TB Contact Investigation Interviewing Skills Course

Learning Objectives

After this session, participants will be able to:

• Define cultural competency
• State the four elements of cross cultural communication

The Importance of Cultural Competency

• Health care workers need to be aware of, and sensitive to, cultural diversity, life situations, and other various factors that shape a person’s identity.
• The first step is an open, non-judgmental attitude.

What is Culture?

Culture has been defined in a number of ways, but most simply, as the learned and shared behavior of a community of interacting human beings.

What is Cultural Competency?

Cultural competency refers to an ability to interact effectively with people of different cultures.

What are Some Examples of Diversity Categories/Cultural Groups?

• Geography
• Culture
• Gender
• Spirituality
• Parental Status
• Homeless persons
• Substance users
• Language
• Disability
• Sexual orientation
• Age
• Incarcerated persons
• Profession (e.g., healthcare workers)

Four Elements for Cross-Cultural Communication

• Awareness of one’s own cultural values
• Are you attentive to your own preconceived notions of other cultural groups?
• Awareness and acceptance of cultural differences
• Do you look for opportunities to meet and interact with individuals who are from cultures other than your own?

Four Elements for Cross-Cultural Communication

• Development of cultural knowledge
• Are you familiar with the world views of cultural groups other than your own?
• Ability to adapt to the cultural context of the case
• Do you know how to navigate cross-cultural interactions?

What Can Culture Affect? (1)

• Description and communication of symptoms
• Perceived causes of illness; understanding of infection, transmission, and contacts
• Health-seeking behavior
• Understanding of disease process, treatment expectations, and decision making

What Can Culture Affect? (2)

• Interaction with the health care system and health care professionals
• Attitudes towards helpers and authorities; reluctance to reveal contacts
• How a person identifies and describes their contacts

Cultural Diversity Exercise

Refer to Appendix M
 

Ask Questions to Get to Know the Individual Case

• How do you prefer to be addressed?
• Where were you born?
• How long have you been in the U.S.?
• Are you more comfortable reading information in your native language or in English?
• How are important healthcare decisions are made in your family?
• Are there certain health care procedures and tests that your culture prohibits?

What do You Want to Find Out? (1)

• Language and literacy level
• Health knowledge and health beliefs
• Health seeking behaviors
• Daily routine activities
• Relevant relationships
• Living situation
• Visitors and/or travel

What do You Want to Find Out? (2)

• Decision making preferences
• Perception of and knowledge of U.S. health care system
• Perception of “western” medicine
• Other health belief systems
• Relevant incentives

Use Open-Ended Questions to Generate Helpful Conversation

• How did you feel when you learned you had TB?
• How do you feel about knowing that you may have infected others with TB?
• What matters most as you are being treated for TB?
• Tell me about anything that may affect your treatment, home visits, etc.

Cultural and Diversity Concerns in Contact Investigation (1)

Culture affects:

• Knowledge
• Attitudes and beliefs about TB transmission
• Beliefs about the BCG vaccine
• Risks and benefits of LTBI treatment
• Identification of contacts

Cultural and Diversity Concerns in Contact Investigation (2)

Understanding who a contact is:

• Nuclear family, extended family
• Members of a group living situation
• Residents of a nursing home, shelter, or jail
• Fellow drinkers, substance users
• Members of a church, temple, or mosque
• Co-workers, supervisor, or boss
• Visitors

Cultural and Diversity Concerns in Contact Investigation (3)

Cultural background may influence the case’s willingness to reveal names:

• Immigration status
• Reasons not to give correct name
• Reasons to hide someone or not name them
• Reluctance to identify contacts

Naming Systems

• Different cultures have different naming systems
  • First, middle, last?
  • Two last names?
  • Family name first?
• Ask for all names, nicknames, aliases
• Make sure forms and registry can accommodate
• Have the case agree to always use the same name

Cultural Competency Resources

[Image: Front cover of the Country Specific Guides from the Southeastern National TB Center.]

[Image: Front cover of Promoting Cultural Sensitivity - A Practical Guide for Tuberculosis Programs from CDC.]

[Image: Front cover of the CDC TB Education and Training Network (TB ETN) Cultural Competency Resource Guide.]

[Image: Front cover of Beyond Diversity: A Journey to Cultural Proficiency Facilitator's Guide from the Heartland National TB Center.]

[Image: Front cover of Cultural Competency and Tuberculosis Care: A Guide for Self-Study and Self-Assessment from the New Jersey Medical School Global Tuberculosis Institute at Rutgers.]

[Image: First page of the Quick Reference Guide for the Philippines from the Southeastern National TB Center.]
 

Language Access Barrier

45 million people in the United States speak a language other than English at home

[Image: Globe]

Impact of Language Barriers

• Less likely to receive care
•  Less likely to understand care
• Increased risk of medical errors
• Reduced quality of care
• Less satisfied with care

Using an Interpreter

• Make sure you agree on ground rules with both the case and the interpreter before the interview begins
• Always speak directly to the case
• Ask for clarification as needed
• Children should not be used as interpreters!

 Resource for Interpretation

Video and viewer’s guide

Making the Connection: www.currytbcenter.ucsf.edu

[Image: Front cover of Making the Connection: An Introduction to Interpretation Skills for TB Control from the Curry International TB Center.]

Review

1. What is cultural competency?
2. What are the four elements of cross cultural communication?