الصحة العامة

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    Supportive Care Services and Quality of Life of Breast Cancer Patients in Governmental Hospitals of the South-ern West Bank PHD
    (Al-Quds Univeersity, 2025-08-24) Ibtisam Ahmed Issa Al-Titi; ابتسام أحمد عيسى الطيطي
    Background: Supportive care and quality of life (QoL) are crucial for positive breast cancer (BC) outcomes. However, there is a widespread lack of fulfilment regarding informational, physical, and psychological needs, and routine QoL assessments are rarely integrated into practice in Palestine. Addressing these gaps is vital, as the sys-tematic assessment of SCNs not only clarifies patients’ needs but also serves as a sig-nificant predictor of QoL. Aim: This research aims to assess supportive care services for women with BC in gov-ernmental hospitals in the southern West Bank and to evaluate their effect on patients' QoL, while analysing the influence of other important determinants Method: This research was conducted in governmental hospitals in the southern West Bank and included several complementary sub-studies. The first data collection phase was carried out between August 2023 and July 2024 and involved a cross-sectional survey of 362 women with breast cancer, as well as the follow-up of newly diagnosed patients (n = 147) throughout their one-year treatment trajectory. The second phase of data collection took place between November 2024 and January 2025, approximately one year after treatment completion. Across these phases, SCNs, coping strategies, spiritual well-being (SWB), and satisfaction with services associations with QoL at diagnosis and treatment were examined. Data were gathered through face-to-face in-terviews using validated study tools. Statistical analysis included descriptive statis-tics, bivariate tests, correlations, and multivariable models, with a significance level set at p < 0.05. Results: Unmet SCNs were highly prevalent in this study. 61% of the total sample and 83.5% of newly diagnosed women reported at least one unmet SCN need. The most affected domains were health system and information (93–95%), physical and daily living (90–93%), and psychological (75–86%). Intensive treatments such as chemotherapy and surgery increased physical and psychological needs, while family and social support reduced them. QoL at diagnosis was modest (global health mean, µ= 45.8), with relatively higher physical (µ =67.1), cognitive (µ=62.8), and role func-tioning (µ=58.6), but low emotional (µ=49.2) and social functioning (µ=34.5). Com-mon symptoms included fatigue (µ=44.67), insomnia (µ=44.7), and pain (µ=39.8). Younger, educated, employed, and married women with family support had better outcomes, while advanced disease, comorbidities, pain medication, chemotherapy, and mastectomy predicted poorer scores. After one year, body image remained mod-est (µ=43.2), while sexual functioning (µ=34.5), sexual enjoyment (µ=34.7), and fu-ture perspective (23.4) were particularly poor. Patient satisfaction strongly influenced QoL. Better communication, skilled nursing, and clean facilities were linked with im-proved body image and sexual functioning, as well as fewer systemic side effects, while poor access predicted more side effects. Coping and family support were pro-tective: positive focus and diversion predicted higher QoL, whereas maladaptive cop-ing reduced functioning. SWB was moderate (µ=29.7), highest for Faith (µ=11.3) and Meaning (µ=11.0), and lowest for Peace (µ=7.4). Higher SWB was associated with better body image, sexual functioning, and fewer systemic, breast, and arm symp-toms. Conclusion: This is the first comprehensive evidence-based research that assesses the supportive care services and QoL of Palestinian women with BC. Findings revealed a high burden of unmet SCN needs, particularly in informational, physical, and psycho-logical domains, with newly diagnosed patients at greatest risk. QoL was modest at diagnosis and remained compromised one year after treatment, especially in body im-age, sexual functioning, and future perspective. In addition, family and social support, education, positive coping strategies, satisfaction with care, and higher SWB im-proved outcomes. Integrating supportive care, psychosocial services, and culturally sensitive spiritual support into oncology practice is crucial to addressing these gaps and improving women’s overall well-being in a resource-limited, conflict-affected set-ting.
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    Pharmacogenomic and Clinical Factors Associated with the Side Effects of Fluoropyrimidines in Palestinian Cancer Patients PHD
    (Al-Quds Univeersity, 2026-01-10) Mohammad Khalaf Ali Dweib; محمد خلف علي اذويب
    Introduction: Fluoropyrimidines (FPs), a cornerstone of modern chemotherapy, remain among the most prescribed and cost-effective anticancer drugs used around the world. Between 10% and 40% of patients have severe and probably fatal toxicity in the first cycles of FP treatment. Deficiency in dihydropyrimidine dehydrogenase (DPD), caused primarily by pathogenic mutations in the DPYD gene, leads to impaired clearance of FPs and results in excessive accumulation of their toxic metabolites. Testing for DPYD mutations before the beginning of treatment has become an internationally recommended strategy. Other factors such as age, gender and using other drugs were found to affect the prevalence of FP toxicity. Despite the well-proven benefit of pharmacogenomic testing, many countries are still under-utilizing this testing due to many factors such as insufficient resources. Palestine represents the challenges faced by Low- and Middle-Income Countries (LMICs) in adopting pharmacogenomics in general. Aim: This study, through its comprehensive design, aimed to evaluate the importance of pharmacogenomic testing in improving the clinical outcomes of cancer patients in Palestine by exploring the knowledge of oncology specialists and cancer patients regarding pharmacogenomic testing and determining the relationship between DPYD mutations and other clinical factors and the occurrence of side effects of FP anticancer drugs. Methods: Study I was a cross-sectional study which utilized a survey distributed to oncologists, oncology residents, and clinical pharmacists across various hospitals in Palestine between February and May 2024. The questionnaire was adopted from a previous study conducted in Saudi Arabia and was slightly modified to suit the Palestinian context. Study II was also a cross-sectional study which utilized a survey distributed to cancer patients that were treated with chemotherapy at three outpatient oncology clinics in the West Bank, Palestine. The questionnaire was developed based on an extensive literature review of similar studies. In study III, DNA was extracted from blood samples of cancer patients that were using fluoropyrimidines using the salting-out method after using previously prepared standard buffers. Allele-specific Polymerase Chain Reaction (PCR) was performed in 25 µL reactions with appropriate master mix, primers, DNA template, and nuclease-free water. The DPYD activity score (AS) was calculated by assigning values to each allele (normal = 1, decreased function = 0.5, no function = 0) and summing both alleles. Clinical data and toxicity information were acquired through a standardized analysis of the patients' electronic health records (EHRs) by trained study team who were blinded to the group in which the patient was allocated. Severe adverse events comprised toxicities with a grade no less than 3 based on the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Results: Study I – Healthcare Providers The questionnaire was completed by a total of 106 healthcare providers (HCPs), consisting of 57.5% specialist physicians, 27.4% clinical pharmacists, and 15.1% resident physicians. More than 70% of participants stated that they had never undergone formal training in pharmacogenomics during their career. Around 80% of participants indicated knowledge of the mutation linked to DPD deficiency and its consequences for FP toxicity. Fewer than 50% of participants indicated that they consistently or occasionally screen for DPD deficiency prior to prescribing FPs. Only 5.7% and 6.6% of participants, respectively, reported the existence of standardized DPD testing and the Palestinian Ministry of Health's promotion of DPD testing before prescribing FPs. About 60% of individuals experienced significant toxicity associated with FPs, a rate considerably higher than the global average of 10–30%. A statistically significant difference was found between HCPs working in private hospitals and those working in governmental institutions in terms of their perception of the influence of DPD testing in clinical practice (p<0.05). No significant differences were seen in awareness of the most important DPYD mutations between groups of different years of experience, designation, nor hospital type (p>0.05). Study II – Patients The study included 368 participants with an almost equal gender distribution (52.4% female, 47.6% male). Only 19.8% of participants had heard of pharmacogenomic testing, and less than 5% had undergone any pharmacogenomic test. One-third reported no understanding of the nature of this test. About 40% of participants believed that pharmacogenomic testing can help doctors choose the best treatment, while 44% trusted its accuracy. Less than half (42%) of participants indicated that they would undergo testing if it was recommended by their physician. More than half of the participants (53%) were willing to pay for the test but 5.4% indicated that patients themselves should be responsible for paying for the test, with a mean WTP of around 230 NIS and a perceived reasonable cost of about 1307 NIS. Most of participants (74%) were willing to provide a blood sample for the test. Study III – Genetic and Clinical Data The study included 134 participants. A high number (85.1%) of participants were found to be normal metabolizers (AS: 2), while 13.4% were intermediate metabolizers (AS: 1–1.5), and 1.5% were poor metabolizers (AS: 0-0.5). The incidence of grade ≥3 side effects in the sample was 17.2%. Hand-foot syndrome and severe fatigue were the most common side effects. All patients who were poor metabolizers experienced side effects, compared to one third (33.3%) of the intermediate metabolizers and 13.2% of the normal metabolizers (p<0.05). Among mutation carriers treated without dose adjustment, 63.6% experienced side effects, while only 11.1% of mutation carriers with adjusted doses experienced side effects (p<0.05). Treatment was interrupted in 6.7% of the participants and completely discontinued in 7.5% of them. Hospitalization due to side effects and complications was reported in 9.7% of the cases. A statistically significant difference (p<0.05) was noted between patients who had a side effect and those who did not have a side effect among these clinical outcomes. Conclusion: These findings support the main hypothesis that DPYD mutations are connected to FP side effects and that genotype-based dosing can improve treatment safety. Palestinian patients demonstrated limited awareness, but moderate acceptance of the pharmacogenomic testing once given some information. Healthcare practitioners are generally well-informed about this important genetic component, nevertheless it is worrisome that fewer than 50% screen for DPD deficiency prior to prescribing. Routine DPYD testing and genotype-guided dosing could improve patient safety, reduce treatment interruption and hospitalization, and support precision oncology in Palestine.
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    Public Health Emergency Preparedness in the West Bank: A Qualitative Comprehensive Overview PHD
    (Al-Quds Univeersity, 2026-01-10) Reem Yacoub Ahmad Miqdadi; ريم يعقوب أحمد مقدادي
    Background: Emergency management is essential for safeguarding communities during crises. Nonetheless, phases of this process would involve distinct mechanisms to enhance the entire cycle. One primary focus is emergency preparedness. Public health emergency preparedness (PHEP) remains limited in conflict-affected health systems like Palestine. Despite multiple emergency responses, institutionalized preparedness mechanisms are weak. Aim: This study explores governance, capacities, and resources influencing PHEP in the West Bank. Methodology: A multi-phase qualitative design included 38 semi-structured interviews with policymakers, health providers, and non-health actors, one focus group with heads of hospitals, along with a review of 5 national and local emergency plans. Data were analysed thematically using MAXQDA and guided by the WHO strategic framework and resilience theory. Findings: The most important findings of this research focused on the fact that the current mentality towards emergency management in Palestine is one of response rather than preparedness, this is mainly linked to a broken cycle of emergency management, and perpetual emergencies in the Palestinian context as a result of protracted Israel occupation and settlor colonial expansion. The current plans are prepared only in the event of an emergency and are mostly response plans. The level of participation in these plans is weak, reflecting the weakness of coordination and partnership. However, the various response experiences evaluated reflect distinct strengths that can be built upon and leveraged in the future to develop a health system better prepared to confront all types of emergencies. The biggest problem identified by the research is the lack of a specific mechanism for documenting these experiences and investing them in building, developing, and exchanging expertise between institutions. The study also found that despite the presence of distinct capabilities within various sectors, there are no clear national mechanisms for conducting risk analysis, assessment, and risk communication with the community in emergency situations. This is also attributed to the lack of a specific budget allocated for emergencies within the government. Conclusions: This research stresses on the role of structural determinants on the ability of health systems to build effective and sustainable emergency preparedness in Palestine under the Israeli settler colonial project and sustaining its resilience. Though it highlights the opportunity to develop the capabilities of the Palestinian health system in the field of health emergency preparedness, and the importance of allocating a budget to emergencies during the preparedness phase. It also shows that the government should form a national body to lead the preparedness process with all its components, starting with the development of a comprehensive national plan for all sectors, with clarification of roles and responsibilities.
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    Lived experiences and quality of life among mothers of children with autism spectrum disorder: A mixed-method quasi- experimental Study in the West Bank, Palestine PHD
    (Al-Quds Univeersity, 2026-01-19) Bashaer “Mohammad Nathmi” Musa Al-Natsheh; بشاير "محمد نظمي" موسى النتشة
    Background: Autism Spectrum Disorder (ASD) presents severe challenges for caregivers, profoundly impacting mothers' quality of life (QoL). While this global impact is established, research on the lived experiences and QoL of mothers in the Palestinian context remains limited. A critical gap also exists in evaluating the effectiveness of support programs designed to improve maternal QoL within this unique sociocultural setting. Aim: This study aimed to: 1) explore the lived experiences of mothers raising children with ASD in the West Bank, Palestine; 2) assess their QoL and associated factors; and 3) evaluate the effectiveness of the 'Mindful Motherhood' support program in improving maternal QoL. Methodology: A mixed-methods design was employed. The qualitative phase used a phenomenological hermeneutic approach, conducting in-depth interviews with mothers of children (aged 4-12) with ASD to interpret their lived experiences. The quantitative phase began with a cross-sectional study (n=119) using the WHOQOL-BREF tool to assess QoL across physical, psychological, social, and environmental domains and identify associated factors. Subsequently, based on initial findings and expert consultation, a 12-week group-based 'Mindful Motherhood' intervention was developed. A quasi-experimental design was employed to evaluate the intervention's effectiveness. Fifty-six mothers were assigned to either the experimental group (n = 28) or the control group (n = 28). QoL was measured at baseline, post-intervention, and at a six-month follow-up. Results: Qualitative analysis identified ten subthemes within the mothers' experiences, synthesized into three core themes: difficult and overwhelming experiences; caregiving challenges and burden; and building resilience. The cross-sectional study indicated a moderate overall QoL (M=2.85). The environmental domain scored lowest, followed by psychological and social domains, while the physical dimension was highest. Significant factors associated with QoL included mother’s age, education, family income, and sleep duration. The intervention study demonstrated significant improvements in all QoL domains for the experimental group compared to controls, with the largest effect sizes in psychological (|δ|= 0.70) and overall QoL (|δ| = 0.68). At the six-month follow-up, overall quality of life gains were largely maintained, though a slight attenuation of benefits was noted, most distinctly in the environmental and social domains. Conclusion: The findings highlight the difficult experiences and moderate QoL of Palestinian mothers of children with ASD, pinpointing environmental and psychological areas of greatest need. The 'Mindful Motherhood' program proved effective in enhancing QoL. The study underscores an urgent need for comprehensive, family-centered healthcare policies and sustainable support systems—including mental health services, socioeconomic aid, and tailored interventions—to improve the QoL of these mothers in Palestine.
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    Understanding the Determinants Influencing Decision-Makers’ Adoption of Public-Private Partnership Strategy in the Palestinian Healthcare Sector: A Mixed-Methods Study (PHD)
    (Al-Quds Univeersity, 2026-05-24) Mohammad Mahmoud Mustafa Baniode; محمد محمود مصطفى بني عودة
    Background: Public–Private Partnership (PPP) is increasingly recognized as a policy mechanism for improving efficiency, quality, and sustainability in healthcare systems, particularly in resource-constrained settings. Although PPPs are included in Palestinian health policy discourse, their implementation remains limited. This study examined the determinants of decision-makers’ intentions to adopt PPPs, as well as sectoral preferences and governance considerations influencing their implementation. Methods: A sequential exploratory mixed-methods design was conducted between 2023 and 2025. The formative phase involved 14 participants to refine the study focus and inform instrument development. The qualitative phase comprised 17 in-depth interviews with key informants from public, private for-profit, and private not-for-profit health sectors. Findings informed the development of a questionnaire grounded in the Theory of Planned Behavior (TPB). The quantitative phase included 163 senior decision-makers from 42 hospitals in the West Bank (71% response rate). Data were analyzed using thematic analysis, descriptive statistics, non-parametric tests, and Structural Equation Modeling (SEM). Results: The formative phase identified context-specific factors shaping PPP adoption and informed instrument development. Qualitative findings highlighted governance, financial, and operational challenges, including limited feasibility evidence, unclear stakeholder roles, weak coordination, and regulatory constraints. Sectoral differences were evident, with public-sector participants favoring regulated PPP models, private for-profit stakeholders preferring greater operational flexibility, and not-for-profit organizations emphasizing equity and access. Quantitative findings showed that Attitude toward the Behavior and Subjective Norm significantly predicted Behavioral Intention, whereas Perceived Behavioral Control and the mediating construct were not significant. The model explained 46.5% of the variance in Behavioral Intention (R² = 0.465). Policy analysis revealed broad support for management and service-operation PPP models in which government retains asset ownership while private partners manage service delivery. Full privatization was consistently rejected. Integration of findings indicated that PPP adoption is influenced by behavioral factors, governance arrangements, institutional readiness, and sector-specific preferences. Conclusion: PPP adoption intentions in the Palestinian health sector are primarily driven by attitudinal and normative factors, while implementation feasibility is shaped by governance and institutional conditions. Effective PPP development requires strengthened regulatory frameworks, improved inter-sectoral coordination, and context-sensitive partnership models aligned with stakeholder priorities.
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    Incidence, Prevalence, and Maternal Journeys: Investigating Preterm Births in the West Bank, Palestine -PHD
    (Al-Quds Univeersity, 2026-07-15) Amani Saleem Ahmad Salim; أماني سليم أحمد سليم
    Background: Preterm birth (PTB) is a leading cause of neonatal morbidity and mortality worldwide. In the West Bank, Palestine, limited evidence exists on PTB incidence, determinants, and maternal experiences. Aim: To determine the incidence, prevalence, risk factors, and neonatal outcomes of preterm births in the West Bank and explore mothers’ experiences caring for preterm infants in Neonatal Intensive Care Units (NICUs). Methodology: A multi-methods approach included three studies: (1) a hospital-based cohort of 18,760 live births (January 2023–May 2024) to assess PTB incidence and risk factors, (2) a cross-sectional study of 1,235 mothers (April–August 2025) examining prevalence, maternal characteristics, and neonatal outcomes, and (3) a qualitative study with 18 mothers exploring experiences in NICUs. Quantitative analyses used descriptive statistics and multivariable logistic regression; qualitative data were analysed using content analysis. Results: In the cohort, 1,427 (7.6%) births were preterm, mostly moderate to late preterm (7.0%). Higher PTB risk occurred in mothers <20 (aOR 1.53) or ≥35 years (aOR 1.32), male infants (aOR 1.16), and multiple pregnancies (twins aOR 4.98; triplets aOR 17.28). Ramallah had the highest PTB rates (aOR 23.5). In the cross-sectional study, PTB prevalence was 14.1%, with 75.3% moderate to late, 16.1% very, and 8.6% extremely preterm. Significant risk factors included maternal age 19–34, household size <3, history of stillbirth (aOR 9.84), assisted conception (aOR 2.18), short interpregnancy interval (aOR 1.89), chronic disease (aOR 3.50), PROM >18 hours (aOR 3.00), preeclampsia (aOR 3.33), antepartum hemorrhage (aOR 2.93), placental abnormalities (aOR 5.97), miscarriage history (aOR 3.55), and one prior caesarean (aOR 1.90). Primigravida women had lower odds (aOR 0.42). Safe healthcare access was protective (aOR 0.67). Preterm infants were more likely to be admitted to NICU (19.0% vs 8.5%) and had low/very low birth weight (43.7% vs 7.6%). The qualitative study revealed one overarching theme: living between fear and hope while struggling for maternal identity, with four main themes: (1) entering motherhood through emotional turmoil and perceived threat, (2) disruption and reconstruction of the maternal role, (3) navigating support and stress in interactions with healthcare providers, and (4) transforming maternal identity through meaning and strength. Mothers’ initial anxiety and identity disruption evolved into competence and adaptive coping via caregiving, professional/family support, and spiritual meaning-making. Conclusion: PTB in the West Bank is influenced by maternal, obstetric, and household factors and linked to adverse neonatal outcomes. Mothers face emotional and identity challenges, but can develop resilience through support and caregiving. Findings emphasize the need for targeted maternal–neonatal interventions and culturally sensitive NICU support.