{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T04:24:34Z","timestamp":1768364674863,"version":"3.49.0"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Women's Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pelvic organ prolapse is a prevalent condition affecting women of various ages; however, many remain unaware of this health issue and its potential complications. This study aimed to assess the knowledge, prevalence of reported POP symptoms, and healthcare-seeking behaviour among women in the West Bank.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional study was conducted using a self-administered online questionnaire with a convenience sample of 317 women ages are 18 and older. Data were collected online via social media after contacting participants by phone and distributing a Google Form questionnaire. Data were analysed by using SPSS; Kruskal-Wallis and Mann-Whitney tests were also utilized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Approximately 208 (65.6%) of the participants exhibited a low level of knowledge regarding Pelvic Organ Prolapse. The prevalence of reported pelvic organ prolapse symptoms was 182 (57.4%). Notably, 151 (82.9%) of the women who reported symptoms did not seek health care accordingly. Factors such as body mass index, residency, stress incontinence, chronic constipation, irregular menstruation, and menopause showed significant associations with the prevalence of reported symptoms of pelvic organ prolapse.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Lower knowledge levels among Palestinian women were significantly associated with increased reports of POP symptoms, which correlated with limited health care-seeking behaviour. This issue is further complicated by cultural barriers to accessing care, political instability, limited availability of healthcare services, and varying levels of awareness among women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>The findings highlight an urgent need for collaboration among healthcare providers, policymakers, and community representatives to address cultural barriers and ultimately improve access to healthcare by designing culturally sensitive health promotion campaigns targeting women aged 30 and above.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12905-025-04023-4","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T09:49:48Z","timestamp":1761904188000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Women\u2019s Knowledge and Health Care-Seeking Behavior Regarding Pelvic Organ Prolapse in the West Bank, Palestine\u00a0"],"prefix":"10.1186","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-7854-3396","authenticated-orcid":false,"given":"Doha Khaleel","family":"Moheasen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0914-7653","authenticated-orcid":false,"given":"Ibtesam Medhat Mohamad","family":"Dwekat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7724-5407","authenticated-orcid":false,"given":"Maha Sudki","family":"Nahal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4815-2441","authenticated-orcid":false,"given":"Eman Awad","family":"Tayem","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"issue":"6","key":"4023_CR1","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1097\/SPV.0000000000000794","volume":"25","author":"Obstetricians","year":"2019","unstructured":"Obstetricians, A., Gynecologists. Pelvic organ prolapse. Female Pelvic Med Reconstr Surg. 2019;25(6):397\u2013408.","journal-title":"Female Pelvic Med Reconstr Surg"},{"issue":"1","key":"4023_CR2","doi-asserted-by":"publisher","first-page":"664","DOI":"10.21608\/ejhc.2021.145421","volume":"12","author":"R Fathi Mohammed","year":"2021","unstructured":"Fathi Mohammed R, D Mohammed M, Hassan Abd El-Rahim A. Determinants and symptoms severity of pelvic organ prolapse and its effect on physical activities among the elderly versus childbearing women. Egypt J Health Care. 2021;12(1):664\u201385.","journal-title":"Egypt J Health Care"},{"issue":"30","key":"4023_CR3","doi-asserted-by":"publisher","first-page":"E1013","DOI":"10.1503\/cmaj.230089","volume":"195","author":"LJ McLeod","year":"2023","unstructured":"McLeod LJ, Lee PE. Pelvic organ prolapse. CMAJ. 2023;195(30):E1013.","journal-title":"CMAJ"},{"issue":"3","key":"4023_CR4","first-page":"524","volume":"53","author":"Z Hadizadeh-Talasaz","year":"2024","unstructured":"Hadizadeh-Talasaz Z, Khadivzadeh T, Mohajeri T, Sadeghi M. Worldwide prevalence of pelvic organ prolapse: a systematic review and meta-analysis. Iran J Public Health. 2024;53(3):524\u201338.","journal-title":"Iran J Public Health"},{"key":"4023_CR5","doi-asserted-by":"publisher","DOI":"10.26355\/eurrev","author":"JF Shi","year":"2023","unstructured":"Shi JF, Xu WZ, Wang HF, Tao WK, Ren YX, Zhang T, et al. An evaluation of pelvic organ prolapses in perimenopausal and menopausal Chinese females. Eur Rev Med Pharmacol Sci. 2023. https:\/\/doi.org\/10.26355\/eurrev.","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"4023_CR6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12905-021-01245-0","volume":"21","author":"A Borsamo","year":"2021","unstructured":"Borsamo A, Oumer M, Asmare Y, Worku A. Factors associated with delay in seeking treatment among women with pelvic organ prolapse at selected general and referral hospitals of Southern Ethiopia, 2020. BMC Womens Health. 2021;21:1\u20138.","journal-title":"BMC Womens Health"},{"key":"4023_CR7","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1590\/s1677-5538.ibju.2018.0581","volume":"46","author":"AY Weintraub","year":"2019","unstructured":"Weintraub AY, Glinter H, Marcus-Braun N. Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse. Int Braz J Urol. 2019;46:5\u201314.","journal-title":"Int Braz J Urol"},{"key":"4023_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12894-015-0062-1","volume":"15","author":"HM Elbiss","year":"2015","unstructured":"Elbiss HM, Osman N, Hammad FT. Prevalence, risk factors and severity of symptoms of pelvic organ prolapse among Emirati women. BMC Urol. 2015;15:1\u20135.","journal-title":"BMC Urol"},{"key":"4023_CR9","doi-asserted-by":"publisher","DOI":"10.1177\/26334941241266921","volume":"18","author":"N Ejigu","year":"2024","unstructured":"Ejigu N, Seyoum K, Gomora D, Kene C, Mengistu S, Geta G, et al. Delay in seeking treatment and associated factors among women with pelvic organ prolapse in Bale zone, Southeast ethiopia: a hospital-based cross-sectional study. Ther Adv Reprod Health. 2024;18:26334941241266921.","journal-title":"Ther Adv Reprod Health"},{"key":"4023_CR10","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1016\/j.ejogrb.2019.01.017","volume":"234","author":"ED Dubinskaya","year":"2019","unstructured":"Dubinskaya ED, Gasparov AS, Babichev\u0430 IA, Kolesnikova SN. Questions surrounding the optimal time for surgical treatment of pelvic organ prolapse. Eur J Obstet Gynecol Reprod Biol. 2019;234:120\u20135.","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"4023_CR11","first-page":"174550652110722","volume":"18","author":"H Malaekah","year":"2022","unstructured":"Malaekah H, Al Medbel HS, Al Mowallad S, Al Asiri Z, Albadrani A, Abdullah H. Prevalence of pelvic floor dysfunction in women in Riyadh, Kingdom of Saudi Arabia: a cross-sectional study. Womens Health. 2022;18:17455065211072252.","journal-title":"Womens Health"},{"issue":"11","key":"4023_CR12","doi-asserted-by":"publisher","first-page":"1235","DOI":"10.1097\/gme.0b013e31826d2d94","volume":"19","author":"J Awwad","year":"2012","unstructured":"Awwad J, Sayegh R, Yeretzian J, Deeb ME. Prevalence, risk factors, and predictors of pelvic organ prolapse: a community-based study. Menopause. 2012;19(11):1235\u201341.","journal-title":"Menopause"},{"key":"4023_CR13","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1007\/s00192-005-0055-9","volume":"17","author":"DE Rizk","year":"2006","unstructured":"Rizk DE, El-Safty MM. Female pelvic floor dysfunction in the Middle East: a tale of three factors\u2014culture, religion and socialization of health role stereotypes. Int Urogynecol J. 2006;17:436\u20138.","journal-title":"Int Urogynecol J"},{"issue":"4","key":"4023_CR14","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1097\/NMD.0000000000001622","volume":"211","author":"S Ait Souabni","year":"2023","unstructured":"Ait Souabni S, Prasad S, Ahmed F, Belhaddad EH. The importance of sociocultural factors for understanding and managing genito-pelvic pain\/penetration disorder: the example of Muslim societies. J Nerv Ment Dis. 2023;211(4):327\u201333.","journal-title":"J Nerv Ment Dis"},{"issue":"1","key":"4023_CR15","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1186\/s12905-024-03360-0","volume":"24","author":"M AboAlheija","year":"2024","unstructured":"AboAlheija M, Masarweh E, Qasem Y, Hijaz H, Amer R, Shawahna R. Prevalence of stress urinary incontinence symptoms and their impact on the quality of life of Palestinian women: the first large cross-sectional study among the general population. BMC Womens Health. 2024;24(1):510.","journal-title":"BMC Womens Health"},{"issue":"3","key":"4023_CR16","first-page":"e61050","volume":"4","author":"R Orji","year":"2012","unstructured":"Orji R, Vassileva J, Mandryk R. Towards an effective health interventions design: an extension of the health belief model. Online J Public Health Inf 2012 Dec 30; 4(3):e61050.","journal-title":"Online J Public Health Inf"},{"key":"4023_CR17","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1186\/s12875-023-02248-6","volume":"24","author":"N Midjani","year":"2023","unstructured":"Midjani N, Hossaini FA, Sharifi N. Promotion of nutritional behaviors in the prevention of cardiovascular diseases: application of the health belief model in primary health care centers. BMC Prim Care. 2023;24:278. https:\/\/doi.org\/10.1186\/s12875-023-02248-6.","journal-title":"BMC Prim Care"},{"issue":"1","key":"4023_CR18","doi-asserted-by":"publisher","first-page":"18","DOI":"10.34172\/jech.2022.4","volume":"9","author":"FS Hosseini","year":"2022","unstructured":"Hosseini FS, Joveini H, Jahromi VK, Sharifi N. Prevention of self-medication in women of reproductive age based on a health belief model: a quasi-experimental study. J Educ Community Heal. 2022;9(1):18\u201325.","journal-title":"J Educ Community Heal"},{"key":"4023_CR19","doi-asserted-by":"publisher","first-page":"1559","DOI":"10.1007\/s00192-015-2695-8","volume":"26","author":"TF Vergeldt","year":"2015","unstructured":"Vergeldt TF, Weemhoff M, IntHout J, Kluivers KB. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J. 2015;26:1559\u201373.","journal-title":"Int Urogynecol J"},{"key":"4023_CR20","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1007\/s00192-016-3080-y","volume":"28","author":"L Ghandour","year":"2017","unstructured":"Ghandour L, Minassian V, Al-Badr A, Abou Ghaida R, Geagea S, Bazi T. Prevalence and degree of bother of pelvic floor disorder symptoms among women from primary care and specialty clinics in Lebanon: an exploratory study. Int Urogynecol J. 2017;28:105\u201318.","journal-title":"Int Urogynecol J"},{"issue":"7","key":"4023_CR21","doi-asserted-by":"publisher","first-page":"1529","DOI":"10.1007\/s00192-022-05417-w","volume":"34","author":"NZ Yohay","year":"2023","unstructured":"Yohay NZ, Cohen R, Hasan M, Daya K, Weiss A, Abukaf H, Yohay Z, Weintraub AY, Eshkoli T. Condition-specific validation of the Arabic version of the prolapse and incontinence knowledge questionnaire (PIKQ) among parturient. Int Urogynecol J. 2023;34(7):1529\u201339.","journal-title":"Int Urogynecol J"},{"key":"4023_CR22","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1007\/s00192-008-0742-4","volume":"20","author":"K Baessler","year":"2009","unstructured":"Baessler K, O\u2019Neill SM, Maher CF, Battistutta D. Australian pelvic floor questionnaire: a validated interviewer-administered pelvic floor questionnaire for routine clinic and research. Int Urogynecol J. 2009;20:149\u201358.","journal-title":"Int Urogynecol J"},{"issue":"1","key":"4023_CR23","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1186\/s41687-022-00459-6","volume":"6","author":"GT de Arruda","year":"2022","unstructured":"de Arruda GT, de Andrade DF, Virtuoso JF. Internal structure and classification of pelvic floor dysfunction distress by PFDI-20 total score. J patient-reported Outcomes. 2022;6(1):51.","journal-title":"J patient-reported Outcomes"},{"key":"4023_CR24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12905-018-0570-8","volume":"18","author":"FT Hammad","year":"2018","unstructured":"Hammad FT, Elbiss HM, Osman N. The degree of bother and healthcare seeking behaviour in women with symptoms of pelvic organ prolapse from a developing Gulf country. BMC Womens Health. 2018;18:1\u20137.","journal-title":"BMC Womens Health"},{"issue":"11","key":"4023_CR25","doi-asserted-by":"publisher","first-page":"e0207651","DOI":"10.1371\/journal.pone.0207651","volume":"13","author":"JL Gjerde","year":"2018","unstructured":"Gjerde JL, Rortveit G, Adefris M, Mekonnen H, Belayneh T, Blystad A. The lucky ones get cured: health care seeking among women with pelvic organ prolapse in Amhara region, Ethiopia. PLoS ONE. 2018;13(11):e0207651.","journal-title":"PLoS ONE"},{"key":"4023_CR26","doi-asserted-by":"publisher","first-page":"1263","DOI":"10.1007\/s00192-020-04309-1","volume":"31","author":"M Dheresa","year":"2020","unstructured":"Dheresa M, Worku A, Oljira L, Mengistie B, Assefa N, Berhane Y. Women\u2019s health seeking behavior for pelvic floor disorders and its associated factors in eastern Ethiopia. Int Urogynecol J. 2020;31:1263\u201371.","journal-title":"Int Urogynecol J"},{"issue":"14","key":"4023_CR27","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19148314","volume":"19","author":"M Nur Farihan","year":"2022","unstructured":"Nur Farihan M, Ng BK, Phon SE, Nor Azlin MI, Nur Azurah AG, Lim PS. Prevalence, knowledge and awareness of pelvic floor disorder among pregnant women in a tertiary centre, Malaysia. Int J Environ Res Public Health. 2022;19(14):8314.","journal-title":"Int J Environ Res Public Health"},{"key":"4023_CR28","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12905-019-0741-2","volume":"19","author":"P Abhyankar","year":"2019","unstructured":"Abhyankar P, Uny I, Semple K, Wane S, Hagen S, Wilkinson J, et al. Women\u2019s experiences of receiving care for pelvic organ prolapse: a qualitative study. BMC Womens Health. 2019;19:1\u20132.","journal-title":"BMC Womens Health"},{"issue":"08","key":"4023_CR29","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1055\/s-0039-1695002","volume":"41","author":"JF Fante","year":"2019","unstructured":"Fante JF, Silva TD, Mateus-Vasconcelos EC, Ferreira CH, Brito LG. Do women have adequate knowledge about pelvic floor dysfunctions? A systematic review. Revista Brasileira de Ginecologia e Obstetr\u00edcia \/ RBGO Gynecology and Obstetrics. 2019;41(08):508\u201319.","journal-title":"Revista Brasileira de Ginecologia e Obstetr\u00edcia \/ RBGO Gynecology and Obstetrics"},{"issue":"2","key":"4023_CR30","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1016\/j.ajog.2013.10.011","volume":"210","author":"CL Mandimika","year":"2014","unstructured":"Mandimika CL, Murk W, McPencow AM, Lake A, Wedderburn T, Collier CH, et al. Knowledge of pelvic floor disorders in a population of community-dwelling women. Am J Obstet Gynecol. 2014;210(2):165-e1.","journal-title":"Am J Obstet Gynecol"},{"issue":"5","key":"4023_CR31","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1016\/j.ajog.2013.06.001","volume":"209","author":"MM Good","year":"2013","unstructured":"Good MM, Korbly N, Kassis NC, Richardson ML, Book NM, Yip S, et al. Prolapse-related knowledge and attitudes toward the uterus in women with pelvic organ prolapse symptoms. Am J Obstet Gynecol. 2013;209(5):481-e1.","journal-title":"Am J Obstet Gynecol"},{"issue":"4","key":"4023_CR32","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1097\/SPV.0b013e318229dd5c","volume":"17","author":"L Hatchett","year":"2011","unstructured":"Hatchett L, Hebert-Beirne J, Tenfelde S, Lavender MD, Brubaker L. Knowledge and perceptions of pelvic floor disorders among African American and Latina women. Female Pelvic Med Reconstr Surg. 2011;17(4):190\u20134.","journal-title":"Female Pelvic Med Reconstr Surg"},{"issue":"2","key":"4023_CR33","doi-asserted-by":"publisher","first-page":"128","DOI":"10.15537\/smj.2023.44.2.20220510","volume":"44","author":"HM Elbiss","year":"2023","unstructured":"Elbiss HM, Rafaqat W, Khan KS. Prevalence of pelvic floor disorders in the Eastern Mediterranean region: a meta-analysis. Saudi Med J. 2023;44(2):128.","journal-title":"Saudi Med J"},{"key":"4023_CR34","doi-asserted-by":"publisher","first-page":"1925","DOI":"10.1007\/s00192-018-03859-9","volume":"30","author":"Z Li","year":"2019","unstructured":"Li Z, Xu T, Li Z, Gong J, Liu Q, Zhu L. An epidemiologic study of pelvic organ prolapse in rural Chinese women: a population-based sample in China. Int Urogynecol J. 2019;30:1925\u201332.","journal-title":"Int Urogynecol J"},{"key":"4023_CR35","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12905-020-00934-6","volume":"20","author":"AH Jokhio","year":"2020","unstructured":"Jokhio AH, Rizvi RM, MacArthur C. Prevalence of pelvic organ prolapse in women, associated factors and impact on quality of life in rural Pakistan: population-based study. BMC Womens Health. 2020;20:1\u20137.","journal-title":"BMC Womens Health"},{"key":"4023_CR36","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2023.1193069","volume":"10","author":"D Addisu","year":"2023","unstructured":"Addisu D, Mekie M, Belachew YY, Degu A, Gebeyehu NA. The prevalence of pelvic organ prolapse and associated factors in Ethiopia: a systematic review and meta-analysis. Front Med. 2023;10:1193069.","journal-title":"Front Med"},{"issue":"1","key":"4023_CR37","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/s12301-023-00383-1","volume":"29","author":"AN Fitri","year":"2023","unstructured":"Fitri AN, Kurniawati EM, Wiyasihati SI, Wungu CD. Risk factors of stress urinary incontinence in pelvic organ prolapse patients: a systematic review and meta-analysis. Afr J Urol. 2023;29(1):53.","journal-title":"Afr J Urol"},{"key":"4023_CR38","doi-asserted-by":"publisher","DOI":"10.1007\/s13224-021-01524-8","author":"MK Ansari","year":"2022","unstructured":"Ansari MK, Sharma PP, Khan S. Pelvic organ prolapse in perimenopausal and menopausal women. J Obstet Gynaecol India. 2022. https:\/\/doi.org\/10.1007\/s13224-021-01524-8.","journal-title":"J Obstet Gynaecol India"},{"issue":"1","key":"4023_CR39","first-page":"53","volume":"29","author":"MK Ansari","year":"2022","unstructured":"Brito LG, Pereira GM, Moalli P, Shynlova O, Manonai J, Weintraub AY, Deprest J, Bortolini MA. Age and\/or postmenopausal status as risk factors for pelvic organ prolapse development: systematic review with meta-analysis. Int Urogynecol J 2022 Jan 1:1\u20135.","journal-title":"Int Urogynecol"}],"updated-by":[{"DOI":"10.1186\/s12905-025-04243-8","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000}}],"container-title":["BMC Women's Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12905-025-04023-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12905-025-04023-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12905-025-04023-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T21:02:48Z","timestamp":1768338168000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12905-025-04023-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,31]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["4023"],"URL":"https:\/\/doi.org\/10.1186\/s12905-025-04023-4","relation":{},"ISSN":["1472-6874"],"issn-type":[{"value":"1472-6874","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,31]]},"assertion":[{"value":"28 January 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 December 2025","order":5,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Update","order":6,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The title of the article has been updated","order":7,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 January 2026","order":8,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Correction","order":9,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"A Correction to this paper has been published:","order":10,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"https:\/\/doi.org\/10.1186\/s12905-025-04243-8","URL":"https:\/\/doi.org\/10.1186\/s12905-025-04243-8","order":11,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical approval was obtained from the Ethical Committee at Al-Quds University in accordance with the Declaration of Helsinki, reference number 285\/REC\/2023. Informed consent for participation in the study was obtained from all participants.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"<!--Emphasis Type='Bold' removed-->Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that there is no competing interest in this study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"529"}}