APPENDIX C

INSTRUCTIONAL STRATEGIES FOR INTERVIEWING ELDERS FROM DIVERSE ETHNIC BACKGROUNDS
Several educational modules in this curriculum suggest having students interview elders from ethnic backgrounds other than their own as part of their learning experience. This appendix provides instructors with some specific strategies and ideas for how to design and optimize such interviewing assignments for students.

Any interviewing assignment should take into account the following:

• the level of education, experience, skills, and maturity of students.
• the nature of the course/training/educational experience of which the interviewing assignment is part.
• the specific ethnic population/sub-population likely to be encountered by students and available for interviewing.

Preparing Students:

• Prior to any interview, students should have completed their own values history and participated in some assignments/discussions designed to explore their own cultural background, attitudes, and beliefs.
• Students should be encouraged to become as knowledgeable as possible about the specific ethnic group(s) of the person(s) they will be interviewing.
• Instructors should review with students some basic guidelines for interviewing older adults and culturally-appropriate communication skills (see Module 4 for outline of communication issues and resources)
• Instructors may wish to involve students in simulation and role-play exercises designed to prepare them to interview those of different ethnic backgrounds. Good examples of such exercises can be found in: 1) Pedersen, P.B., & Ivey, A. E. (1993). Culture-centered counseling and interviewing skills: A practical guide. Westport, CT: Praeger Publishers/Greenwood Publishing Group, Inc.; and 2) Pedersen, P. (1988). A handbook for developing multicultural awareness. Alexandria, VA: American Association for Counseling and Development.).
• Students should be encouraged to practice interview questions with each other or the instructor before conducting the interview.
• It may be advisable to have a cultural guide (i.e., representative, respected leader, or provider) help to prepare students for their interview experience, orient them to salient cultural beliefs/values, and/or review the interviewing assignment/questions.

Recruiting Interviewees:

• Older adults from diverse ethnic backgrounds may be contacted through formal or informal networks. Formal networks include: Area Agencies on Aging, county/city offices on aging, local senior centers, health and social service agencies, retirement communities, long-term care facilities, and senior housing units and assisted living residences. Depending on your geographic location, agencies or organizations may exist which serve elders from specific ethnic backgrounds exclusively (e.g., a Chinese-American senior center, Indian Health Service, coalition serving elders of Asian descent, etc.). Informal sources might include churches, synagogues, or faith-based communities and family or extended-family networks.
• Depending on the number of students and the number of interviews to be completed, it may be advisable for instructors either to recruit interviewees themselves or to make the initial contacts with the formal sources to be used in recruitment. Think of how burdensome it could be for the social service director at a local senior center to be contacted with 20 separate requests for interviews with African-American elderly clients.
• When contacting potential interviewees or recruitment sources, it would be helpful to provide an information sheet that briefly describes the purpose of the interview, identifies the course or educational experience of which it is a part, and specifies what the interview involves (e.g., time commitment, types of information sought, how confidentiality will be handled). People may be more inclined to participate if they understand the rationale behind the request and the specifics about what is involved.

Suggested Strategies: Depending on the nature of the course/educational experience of which the interviewing assignment is part, instructors have many issues and options to consider:

• longitudinal experience - have the student develop a relationship with one ethnic elder and interview him/her on several different occasions.
• exposure to diversity (student level) - have the student interview several different ethnic elders and compare similarities/differences.
• exposure to diversity (class level) - have each student interview one ethnic elder, with different ethnic populations/sub-populations represented among interviewees.
• exposure to diverse settings/environments - interviews can be conducted in different settings (e.g., interviewee’s home, service delivery setting, or educational institution), and the setting can become part of the learning experience for the student.

Regardless of strategy, instructors should consider creating a structured interview guide, with questions focused around the learning objectives for the course or/and the specific curriculum module(s) under consideration. Such a guide could be created in conjunction with students, making the construction of the interview guide a participatory learning experience. Drafts of the proposed interview guide should be reviewed with a knowledgeable cultural guide/broker.

Some sample interview questions, organized around the modules of this core curriculum, are presented in the table below:

Module	Focus of Interview	Sample Questions*
Module 1	General background, i.e., cultural beliefs, religious beliefs, customs Level of acculturation	In what country were you born? How long have you (or your ancestors) been in this country? What language did you first learn to speak? What language is used at home? How do you identify yourself (in terms of your ethnic/racial background, heritage, or culture)? What is important for others to know and understand about your background or culture? How has your background or culture influenced who you are today? >What is the role of spirituality, faith or religion in your life? Do you identify with any formal religion/belief system? What customs or traditions are important to you/your family? What does your culture/religion/heritage teach you about aging/growing older/ elders or older people? What has been the biggest adjustment for you/your family about life in this country?
Module 2	Informal/Family support Experience with disease/illness	Tell me about your family/or the people closest to you. In times of illness or need, to whom do you turn? What help or assistance do you give to family members/others close to you? What help or assistance do you expect &/or receive from family members/others close to you? Who makes (or is involved in) decisions regarding your health or well-being? Tell me about your experience with _________ (specific disease/illness).
Module 3	Health belief systems Models/Traditions of healing Historical experiences of cohorts	What does it mean to be sick or ill? When a person is sick or ill, what treatments or remedies should he/she seek? How is the tradition of healing or care in your culture/heritage different from Western medicine (i.e., medicine in the US)? What events in history have helped shape the attitudes and beliefs that you/your family/people of your heritage/descent?
Module 4	Clinical Assessment	See Module 4 for specific areas of ethnogeriatric assessment Questions can also be tailored to the specific discipline and/or focus of the class (e.g., psychosocial aspects, medical issues, etc.)
Module 5	Service Access & Utilization	How do you stay healthy? What types of healthcare/other services do you use & how often? When you have an identified need or illness, what keeps you from using available services (probe for accessibility, and acceptability issues)? Tell me about your most recent experience with a health care system or provider (try to elicit reactions to the experience, level of satisfaction with care, examples of misunderstanding -- e.g., anything that made you/your family uncomfortable, offended you/your family?) What advice would you give to health care providers (i.e., doctors, nurses, etc.)?

*Some questions may not be appropriate to all ethnic populations/sub-populations. Phrasing of questions should be tailored to the ethnic group(s) being interviewed.

Debriefing, Feedback & Evaluation

• Students should be presented with the opportunity to debrief after the interview. A guided in-class discussion can help students to discuss their experiences, verbalize their findings, consider their own personal and cultural reactions, and generate suggestions for future interactions and interviews. Such discussion may also be useful in modifying the interview guide to make questions more relevant or appropriate.
• Students can be asked to write a reaction paper or essay that summarizes his/her experience and relates the experience to the objectives of the course/educational endeavor. The instructor can then use this written work to evaluate the student.
• For advanced students, instructors may wish to consider specific mechanisms to help measure and evaluate student competencies in interviewing, history taking, and communication with elders of different ethnic backgrounds. Videotape, observation (by a peer, instructor, or cultural guide), and/or standardized patients may be useful in assessing student competencies and effectiveness.
• Interviewees can also be asked to provide feedback about the interviewer, his/her style, and effectiveness. Such feedback could be sought via direct questioning following the interview (e.g., "Were there any questions that offended you or made you uncomfortable?") or through an anonymous survey or response form that is returned to the instructor.