SETTING: The Abagusii people in rural south-west Kenya. OBJECTIVE: To investigate tuberculosis (TB) treatment pathways and factors associated with treatment-seeking behaviour. METHOD: Quantitative data were obtained using a structured questionnaire administered to 100 household heads, while qualitative data were obtained from three focus group discussions (FGDs), six key informant interviews and seven case histories that focused on experiences of TB. RESULTS: Data reveal that patients follow oscillatory pathways in treatment seeking. Treatment-seeking behaviour is influenced by socio-structural and superstructural forces such as beliefs and perceptions regarding treatment and disease-causing factors. CONCLUSION: To improve TB treatment, these socio-structural and superstructural factors should be addressed.