the patient for contacts? Why?

9. Is there anything you would have done differently in this situation?  If so, what and why?

10. How do the activities portrayed here relate to the way things occur in your locality? 

11. Is there anything else you noticed about this TB interview scenario that you would like to discuss?

Javier

1. Based on this scenario, why is the reinterview important?  Why is the interview in the home important?

  • The reinterview can help the interviewer obtain more in-depth information, especially after having developed rapport with the patient.
  • In the home, the interviewer can see evidence of others (e.g., children’s toys, family pictures) who spend time in the home.

2. What did Khalil (the outreach worker) do to address the issue of stigma?

  • Reminded Javier that since TB is airborne, anyone can get it (e.g., “people from all walks of life can get it”)
  • Indicated that though he will not tell Javier’s aunt and uncle that Javier has TB, they will be told that they are contacts of someone with TB.  He indicated that they might realize it is Javier.  Khalil offered to be present if Javier decides to tell his aunt and uncle that he has TB, so that he can help answer any questions and explain that Javier is no longer contagious

3. What is the purpose of an interpreter?

  • To communicate everything that the patient and interviewer are saying, accurately and in the first person

4. How might the interaction with the interpreter have been improved?

  • The interpreter could have been positioned correctly, next to and slightly behind the patient, in order to allow for good eye contact between Javier and Khalil.
  • Khalil could have had a presession with the interpreter during which explained his needs and expectations.  If a presession had been conducted, the interpreter could have understood that she was to only communicate the exact statements given by the interviewer and patient.  She could also have understood that it is appropriate to ask for clarification from both parties if anything is not clear.
     

5. What techniques did Khalil use to elicit information about the additional children in the home, which Javier was clearly reluctant to provide?

  • Paid close attention to the home environment (e.g., used the presence of age-inappropriate toys as cue to ask about other contacts);
  • Asked probing questions;
  • Emphasized the importance of knowing whether there were additional children who might have been exposed; and
  • Used persistence, by dropping the subject of other contacts but returning to it, until he got an answer.

Questions on Opinions and Relevance to Local Situations

6. What do you think of the manner in which Khalil dealt with Javier’s home remedy (tea)?

7. What might you have done differently in this scenario?

8. How would you address concerns about undocumented immigrants in workplace assessments in your areas?

9. Is there anything else you noticed about this TB interview scenario that you would like to discuss?

Sheila

1. Why did Marianne (the public health nurse) put on her respirator upon entering the home?  How did she address this with the patient?

  • Marianne did not know whether this infectious patient was wearing her mask at all times as instructed by her doctor.
  • Marianne did not put on the respirator until she was in the patient’s home and explained to the patient that she would be wearing the respirator.  She told the patient that she needed to wear the respirator to protect herself.

2. Sheila was a private patient in a rural area.  She could have been interviewed easily over the phone.  What would have been missed had this been done?  When is it appropriate to obtain information over the phone?

  • By conducting the interview over the phone, it would have been difficult to establish rapport with the patient.  The interviewer would also have missed the fact that the patient was not wearing her mask as instructed, and Marianne might have noticed that the patient was wearing the wrong mask (she should have been wearing a surgical mask).  Also, during a home interview, the interviewer can see the home environment to assess other possible exposure and look for signs of other contacts whom the patient may not mention.
  • There are very few circumstances in which it is appropriate to interview the patient over the phone; however, this varies based on local circumstances.  Perhaps once rapport has been established with a patient, an occasional phone call can be placed to verify information.

3. Who are the high-priority contacts?

  • Baby and family (i.e., Sheila’s son, husband, and mother)
  • Children in vanpool
  • An assessment of the adult school classroom environment should be done to determine the priority of the contacts in the room.

4. How well did Marianne handle the sensitive questions, e.g., HIV and other contacts?

  • Marianne explained to the patient ahead of time that she would be asking some questions which she asked all of her patients.
  • Marianne acknowledged that naming all contacts may not be comfortable for Sheila, but that it was important.  Marianne explained the nature of TB transmission, which helped Sheila understand why it was important to name certain contacts.

5. As a nurse, what else could Marianne have done in the home during the interview?

  • Talked about the side effects of the medications
  • Administered a skin test to other family members, if available
  • Completed a physical exam on the patient or any contacts

Questions on Opinions and Relevance to Local Situations

6. Is it common to see an infectious patient in the home in your area?  If so, what instructions should the patient be given while in the home?

7. If directly observed therapy, home visits, or both are not options, what medicating options can be given to this patient? 

8. What would you have done differently from Marianne?  Why?

9. Is there anything else you noticed about this TB interview scenario that you would like to discuss?

 
Contact Us:
  • Centers for Disease Control and Prevention
    Division of Tuberculosis Elimination (DTBE)
    1600 Clifton Rd., NE
    MS E10
    Atlanta, GA 30333
  • 800-CDC-INFO
    (800-232-4636)
    TTY: (888) 232-6348
  • Contact CDC–INFO
USA.gov: The U.S. Government's Official Web PortalDepartment of Health and Human Services
Centers for Disease Control and Prevention   1600 Clifton Rd. Atlanta, GA 30333, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDC–INFO
A-Z Index
  1. A
  2. B
  3. C
  4. D
  5. E
  6. F
  7. G
  8. H
  9. I
  10. J
  11. K
  12. L
  13. M
  14. N
  15. O
  16. P
  17. Q
  18. R
  19. S
  20. T
  21. U
  22. V
  23. W
  24. X
  25. Y
  26. Z
  27. #