Skip to content
1887

Access Microbiology open research platform logo Access Microbiology

Volume 7, Issue 12

Knowledge, attitudes and practices regarding tuberculosis in a low-incidence area in the USA Open Access

Abstract

Tuberculosis (TB) remains a large global health threat, including increasing cases in generally low-incidence areas of the USA. However, the knowledge, attitudes and practices (KAP) regarding TB in these low-incidence areas are underexplored, precluding planning for effective health communication in these areas regarding travel to high-incidence areas or potential future outbreaks in currently low-incidence areas. Using the health belief model as a theoretical framework, we developed a KAP survey to assess public perceptions of TB in Colorado, a currently low-incidence area. We collected complete responses from =225 adults. We found that participants had higher self-assessed knowledge than actual knowledge about TB. We also found that while participants recognized TB as a global health threat, they were not personally worried about contracting TB. However, a portion of participants indicated that they would feel shame if they contracted TB. Public knowledge and risk perception about TB could be improved by providing information in low-incidence areas on the public health burden of TB. Additionally, providing health communication to focus on emotion management and reducing stigma about the disease would be important to promote healthcare-seeking and treatment compliance in case of a future outbreak.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): health communication , knowledge, attitudes and practices (KAP) survey and tuberculosis
© 2025 The Authors
  • This is an open-access article distributed under the terms of the Creative Commons Attribution License. This article was made open access via a Publish and Read agreement between the Microbiology Society and the corresponding author’s institution.
Loading

Article metrics loading...

/content/journal/acmi/10.1099/acmi.0.001038.v3
2025-12-15
2026-02-08

Metrics

Loading full text...

Full text loading...

/deliver/fulltext/acmi/7/12/acmi001038.v3.html?itemId=/content/journal/acmi/10.1099/acmi.0.001038.v3&mimeType=html&fmt=ahah

References

  1. WHO TB incidence. n.d https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2023/tb-disease-burden/1-1-tb-incidence accessed 7 February 2025
  2. Centers for Disease Control Tuberculosis (TB)—Data and Statistics; 2024 https://www.cdc.gov/tb/statistics/default.htm accessed 28 March 2024
  3. Rosen A. Tuberculosis in Kansas: The Larger Picture; 2025 https://publichealth.jhu.edu/2025/tuberculosis-in-kansas-the-larger-picture accessed 7 February 2025
  4. Krentel A, Fischer P, Manoempil P, Supali T, Servais G et al. Using knowledge, attitudes and practice (KAP) surveys on lymphatic filariasis to prepare a health promotion campaign for mass drug administration in Alor District, Indonesia. Tropical Med Int Health 2006; 11:1731–1740 [View Article]
     [Google Scholar]
  5. Champion V, Skinner C. The Health Belief Model. In Health Behavior and Health Education San Francisco: Jossey-Bass; 2008 pp 45–65
     [Google Scholar]
  6. Contzen N, Mosler HJ. The Risks, Attitudes, Norms, Abilities, and Self‐regulation (RANAS) approach to systematic behavior change. Dübendorf, Switzerland: Eawag, Swiss Federal Institute of Aquatic Science and Technology; 2015
  7. Howley MM, Rouse CD, Katz DJ, Colson PW, Hirsch-Moverman Y et al. Knowledge and attitudes about tuberculosis among u.s.-born blacks and whites with tuberculosis. J Immigrant Minority Health 2015; 17:1487–1495 [View Article]
     [Google Scholar]
  8. Hong YP, Kwon DW, Kim SJ, Chang SC, Kang MK et al. Survey of knowledge, attitudes and practices for tuberculosis among general practitioners. Tuber Lung Dis 1995; 76:431–435 [View Article] [PubMed]
     [Google Scholar]
  9. Malhotra A, Kumar V, Juyal D, Gautam D, Malhotra R. Knowledge, attitude, and practices of health-care providers toward antibiotic prescribing, antibiotic resistance, and multidrug-resistant tuberculosis. Perspect Clin Res 2021; 12:146–152 [View Article] [PubMed]
     [Google Scholar]
  10. Bashorun AO, Linda C, Omoleke S, Kendall L, Donkor SD et al. Knowledge, attitude and practice towards tuberculosis in Gambia: a nation-wide cross-sectional survey. BMC Public Health 2020; 20:1566 [View Article] [PubMed]
     [Google Scholar]
  11. Datiko DG, Habte D, Jerene D, Suarez P. Knowledge, attitudes, and practices related to TB among the general population of Ethiopia: Findings from a national cross-sectional survey. PLOS ONE 2019; 14:e0224196 [View Article] [PubMed]
     [Google Scholar]
  12. Luba TR, Tang S, Liu Q, Gebremedhin SA, Kisasi MD et al. Knowledge, attitude and associated factors towards tuberculosis in Lesotho: a population based study. BMC Infect Dis 2019; 19:96 [View Article] [PubMed]
     [Google Scholar]
  13. Vericat-Ferrer M, Ayala A, Ncogo P, Eyene-Acuresila J, García B et al. Knowledge, attitudes, and stigma: the perceptions of tuberculosis in equatorial Guinea. Int J Environ Res Public Health 2022; 19:8227 [View Article] [PubMed]
     [Google Scholar]
  14. Zhang Y, Zahreddine M, Abreu K, Dantas MA, Charland K et al. Knowledge, attitude and practice (KAP) and risk factors on dengue fever among children in Brazil, Fortaleza: a cross-sectional study. PLoS Negl Trop Dis 2023; 17:e0011110 [View Article] [PubMed]
     [Google Scholar]
  15. Kelp NC, Witt JK, Sivakumar G. To vaccinate or not? the role played by uncertainty communication on public understanding and behavior regarding COVID-19. Science Communication 2022; 44:223–239 [View Article]
     [Google Scholar]
  16. Auer C, Sarol J Jr, Tanner M, Weiss M. Health seeking and perceived causes of tuberculosis among patients in Manila, Philippines. Tropical Med Int Health 2000; 5:648–656 [View Article]
     [Google Scholar]
  17. Ayisi JG, van’t Hoog AH, Agaya JA, Mchembere W, Nyamthimba PO et al. Care seeking and attitudes towards treatment compliance by newly enrolled tuberculosis patients in the district treatment programme in rural western Kenya: a qualitative study. BMC Public Health 2011; 11:515 [View Article] [PubMed]
     [Google Scholar]
  18. Nguyen  PH, Thorson AEK, Nguyen  HL, Diwan VK. Knowledge of tuberculosis and associated health-seeking behaviour among rural Vietnamese adults with a cough for at least three weeks. Scand J Public Health 2003; 31:59–65 [View Article]
     [Google Scholar]
  19. Viney KA, Johnson P, Tagaro M, Fanai S, Linh NN et al. Tuberculosis patients’ knowledge and beliefs about tuberculosis: a mixed methods study from the Pacific Island nation of Vanuatu. BMC Public Health 2014; 14:467 [View Article] [PubMed]
     [Google Scholar]
  20. Watkins RE, Plant AJ. Pathways to treatment for tuberculosis in Bali: patient perspectives. Qual Health Res 2004; 14:691–703 [View Article] [PubMed]
     [Google Scholar]
  21. Riad A, Drobov A, Rozmarinová J, Drapáčová P, Klugarová J et al. Monkeypox knowledge and vaccine hesitancy of czech healthcare workers: a health belief model (HBM)-based study. Vaccines (Basel) 2022; 10:2022 [View Article] [PubMed]
     [Google Scholar]
  22. Weinstein ND. Why it won’t happen to me: perceptions of risk factors and susceptibility. Health Psychol 1984; 3:431–457 [View Article] [PubMed]
     [Google Scholar]
  23. Yoo JH, Jang S. An attributional analysis of stigma associated with sexually transmitted diseases and its relationship with communication efficacy. Glob J Health Sci 2012; 4:15–26 [View Article] [PubMed]
     [Google Scholar]
  24. Ziaee A, Ziaee M, Asghari A, Elhamirad S, Azarkar G. Unpacking HPV stigma: assessing healthcare workers’ knowledge and stigma towards hpv while exploring the connection between the two. J Med Educ Curric Dev 2024; 11:23821205241260596 [View Article] [PubMed]
     [Google Scholar]
  25. Mak WWS, Mo PKH, Cheung RYM, Woo J, Cheung FM et al. Comparative stigma of HIV/AIDS, SARS, and tuberculosis in Hong Kong. Social Science & Medicine 2006; 63:1912–1922 [View Article]
     [Google Scholar]
  26. Fischer LS, Mansergh G, Lynch J, Santibanez S. Addressing disease-related stigma during infectious disease outbreaks. Disaster Med Public Health Prep 2019; 13:989–994 [View Article] [PubMed]
     [Google Scholar]
  27. Sommerland N, Wouters E, Mitchell EMH, Ngicho M, Redwood L et al. Evidence-based interventions to reduce tuberculosis stigma: a systematic review. Int J Tuberc Lung Dis 2017; 21:81–86 [View Article] [PubMed]
     [Google Scholar]
  28. Kousoulis A. Public responses to infectious diseases outbreaks: the role of emotions. London School of Hygiene & Tropical Medicine; 2021 https://researchonline.lshtm.ac.uk/id/eprint/4661173/ accessed 7 February 2025
  29. Smith RA. An experimental test of stigma communication content with a hypothetical infectious disease alert. Communication Monographs 2012; 79:522–538 [View Article]
     [Google Scholar]
  30. Laurence YV, Griffiths UK, Vassall A. Costs to health services and the patient of treating tuberculosis: a systematic literature review. Pharmacoeconomics 2015; 33:939–955 [View Article] [PubMed]
     [Google Scholar]
  31. Mauch V, Bonsu F, Gyapong M, Awini E, Suarez P et al. Free tuberculosis diagnosis and treatment are not enough: patient cost evidence from three continents. Int J Tuberc Lung Dis 2013; 17:381–387 [View Article] [PubMed]
     [Google Scholar]
  32. Kelp N. Inclusive science communication as a tool to address one health challenges. BioScience 2025 [View Article]
     [Google Scholar]
  33. Rimal RN. Closing the knowledge-behavior gap in health promotion: the mediating role of self-efficacy. Health Commun 2000; 12:219–237 [View Article] [PubMed]
     [Google Scholar]
  34. Sitto K, Lubinga E, Geya M. The power of narrative health communication: exploring possible effects of first-hand experiential stories on cancer awareness amongst university students. TDSA 2021; 17:10 [View Article]
     [Google Scholar]
  35. Nugraha YR, Aditjondro E, Svenson D, Husada S et al. Harnessing the power of testimonial videos: a deep dive into the #1minute2quit campaign for spreading awareness on the health hazards of tobacco. JKMJC 2024; 40:450–465 [View Article]
     [Google Scholar]
  36. Yang S, Tao R, Bhattar M, Shen L, Jones M et al. Designing and testing social media campaign messages to promote COVID-19 vaccine confidence among rural adults: A community-engaged approach featuring rural community leader and clinician testimonials. Prev Med Rep 2023; 36:102508 [View Article] [PubMed]
     [Google Scholar]
  37. Macq J, Torfoss T, Getahun H. Patient empowerment in tuberculosis control: reflecting on past documented experiences. Tropical Med Int Health 2007; 12:873–885 [View Article]
     [Google Scholar]
  38. Valente TW, Paredes P, Poppe PR. Matching the message to the process: the relative ordering of knowledge, attitudes, and practices in behavior change research. Hum Commun Res 1998; 24:366–385 [View Article] [PubMed]
     [Google Scholar]
  39. Lee C-H, Lee M-C, Lin H-H, Shu C-C, Wang J-Y et al. Pulmonary tuberculosis and delay in anti-tuberculous treatment are important risk factors for chronic obstructive pulmonary disease. PLoS One 2012; 7:e37978 [View Article] [PubMed]
     [Google Scholar]
  40. Worthington L et al. After 30 years of decline, tuberculosis is rising in the U.S. again. How did we get here?; 2025 https://www.bu.edu/neidl/2024/06/after-30-years-of-decline-tuberculosis-is-rising-in-the-u-s-again-how-did-we-get-here/ accessed 7 February 2025
/content/journal/acmi/10.1099/acmi.0.001038.v3
Loading
Knowledge, attitudes and practices regarding tuberculosis in a low-incidence area in the USA
Access Microbiology 7, 001038.v3 (2025); https://doi.org/10.1099/acmi.0.001038.v3
/content/journal/acmi/10.1099/acmi.0.001038.v3
/content/journal/acmi/10.1099/acmi.0.001038.v3
Loading

Data & Media loading...

Supplements

Supplementary material 1

PDF

Supplementary material 2

EXCEL

Most cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An error occurred
Approval was partially successful, following selected items could not be processed due to error