Knowledge, attitudes, and reported practices regarding the “Double D” injection (diclofenac + dexamethasone) among Palestinian medical trainees: a multi-institutional cross-sectional study

The intramuscular combination of diclofenac and dexamethasone, informally referred to as the “Double D” injection, is used for symptomatic treatment despite potentially additive gastrointestinal, renal, glycaemic, cardiovascular, and injection-site risks. Evidence regarding how medical trainees understand and encounter this practice is limited. We conducted a multi-institutional web-based cross-sectional survey of medical trainees at five Palestinian medical schools between 14 December 2025 and 6 January 2026. The bilingual, author-developed questionnaire underwent expert face and content review and an internal pilot. Knowledge was scored from 0 to 10 and attitudes from 9 to 45; practice-related experiences were analysed item by item. Multivariable linear regression examined continuous knowledge and attitude scores, and logistic regression examined ever administering, prescribing, or formally recommending the injection. All 400 eligible submissions were analysed. Overall, 252 (63.0%) participants had observed the injection in clinical settings, 151 (37.8%) had administered, prescribed, or recommended it during training, and 218 (54.5%) had personally received it. Mean knowledge was 6.19 ± 2.63 and mean attitude was 31.66 ± 4.55. Full-sample reliability was good for knowledge (KR-20 = 0.804) and modest for attitudes (Cronbach’s α = 0.651). Only 107 (26.8%) reported that a clear indication was often or always documented or explained. Formal risk education was associated with higher knowledge (β = 0.62, 95% CI 0.19–1.04), and knowledge with higher attitude scores (β = 0.53, 95% CI 0.33–0.72). Neither knowledge (adjusted OR = 1.01, 95% CI 0.90–1.14; p = 0.858) nor attitudes (OR = 0.99, 95% CI 0.93–1.05; p = 0.697) were independently associated with participation. Observing use more than five times in the past month was strongly associated with participation (OR = 22.14, 95% CI 8.30–59.00). Palestinian medical trainees commonly reported exposure to the “Double D” injection. Knowledge estimates depended partly on scoring, attitude-scale reliability was modest, and documentation of indication was infrequently reported. These observational findings identify medication-safety education, indication documentation, and supervisor-led review as priorities for institutional evaluation; they do not establish that education changes behaviour.