Cultural differences have been shown to have an influence on outcome following traumatic brain injury (TBI). This study examined illness representations and the nature of beliefs about TBI in Botswana, a small middle income country in southern Africa. Participants included 26 people who had sustained moderate to severe TBI, 18 caregivers (all significant others) and 27 healthcare workers. A mixed-methods approach was utilised. Illness representations were assessed using the revised Illness Perception Questionnaire (IPQ-R), and beliefs and perceptions about cause of injury were established through semi-structured qualitative interviews. Results indicated that participants considered TBI to be chronic in nature and accompanied by serious consequences. Participants held positive attitudes about the manageability of symptoms despite having little understanding about TBI and its consequences. People with TBI tended to report fewer symptoms than did their caregivers. In addition, although some participants held concrete beliefs about the causes of injury, many participants attributed the injury to supernatural causes. Religious interpretations were also commonly held. Although age appeared to be associated with beliefs, no significant relationships existed between demographic factors and beliefs about the injury. This study highlights the importance of understanding the cultural perspectives of patients and their families in order to provide effective care.