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Effective TB Interviewing for Contact Investigation: Self-Study Modules

Return to Module 4 Table of Contents

Challenges During the TB interview

If the medical record review does not suggest the existence of any special circumstances, or if no medical record is accessible, it is the interviewer’s responsibility to interpret verbal and nonverbal cues that may influence the successful exchange of information. The following circumstances may cause challenges to conducting a TB interview:

  • Unlikelihood of Follow-up Interviews
    Some patients may be difficult to locate for more than one interview, making the initial interview most important for collecting information. To the extent possible, all objectives of the TB interview must be accomplished during this one interaction. For example, patients who are homeless or have a history of migration can be difficult to locate for follow-up interviews.
  • Distrust of Authority
    Past negative experiences with government or healthcare agencies may cause a patient to refuse interview requests or to provide little or no information during the TB interview.
  • Fear of Legal Consequences or Moral Judgments
    Anything alluding to the legality or morality of patient actions can frighten a patient who is involved in illicit or illegal activities such as drug use, undocumented immigration status, commercial sex work, or previous negative experiences with the law.

    A patient can be reluctant to reveal participation in behaviors that are illegal, perceived as immoral, or different from that of mainstream society (e.g., drug use, unreported work, or alternative lifestyle). The patient can also fear the consequences of revealing that contacts are involved in illicit activities. This fear can outweigh the perceived responsibility to identify priority contacts exposed while engaging in these activities.
  • Inability to Provide Identifying and Locating Information
    An index patient may make sincere attempts to identify priority contacts. However, due to the nature of the patient’s or contacts’ lifestyles (e.g., homelessness or substance abuse) or the setting(s) (e.g., drug den, bar, or social club) in which the contacts were exposed, the patient may not be able to provide the names or locating information of the contacts.
  • Undocumented Immigration Status of Contacts
    If contacts are in the country illegally or were exposed in a work setting and do not have valid work permits, a patient may hesitate to name them for fear of jeopardizing their status in the country and at the work site.
  • Unmet Personal Needs and Coexisting Medical Conditions
    A patient may consider health, housing, family, occupational, or financial concerns as being of higher priority than completing TB treatment or participating in the contact investigation process. Persons who are homeless, HIV infected, primary caregivers, or on public assistance may not be entirely engaged in the interview process due to other concerns.
  • Physical or Mentally Inability to Adequately Communicate
    Some patients may not be competent or able to understand or communicate effectively because of a physical or mental disability.

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