Blood Donation Knowledge, Attitudes, and Practices Amid Instability: A Biphasic Cross-Sectional Study in West Bank, Palestine (2022 vs 2025).

Introduction: Blood supply shortages remain a pressing global health issue, particularly in resource-limited regions. The West Bank region in Palestine, characterized by frequent conflicts and instability, faces additional challenges due to its fragile healthcare system, where a substantial proportion of blood donations still relies on family-replacement donors rather than voluntary donations.

Objective: This study examines changes in knowledge, attitudes, and practices (KAP) related to blood donation among Palestinians from 2022 to 2025, aiming to guide strategies for a sustainable voluntary donation system.

Methods: A comparative cross-sectional survey was conducted in two phases during January to February 2022 and 2025 using cluster sampling, involving 1,270 adults (626 in 2022; 644 in 2025). Electronic questionnaires on KAP were distributed digitally. KAP scores, demographics, and donation behaviors were analyzed with t-tests, chi-square tests, and binary logistic regression to evaluate trends and predictors.

Results: Blood donation knowledge improved from 47.1% in 2022 to 50.9% in 2025 (p < .001). Positive attitudes were reported by 93.4% of participants, yet 77% had never donated. Voluntary donations accounted for 43.2% of donations, while family-replacement donations remained significant at 34.2%. Males were twice as likely to donate as females (adjusted odds ratio [OR] = 2.0, 95% confidence interval [CI]: 1.5-2.6; p < .001). Unemployed individuals (adjusted OR = 1.9, 95% CI: 1.1-3.2; p = .024) and general workers (adjusted OR = 2.7, 95% CI: 1.5-4.7; p < .001) donated more frequently than health professionals. Lack of opportunity was the main barrier to blood donation for 65.9% of nondonors.

Conclusion: Despite knowledge gains and positive attitudes, a significant gap remains between positive attitudes and actual donation rates, with family-replacement donations still comprising a substantial share. Targeted educational campaigns, improved access to donation facilities, and community engagement with healthcare stakeholders are essential to promoting voluntary donations in resource-limited and conflict-affected regions.