Effective TB Interviewing for Contact Investigation: Self-Study Modules
Patient Education During the TB Interview
When two individuals communicate, there is a sharing of ideas, beliefs, values, goals, sincerity, and level of trust. These characteristics can be conveyed verbally, nonverbally, or both. All verbal and nonverbal cues provide vital information between the interacting individuals. For the purposes of TB interviewing, understanding and utilizing communication skills will assist in establishing trust and rapport with the patient. Both the interviewer’s and the patient’s styles of communication can set the groundwork for the success of the interview process.
Table 1 summarizes communication skills described in this module. The left side of the table lists each communication skill. The right side of the table shows the purpose of each skill in the context of health education about TB.
Table 1. Summary of Effective Communication Skills
Understand the patient’s history
Understand the patient’s current knowledge about TB
Identify and help solve any problems the patient may be facing
Motivate the patient by emphasizing his or her important role in the interview process
Emphasize that a healthcare worker is a partner in working through the contact investigation process with the patient
Ensure that the patient understands and remembers the TB education and contact investigation information
Obtain relevant contact investigation information
The communication skills highlighted in Table 1 are discussed in further detail in this module.
Make interactions with the patient a positive experience.
How the interviewer expresses himself or herself is as important as the content of the messages. The interviewer should make the patient interaction a positive experience by providing encouragement and support. By demonstrating a caring and respectful attitude, the patient may be more likely to provide the necessary information and not hesitate to ask questions. A caring attitude is demonstrated through the interviewer’s actions, words, body language, tone of voice, and eye contact.
When an interviewer interacts with a patient, the interviewer should address the patient by name and respect the patient’s time by attending to the patient as soon as possible. The interviewer should not appear judgmental about the patient’s lifestyle, beliefs, and behaviors. Such judgments might be conveyed through nonverbal body language. Judgment-laden communication can negatively impact the interviewer’s relationship with the patient and possibly compromise interview goals. The interviewer should also acknowledge the patient’s competing issues and priorities by demonstrating empathy.
The TB interview process involves asking questions about whom a patient has spent time with and where this time was spent. It also is based on the fact that the patient may have spread TB infection to others. In order to motivate a patient’s participation in the interview process, the interviewer should acknowledge and thank the patient for providing information despite its personal nature and the fact that the patient may be quite ill.
Use the appropriate verbal and written language.
Using words that are familiar to patients can make information relevant and understandable. Prior to imparting any education, the interviewer should be aware of the patient’s level of TB knowledge. Some patients may readily ask questions, which may provide some indication of the patient TB knowledge. Others may require probes from the interviewer such as
- “Tell me what you know about TB.”
- “What did they tell you in the hospital about this interview?”
- “What do you know about how TB is spread?”
Evaluation of the patient’s knowledge and understanding is a continual process, since the patient may not understand all aspects of the information exchanged throughout the interview. It is the interviewer’s responsibility to look for verbal and nonverbal patient cues to see how well the information being shared is processed or if the patient is hesitating to ask questions. The interviewer should look for any signs in the patient’s body language that may suggest confusion (see Table 2).
The language used to deliver information is very important. Medical jargon should be avoided in most cases, but if it is used, it must be followed by an explanation. Simple, nonmedical terms should be used in explanations to the patient. For example, when explaining TB transmission, it is much more helpful to say, “The TB germs are spread through the air,” than “TB bacilli are transmitted via an airborne route.” The interviewer should also be aware that TB may be referred to by different terms such as “consumption” or “weak lungs.”
Printed materials can also be helpful in providing patient education. The language used in education materials should match the patient’s level of comprehension and be culturally appropriate. Effective educational materials generally assume no more than a sixth-grade reading level. For patients below that level, the interviewer should review materials verbally with the patient (See Resource List for information on patient education materials). Information about the patient’s level of understanding should be included in the patient’s interview notes for follow-up.
Limit the amount of information given at any one time.
A patient may not be able to remember the important components of the interview if too much information is given at one time or if they are not prepared to receive detailed information. The patient may be overwhelmed and experiencing fear over the diagnosis of TB disease. In addition, illness may make it difficult for the patient to fully participate. The interviewer should be aware of the limits of the patient’s ability to pay attention and to absorb relevant information. The duration and intensity of the interview should be adjusted accordingly.
Provide an overview of the interview at the beginning and upon conclusion.
People remember information presented at the beginning and at the end of a session more easily than the information presented in the middle. The interviewer should inform the patient about the purpose of the interview, with an emphasis on confidentiality, and the importance of contact identification at the beginning of the interview. Important information should be summarized at the end of the interview.
Repeat important information.
Some people need to hear new information several times before they remember it. Key messages should be reviewed throughout the interviews. These messages should include the purpose of the TB interview and the fact that the collected information will be used to locate contacts for evaluation and, perhaps, treatment.
Encourage the patient to ask questions.
Patients should feel comfortable asking questions about information they do not understand. After giving instructions or an explanation, healthcare workers can pause and ask, “I know we are discussing a lot of information at once. What questions do you have?”
Patients may be timid and concerned about appearing uneducated or they may be nervous or not feeling well and simply want to complete the interview quickly. It may take courage for them to ask questions. Patients should be praised for asking questions. For example, an interviewer can say:
- “I’m glad you asked that question.”
- “Good question.”
All questions should be answered thoughtfully and carefully. Interviewers should also be aware of what questions can be answered within the scope of their job responsibilities and knowledge. If an interviewer does not know the answer to a question, it is acceptable for him or her to say, “I don’t know the answer to that…” or “That isn’t an area that I have experience with, but I will be glad to find out the answer and get back to you.”