Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Haeok Lee

Second Advisor

Carol Ellenbecker

Third Advisor

Courtenay Sprague


Tuberculosis (TB) is an airborne disease that can be preventable by stopping the spread of its bacteria through the air from infected individuals to uninfected individuals. However, Malawi, a low-income country in sub-Saharan Africa, has reported 70 times higher TB incidence than the US and an almost 50% of TB/HIV co-infection rate. Limited literature investigated TB transmission prevention behaviors of persons with TB.

Therefore, this study was aimed at providing in-depth knowledge about TB transmission prevention behaviors with hygiene, geo, temporal, and dimensions among Malawian women with human immunodeficiency virus (HIV)/TB and its correlates (knowledge, attitude, perceived social support, perceived health care access, and living environment). This study focused on women because women have more frequent contact with households, especially with children, than men, which means women are at the center of transmitting TB in households in Malawi.

The study was a cross-sectional mixed-methods design with a computer-assisted personal survey and field research, guided by the situation-specific theory developed for this study. A total of 102 women with HIV/TB joined the survey, of whom 16 women were selected for a field research to observe their houses. Data derived from the survey was analyzed using SPSS 28, Stata 15, and NetMiner 4.

In this study, women with HIV/TB performed appropriate TB transmission prevention behaviors overall, with the lowest score on the temporal dimension than the hygiene and geo dimensions. They had a lack of knowledge about transmission and were unable to afford some of the essential materials necessary to prevent TB spread while they experienced less stigma about themselves with TB and by others, perceived enough support from HCP and family, and perceived health care as accessible and available. The factors significantly influencing TB transmission prevention behaviors were family size, self-stigma about living with TB, perceived HCP support, and perceived affordability. The participants’ living environment, including air ventilation, water, and sanitation system in houses, was also inappropriate to curb TB transmission in households. There is a need for developing health education about TB transmission and policy support to promote TB transmission prevention behaviors of people with TB at the household level.


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Available for download on Wednesday, December 31, 2025