Abstract
BACKGROUND: Beta-thalassemia major (β-TM) is a severe hereditary blood disorder, common in Palestine due to high consanguinity rates. Lifelong iron chelation therapy (ICT) is vital for managing iron overload from regular transfusions, but adherence remains a major challenge. OBJECTIVE: This study investigates factors influencing ICT adherence among β-TM patients in Palestine, focusing on sociodemographic, clinical, psychological, and healthcare-related aspects. METHODS: A cross-sectional study was conducted at the National Thalassemia Center, Nablus, from July 2024 to the end of October 2024, including 120 β-TM patients aged 3-33. Data were collected through structured interviews using a validated questionnaire covering demographics, disease knowledge, adherence, and satisfaction with healthcare. Adherence was based on missed doses and ferritin levels, analyzed using SPSS V21.0. RESULTS: 62.5% of patients were adherent, with ferritin levels ≤ 2500, while nonadherent patients had levels ≥ 2501 (p < 0.001). Although 98.7% of adherent and 100% of nonadherent patients had good disease knowledge, it did not predict adherence. Barriers included psychological distress (21.7%), medication side effects (16.7%), and inconsistent medication supply. Satisfaction with healthcare staff (p < 0.001) and socioeconomic status, particularly income (p = 0.014), significantly affected adherence. CONCLUSION: Adherence is influenced more by psychological, economic, and healthcare service factors than knowledge. A multidisciplinary approach-providing psychological support, stable medication access, and stronger patient-provider relationships-is essential to improve adherence and outcomes for β-TM patients in Palestine.