Tabriz University of Medical Sciences Health Promotion Perspectives 2228-6497 16 2 2026 08 21 Cognitive Determinants of Tuberculosis Preventive Behaviors in High-Risk Individuals: A Cross- Sectional Study in Iran 244 252 10.34172/hpp.45929 EN Towhid Babazadeh https://orcid.org/0000-0002-2172-6877 Erfan Saeedi Tazekand Sara Pourrazavi https://orcid.org/0000-0002-4036-8569 MohammadAli Dini-Ghareoghlan Masoomeh Gholizadeh Sana Saedi Khalil Maleki Chollou Elham Davtalab Esmaeili Journal Article 10.34172/hpp.45929 2026 05 06 2026 06 22 Introduction: Tuberculosis (TB) remains a major global public-health challenge, particularly among individuals at increased risk. This study aimed to identify the cognitive factors associated with TB preventive behaviors and assess their predictive power while controlling for sociodemographic characteristics. Methods: This cross-sectional study was conducted from April and August 2024 among 300 high-risk individuals recruited through multistage cluster sampling from four health centers in Sarab, Iran. Data were collected through researcher-developed questionnaires. Hierarchical linear regression and structural equation modeling were used to examine associations between cognitive factors and TB-preventive behaviors. Results: Cognitive factors were significantly associated with TB-preventive behaviors. Demographic characteristics explained 9.7% of the variance in preventive behaviors, and adding cognitive factors increased the explained variance to 32.4%. In the final regression model, health literacy (β=0.505, P=0.001) and attitude (β=0.103, P=0.046) emerged as the only significant cognitive predictors. SEM also showed a direct association between health literacy and preventive behaviors. Conclusion: Health literacy was the strongest determinant of TB-preventive behaviors among high-risk individuals. TB-control programs should prioritize health-literacy-based interventions and strategies that promote positive attitudes toward preventive practices in high-risk populations.