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

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. 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. 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. 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. 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.