Many of the problems of TB control are more human than technical, involving factors on both sides of the equation, representing the relation between the provision and administration of control measures, on one side, and the acceptance of such measures by the general population, on other. The present study identifies some of these behavioral factors on the basis of an analysis of the relation between the TB control program and local health behaviour in one low-income rural county in eastern Kentucky, USA, where TB death rates are still twice the national average.

Certain behavioural variables (cultural, social, psychologic, physiologic and physical environmental) impacted every step of the TB control process, from case finding to treatment and follow-up observation. Fundamental economic problems were found, both in the limited funds for health programs and personnel and, in the chronically depressed local economy that fostered low standards of living. In addition, the characteristic pattern of health behaviour proceeded from denial or acceptance of symptoms, through reliance on home or patent remedies or faith healing, to only partially accepted modern medicine. Therefore, it was determined that those aspects of TB control (the TB tests etc.) which required the least personal effort, the least modification of culturally sanctioned beliefs and the fewest rearrangements of customary social relations were most likely to be accepted and vice versa.