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Effective TB Interviewing for Contact Investigation: Self-Study Modules

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Case Presentations

The following case presentations demonstrate concepts from this module. You may review them with your supervisor if you have questions.

Case 1

Part 1 – You have been asked to conduct an interview in the home of Sona, a 27-year-old woman who has been diagnosed with smear-positive suspected pulmonary TB. According to her medical record, she arrived in this country 3 months ago and has been told by her doctor to stay at home until she is noninfectious. She speaks English fluently. You go to her home, introduce yourself, and are ushered inside by a man who introduces himself as Sona’s husband. He asks you to sit down. Sona goes into the kitchen and returns with a drink for you. The husband sits down, as you are about to start your interview.

Should you proceed with the interview in this situation? If so, how?

Explanation: It is important to let both individuals know that you are there to share information with Sona. However, the acceptable way of interviewing for this patient may be for another individual to speak for her.

You should first professionally and respectfully indicate to Sona and her husband that you are from the health department to discuss an important health matter. If and when, in private, Sona agrees that it is all right to speak openly about her TB with her husband present, the three-way discussion may occur. Stressing confidentiality procedures and respectfully thanking Sona and her husband for their understanding will also exemplify your commitment to privacy.

During the interview, speak directly to Sona even if answers to your questions are coming from another person. However, if the husband is speaking to you, maintain eye contact with him. Try to schedule a re-interview at a later date with only Sona present.

Part 2 – The husband answers the questions for Sona and asks TB-related questions. He is very cooperative and lets Sona answer questions for which he is unsure of the answer. As you build rapport, Sona also begins to speak directly to you but does not maintain eye contact. She also keeps her hands in her lap and speaks softly and briefly.

How can you be sure that Sona is engaged in the discussion?

Explanation: Sona may be uncomfortable with direct eye contact or even speaking with her husband present. You should use open-ended questions for broader answers. You should also ask Sona throughout the interview if she is feeling all right, and if she has any questions. She may need to hear you state that it is acceptable to interrupt you if she has questions or remembers anything she or her husband forgot to tell you.

Part 3 –When you begin eliciting contact names, the husband explains to you that he is afraid of telling you the names of any contacts as they will be very upset. While he trusts that you will keep Sona’s identity confidential, he fears that the contacts will be very upset, since TB is a “killer” disease in his country of origin.

What can you say to address the fears of Sona and her husband?

Explanation: Reassure them that you are conducting this interview so that you can 1) help prevent the further spread of TB, 2) provide education on the status of Sona’s treatment, 3) answer any questions she may have about her disease, and 4) refer priority contacts for medical evaluation, treatment if infected, and cure if found to have disease. Let her know that you will find out the answers to any of her questions for which you do not know the answers.

Case 2

Part 1 – You are conducting an interview of Razia, a 21-year-old woman who is a TB suspect. This interview is in the patient’s apartment. She is a recent immigrant to the United States, but speaks fluent English. You note from her medical record that she is a homemaker and lives with her husband. He is at work during the interview. The record states that Razia has only listed her husband as an emergency contact and has no children. As you walk to her home, you notice that she lives on the third floor of a multifamily house. There are two other apartments, and you hear people inside.

As you proceed with the interview, Razia appears to understand the purpose of the interview and the information you are providing about her diagnosis and treatment. When you begin to elicit contacts, Razia states no one else lives in her home, a small 3-room apartment. However, when she gives this information is given to you, Razia’s eye contact begins to waiver and her voice tone is quieter. Upon questioning whether she has visitors or employment within her home, she insists that no one else besides her husband is in her home.

Since it is obvious that Razia is not confidently providing this information, how should you proceed?

Explanation: Since you must elicit all contacts, ask your questions in other ways such as “Whom do you spend time with regularly?” Razia’s priority contacts may not all be in her home. You can also touch upon her interactions with the other apartment dwellers by asking, “How much time do you spend with your neighbors?” These are just the preliminary questions you should ask before looking into other spheres of her life such as work, school, and social activities.

Part 2 – When you ask Razia a general question about whom she spends a lot of time with, she still insists that she spends time at home all day until her husband arrives. When you ask about other contacts, she mentions some other friends whom she rarely saw during the infectious period. A few minutes later, an elderly woman walks into the apartment without knocking. The woman speaks to Razia in her native language and is carrying food that she leaves on a table. Razia says something to the woman, who then leaves.

How do you approach the topic of others who spend time in Razia’s home in light of observing the visitor who just arrived?

Explanation: It is obvious that the visitor is familiar enough to be someone with whom Razia spends a lot of time. This visitor is also someone who may not live with Razia, but probably lives nearby, perhaps even in one of the other apartments in the house.

Part 3 – You reiterate the importance of identifying priority contacts and tell Razia that she needs to be candid about all people with whom she spends prolonged periods of time. You then directly ask Razia about the woman who walked into her home. Razia hesitates, but then tells you it is her mother-in-law who lives downstairs. She came to bring some food for her and her husband. She then mentions that her husband’s family lives in the other two apartments. She spends considerable time with them while she watches her sister-in-law’s two small children 2 days a week. Razia states that she was too embarrassed to tell you this, and that none of the family members know that she has TB.

How should you react to Razia’s admission?

Explanation: In a nonjudgmental tone of voice, you should thank Razia for sharing the information and tell her it must have been hard for her to tell you this. However, it was important that she told you about other people she spends time with, especially any elderly or very young contacts. You now need to ask Razia some very specific questions about who lives in the other two apartments, how much time she spends with them, and if there are other visitors who come to those homes while she is there. As needed, reassure the patient that she is doing the right thing by sharing the names of other contacts with you. It will make the contact investigation go more smoothly and may allow these persons to be more supportive of her. You tell her that perhaps her husband and even you can be there while she tells them; however, this is her choice.

 
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