Abstract
<title>Abstract</title> <p>Background Tuberculosis (TB) prevention and cotrol in universities represents a critical yet challenging aspect of China's public health strategy. The effectiveness of TB prevention and control in these environments is not dictated by isolated factors; rather, it is shaped by the intricate interplay between individual psychology and the institutional environment. Moving beyond traditional linear analyses, this study employs a configurational approach through fuzzy-set Qualitative Comparative Analysis to reveal the multiple driving paths that contribute to effective TB prevention and control, thereby informing the development of targeted strategies. Methods This cross-sectional study focused on students from five universities in Heilongjiang Province, China, during November and December 2024. Data on demographics, psychological and institutional factors, as well as knowledge, attitudes, and practices (KAP) regarding tuberculosis prevention were collected. Descriptive statistics were used to summarize the KAP status, and fuzzy-set Qualitative Comparative Analysis was employed to identify the core antecedent conditions and driving paths influencing the effectiveness of TB prevention and control. Results Analysis revealed that both individual psychological factors and institutional environmental factors were pivotal for effective tuberculosis prevention and control. The results of fuzzy-set qualitative comparative analysis identified five distinct driving paths pathways (solution consistency = 0.880), each exhibiting a consistency exceeding 0.8. This indicated the presence of multiple robust combinations of conditions that contributed to high efficacy in TB prevention and control within university settings. Conclusions The effectiveness of tuberculosis prevention and control in universities results from the complex interplay of multiple concurrent factors rather than the dominance of any single element. This study identifies two core pathways—individual psychologically-driven and institutionally-oriented—providing a configurational theoretical framework and practical implications for precisely and differentially enhancing tuberculosis prevention and control effectiveness in academic settings.</p>