Barriers to disease notification among primary healthcare physicians in West Bank, Palestine: a cross-sectional survey

Introduction Underreporting remains a persistent challenge for infectious disease surveillance systems. Evidence on notification knowledge and practices among physicians in the West Bank remains limited, although they play a critical role in disease notification. We aimed to assess the knowledge, attitudes, and practices of primary healthcare physicians in disease notification, identify factors associated with appropriate notification of suspected mumps, measles, and chickenpox cases, and describe barriers to notification. Methods We conducted a cross-sectional survey on primary healthcare physicians in the Palestinian Ministry of Health primary healthcare centers between August 2024 and May 2025. The questionnaire assessed knowledge, attitudes, and self-reported notification practices. Multivariable logistic regression was used to identify factors associated with recent notification practices. Results Among 223 respondents, 30.9% were categorized as having a good knowledge score of the disease notification process across multiple operational domains of disease notification, while 93.3% were categorized as having a good attitude score. Common misconceptions included laboratory confirmation being required for notification (61.0%) and that surveillance case definitions require laboratory criteria (65.5%). Over 80% of respondents notified their last-encountered measles, mumps, or chickenpox case. However, timely notification was lower; 52.4% of measles cases were reported immediately, compared with 19.3% of mumps and 14.0% of chickenpox cases reported within the recommended timeframes. Commonly reported barriers included lack of time (60.5%), and uncertainty about which diseases to notify (38.1%) and when (32.3%). Knowledge and attitude scores were not significantly associated with notification practices, although limited observations and composite scores may have obscured these associations. Physicians who received recent supervisory feedback on disease notification had higher odds of notifying chickenpox cases (OR: 4.01, 95%CI: 1.40-11.43). Compared to general practitioners, other medical specialties had lower odds of notifying mumps (OR: 0.21, 95%CI: 0.06–0.81) and chickenpox cases (OR: 0.23, 95%CI: 0.08–0.69). Conclusions Despite positive attitudes towards the notification system, knowledge gaps and misconceptions may contribute to underreporting of notifiable conditions. Strengthening training, clarifying guidance, improving feedback mechanisms, and addressing identified barriers and preferences may enhance disease notification performance by primary healthcare physicians in the West Bank.