Exploring Public Attitude and Barriers toward Thalassemia Screening Strategies: A Systematic Review of Qualitative Studies

Background: Over the last decade, several countries have sought to mitigate the rise in thalassaemia through preventive screening policies; however, incidence remains high. While existing studies, predominantly quantitative, have examined thalassaemia screening, limited attention has been given to synthesizing qualitative evidence on public attitudes and barriers. Consequently, a comprehensive qualitative synthesis is needed to inform contextually relevant, effective, and equitable screening strategies.Purpose: This review systematically explores public attitudes and barriers toward thalassaemia screening strategies (TSS).Methods: A literature search was conducted according to PRISMA guidelines using four electronic databases—Scopus, PubMed, ProQuest, and ScienceDirect—covering studies published in the last ten years up to July 2, 2023, using specific keywords. The study population included the general public or parents of children with thalassaemia or sickle cell disease, and studies that investigated attitudes or barriers toward thalassaemia screening. A thorough screening of abstracts and full texts was conducted based on predetermined criteria. Overall, 11 of 472 studies were selected for qualitative analysis. The quality of abstracts and full papers was reviewed using the CASP tool, and thematic analysis was conducted line by line with assistance from OpenCode 4.03 software.Results: The findings were mapped according to attitudes and barriers toward TSS. Five main themes emerged from the thematic content analysis: (1) negative attitudes influenced by cultural and personal factors; (2) inadequate family support and decision-making; (3) limited knowledge of hereditary and genetic conditions; (4) low self and parental awareness of thalassaemia; and (5) poor communication with healthcare professionals and barriers to screening accessibility.Conclusion: Various barriers at the individual, family, and health system levels suggest that thalassaemia screening is a complex sociocultural and behavioral issue, particularly at critical life stages such as the premarital period. Education on thalassaemia and genetic inheritance should be incorporated into youth programs prior to marriage. Family-centered interventions, training in nursing and health communication, and proactive counseling to encourage regular screening and integrate thalassaemia screening into primary care are crucial for future efforts.