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Effective TB Interviewing for Contact Investigation: Self-Study Modules

Return to Module 2 Table of Contents

Barriers to Communication

During an interview, various barriers to communication may occur that can potentially hinder the interview process if not quickly resolved. Some of these barriers may occur due to the patient’s actions, while some may occur in part due to the interviewer. Barriers can be physical or nonphysical.

Table 7. Examples of Communication Barriers



  • Desk or table between interviewer and patient
  • A person wearing sunglasses
  • Noise
  • People actively moving about the interview room
  • Body language suggestive of insecurity, poor listening, or disinterest
  • Lack of privacy
  • Uncomfortable room temperature
  • Time pressure
  • Language
  • Interruptions
  • Judgmental attitude
  • Education level
  • Insecurity
  • Selective listening or failure to listen
  • Lack of cultural competency

Overcoming Barriers

Noting that some barriers are difficult to overcome, an interviewer can minimize the occurrence of barriers and their effects by

  • Scheduling interviews at a time convenient to both the patient and interviewer, keeping in mind health department interview completion deadlines;
  • Conducting interviews in quiet, private areas, whenever possible;
  • Following appropriate verbal and non-verbal cues;
  • Engaging in active listening;
  • Utilizing an interpreter as needed;
  • Using terminology the patient understands; and
  • Consistently assessing the need for a proxy (a person who knows the patient well and is able to provide interview information when the patient is unwilling, or mentally or physically unable, to participate in the interview; see Module 4).

Understanding the Patient

Another way to overcome barriers is for the interviewer to ensure that he or she completely understands the information that the patient is conveying. It is also important for the patient to see that the interviewer is actively listening to what is being stated and is sincere in addressing the emotions and concerns the patient may be having throughout the interview. This can be accomplished through a combination of three communication techniques: paraphrasing, reflection, and summarizing.

Paraphrasing is the rewording of a patient’s response in order to verify information and display that the interviewer is actively listening.

Examples of Paraphrasing Techniques

Example 1

Patient: I don’t know how I got TB. I eat well and I don’t smoke.

Paraphrase: So, you don’t understand how you got TB since you take good care of yourself.

Example 2

Patient: I am feeling very tired these days and the meds mess up my drug use. I don’t know if it’s all worth it.

Paraphrase: It sounds like you are considering not taking your medications anymore.

Example 3

Patient: I have not always been positive for TB. I think my first exposure was when I lived in shelters and a lot of the people who lived there coughed. That was about 3 or 4 years ago.

Paraphrase: So you think that you got exposed to TB about 3 or 4 years ago when you were staying in a shelter.

Reflection is the rewording of a patient’s emotional reactions by acknowledging the displayed feeling(s) and its cause. A reflection should be followed by the interviewer’s next statement, which should help resolve what is causing the feeling.

Examples of Reflecting Techniques

Example 1

Patient: I don’t want to get the HIV test. What’s the use anyway, it doesn’t make much difference. I would rather not know I have AIDS.

Reflection: It sounds like the HIV-testing process may be scary for you…

Example 2

Patient: I don’t see any reason why people need to see me take my medicines. I am not a child anymore.

Reflection: It seems like you feel unhappy about being on DOT...

Example 3

Patient: (makes statement with a trembling voice) Sure, I’ll answer your questions.

Reflection: You seem a bit nervous…

Example 4

Patient: You have asked me all sorts of questions already. I have answered them all, but I’m not going to give you the names of my friends. We don’t like snitches.

Reflection: So you’re feeling like you’ve been very cooperative but feel offended by the request to reveal the names of your friends…

Example 5

Patient: You’re telling me that I might have given TB to the people I work with! They’ll be so mad at me if they find out it’s me.

Reflection: It sounds as though you are anxious about others’ involvement in this contact investigation...

Summarizing is the rephrasing of a series of statements that have occurred through a dialogue in order to verify information and display that the interviewer is actively listening.

Examples of Summarizing Techniques

Example 1

Patient: Actually, I know very little about TB. Like I said, I thought I had the virus ’cause I started feeling weak and tired. I lost my appetite. I don’t know much about it, thought you could catch it overnight. I didn’t realize that you had to be exposed for a long time. I think I got it from working on ships. A lot of the workers came from places where they have a lot of TB so I think I got it from one of them.

Summary: So you think that TB is a virus and that you got it while working with people who came from places with a lot of TB. You also know that it takes exposure over a long time to become infected and that tiredness and loss of appetite are symptoms of TB.

Example 2

Patient: You’ll have trouble approaching the people I use drugs with about TB. They know we never discuss that ‘cause it’s sort of common knowledge. The only reason they go to take an AIDS test or TB test is because someone is paying them and a lot of them come out positive and they don’t even bother to do anything about it. Most people have other things to worry about like money and food.

Summary: You think that the people you use drugs with do not have to be educated about TB because they already know about it. But if I would want to get them in for testing, I would have to offer them money as an incentive.

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