Congenital heart disease (CHD) is a major contributor to infant morbidity and mortality worldwide. Although prenatal screening, neonatal assessment, pulse oximetry screening, and routine pediatric evaluation contribute to CHD detection, some cases may remain unrecognized until after discharge or later in infancy. Parental recognition of warning signs may support timely healthcare-seeking, but it should be considered one component of a broader diagnostic and referral pathway. This study assessed parental knowledge, awareness, and intended healthcare-seeking responses toward CHD among parents in the West Bank, Palestine. A cross-sectional study was conducted among parents and primary caregivers in the West Bank, Palestine, between February and April 2026. Participants were recruited using convenience sampling and completed a structured Arabic questionnaire assessing sociodemographic characteristics, prior awareness of CHD, knowledge of CHD warning signs and risk factors, and intended healthcare-seeking responses to CHD-related symptoms. Composite knowledge scores were calculated for warning signs and risk factors. Non-parametric tests, Spearman’s correlation, and multivariable linear regression were used to examine factors associated with knowledge scores and their associations with intended healthcare-seeking responses. A total of 1,003 parents participated. Knowledge of CHD warning signs was moderate, with a median score of 6.0 out of 10, while knowledge of CHD risk factors was relatively higher, with a median score of 6.0 out of 9. Most participants reported appropriate intended healthcare-seeking responses, including immediate emergency care for cyanosis. However, gaps were identified in recognition of several clinical warning signs, particularly the misconception that cardiac murmurs always indicate CHD. Warning-sign knowledge was significantly associated with correct emergency response to cyanosis, likelihood of consulting a physician for feeding-related fatigue, and confidence in recognizing abnormal symptoms. Risk-factor knowledge showed weaker associations with intended responses. In adjusted analyses, prior awareness of CHD, self-rated CHD knowledge, and selected sociodemographic and informational factors were associated with knowledge scores. Among sampled parents in the West Bank, Palestine, CHD-related knowledge was variable, with persistent gaps in recognition of clinically important warning signs despite generally appropriate intended healthcare-seeking responses. Warning-sign knowledge showed stronger associations with intended healthcare-seeking responses than risk-factor knowledge. These findings suggest that future health education efforts may benefit from emphasizing recognition of CHD warning signs through primary healthcare services, community education, and digital platforms, while remaining integrated with screening, referral, and specialist cardiac-care pathways.
Swidan et al. (Tue,) studied this question.