Effective TB Interviewing for Contact Investigation: Self-Study Modules
All TB interviews should be guided by the same principles and skills. In all cases, the TB interviewer’s initial introduction and self-identification is crucial. While being identified as a member of the health department, the TB interviewer should emphasize protection of the public good and the health of those the patient knows or has come into contact with as the reason for initiating the TB interview. Also, reiteration of confidentiality and provision of education, with many opportunities for patient questions, should be ongoing.
Patient concerns may surface throughout the interview, necessitating various approaches to address the unique nature and circumstances of each patient.
- Patient Reluctance
A patient may hesitate to reveal information about illicit activities or contacts. The interviewer must emphasize that the interview is being conducted for the purpose of identifying and evaluating priority contacts, and not to implicate or pass judgment. It is important that the interviewer safeguard patient information and assure the patient that this information will not be shared with authorities or prevent the patient from receiving services. This should be reiterated each time a patient shares concerns or shows evidence of reluctance to provide information.
- Vague or No Contact Information
If a patient cannot give names or addresses of priority contacts, the patient should be asked for nicknames, physical descriptions, and descriptions of locations in which exposures have occurred. However, descriptions can be difficult to specify. When gathering descriptive information, the interviewer should provide reference points for the patient to use such as: “How tall is John? Is he about my height?” The same is true for exposure setting descriptions. For example, “Where is the diner? What is the nearest store or landmark? Tell me how to get there from the shelter where you live.”
- Undocumented Immigration Status
Since the goal of the TB interview is to provide education and identify contacts, the patient’s immigration/visa status and standing with the law is not relevant. Interviewers should not ask about immigration/visa status or legal standing. If the patient volunteers this information or reveals it in an effort to determine how this may affect the contact investigation, the interviewer should reinforce that the health department is only concerned about preventing transmission and medically evaluating exposed contacts.
- Other Pressing Life Concerns
A patient may display disinterest in the interview process as evidenced by body language or frequent diversions to other topics. The interviewer should address this to discover what concerns the patient has and how they can be resolved, if possible, and should make referrals according to health department policy. A case manager or other personnel within the health department can address overwhelming social and medical needs and other concerns. Discussing patient concerns can assist the patient in completing TB treatment and provide information for the TB interview process.
- Uncooperative Behavior
Some patients may not want to participate in the contact investigation process. They may feel that questions about contacts and exposure sites are too personal. Also, the patient may state a lack of concern for his or her contacts. While not easy to do, it should be explained that, in the patient’s case, someone spread TB to him or her and that the same could happen to others if contacts are not identified. Or, there may be contacts who have developed active cases of TB and will spread the germs to others. The patient’s role is very important in this regard. The patient should also be reassured about confidentiality, as this may also be a worry on the patient’s part. If all attempts to engage the patient fail, another healthcare worker may attempt to conduct the interview.
Often, cues from the patient may be subtle; the interviewer should look for verbal and nonverbal cues to assess fear, discomfort, hesitance, and lack of understanding. Use of problem identification and problem-solving strategies such as patient assessment, review of the interview objectives, emphasis on confidentiality, and prompting for locating and descriptive information should be employed as often as necessary. These are used to educate the patient about the purposes and importance of the TB interview as well as to inform him or her of how any collected information will be used.