Tuberculosis (TB)

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Effective TB Interviewing for Contact Investigation: Self-Study Modules

Patient Education During the TB Interview

Verbal and Nonverbal Communication

How something is said conveys meaning in addition to what is actually said. Characteristics of how something is said can convey many meanings particularly when viewed in conjunction with nonverbal cues. Nonverbal communication, or “body language,” can provide more additional meaning than speech alone.

The key to effective communication is to be aware of verbal and nonverbal cues. The interviewer should be observant of how the patient portrays these cues. In turn, the interviewer should display the appropriate body language indicated in Tables 2 and 3 while speaking to or listening to the patient.

Table 2. Building Rapport through Nonverbal Communication

Communication Through Body Language
Builds Rapport		Does Not Build Rapport
Eye Contact
Meeting the patient’s eye without aggressively forcing eye contact	Looking at other objects Looking down Looking defiantly Shifting eyes from object to object Looking away when the client looks at you or verbally responds to you
Facial Expressions
Pleasant expression Brow relaxed Sincerity	Frown Scowl Grin Pained look
Posture
Leaning slightly toward the client Sitting in a relaxed but attentive manner Facing the client Consideration of personal space	Sitting sideways or away from the client Slouching Crossing arms in front as if to protect self Taking an aggressive stance Standing over the client
Gestures
Demonstrating with hands to show sizes Nodding in recognition or agreement	Flailing arms Tapping feet Fidgeting Shrugging shoulders noting disapproval Winking Tending to other tasks during the interview
Touching
In most cultures, touching someone you have not developed a rapport with is not acceptable. However, a handshake is usually acceptable upon greeting.

Table 2. Building Rapport through Nonverbal Communication, continued

Nonverbal Behavior Using the Environment
Builds Rapport	Does Not Build Rapport
Distance
Interviewer moves in relation to movement initiated by client	Interviewer moves away from client as client moves toward interviewer Interviewer takes the initiative in establishing distance instead of client taking the initiative

Arrangement of Physcial Setting
Builds Rapport	Does Not Build Rapport
Tidy, organized Warm, soft Casual, cheerful Quiet Well lit Private	Untidy, disorganized Cold, formal Cheerless, no color Filled with distractions Dark Crowded with other patients, healthcare workers, or others

Table 3. Interviewer Verbal and Nonverbal Cues

Cue	Display
Eye contact	Consistent eye contact; eyes should not move around, as this may indicate disinterest and distraction
Posture	Natural and comfortable, not overly rigid or slouching
Voice	Natural volume and tone; if voice is loud, the patient may be intimidated and if too soft, the message may be inaudible or sound hesitant
Speech	Regular pace; excess speed can indicate a feeling of being rushed, while slow speech can sound tentative
Hand motion	Although quite common and acceptable, it should not be distracting to the patient
Interruptions	Kept to a minimum; however, they can be used to move the conversation back into a useful direction if it diverts from the topic
Arms	Not crossed during an interview; use relaxed, open posture
Silence	While uncomfortable, may be an indication of a thought process occurring; silence may reflect thinking both on the part of the interviewer and patient, particularly if there is an unexpected question or statement
Listening	Done while offering eye contact in conjunction with affirmative head nodding or reactive emotions (e.g., smile or empathy); this displays engagement in and acknowledges the value of what is being communicated

Although the cues described in Table 3 pertain to the interviewer, these cues can also pertain to the patient and indicate similar meaning to what is mentioned above. Signs of problems occurring with communication, as indicated from the patient, are included in Table 4.

Table 4. Patient’s Nonverbal Language

Nonverbal Cue	Possible Meaning
Faltering eye contact	Boredom, fatigue, disengagement
Intense eye contact	Fear, surprise, confrontation or anger
Rocking	Fear, nervousness, preoccupation
Stiff posture	Discomfort, nervousness
Elevated voice tone	Confrontation/anger
Prolonged and frequent periods of silence	Disinterest, loss of train of thought, inability to understand, fatigue
Fidgeting	Discomfort, disinterest, nervousness, possible drug use

Distress on the patient’s part needs to be addressed immediately or the interview will be unproductive. When communication becomes strained, the interviewer should ask how the patient feels and if it is permissible to continue. Acknowledging the amount of information being exchanged and its personal nature may put the patient at ease. The patient may simply not feel well and may need to take a break or continue the interview at another time. Making an appointment for the next day, if possible, may be the best intervention if an interviewer perceives distress. The interviewer should attempt to obtain as much information as possible, as there is a chance that the interviewer may not see the patient again. However, an interviewer should recognize a patient’s limits.

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