Rare blood, rare voices: a participatory approach to advancing transfusion equity in the Bedouin community

Background: The shortage of Jr(a−) antigen-free blood donations among semi-nomadic Bedouin communities in Southern Israel represents a critical health equity challenge that disproportionately affects marginalized populations. This study employs a participatory approach to identify socio-cultural determinants affecting blood donation practices and develop culturally appropriate strategies for increasing rare blood type donations in this underserved community. Methods: Using a mixed-methods approach guided by participatory research principles, we conducted the research in three sequential stages: an introductory study to map the socio-cultural and structural context; qualitative research (ethnographic observations, interviews, and focus groups) to identify perceived barriers and enablers; and quantitative research (a culturally sensitive survey) administered to 100 community members to validate and measure the prevalence of the themes that emerged from the qualitative phase. Insights from each stage informed the next, ensuring that the final recommendations were firmly rooted in both community perspectives and empirical data. Results: Multiple intersecting barriers emerged, including gender-based modesty norms, religious interpretations, institutional mistrust, and accessibility challenges. Family consent proved pivotal, particularly for individuals with personal or familial exposure to transfusion needs. The findings revealed how power dynamics between healthcare institutions and the Bedouin community significantly influence health-seeking behaviors, with an absence of culturally appropriate health communication identified as a key structural barrier. Conclusion: These findings informed the development of a transformative strategic plan centered on community-led education, culturally responsive patient management, and periodic blood drives co-designed with community members. Addressing socio-cultural determinants of health through a participatory framework, provides actionable insights for advancing health equity in marginalized populations and offers a foundation for culturally competent public health interventions that recognize community agency and resilience. This study further contributes to the global understanding of how sociocultural inequities in minority populations affect access to critical health services such as blood transfusions.