University-linked adults in Palestine show strong thalassemia awareness but low screening uptake

Adults recruited through university-associated networks in Palestine show substantial awareness of thalassemia and strong support for carrier screening, yet only a small minority have actually been tested, according to a cross-sectional survey published in BMC Public Health. The study, conducted online between 28 June and 26 July 2026, surveyed 1,103 participants and found that just 21.4 percent reported having previously undergone screening for the inherited blood disorder, despite 67.0 percent meeting a prespecified threshold for positive behavioral intention toward screening. The survey used an Arabic adaptation of a validated knowledge, attitude, and practice questionnaire.

Participants were recruited through university-associated networks targeting students and graduates, although the researchers note that current educational status and university affiliation were not recorded or independently verified. Women made up 70.1 percent of the sample, and 43.4 percent of respondents were aged 18 to 21 years. Using operational thresholds set at 75 percent, the researchers classified 49.9 percent of participants as having good knowledge of thalassemia, while 66.7 percent met the threshold for a positive attitude.

The gap between favorable attitudes and actual screening behavior was one of the most striking features of the results. Half of the respondents, 50.8 percent, reported having encouraged relatives to undergo screening, suggesting that participants see value in testing even when they have not pursued it themselves. Field of study emerged as a strong predictor of knowledge.

Participants from medical or health sciences disciplines were significantly more likely to meet the good knowledge threshold than those from other fields, an association that held after statistical adjustment. Age showed the most dramatic relationship with screening behavior. Compared with respondents aged 18 to 21, those older than 30 had an adjusted prevalence ratio of 6.11 for previous screening, with a 95 percent confidence interval of 4.21 to 8.85.

In other words, older participants were roughly six times more likely to report having been tested, a steep gradient across the age range. The authors caution that the mechanism behind this age gradient remains uncertain. Premarital medical examination is formally required in Palestine, and older adults may have encountered screening through marriage-related testing or other life-stage factors.

However, because marital status was not measured in the survey, this interpretation remains hypothetical rather than demonstrated. The study also found that region, residence type, and parental education were not significantly associated with any outcome after adjustment, suggesting that the observed differences were driven primarily by age and academic background. Thalassemia remains an important inherited blood disorder in Palestine, where carrier screening and genetic counseling are central to prevention efforts.

Although premarital examination is formally required, the study's background notes that access to comprehensive carrier screening and genetic counseling is uneven across the population. The research team, led by Amjad Ibrahim and colleagues, analyzed the data using modified Poisson regression with HC3 robust standard errors, reporting adjusted prevalence ratios for the primary binary outcomes. The authors emphasize an important limitation: the findings describe adults reached through university-associated networks and should not be interpreted as population estimates for Palestine more broadly.

Subject of Research: Thalassemia knowledge, attitudes, and screening behavior among adults recruited through university-associated networks in Palestine

Article Title: Thalassemia knowledge, attitudes, screening behavior, and behavioral intentions among adults recruited through university-associated networks in Palestine: a cross-sectional study

Article References: Ibrahim, A., Badawi, A., Bsharat, A., Badawi, M., Nazzal, J., Mosimi, R., Khderat, N., Dwiekat, H., Awwad, S., Salhab, A., & Amer, J. (2026). Thalassemia knowledge, attitudes, screening behavior, and behavioral intentions among adults recruited through university-associated networks in Palestine: a cross-sectional study. BMC Public Health. https://doi.org/10.1186/s12889-026-29703-0

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29703-0

Keywords: thalassemia, carrier screening, Palestine, cross-sectional study, genetic counseling, premarital testing, public health, university students, knowledge and attitudes, BMC Public Health, hemoglobinopathy, knowledge