A convenience sampling method was applied to carry out a questionnaire survey targeting college students at a university in Hainan Province from January to February 2023. At the first, researchers designed the electronic questionnaire and published through the Wenjuanxing platform. Secondly, researchers conducted on-site interception visits to students in the school canteen, activity center, dormitory building and other places. Then, the students be questioned according to the inclusion and exclusion criteria, and identified the students meet the inclusion criteria. At the last, researchers issued electronic questionnaires to that students to fill out.

WenJuanxing is a specialized online questionnaire survey platform that offers users humanized online data collection, survey results analysis, and other related services. It boasts the advantages of rapid data collection and low cost, and is extensively utilized in academic institutions, businesses, and by individuals.

The inclusion criteria were as follows: (1) individuals aged 16 years or above; (2) enrolled as full-time students at the university; (3) registered students of Hainan University of Science and Technology; and (4) willingness to volunteer for the study. Conversely, the exclusion criteria encompassed: (1) students who are suspended or have discontinued their studies; and (2) individuals unable to complete the survey within the stipulated timeframe.

When exploring the influencing factors of related variables, the minimum sample size is typically recommended to be 5–10 times the number of variables in the study (16). Given that the questionnaire used in this study contains 25 items, accounting for a 10% margin for potential invalid responses, a planned distribution of 25*10*(1 + 10%) = 275 questionnaires is proposed.

The questionnaire was meticulously crafted by the researchers, drawing on extensive literature review and consultations with experts in the field, including school physicians, epidemiologists, and CDC staff. Structurally, the questionnaire comprises three parts, focusing on participants’ basic information (8 questions), information pertaining to TB prevention and control (8 questions), and attitudes (4 questions) and practices (5 questions) related to TB prevention and control. To test the questionnaire, a pilot study was conducted in Dec 2022 among first, second, and third year medical and non-medical students. The questionnaire’s internal consistency was assessed using Cronbach’s α coefficient, yielding a value of 0.960, indicating high reliability. Additionally, the Kaiser-Meyer-Olkin (KMO) test, which produced a KMO value of 0.814, confirmed the questionnaire’s satisfactory reliability and validity.

Single Item Knowledge Awareness Rate = Number of individuals who answered the item correctly/Total number of survey respondents ×100%; Correct Knowledge Awareness Rate = Number of correctly answered questions/Total number of questions×100%. According to the given criteria by Chinese CDC, the benchmark for compliance is: Correct Knowledge Awareness Rate > 80%.

The data collected through the electronic platform is the original data, and the results are presented as item options that need to be transformed for statistical analysis. Data entry was carried out by two skilled individuals utilizing EpiData 3.1 software, whereas the subsequent analysis of the data was performed using SPSS 26.0 software.

Descriptive statistics such as frequency and percentage were employed to delineate count data. Separate scores were calculated for questions related to knowledge, attitude, and behaviors. Score mean (SM) and standard deviation (SD) were computed for different subgroups on the basis of various categories. In order to analyze the disparities in the knowledge, practice, and attitudes concerning TB prevention and control amongst students from various categories, T-test and ANOVA analysis was undertaken. Statistical significance was determined at a significance level of p < 0.05.

Using the number of correctly answered items as the dependent variable and participants’ basic information as the independent variables, a multiple linear regression model was employed to examine the influencing factors of KAP relating to tuberculosis prevention and control among students. Gender (1 = male, 2 = female), grade (1 = freshmen, 2 = sophomores, 3 = juniors, 4 = seniors and above), place of origin (1 = rural areas, 2 = town areas), major (1 = medical, 2 = non-medical), whether received TB education (1 = yes, 2 = no), father/mother’s educational level (1 = junior high school and below, 2 = high school/vocational school/junior college, 3 = Undergraduate and above) are assigned as categorical variable and incorporated into the model as a dummy variable. A two-sided test was conducted at a significance level α = 0.05 to evaluate the model’s statistical significance.

The studies involving human participants were reviewed and approved by the Medical Ethics Committee of Hainan General Hospital (no. Med-Eth-Re [2022]752). Written informed consent to participate in this study was provided by the participants and, for participants under the age of 18, written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin.

In this study, a total of 280 questionnaires were distributed to participants, yielding 265 valid responses, indicating an effective response rate of 94.6%. The sample comprised 136 male and 129 female respondents. The respondents were all over 18 years old, with an average age of (21.58 ± 0.96) years. Geographically, 107 respondents were from rural areas, and 158 were from urban areas. Additionally, there were 121 respondents majoring in medical fields and 144 in non-medical fields. Detailed demographic information is presented in Table 1.

The findings reveal that the accurate knowledge awareness rate of college students regarding TB prevention and control is 46.79%. Of the 8 items assessing core knowledge of TB prevention and control among college students, the top three items with the highest correctness rates were “Older adult people and individuals with low immunity are susceptible to TB,” “The main mode of transmission of TB is through respiratory spread,” and “Individuals with symptoms suspicious of TB, such as coughing, sputum production for more than 2 weeks, or coughing up blood, should promptly seek medical attention at TB prevention and control institutions,” with correctness rates of 90.48, 85.71, and 80.95%, respectively. Conversely, the item with the lowest correctness rate was “The main strategy for TB prevention is to detect and treat infectious patients,” with a correctness rate of 36.81%. Detailed findings are presented in Table 2.

The findings from the survey of college students revealed that, out of the 9 items related to attitudes and practices in TB prevention and control, the three items with the highest correctness rates were as follows: “Students and teachers should proactively report suspected symptoms or diagnosis of TB and avoid concealing them,” “Avoid indiscriminate spitting,” and “Cover the mouth and nose with hands or a tissue when coughing or sneezing,” with correctness rates of 85.66, 84.90, and 79.62%, respectively. In contrast, the item with the lowest correctness rate was “Regular physical exercise,” with a correctness rate of 36.98%. Further details can be found in Table 3.

The findings reveal that students majoring in medical disciplines and those who have received tuberculosis health education exhibit higher levels of adherence to correct KAP concerning TB prevention and control. Furthermore, as college students progress through their academic years, they show increasing compliance with standards for correct attitudes towards TB. Additionally, students with parents possessing higher levels of education display greater adherence to standards for correct practice. These disparities are statistically significant (p < 0.05). However, there were no statistically significant differences observed in the levels of adherence to correct KAP among college students of different genders and ethnic backgrounds (p > 0.05). Refer to Table 4 for further details.

Table 5 displays the outcomes of a linear multiple regression analysis, which identifies the variables that impact students’ KAP regarding tuberculosis prevention and control. The analysis revealed that three variables significantly influenced students’ KAP in this area, accounting for 33.4% of the variance (F = 11.930; p < 0.001). These influential variables were Grade (β = 0.794), major (β = 0.545), and whether the students had received tuberculosis education (β = 1.260). Specifically, students in higher grades, those majoring in health-related fields, and those who had received TB education demonstrated better KAP in TB prevention and control.

The results of the study indicate that the accurate knowledge awareness rate of college students regarding TB prevention and control is only 46.79%, significantly lower than the target value of 80% set by the National Health Commission (18), which is consistent with the findings of Wu T and others (19, 20). Given that college students are among the high-risk groups for TB, the densely populated nature of college campuses poses potential serious consequences in the event of TB outbreaks (21, 22). Additionally, the unique tropical climate of Hainan Province, characterized by high temperatures and high water vapor pressure, can elevate the risk of TB incidence and transmission (14). Educating college students in Hainan Province about TB prevention and control is therefore paramount for establishing a robust campus health and safety system and enhancing public health safety management. Public health prevention agencies and campus administrators should prioritize the education of college students on TB prevention and control and implement diverse and efficient educational activities on campus. In light of the survey results, targeted promotional and educational initiatives should be developed, and regular educational activities should be organized for college students on campus, such as knowledge quizzes with incentives and community service engagement.

The study revealed that there is room for improvement in the overall habitual exercise patterns of college students. The research findings indicate that the aspect with the lowest adherence rate among college students in relation to TB prevention and control is “regular physical exercise,” standing at a mere 36.98%. This implies that the overall practice of regular exercise among college students is subpar. Telford DM contends that inadequate physical activity and prolonged sedentary practice have emerged as significant factors compromising the health of young individuals (22, 23). The “Chinese Children and Adolescents Physical Activity Guidelines” recommend a minimum of 60 min of moderate to vigorous physical activity daily to enhance the physical well-being of young people (24). The “Outline of Building a Strong Sports Nation” advocates for prioritizing school-based physical education as a key strategy for promoting youth health and implementing plans to bolster sports activities among the youth (25). Therefore, educational institutions should advocate the principle of “enhancing physical fitness through sports and building a robust nation through sports,” and fortify the physical well-being of young individuals through exercise to strengthen the campus health management system. College students are confronted with academic, employment, and emotional stressors, which contribute to their lackluster daily exercise habits (26). Hence, society and educational institutions can integrate physical activity with emotional regulation and stress alleviation to motivate students and optimize the efficacy of exercise.

The findings of the multiple linear regression analysis revealed significant associations between Grade (β = 0.794), major (β = 0.545), and the reception of tuberculosis (TB) education (β = 1.260) with student KAP scores in relation to TB prevention and control. Specifically, the results indicate that students in higher grade levels, those majoring in health-related fields, and those who have received TB education exhibit better KAP towards TB prevention and control. This aligns with the outcomes of previous research. Notably, a study conducted at a Jordanian university demonstrated that students enrolled in healthcare disciplines exhibited significantly higher KAP scores (9). This can be attributed to the inclusion of infectious disease education, including TB, in the healthcare curriculum, thereby enhancing students’ preparedness in tuberculosis prevention (14). Furthermore, healthcare students face an increased risk of TB exposure during their work in healthcare settings, which motivates them to actively seek out knowledge related to TB prevention (34). Consequently, students who have received TB education are found to possess superior KAP compared to those who have not. This finding is corroborated by the work of researcher Hassan AO, who similarly concluded that TB education positively influences students’ KAP related to tuberculosis (35). Based on these insights, it is recommended that universities devise interventions aimed at enhancing students’ KAP of TB prevention, potentially through integrating disease education with their course materials. Additionally, it was observed that students at higher academic levels exhibited better KAP than those at lower levels, as supported by a cross-sectional study in Namibia, which identified the student’s year of study as a significant factor influencing TB knowledge (36). Similarly, a survey conducted at Taif University found that students in the earlier stages of their academic journeys had inadequate KAP towards TB (22).

This study has illuminated the KAP surrounding TB prevention and control among college students in Hainan Province. However, several limitations should be noted. Firstly, the sample size of 265 respondents may not provide sufficient grounds for generalizing the findings to the entire student population. In addition, the demographic composition of the sample may not accurately reflect the diverse population of the province. Furthermore, the reliance on self-reported data introduces the potential for response bias and lacks validation measures. The cross-sectional design of the study allows for a snapshot of TB-related perceptions but hinders the ability to assess changes over time or establish causal relationships. While the study offers valuable insights, it is imperative to address these limitations by utilizing larger, more diverse samples and longitudinal designs to enhance the reliability and relevance of future research in this area.