S E T T I N G. 1 TB is a widespread global disease that affects family and social relationships and results in adverse health and economic consequences. 2,3 Individuals with TB and their families can experience prejudice and negative attitudes, such as shame, blame and a sense of judgment. [4][5][6][7][8] Enacted TB stigma refers to exclusion, rejection or devaluation by others against patients and their families based on beliefs of social unacceptability or inferiority. 9 Perceived TB stigma refers to patient and family fears of inferiority stemming from the anticipation of an adverse judgment related to a TB diagnosis. 9 TB stigma can be a barrier to early diagnosis and a deterrent to treatment adherence. 10-13 Multicountry studies comparing TB stigma suggest intra-and intercountry differences. 14-16 However, little is known as to how similarities or differences in the knowledge, attitudes and health responses of individuals or communities infl uence TB stigma. To reduce barriers to diagnosis and treatment pathways, TB stigma needs to be understood within the socio-cultural context. This will allow for control efforts to address stigma at the individual, community and system levels.The aim of this review was to describe the infl uence of stigma on knowledge, attitudes and responses to TB and to identify similarities and differences across countries. METHODSFor this review, the PubMed/Medline, Web of Science, Cochrane, PsycINFO and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched in January 2012. Medical subject heading (MeSH) terms included 1) 'tuberculosis' AND 'tuberculosis/psychology' and 2) 'prejudice' OR 'stereotyping' OR 'social perception' OR 'social stigma' OR 'social isolation' OR 'health knowledge, attitudes, practice.' Inclusion criteria were English language, peer-reviewed, original research using qualitative, quantitative or mixed methods, and study S U M M A R YCultural attitudes toward TB 169 fi ndings related to attitudes, beliefs or responses in relation to TB stigma. Exclusion criteria were intervention studies, review articles, dissertations, commentaries, letters and guidelines. The title and abstract were fi rst reviewed by one author, then both authors screened the remaining articles based on the inclusion criteria.The 'signal and noise' technique, a narrative interpretive method of systematic review and a technique that is intuitive and value-based, was used for study appraisal. 17,18 According to Edwards et al., the 'weight of evidence' in a topic area can be judged by assessing the 'signal' from available research publications and tempering the importance attached by the level of 'noise' (the inverse of methodological quality).' 17 The signal and noise evaluation technique is valid and reliable and can be applied to the 'qualitative overview' segment of systematic reviews. 17 As an alternative to evaluating the quality of studies, a signal score is used to assess the relevance of publications. The process does not eliminate research simply b...