High awareness, moderate knowledge, and prevention-oriented practices regarding β-thalassemia among young adults in Palestine: a cross-sectional study

BACKGROUND: β-Thalassemia is an inherited hemoglobin disorder caused by reduced or absent synthesis of the β-globin chain, leading to variable clinical severity and substantial lifelong health burden. Because prevention depends heavily on awareness, screening, and informed reproductive decision-making, understanding public knowledge, attitudes, and practices is essential for designing effective control strategies. METHODS: An analytical cross-sectional study was conducted between November 2025 and January 2026 using a structured, self-administered Arabic questionnaire distributed online through Google Forms. The survey was adapted from a previously validated thalassemia KAP instrument and disseminated using snowball sampling through social media platforms. The minimum required sample size was 358, calculated using a single-proportion formula with an expected awareness proportion of 36.8% from a previous young-adult β-thalassemia KAP study, 95% confidence level, and 5% margin of error. A total of 424 Palestinian participants were included in the final analysis. Participants who had never heard of thalassemia were classified as unaware and excluded from domain-based KAP scoring analyses. Knowledge, attitude, and practice domains were scored using Bloom's 60% cut-off criterion. Descriptive statistics, chi-square tests, t-tests, ANOVA, correlation analyses, and multivariable logistic regression were used for data analysis. RESULTS: Overall, 87.0% of participants had heard of thalassemia. Among aware participants (n = 369), 46.1% demonstrated adequate knowledge, 73.7% had a positive attitude, and 82.7% had positive practice. Knowledge was stronger for hereditary concepts, carrier status, and the role of consanguinity, but weaker for disease treatability, clinical subtypes, and prevention policies. Females had significantly higher knowledge and practice scores than males, while positive attitude did not differ significantly by sex. Previous screening uptake was limited, but endorsement of premarital testing, prenatal diagnosis, and knowledge sharing was high. Knowledge score was positively correlated with practice score and independently predicted positive practice (aOR = 1.35, 95% CI: 1.15-1.57, p < 0.001). Female sex, increasing age, and higher education were independently associated with adequate knowledge. CONCLUSIONS: Although awareness of beta thalassemia among Palestinian young adults was high, important gaps remained in functionally relevant knowledge and in the translation of preventive intentions into actual screening behavior. The independent association between knowledge and positive practice suggests that strengthening practical genetic literacy may be a key pathway for improving prevention-oriented behavior. These findings support the need for culturally appropriate educational strategies, premarital counseling, and community-based initiatives to enhance informed decision-making and strengthen thalassemia prevention efforts in Palestine. Nurse-led health education, premarital counseling, and accessible community-based screening may help translate awareness into informed preventive action.