Regression analyses revealed similar attitudes and perceptions for the young and the old, for men and women, and for the lower and higher educated -- suggesting that people in this population share the same attitudes and perceptions. Our findings are likely to reflect the actual situation of TB patients in this population. The more so because most respondents know people with TB in their immediate environment.
TB knowledge can be considered fairly good among this community. The perception on "respondent believes it is mainly irresponsible people who do not take their treatment who are to blame for spreading TB" did not imply stigma only. Since some level of the treatment failure is due to irresponsible people this is also an indicator of knowledge.
However, respondents mainly considered TB to be an African disease and were under the misconception that all TB patients will also develop HIV. This perceived link can be explained by the fact that TB is main cause of death among the estimated 5.5 million South Africans living with HIV/AIDS (>10% of the country's population). Indeed, the co-infection rate approaches 73% in TB patients among all age groups . Future publicly released information should emphasize that having active TB disease in an individual who is also infected with HIV leads to a worsening of the HIV illness, but having TB does not lead to becoming infected with HIV. Scores on the other items were fairly good, which contradicts prior findings suggesting that people in developing countries lack TB knowledge [8, 16, 19, 20, 25–27]. The population in the current study appears to be better informed in this regard.
The results are suggestive of a high level of stigmatization: a full 95% of respondents believe people with TB tend to hide their TB status because they are afraid of what others may say. People think that irresponsible individuals who do not take their treatment are mainly to blame for spreading TB. Besides blaming those individuals, they accuse them of hiding their TB status for fear of what others might say. They also think that people who acquire TB through drinking and smoking are getting what they deserve and that TB patients are less respected within the community. While research shows that the increased TB incidence and prevalence during the last decade is mainly due to population increase where TB is most prevalent, increase of HIV and increased poverty  most people within this community believe it is mainly the irresponsible patients who do not take their treatment that are to blame for spreading TB. Also the finding that respondents believe people who drink and smoke "get what they deserve" indicates blame and potential stigmatization.
More than half of the respondents believe that TB patients interrupt treatment because they think they are cured. This finding is interesting and justifies the need for improved communication and mutual understanding between care providers and patients. Implementing of interventions aimed at improving communication and mutual understanding between care providers and patients into this matter by the national tuberculosis program would improve TB treatment outcomes nationally. The second most important perception of respondents as main reason for non-adherence (they are afraid people will talk bad about them when they go to the clinic) is suggestive of stigma within the community. The fact that respondents mention this in their top 2 of most important reasons for default from treatment shows that people within this community believe stigma to be a real problem for adherence to TB treatment. This is in line with prior findings indicating that stigma plays a significant role in adherence [7, 8, 29–33]. If the perceptions of the respondents represent the actual situation for TB patients in the Eastern Cape, stigma causes people to reject the diagnosis, leading to the infection of more people and potential drug resistance.
Furthermore, it is interesting that most respondents believe TB patients prefer active involvement by travelling to the hospital and clinics themselves, compared to having a family member or DOTS volunteer daily delivering the medicine at home.
The major limitation of our study is that we studied perception of the lay public only, not actual behavior. Since attitudes of the lay public play a central role in the patient's decision-making process it is important to gain insight into what actually influences an individual's decision to seek treatment and adherence to that treatment instead of looking at behavior only. However, after learning how these mechanisms work it is important to investigate whether changes in attitudes and perceptions also lead to actual behavior change. Therefore, it would be interesting to conduct a follow-up study amongst TB suspects, adherent and non-adherent TB patients to document actual behavior.
The reason why the majority of respondents were women and older people were overrepresented in comparison to general population figures could be related to the inherent limitation of the conventional Kish grid . Use of this instrument often leads to a higher proportion of women and older people. Regression analyses of age, gender and education show that there are very few significant differences in knowledge, attitudes and perception among these subgroups. Therefore, the higher proportion of women and older people does not appear to have affected our study findings.