Page 57 - Nutrition Counseling and Education Skills: A Guide for Professionals

surroundings can enhance an interview. A setting should be arranged in which eye contact can be maintained.
Since standing over a patient lying in a hospital bed may trigger deferential behavior, it is preferable to be at
the same head level. The optimum distance between people involved in an interview is 2 to 4 ft (0.6 to 1.2 m),
about an arm’s length, but cultural practices differ.3

The most formal seating arrangement is for one person to sit across the desk from another, whereas a chair
alongside the desk is less formal and makes people feel more equal. Two parties seated without a table is
informal, but when viewing materials, a round table is less formal than a square or rectangle because it
eliminates the head-of-the-table position. In general, the fewer the barriers in the line of sight, the better. A
desk top with a computer, telephone, books, plants, and other materials between you and the client is a
psychological barrier.

Emotional Objectivity

The patient should feel free to express all feelings, attitudes, and values. An attitude of acceptance and
concern for the interviewee should be maintained, with a desire to understand behavior rather than pass
judgment. A raised eyebrow, look of shock, surprise, or amusement, or an incredulous follow-up question
(e.g., “You had three beers for lunch?” or “All you had for lunch was a box of cookies?”) may cause the client
to change or end the story.

Interviewers need to develop an awareness of their own conscious and unconscious values, biases, and
prejudices. These include not only racial, ethnic, and religious preferences, but also exaggerated dislikes of
people and their characteristics. Examples may include the poorly dressed, the less educated, aggressive
women, meek men, highly pitched voices, or weak handshakes. Identifying your own intolerances may help to
control any expression of them through nonverbal behaviors.

Personal Context

People bring with them their own personal contexts or systems of beliefs, attitudes, feelings, and values that
must be recognized. Concerns about perceived threats to health can be so frightening, for example, that they
preoccupy thoughts and block conversation. Interviewers need to recognize the respondent’s situation and the
subjective and objective aspects of it. After a heart attack, for example, a man may feel fear, resentment, anger,
anxiety, dependence, or regression, which may interfere with concentration and cooperation. An
understanding of the psychological reactions to illness and ways of dealing with them is helpful.

The professional relationship is most easily established with persons similar to ourselves, whereas barriers
may arise with others. Interviews should be age-appropriate and population-specific with lists of foods based
on the population’s dietary habits.7 A thorough understanding of the food choices and practices of various
groups is important.

People from all socioeconomic groups, various cultural and ethnic groups, and ages from young to elderly
participate differently in the professional relationship. Eye contact and other nonverbal behaviors should be
culturally appropriate. Young children, for example, are not used to talking with adults other than family and
friends. Knowing the child’s vocabulary level is helpful.

The interviewer may need to facilitate the venting of feelings and to acknowledge them before proceeding
with the interview. A job applicant, for example, may have been laid off recently from a long-time position.

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