Date of Submission



Tuberculosis (TB) is a major public health threat, which is affecting a third of the world’s population and is reportedly the second most common illness causing death worldwide, secondary to HIV/AIDS. The developing world is mostly vulnerable, with factors like poverty, malnutrition, overcrowding, poor access to healthcare services, impact of HIV/AIDS and limited or lack of diagnostic facilities and trained healthcare personnel — all compounding the extent of this global epidemiology. This research was an exploratory enquiry on patients’ and nurses’ perceptions of factors that impact on TB care in Australia and Malawi. The main aim of this research was to investigate the factors that enhance and/or impinge on the provision of nursing care to TB patients from the perspectives of patients and nurses. A secondary aim was to develop a model of TB care to improve patients’ outcomes. This research design was cross-sectional utilising a mixed methods approach. The conceptual framework was primary health care. The methodological framework was critical paradigm. There were five methods, one quantitative and four qualitative. The largest research method was survey questionnaire. The qualitative methods were open-ended survey questionnaire comments, interviews, field notes/reflective journaling and photography. Patient data was collected from 44 participants in Australia and a further 150 in Malawi. Nurses’ data was collected from 26 participants in Australia and a further 20 in Malawi. Convenient sampling was applied. Descriptive and inferential statistics including multivariable logistic regression models were constructed to assess predictors of dissatisfaction from patients. The overall quantitative and qualitative results indicated that patients and nurses were dissatisfied with TB care in Australia and Malawi. Dissatisfaction was predominant throughout all components of care: healthcare systems, patients and nurses. Dissatisfaction has 4 embedded components: insensitivity and judgmental attitudes, inadequate resources, lack of knowledge and experience and nurses are ‘victims’. The results also revealed a second minor theme of satisfaction experienced by a minority of patients and nurses, primarily in Malawi. The quantitative results revealed there were no statistical significant differences in the demographic characteristics of Australian and Malawian patients. Multivariable logistic regression analysis controlled for covariates such as age, gender, marital status, employment status, being inpatient or outpatient, physical and mental wellbeing. Being inpatient and altered physical and mental health were the major variables that predicted dissatisfaction. Again, there were no statistical significant differences between the Australian and Malawian nurses in terms of their demographic characteristics. The level of education, qualifications, specialty of practice, duration of practice and infection control practices showed statistical significant differences. Based on the results and recommendations to improve care, a TB model of nursing care was developed. The model incorporates primary health care and health promotion principles. The model aims to give a voice to patients and change the status quo of this ‘marginalised’ group. It will therefore assist healthcare professionals to improve the health of TB patients.


School of Nursing, Midwifery & Paramedicine

Document Type


Access Rights

Open Access


319 pages

Degree Name

Doctor of Philosophy (PhD)


Faculty of Health Sciences

Included in

Nursing Commons


Research Location