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Assessment of Adherence to Iron Chelation Therapy Among Thalassemia Patients in Palestine
Hamzeh Al Zabadi1, Zein Ieran2, Ibrahim Taha3
1Public Health Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, State of Palestine, najah.edu.
Insights
Adherence to iron chelation therapy for beta-thalassemia major in Palestine is significantly impacted by psychological and economic factors, not just disease knowledge. Improving patient outcomes requires a multidisciplinary approach addressing these barriers.
Area of Science:
- Hematology
- Public Health
- Patient Adherence Studies
Background:
- Beta-thalassemia major (β-TM) is a severe inherited blood disorder prevalent in Palestine, often linked to high consanguinity rates.
- Lifelong iron chelation therapy (ICT) is crucial for managing iron overload in β-TM patients due to regular blood transfusions.
- Patient adherence to ICT is a significant challenge impacting treatment efficacy and long-term outcomes.
Purpose of the Study:
- To investigate the sociodemographic, clinical, psychological, and healthcare-related factors influencing ICT adherence among β-TM patients in Palestine.
- To identify key barriers and facilitators affecting medication adherence in this specific patient population.
- To provide evidence-based recommendations for improving ICT adherence and patient management.
Main Methods:
- A cross-sectional study involving 120 β-TM patients (aged 3-33) was conducted at the National Thalassemia Center in Nablus.
- Data were collected via structured interviews using a validated questionnaire assessing demographics, disease knowledge, adherence, and healthcare satisfaction.
- Adherence was determined by missed doses and serum ferritin levels, with statistical analysis performed using SPSS V21.0.
Main Results:
- 62.5% of patients demonstrated adherence, characterized by ferritin levels ≤ 2500, contrasting with nonadherent patients (ferritin ≥ 2501).
- High disease knowledge was prevalent (98.7% adherent, 100% nonadherent) but did not correlate with adherence.
- Key adherence barriers included psychological distress (21.7%), medication side effects (16.7%), and inconsistent medication supply; satisfaction with healthcare staff and income significantly influenced adherence.
Conclusions:
- ICT adherence in β-TM patients is primarily driven by psychological, economic, and healthcare service factors rather than disease knowledge.
- A multidisciplinary strategy is essential, encompassing psychological support, consistent medication access, and enhanced patient-provider relationships.
- Implementing these interventions can significantly improve adherence rates and health outcomes for β-TM patients in the Palestinian context.
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.
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