Open ended questions vs. Closed ended questions
for HIV Test Counselors

Nicolas Sheon, October 1996

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Closed-ended questions can be answered by "yes" or "no." For example, "Are you using condoms every time?" would generally produce a "yes" or "not since we both got tested and are monogamous..." Closed-ended questions direct the conversation toward the counselor's own agenda. This type of interaction is disempowering since it imposes the counselor's interpretations of the client's situation. Practically all the risk assessment questions on the form are closed-ended. Closed-ended questions tend to place people on the defensive, like they are on trial. They will answer with what they think you want to hear because the question is perceived as a bureaucratic barrier to a service: the test.

Avoid questions beginning with "Why do you..." as these will elicit a self-judgment. Use questions beginning with "What " and "How" so that the locus of causality is generalized and not directed at the participant.

Open-ended questions are the key to client-centered counseling. They provide an opportunity for the client to explore and reflect upon their situation and emotional state. They encourage the client to take more control over the conversation, providing only the information they want and framed within a narrative of their own choosing. The context provided by answers to open-ended questions provide the counselor with valuable clues about the client's willingness to change, sense of control, and even whether they see their situation as problematic or not.

An open-ended version of the closed-ended question, "Are you using condoms every time?" would be "What decides whether you use condoms or not with your partners?" or "Which partners do you use condoms with?" The latter questions will elicit much more information and force the client to think about their answer.

Here is a list of useful open-ended questions for HIV test counselors. Many are not strickly open-ended but I include them because they work to start a dialogue or elicit a narrative rich with contextual information.

Have you been tested before?

Do you think you may be at risk for HIV?

Who's idea was it to get tested? Yours or your partner's?

What is safer sex for you?

Have you (your partners) ever had any condoms feel uncomfortable or break?

Have you thought about how you might react if the test came back positive?

Would a negative result change anything you are doing?

Do you think using alcohol or drugs affects your decisions to use condoms?

How did you feel after your last test?

How do you feel when that happens?

What decides whether you use condoms or not with your partners?

How do you know when to use condoms with a certain person?

How do you feel the next day?

What does this test result mean for you?

People get tested for a lot of reasons. Are there any reasons, other than risk of exposure, that bring you in for testing?

Do you see yourself getting tested in the future? For what purpose?

How do think your partner feels (or would feel) about that?

Have any of your partners complained about using condoms?

Whose idea was it to get tested?

When was the last time you used a condom?

What was it specifically about condoms that you didn't like?

Are you getting what you need from your sexual partners?

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