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

Thalassemia remains an important inherited blood disorder in Palestine. Premarital medical examination is formally required, but access to comprehensive carrier screening and genetic counseling is uneven. Evidence among university students and graduates is limited. A cross-sectional online survey was conducted in Palestine from 28 June to 26 July 2026 using an Arabic adaptation of a validated knowledge, attitude, practice questionnaire. Adults were recruited through university-associated networks targeting students and graduates; current educational status and university affiliation were not recorded or independently verified. Prespecified operational 75% thresholds were used to classify good knowledge, positive attitude, and positive behavioral intention. Modified Poisson regression with HC3 robust standard errors was used for the primary binary outcomes, with adjusted prevalence ratios reported. Among 1,103 participants (70.1% female), 43.4% were aged 18 to 21 years, 49.9% met the operational threshold for good knowledge, 66.7% met the operational attitude threshold, and 67.0% met the operational behavioral intention threshold. Previous screening was reported by 21.4%, and 50.8% reported having previously encouraged relatives to undergo screening. The medical or health sciences field of study was strongly associated with good knowledge. Previous screening increased markedly with age (adjusted prevalence ratio: 6.11; 95% CI: 4.21–8.85 for > 30 vs. 18–21 years). Region, residence type, and parental education were not significantly associated with any outcome after adjustment. Participants showed high endorsement of several screening-related attitudes and future intentions, but previous screening uptake was low. The age gradient in previous screening could reflect premarital testing or other life-stage factors, but this interpretation remains hypothetical because marital status was not measured. These findings describe adults reached through university-associated networks and should not be interpreted as population estimates.