Abstract
<title>Abstract</title> <p>Background University students represent a large and vulnerable population for Tuberculosis (TB) infection. As future professionals and community members, they are well-positioned to influence TB prevention efforts and contribute to progress toward global TB control; however, they remain under-engaged in current initiatives. Exploring TB-related knowledge, attitudes, and preventive practices (KAP) is therefore essential to inform targeted interventions. This study examined TB-related KAP among university students at a public university in Bali Province, Indonesia, employing the Health Belief Model (HBM) to guide the interpretation. Methods This was a sequential mixed-method study conducted between March and August 2025. The first phase involved a quantitative online survey assessing TB-related KAP. Participants were university students aged ≥ 18 years selected using non-probability, convenience sampling technique. Quantitative data were analyzed using descriptive statistics, independent t-tests, one-way ANOVA, Pearson correlation, and multivariable linear regression, with KAP levels categorized using Bloom’s cut-off scores. The second phase comprised four focus group interviews to further explore the quantitative findings. Qualitative data were analyzed using summative content analysis. Findings from both phases were integrated during the interpretation stage. Results Participants demonstrated poor knowledge (44.2%), good attitudes (73.9%), and moderate preventive practices (54.8%). TB KAP scores were significantly correlated (p < 0.001). Knowledge scores were lower among students from non-health faculties and those with limited TB information exposure (p < 0.001). Attitude scores were higher among participants with a TB history (p = 0.003), while practice scores were higher among students whose mothers had education higher than high school (p = 0.033). Qualitative findings identified enablers (prior exposure, TB knowledge, high perceived risk, and future initiatives) and barriers (TB negative impacts, TB knowledge gaps, low perceived risk, and student lifestyle) in engaging in TB prevention. Conclusions Interpreted through the HBM, the findings integration reveal gaps in risk perception, symptom recognition, screening practice, and confidence to engage in TB prevention. Universities could serve as a critical setting for targeted, evidence-based TB interventions by improving personal risk/early symptoms understanding, and providing clear, step-by-step guidance for screening. In addition, strengthening institutional cues to action and fostering a supportive campus environment may help reduce delays in help-seeking and promote timely care.</p>