Screening practices, diabetic retinopathy knowledge, and conflict-related barriers to healthcare access among adults with diabetes in Palestine: a cross-sectional study

Background Diabetic retinopathy (DR) is a major preventable cause of vision loss. This study assessed DR-related knowledge and screening practices among adults with diabetes in Palestine and explored conflict-related barriers to healthcare access. Methods A cross-sectional survey was conducted from June to December 2025 using an Arabic questionnaire distributed in ophthalmic clinics and online. Knowledge was assessed as a continuous score (0–14) and analyzed using multiple linear regression analyses. Comprehensive screening practice was strictly defined as receiving a dilated fundus examination in the preceding 12 months. Multivariable models identified the independent factors associated with knowledge and comprehensive screening. Results A total of 740 participants were included (mean age 55.6 years; 59.9% female; 84.2% type 2 diabetes). The mean knowledge score was 10.65/14. Although general awareness was high, disease-specific knowledge and treatment awareness were limited. Multiple linear regression analyses (Adjusted R² = 0.432) demonstrated that higher education, urban residence, and higher income were significantly associated with higher knowledge scores. Notably, reporting conflict-related healthcare disruptions was independently associated with a 1.02-point increase in knowledge (p 0.001). While 75.0% reported any eye examination in the last year, only 30.7% reported receiving a comprehensive dilated fundus examination. The most common reason for not being examined in the last year was perceiving screening as unnecessary. Conflict-related reduced healthcare access was reported by 67.4%. In multivariable logistic regression analyses, urban residence and a history of eye disease were strong independent correlates of comprehensive screening adherence, whereas the conflict was not significantly associated (p = 0.681). Conclusions Despite high general awareness, gaps persist in DR-specific knowledge and in receipt of comprehensive retinal screening. Targeted education, standardized referral pathways, and accessible screening models are needed, particularly for rural and socioeconomically disadvantaged groups where structural and geographic barriers appear to outweigh the acute impact of healthcare disruptions on screening adherence.