literature review on blood donation

• Research article
• Open access
• Published: 08 February 2021

Promoting the propensity for blood donation through the understanding of its determinants

• Roberta Guglielmetti Mugion   ORCID: orcid.org/0000-0002-4976-9123 1 ,
• Maria Giovina Pasca 1 ,
• Laura Di Di Pietro 1 &
• Maria Francesca Renzi 1  

BMC Health Services Research volume  21 , Article number:  127 ( 2021 ) Cite this article

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The paper aims to understand the main antecedents related to the blood donation propensity related to both donors and non-donors. With our research, we will analyse the two perspectives to identify similarities and differences concentrating on the Italian context. Blood is a vital resource that strongly affects every national healthcare system’s efficacy and sustainability and the system’s ability to achieve the goal of universal coverage.

The purpose of this paper is to understand the main antecedents of citizens’ blood donation intention and the propensity to encourage communication about blood donation among both donors and non-donors. The Theory of Planned Behaviour is adopted as a theoretical lens. An empirical investigation was performed in Italy, adopting a mixed methods research design. First, a qualitative analysis was carried out through 30 in-depth interviews. Then, a survey was used to quantitatively investigate the intention to donate among both donors ( N  = 173) and non-donors ( N  = 87). A conceptual model was developed and tested through Structural Equation Modelling, developing a multi-group approach.

The present study confirms the relations proposed by the Theory of Planned Behaviour, even though some differences between the two groups are shown. The construct Information and Communication is crucial for donors, non-donors, whereas for non-donor inhibitors is vital. Service quality has an impact on the propensity to recommend and communicate the value of blood donation.

This paper reveals the main differences between donor and non-donor perspectives. Fruitful insights for enhancing blood donation awareness are provided.

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Blood is a vital healthcare resource that strongly affects every national healthcare system’s efficacy and sustainability and the system’s ability to achieve the goal of universal health coverage [ 1 ]. Unfortunately, blood is a limited resource that cannot be reproduced and presents a little lifecycle from donation to utilisation [ 2 ]. National governments must raise awareness of the phenomenon of blood donation by ensuring access to sufficient and safe blood. In Italy, donating blood is a voluntary, unpaid activity and anonymous as it is not possible to “address” the donated blood for ethical and safety reasons. Hence, it may be defined as a social activity that individuals carry out to contribute to human well-being [ 3 ] positively.

Although the WHO highlights that from 2008 to 2015, an increase of 11.6 million blood donations from voluntary non-remunerated donors was detected [ 4 ], blood demand is continuously increasing. It will continue to grow in the next decades due to both stricter parameters to assure the safety of collected blood [ 5 ] and the broader blood demand coming from, the older population [ 6 ]. As pointed out by Greinacher et al., all these aspects could generate a dangerous shortage of available blood [ 7 ]. Therefore, it is crucial to incentivise an increase in the number of citizens who voluntarily decide to contribute to donation, thus overcoming the deficiency of available blood and contributing to community well-being. In order to build a stable base of blood donors, there are the following two main strategies: i) recruiting new donors, particularly among young generations, and ii) retaining donors and increasing their frequency of donation [ 8 , 9 ].

As stated by the WHO and the International Federation of Red Cross and Red Crescent Societies (IFRC), “ building a sustainable base of safe blood donors requires a long-term approach, that requires not only the establishment of an effective voluntary blood donor program but also an improved public awareness of the importance of blood donation as a social norm ” [ 10 ].

Abbasi et al. [ 11 ] pointed out that “to meet the requirements for blood in developing countries, 1% of the population needs to donate blood”. They identified a substantial inequity in the attitude towards voluntary blood donation between developed and developing countries.

It is essential to emphasise that blood availability is fundamental in first aid services, surgery, the treatment of certain diseases (e.g., oncological diseases), transplants and transfusions. Thus, self-sufficiency is undoubtedly a crucial element both at the regional and individual hospitals, and hospitals have an increasing need for blood donations [ 3 , 12 , 13 ].

In the Italian healthcare sector, blood donation is a complex process in which several public and private stakeholders are involved, including public hospitals, donation associations, private foundations and citizens. Italian government states that blood donation is an unpaid activity for the engaged donors, which can only be compensated with low-cost services, small tokens, refreshments such as free breakfast or a discount voucher for theatres and cinemas. For this reason, legal action may be taken against anyone who donates blood for money (Art. 22, Law 219/2005). Hence the donation is considered a free, conscious and non-profit activity, carried out by voluntary non-remunerated blood donors (VNRD). The Italian Blood Volunteers Association (AVIS) have defined ethical requirements for becoming and being donors. To become a donor, it is necessary to be between 18 and 65 years old, weigh at least 50 kg, and present a doctor’s certification. Every year a donor can donate up to 4 times for men and woman not of childbearing age and two times for women in the childbearing age, with a minimum interval of ninety days (Ministerial Decree 25/1/01). The maximum blood which can be donated at one time is 450 ml ± 10%. It is estimated that 40 units of blood are needed per year for every 1000 people, that is about 2,400,000 units only for Italy. In 2019 in Italy, 1,683,470 blood donors and among these 213,422 were donors in the younger group (18–25 years), and the new donors were just over 362,000, down by 2.3% [ 12 ].

However, it appears that there is a lack of donors compared to the actual needs. Therefore, it is a priority to investigate the propensity for donation among citizens to plan awareness actions and to identify the key factors and an effective incentive system to promote donation. On this strength, this study’s primary purpose is to understand the main determinants of citizens’ intention to donate blood and their propensity to encourage word of mouth about blood donation to identify similarities and differences between donors and non-donors.

To achieve this goal, we developed an empirical study in Italy to understand the main determinants of the individuals’ intention for donating blood [ 14 , 15 , 16 , 17 , 18 ].. We integrated the TPB considering further variables [ 19 ] on the differences between Italian donors and non-donors. A mixed-methods approach [ 20 ] was adopted.

The paper is structured as follows. Section 1 presents the literature review, the research hypotheses, and the conceptual model proposed. Section 2 offers the methodological approach, including the research plan, data collection and analysis. The results of our empirical study are presented in Section 3. Section 4 provides a discussion and findings. Finally, Section 5 provides conclusions, future perspectives and managerial implications.

Main document

Literature review and research hypotheses.

Although there are many studies about blood donation, the majority of them were carried out in Anglo-Saxon countries [ 21 ]. There is a need to further investigate the phenomenon in other countries by developing empirical studies to analyse the main antecedents of citizens’ behavioural intention. The Theory of Planned Behaviour [ 14 ] has been primarily used to analyse blood donation intention, as it provides interesting insights for studying the phenomenon. Several researchers have reported that the TPB can be used to determine the predictors of blood donation [ 18 , 22 ]. In particular, Reid and Wood [ 9 ] recognise the TPB as “the more appropriate model for investigating blood donation”. Hardeman et al. [ 23 ] emphasise the TPB contribution to the study of behavioural change interventions when the motivation to act is not known [ 22 ]. It is necessary to consider three main factors for studying the intention to donate by using the lens of the TPB: attitudes (overall evaluation of a specific behaviour), subjective norms (beliefs about the importance of others’ approval), and perceived behavioural control (beliefs about the ability undertake the proposed behaviour). Through the lens of the TPB in the blood donation context, it is possible to notice that donation behaviour can be affected by a positive attitude towards donation, a positive evaluation of donation among others and the perceived control of the donation experience [ 24 ].

However, France et al. [ 25 ] stated that additional factors might affect people’s motivations and behaviours regarding blood donation, emphasising the need for new studies on this research topic. Similarly, Reid and Wood [ 9 ] suggested considering a broader set of variables to increase this research’s usefulness. In line with this view, several authors [ 22 , 24 , 26 , 27 , 28 , 29 ] proposed extended and more comprehensive versions of the model to increase its predictive power [ 21 ]. For instance, Armitage and Conner [ 18 ] believe that the personal moral norm, namely, the sense of moral obligation, strongly impacts the intention to become a blood donor. Some authors [ 18 , 22 , 24 , 30 ] that perceived behavioural control should be replaced by the construct of self-efficacy [ 31 ], that is, one’s perceived ability to perform the considered behaviour. To predict the intention to donate blood, Williams et al. [ 32 ] integrated the TPB with the self-determination theory (SDT) motivational variables proposed by Hagger and Chatzisarantis [ 33 , 34 ]. Following the authors’ idea, this theoretical integration offers a complementary approach to identify the elements of blood donors’ behaviour, discovering that autonomous motivation has a positive direct effect on intention, as well as indirect effects via attitudes, subjective norms and perceived behavioural control. France et al. [ 35 ] introduced the “blood donation satisfaction” dimension as an antecedent of donor attitude; similarly, Schreiber et al. and Thomson et al. [ 36 , 37 ] highlighted its influence on the retention of the donor’s status over time. The possibility of “helping other people” or “altruism” seems to be one of the most relevant motivations for both first-time and repeat donors to donate blood [ 6 ]. In light of the presented review, the TPB was adopted as the primary lens of our model to understand the determinants of blood donation, and we posit the following hypotheses:

H1: Attitude positively affects intention to donate .

H2: Subjective norm has a positive effect on intention .

H3: Perceived Behavioural Control has a positive effect on intention .

In literature, several authors call for a more in-depth and wider investigation to identify the elements that can motivate the citizens’, pushing them toward the blood donation [ 9 , 25 ]. For instance, some authors [ 24 , 38 ] have investigated the influence of donation knowledge on the intention to donate. It emerged that it is essential to create awareness around the donation, enhancing the dissemination of right and transparent information throughout an accurate communication. For instance, Williams et al. [ 32 ] suggested that developing “messaging designed to recognise and enhance an individual’s autonomy in deciding to donate again may be a more effective retention strategy than simply encouraging donors to return” [ 25 ]. Often, the lack of information on donating blood emerges as a reason for not donating [ 39 ]. WHO [ 10 ] states the role of communication is crucial to obtain the first donation and encourage first-time donors to return for repeat donations and generate a positive word of mouth (WOM). Indeed, communication is the core of a successful and sustainable blood donor program [ 10 ]. Effective communication strategies promote blood donation attitude [ 40 ]. For instance, the study conducted by Josefa et al. [ 41 ] highlights that the radiophone campaigns generate a change in the attitude to donate blood. Effective information and communication initiatives can then encourage people to change their behaviour by removing real or perceived inhibitors [ 41 , 42 , 43 , 44 ]. Communication strategies such as advertising, public relations, promotional campaigns, social media can play a crucial role in overcoming and mitigating these inhibitors to recruit and retain donors.

Moreover, Abbasi et al. [ 11 ] pointed out that social networks may play a crucial role in disseminating information, educating citizens, and sharing blood donation requests. In that sense, the role of traditional forms of communication should be strengthened by sharing information and experiences throughout individuals’ WOM and electronic WOM (e-WOM). Indeed, both WOM and e-WOM have a significant impact on consumer behaviour and decision-making [ 45 ] and a more significant influence on behaviour than other sources due to the reliability and flexibility of interpersonal communication and personal sources being viewed as more trustworthy [ 46 , 47 ]. To understand the contribution of communication in fostering the blood donation, the following research hypotheses are formulated:

H4: Communication positively influences attitude .

H5: Communication positively influences WOM .

H6: Communication affects Inhibitors.

Multiple studies have investigated how donation-related fear and anxiety can negatively affect both the recruitment and retention of new donors. Indeed, the fear of donating blood is one of the main deterrents of becoming donors. As stated by France et al. [ 48 ], it directly affects donor retention rates and an indirect effect on increasing the risk of syncopal episodes [ 49 ].

Blood donation inhibitors are classified into physical risks (transmission of disease), psychological (fear), social (moral responsibility or religious aspects) also defined as internal inhibitors and lack of time, inconvenient schedule and location classified as external inhibitors [ 50 , 51 ]. However, the most recurrent inhibitors that influence the intention to donate blood are fear of needles or fainting, the transmission of infectious diseases, pain when drawing and unpleasant sensations related to the withdrawal (fainting, weakness, nausea) [ 9 , 52 ]. To better understand the causes of fear and anxiety, it is useful to identify ad hoc strategies to attract new donors and keep them for years. In that sense, Charbonneau et al. [ 53 ] advise investigating the obstacles together with donors’ demographic characteristics. Thus, the following research hypothesis is stated:

H7: Inhibitors influence Intention .

Sueming et al. [ 6 ] noticed that existing donors play an essential role in informing and motivating new volunteers. Martín-Santana and Beerli-Palacio [ 54 ] and Gazibara et al. [ 55 ] tested that donor experience is a factor influencing intention to donate blood in the future recommend donating blood to friends and relatives. Indeed, a donor’s positive experience encourages to re-donate, and the donor is more likely to generate Word of Mouth (WOM), therefore encouraging and promoting to donate blood [ 56 ]. On this base, we decided to test the relation between the intention of blood donation and WOM positing the following hypothesis:

H8: Intention affects WOM.

Finally, this study identifies the role of service quality in the blood donation process identifying the critical aspects of donor experience. It’s crucial to provide an optimal donation experience to promote and incentive blood donation [ 56 , 57 ]. An effective and efficient donation system must consider and monitor service quality [ 55 , 58 ] to ensure donor loyalty and satisfaction. If the donor has an awful experience generated by excessive waiting times to donate, impure structures, absence of support during and after the donation, medical staff unqualified [ 59 ] will decrease donors’ satisfaction and loyalty.

Anyway, there aren’t contributions that investigate the effects of service quality on the propensity to generate WOM in blood donation context and thus, we stated the following hypothesis to address this gap:

H9: Service Quality has a positive effect on WOM.

Starting from the above assumptions and theoretical background, we highlighted extensive literature on blood donation. Still, several authors have asked for further empirical studies to identify a larger number of antecedents related to the intention to donate. Moreover, only a few studies have discussed the similarities and differences between donors and non-donors [ 19 ]. In particular, the study conducted by Bednall et al. [ 21 ] emphasises that no previous studies have explored the effect of knowledge and awareness on donation behaviour, particularly taking into account and comparing donors versus non-donors. Similarly, a lack of research aimed to investigate the contribution of service quality in fostering blood donation.

On this strength, our study aims to understand the main antecedents of citizens’ intention to donate and the propensity to generate WOM, namely the propensity to recommend and communicate the value of blood donation and compare these factors donors and non-donors. We proposed a conceptual model grounded on the TPB model [ 14 ] and including other relevant variables for the blood donation and communication, inhibitors, service quality and WOM.

We want to emphasise that the same hypotheses were tested for both donors and non-donors. The main assumptions for the decision to analyse the two perspectives are following explained. It is vital to elicit the donors’ antecedents because they can provide insights for re-donate; on the other hand, it is crucial the perspectives of non-donors because it allows acting on overcoming some potential barriers to potentially donating and re-donate. Since the two groups present a different starting viewpoint, we expect some differences in the antecedents emerged; thus, we would like to highlight them.

Figure  1 illustrates the hypotheses in the conceptual model.

Conceptual model and research hypotheses

Methodology

An empirical study was conducted in Italy to understand better how to enhance citizens’ intention to donate and understand their propensity to donate. A mixed-methods approach was planned and implemented. As highlighted by several authors [ 60 , 61 , 62 , 63 ], the mixed methods approach combines qualitative and quantitative techniques to provide a more extensive and multifaceted analysis of a phenomenon. For this reason, in the last decade, the mixed methods approach has considered a methodological pillar [ 63 , 64 ]. In particular, following the Priority-Sequence Model proposed by Morgan (1998) [ 20 ], a “qualitative preliminary approach” was adopted to guide the data collection in the principally quantitative step of the study.

Qualitative and quantitative surveys were conducted involving a sample of Italian citizens recruited in the country and did not receive any incentives for participating in our research.

The sample of the qualitative survey was composed of donors ( N  = 15) and non-donors (N = 15), while the quantitative survey sample was composed of donors ( N  = 173) and non-donors ( N  = 87).

Research design, data collection, and analysis

The qualitative research explores the phenomenon of blood donation by investigating multiple aspects among both donors and non-donors. In general, the purpose of the semi-structured in-depth interviews was to examine and analyse the blood donation phenomenon’s strengths and weaknesses and compare them across both groups. Accordingly, the interview was carried out following two semi-structured topic guides one for the donors and one for the non-donor. The semi-structured interviews were composed of 7 guiding questions that were chosen a priori to facilitate discussion and maintain consistency [ 65 ], allowing respondents to express themselves naturally. Additional aspects were explored when raised by the respondents [ 65 ]. The semi-structured in-depth interview guides (Appendix I) were structured as follows: first, general questions on the phenomenon were used for both groups, and then, some customised questions were posed based on the “status” of the respondent (donors/non-donors). In the donors’ case, the motivations for the experience of donations were investigated, whereas obstacles and shortcomings were examined in depth for the non-donors. In both cases, suggestions to increase the propensity towards blood donation were assessed.

After they donated at the blood transfusion centre of an Italian hospital located in Rome (Italy), the donors’ sample was selected. The non-donors were selected through a snowball approach [ 66 ]. In February 2018, by adopting the themes saturation criteria [ 67 ], 30 individuals underwent face-to-face in-depth interviews (15 = donors; 15 = no-donors). The interviews, approximately 30/40 min each, were audio-recorded, transcribed in verbatim and subjected to hermeneutical and analysed by content analysis [ 68 ]. Specifically, to analyse the qualitative data, we followed the four phases of content analysis: coding, categorising, thematising and integrating [ 68 , 69 , 70 ]. The MAXQDA18 software was adopted to manage and analyse the data, and we followed a rigorous process to reduce any potential research bias. First, the collected qualitative data were coded in parallel by two researchers; a third researcher performed a second comparison of the two results. Finally, the discussion and the interpretation of the content analysis were jointly performed by the three researchers.

Thereafter, integrating the literature review and the qualitative results, a quantitative analysis was planned to investigate the attitudes, motivations and behaviour of both donors and non-donors. Hence, two questionnaires were developed based on the TPB, previous studies on the same topic [ 19 ], and the qualitative analysis findings. The two questionnaires were structured in the same way; only three items slightly differ due to the specific status of donors and non-donors. Hence, eight common dimensions were defined: Attitude , Subjective norm , Perceived behavioural control , Inhibitors and obstacles to donat ing, Information and Communication , S ervice quality , Intention , Word Of Mouth . Both questionnaires were composed of 29 items. A seven-point Likert scale was adopted to gather responses (1=“ completely disagree” to 7=“ completely agree”). The dimensions and items proposed in the questionnaires are shown in Table  1 .

Both questionnaires close with an open question, aimed at allowing participants to explain the main motivations behind their behaviour to donate/do not donate. These two open questions were analysed by classifying and coding the motivations shared by the respondents.

The questionnaire was tested through a pilot survey on a sample of 30 respondents. The formulations of some questions were adapted to improve the clarity and consistency of items and dimensions. Then, the quantitative survey was administered via the web using the support of social networks and the institutional websites of blood donation associations and foundations (October–November 2018). The convenience sample used in this study was considered appropriate for addressing the aim of the research [ 71 , 72 ]. The sample size is suitable for testing the statistical significance of the hypothesised relationships for both the groups of donors and non-donors.

Here, the semantic meaning of the proposed dimensions is explained.

“Attitude” towards blood donation assesses whether a respondent believes that this activity is ethical, safe, useful, and a citizen’s moral and social obligation. “Subjective norm” considers beliefs about whether significant other people approve of and appreciate blood donation behaviour. Indeed, the construct is generated by the perception that other people appreciate blood donation and the recurrence of donating. “Perceived Behavioural Control” indicates the degree to which people think they can control a specific behaviour such as having the requisites and a lifestyle suitable for donating and not find it difficult to donate. “Information and Communication” assesses citizens’ perceptions of the need to increase donation awareness through mass media, promotional campaigns on social networks and educational initiatives in schools/universities.

“Service quality” assesses the perceptions attributed to the kindness, competence and availability of medical staff. “Inhibitors and obstacles to donating” assess some unpleasant sensations related to blood donation and personal fears related to blood donation (i.e., fainting, fear of the needle, the sight of blood, pain). “Intention” assesses the willingness to donate in the future (or for the first time) and more often but without receiving benefits (discounts, economic benefits, etc.) as the Italian regulation foresees it. “Propensity to Generate WOM”, is namely the propensity to recommend and communicate the value of blood donation to other people. Thus, this dimension assesses respondents’ intention to recommend blood donation to friends and family face-to-face and on social media and social networks.

According to data analysis, firstly, the reliability and validity of the multi-item scales were verified according to the internal consistency (Cronbach’s alpha) and the convergent validity through Average Variance Extracted (AVE) and Composite Reliability (CR) [ 73 , 74 ].

Then, the data analysis was carried out using the SPSS IBM 17.0 and Mplus 7 software packages [ 75 ]. Structural equation modelling (SEM) was used to verify the relations and test the conceptual model [ 76 ]. In particular, the multi-group SEM allows to simultaneously test the same model on multiple independent samples, based on the possession of a specific characteristic (donors, non-donors) [ 67 ].

This section presents the qualitative survey results (4.1) and the quantitative survey (4.2).

Qualitative results

During the preliminary qualitative phase of the analysis, 30 in-depth interviews were conducted (15 = donors; 15 = non-donors). The sample’s composition was balanced for pursuing explanatory power concerning different characteristics of the two distinct groups.

As shown in Appendix II, the sample of donor interviewees is composed of 7 males and 8 females, and the age range is balanced as follows: 18–25 (2); 26–35 (6); 36–45 (6); 46–55 (1). The majority of interviewees are regular donors (9); they donate 3–4 times a year. While the non-donors interviewed are 5 males and 10 females. The highest number of non-donors is found in the age groups: 18–25 (6); 26–35 (7); 36–45 (2).

During the analysis, the divergences of subjective interpretation and codification were discussed or reanalysed to solve the conflicting view [ 77 ]. The results were compared to identify the vital common aspects and priorities for both donors and non-donors.

The qualitative analysis’s main output has been summarised by developing a cognitive map for donors and non-donors (Figs.  2 , 3 ) and a table explaining donation meaning and motivations (Table  2 ).

Qualitative results: the donors’ cognitive map

Qualitative results: the non-donors’ cognitive map

The maps showed the three main cross dimensions from the qualitative interview analysis: i) Service quality, ii) Information and Communication and iii) Inhibitors to donation.

The main difference that emerged was related to the motivations at the basis of the process of donation. In particular, the Inhibitors play an important role for the non-donors, because they represent the intimate obstacles of individuals such as fear of the blood or fear for lack of safety etc.

The content analysis revealed that service quality aspects are pivotal for individuals engaged in the blood donation process. In particular, the donor respondents take into account waiting times to donate, the cleanliness of transfusion centres and the availability and professionalism of the medical staff (Fig.  2 ) (i.e. “When I donate I pay attention to whether medical staff are friendly and qualified, polite treatment and to tangible aspects such as the cleanliness of the facilities”). Moreover, the non-donors considered the security of transfusion centres and easy access to information about donation (e.g., places and times) as strengths of service quality (i.e. “The transfusion centres must guarantee the easy access to the donation centre and the easy-to-find information about places and times. Transfusion centres must also be safe and therefore guarantee hygiene and staff qualified”).

Indeed, the qualitative analysis shows that the low propensity to donate among non-donors is justified by intimate psychological factors (i.e., needles, infectious diseases, the sight of blood), the physical characteristics that inhibit donation (e.g., low blood pressure and abnormal blood levels), (i.e. “I can’t donate due to my health condition.” “The sight of blood is unpleasant and I’m afraid of needles and of infectious disease transmission”), the lack of communication and information about initiatives, the lack of interest and the lack of transparency in the system, which generates insecurity. Respondents argued that there is a low propensity to donate among young people due to the lack of information, disinterest and a loss of moral values. (i.e. “ It is necessary to meet young people and take initiatives in schools and universities to sensitise them to blood donation”). For donors, the main obstacles to donation are long queues, the location and accessibility of transfusion centres as well as lack of information and communication about blood donation events and initiatives. (i.e. “In small towns, people are not informed about the importance of donation. Donation initiatives are not advertised. Information is often not provided on the places, days and times to donate.”). Both donors and non-donors suggested promoting communication-related to blood donation events by using traditional WOM and advertising campaigns on social networks (e-WOM) and educational events in schools and universities. (i.e. “More communication and involvement in the donation are needed. Social media platforms and influencers should be used to receive and transmit information on blood donation campaigns and requests.”. “Given the lack of blood, the advertising campaign should be increased, especially in the summer, given the low number of donors.”).

As shown below (Table 2 ), both groups consider blood donation a personal responsibility (21) and a custom of altruism and generosity (18) that creates collective well-being. For donors, the donation is a moral obligation (6). Donors believe in the intrinsic values of donation (7); they donate to help friends/family (6) or for external influences (2) such as meeting new people, having a free check-up or obtaining social recognition among friends/family. The main motivations for not donating are fear (8), which includes fear of needles, the sight of blood, bruising and adverse reactions or the lack of requisites to donate (3). Besides, the non-donors do not donate due to the lack of transparency (2), which generates insecurity or is not interested in blood donation (2). Donors are perceived as people with a healthy lifestyle (20), people who are altruistic (12) and people who are responsible (7). Also, the non-donors perceive donors as courageous (3) and religious (2).

Quantitative results

The sample comprises 260 respondents, divided into donors ( N  = 173) and non-donors ( N  = 87). Next, the results of the collected data from the two questionnaires are shown.

Sample description

An overview of the sample characteristics is shown in Table  3 .

The sample of donors is composed of 173 respondents, including 87 males (50.3%) and 86 females (49.7%) who belonged to the 18–24 (17.3%), 25–34 (38.7%), 35–44 (18.5%), 45–54 (19.1%), 55–64 (5.8%) and over 65 (0.6%) age ranges. High school is the most common level of education (60.1%) of donors. A total of 57.2% of donors are civil servants, and 24.3% are students.

Regarding the donation career of respondents emerged that:

- 33 donors (10 males, 23 females) donate occasionally once a year;

- 53 respondents (12 males, 41 females) donate blood two times a year;

- 38 respondents (28 males, ten females) donate three times a year;

- 49 donors (37 males, 12 females) are regular donors (4 times a year).

The non-donors sample included 87 respondents, of which 65.5% were females, and 34.5% were males. The majority of the non-donor sample (52.9%) is in the 25–34 age range. The other respondents belonged to the following age ranges: 18–24 (23%), 35–44 (13.8%), 45–54 (5.7%), 55–64 (2.3%) and over 65 (2.3%). The majority of the sample had a bachelor’s degree (36.8%); 43.7% were civil servants, 34.5% were students, and 10.3% were unemployed.

The distribution of the respondents across Italian regions (Appendix III) shows that the significant number of respondents are Veneto (25.4%), Piedmont (17.9), Latium (17.9%) and Puglia (11.6).

Concerning the motivations behind the donation, from the analysis of the open questions, it emerged that the main aspects enticing donors to donate are the following: personal choice and beliefs (37%), educational activities (17%), to have accompanied relatives and friends to donate (13%), and sensitive campaigns (13%) (Table  4 ). In contrast, donating’s favourite locations seem to be schools and universities (45%) and ad hoc areas in the city centre (24%). For non-donors, the primary aspect that may encourage them to start donation dating is the needs of blood from friends and family members (54%) followed by sensitive companies (21%) (Table 4 ).

Donors’ and non-donors’ internal reliability and validity

Regarding the donor dataset, the internal reliability of each factor was calculated by using Cronbach’s alpha coefficient [ 78 ], and the construct validity Convergent Variance Extracted (AVE) and Composite Reliability (CR). All the data meet the criteria for acceptable reliability and validity: 0.7 for Cronbach’s alpha [ 73 , 79 , 80 ], 0.5 for AVE and 0.7 for CR [ 74 ]. Additionally, for the non-donor dataset, reliability and validity were calculated using the same measures.

As shown in Table  5 , the data meet the criteria for acceptable reliability and validity [ 73 , 79 , 80 ].

Structural equation models: a multi-group analysis

The conceptual model was tested with SEM using Mplus 7 software [ 75 ].

The adopted procedure is as follows. First, we separately developed models for Group A, i.e., the donors ( N  = 173), and Group B, i.e., the non-donors ( N  = 87). Then, we used the multi-group analysis to identify the main differences between the two independent samples simultaneously. The invariance between the two samples was tested by using multi-group SEM. The baseline model was fitted to the data on both groups simultaneously, χ2 (df = 715) = 1.326.504, p  < .01, CFI = .903, RMSEA = .080 (95% CI = 0.074 0.088), SRMR = .065, supporting the configural invariance hypothesis. Then, constraining the loadings between the groups yielded a nonsignificant increase of the CFI (ΔCFI = .003), providing support for metric invariance. Moreover, constraining the intercepts between the groups, we observed a small decrease in the CFI: (ΔCFI = .003). The model is assumed to be non-invariant if the decrease in CFI is larger than 0.002 [ 81 ] compared to the baseline model. We have not considered the difference between the chi-square of nested models considering the strong dependence of the chi-square on the sample size [ 82 ]. Thus, the hypothesis of scalar invariance can be accepted.

Hence, a graphical representation of the model is proposed. The robust estimator MLMV was used for continuous variables to correct covariance. Table  6 shows the results of the goodness-of-fit parameters. Then, a graphical representation of the measurement models is proposed for both groups.

The results of the SEM goodness-of-fit parameters are presented below (Table 6 ):

Root mean square error of approximation (RMSEA = 0.073; 90% C.I. = 0.066;0.080): acceptable according to Browne and Cudeck [ 83 ];

Critical fit index (CFI = 0.915): acceptable according to Bentler [ 84 ];

Tucker-Lewis index (TLI =0.901): acceptable according to Tanaka [ 85 ];

Standardised root mean square residual ( SRMR = 0.062): acceptable according to Hu and Bentler [ 86 ].

The analysis confirms that the χ 2 (chi-squared) value is significant with its linked probability value. The χ2 test was statistically significant, which indicates an unsuitable fit, even if, according to several authors, it needs to be compared with other indexes before rejection [ 85 , 86 , 87 , 88 ].

The other indicators of goodness of fit can be considered adequate since all the values fall within the thresholds suggested by the literature. The graphical representation of the model is shown for both groups: donors (Fig.  4 ) and non-donors (Fig.  5 ), including only the significant relations between factors ( p  <  0.05).

Quantitative results: The structural model of Group A (Donors). The structural equation model of Group B (Non-donors) for the prediction of blood donation determinants and WOM

Quantitative results: The structural equation model of Group B (Non-donors) for the prediction of blood donation determinants and WOM

Group A’s observed model shows that there is the covariance between Subjective Norm and Perceived Behavioural Control (β = 0.644), as in the model previously tested by Ajzen [ 14 ].

The observed model of Group B shows that there is the covariance between Subjective Norm and Perceived Behavioural Control (β = 0.603), as in the model previously tested by Ajzen [ 14 ], as well as between Perceived Behavioural Control and Communication (β = 0.524).

The results of the two groups are summarised in Tables  7 . It is possible to notice that the indicators have significant loadings on their assigned constructs. The residual variances are reported in Appendix IV.

The main results and the status of the research hypotheses for both groups are summarised in Table 8 .

Regarding the donors, all the proposed hypotheses are supported ( p -value < 0.005), except for H2, H6 and H7. The observed model in Group A (donors) shows that Attitude (β = 0.441) and Perceived Behavioural Control (β = 0.553) directly and positively influence Intention (H1, H3). Communication has a substantial impact on attitude (β = 1.005) and on Propensity to Generate WOM (β = 0.494) (H4, H5). The propensity to Generate WOM is influenced by intention (β = 0.216), Service Quality (β = 0.268) and Communication (β = 0.494) (H8, H9, H5). However, Subjective Norm (β = − 0.031) and Inhibitors (β = − 0.025) do not significantly affect intention to donate (H2, H7), and communication (β = − 0.066) does not significantly affect Inhibitors (H6) ( p  > 0.05). In particular, Subjective Norm does not affect Intention or Inhibitors. Besides, communication does not influence Inhibitors (β = 0.271).

Regarding the non-donors, all the proposed hypotheses are supported ( p -value < 0.05), except H1 and H7. In particular, the results reveal that Subjective Norms (β = 0.346), Perceived Behavioural Control (β = 0.410) and Attitude (β = 0.052) affect intention to donate (H2, H3, H1). Concerning the construct Attitude, its p-value can be considered marginally significant (p-value = 0.054), and for the principle of conservation, we decided to accept H1. Communication positively influences attitude (β = 1.000) and Inhibitors (β = 0.183) (H4, H6). Communication (β = 0.505), Intention (β = 0.174) and Service Quality (β = 0.209) affect Propensity to Generate WOM (H5, H8, H9). However, Inhibitors (β = − 0.039) does not affect the intention to donate (p-value = 0.493) (H7). In particular, Inhibitors is not a significant antecedent of the intention to donate among non-donor respondents.

Summarising, the donors group’s results show that Attitude and Perceived Behavioural Control are antecedents of intention to donate (again). Subjective Norm does not affect the intention. Moreover, the results reveal that Inhibitors influence neither intention to donate nor the WOM, which makes sense in donors’ case. Communication and information, which has no impact on Inhibitors, affect Attitude and Propensity to Generate WOM, affected by Intention and Service Quality.

While, the case of non-donor Attitude, Subjective norm and Perceived Behavioural Control directly influence the intention to donate (for the first time). Even among non-donors, Information and Communication predict both Attitude and Inhibitors. Regarding propensity to generate WOM, there are three main predictors: Intention, Service Quality and Communication. The non-donors’ propensity to generate WOM is affected by their intention and their importance to Service Quality. Among non-donors, attitude is even influenced by communication, and communication has a positive impact on Inhibitors and Propensity to Generate WOM.

Discussion and findings

The present paper proposes a conceptual model grounded on the literature and aimed to study the main determinants of the donation intention and the propensity to empower the donation WOM. Throughout adopting the mixed-method approach, qualitative and quantitative research was integrated to verify the model on two different groups: donors and non-donors.

The qualitative step of the research confirms the existence of multiple dimensions affecting the decision to donate for both groups, highlighting the importance to propose more complex model respect to the TPB [ 14 ] including further variables as suggested by other authors [ 9 , 25 ]. More specifically, the qualitative results confirm the importance of service quality to repeat and promote the donation [ 44 , 57 ]. Similarly, the qualitative analysis corroborates the presence of a long list of perceived inhibitors that hamper the donation and identified in the literature analysis [e.i. 41,43,48,49,50,51,53,58,59]. Finally, it seems to emphasise the central role of the information and communication processes in fostering both the retention and promotion of blood donation [e.i. 10,25,40,46,47]. These qualitative findings were used as input to develop the quantitative questionnaires aimed to test the proposed conceptual model. Indeed, the model was simultaneously tested on two independent samples of donors and non-donors, and the results are very interesting. The goodness of fit indexes can be considered adequate following the literature thresholds. Thus, the conceptual model is validated by our data. Some differences and similarities in the antecedents of blood donation are found between the two groups.

It is worth emphasising that our findings confirmed the relations identified by previous studies [ 14 ], namely, Attitude and Perceived Behavioural Control are predictors of intention for donors. In contrast, Attitude, Subjective Norm and Perceived Behavioural Control are the main predictors for non-donors. Unlike non-donors, donors decide to donate blood regardless of social influences. While, for non-donors, social influences affect the decision to donate, extending beyond the individual’s appraisals on blood donation and the perceptions of how difficult or easy it will be performing the donation.

These findings are aligned with previous studies that have implemented the TPB model for blood donation [ 18 , 22 ]. Nevertheless, some new constructs were included in the present study to fill the gaps in knowledge identified in the literature review [e.i. 9, 25].

Indeed, the present study suggests that Service Quality is an essential dimension for both donors and non-donors. Assessments of Service Quality include the individual’s perceptions of the kindness, competence and availability of medical staff, waiting times for donation, cleanliness of transfusion centres and ease of finding information on places and times where donation occurs. It is vital to enhance the propensity to generate WOM among donors. Indeed, donation centres need to improve the quality of their services to be more attractive to donors. The medical staff must be kind, available and organised to reduce waiting times. Donation centres should be clean and provide information on days and places where people can donate, preferably giving appointments to donors via the web. This is aligned with the hypothesis of Pagliariccio and Marinozzi [ 89 ] concerning the positive influence of donation satisfaction on the behaviour to donate again.

Moreover, our findings recognise that the construct Information and Communication is crucial for both donors and non-donors, indicating a need to sensitise and increase donation awareness through mass and social media by developing recruitment campaigns mainly on social networks and through promoting educational activities in schools and universities. Communication should promote donations mostly among young adults, provide clear and educative information, explain the process of donation and the concrete experience, describe legal health requirements, and ensure citizens that the donation process is safe. This centralised mass and virtual communication process could have a positive impact not only in engaging new donors among young people and millennials but also in recruiting previous donors.

Finally, Inhibitors that represent the unpleasant sensations related to the blood draw and personal fears related to the blood draw (i.e., fainting, fear of the needle, the sight of blood, pain) were not a significant direct predictor of intention in either group. Our results confirmed that the donors’ awareness of the importance to donate prevails over inhibitors for the donors’ sample. For the non-donors, a crucial role is played by the information and communication initiatives that can mitigate real and perceived inhibitors by encouraging people to recommend to friends/family and on social networks to donate.

Anyway, both groups are affected by Communication and Information that influence the Propensity to WOM. People who are inclined to Inhibitors are more difficult to be recruited and sensitised to blood donation. Although non-donors cannot be easily converted into donors because they cannot overcome those obstacles [ 90 , 91 , 92 ], information and communication could sensitise them to blood donation and overcome their limits.

Although they are non-donors, they can generate WOM for blood donation, by becoming vehicles of promotion. Moreover, non-donors are also susceptible to Subjective Norm that considers beliefs about whether significant other people approve of and appreciate blood donation behaviour. Even if they are not donors (for instance, for lack of requirements or fear), they may promote the importance of donating blood within their networks, particularly among those who have the specific features to become donors and, at the same time.

Originality and managerial implications

From an academic viewpoint, our study’s originality stands on the analysis of the blood donation phenomenon to understand the antecedents of citizens’ intention to donate and their propensity to recommend and communicate the value of blood donation. Also, the research proposes a combined analysis of two different groups: donors and non-donors.

Our findings show differences and similarities in the antecedents of blood donation among donor and non-donor groups. The study confirms the TPB’s appropriateness in analysing the blood donations phenomenon, introducing further relevant dimensions that have an important role as a determinant to donate and promote a positive WOM towards the donation. These dimensions are Attitude, Perceived Behavioural Control, Information and Communication, Service quality, Intention and WOM.

Our findings can also provide useful insights at different levels (macro, meso and micro) to promote blood donation.

At the macro level, including the government and policymakers such as the Health Ministry, our study highlights the vital role of information and communication for developing effective strategies to promote blood donations in the Italian community. Moreover, social media and networks can play a fundamental role in promoting blood donation activity through educational activities.

The macro-level role is crucial for proposing effective and efficient strategies able to promote blood donation as much as possible, orienting the meso level to take concrete actions to educate citizens, especially young people and millennials. The meso level is represented by companies, healthcare organisations, schools and universities. In the era of smart working and e-learning, the realisation and administration of educational videos and e-seminars on blood donation should be worthwhile for converting non-donors into donors and to reinvigorate previous donors. Moreover, a good campaign of communication could also be useful for acting on non-donors Inhibitors. The information and communication should be clear and detailed regarding the procedures and the safety of the process, guaranteeing safeguard and protections to donors. Furthermore, our study suggests to healthcare organisations and blood associations that the Service Quality of blood centres may influence the propensity to generate WOM, which indirectly promotes blood donation. Thus, it is crucial to invest resources in improving the service quality of blood centres.

Finally, at the micro-level, our results allowed us to understand better individuals’ behaviour related to blood donation for donors and non-donors. Our findings indicate the role of inhibitors that seem to be the strong barrier for non-donors, even though communication and information could support overcoming them in the long term.

Limitations and future perspectives

Despite the importance of this study’s main findings, some limitations exist and should be overcome by future studies. First , the present research was carried out before the COVID-19 pandemic. It could be interesting to repeat the analysis to investigate how and why the pandemic has affected the donation phenomenon, influencing the propensity and promotion of blood donation.

Second , both for the donors and non-donors the sample size is consistent with the proposed study’s explorative nature, even if in future research, the sample will be enlarged to enrich the proposed findings. Indeed, the sample only includes Italian citizens. Still, it can be enlarged to other countries since it can help investigate different cultural viewpoints, evidencing the normative differences among Countries. Indeed, as Suemnig et al. [ 6 ] stated, the factors that affect behaviours among donors and non-donors can vary based on sociodemographic features such as cultural background (age, gender, etc.). Hence, future research may investigate and compare the phenomenon in different cultural contexts to generalise the factors that encourage citizens to donate over time.

Abbreviations

Structural Equation Modelling

Self-determination Theory

Theory of Planned Behaviour

Word Of Mouth

electronic WOM

Word Health Organization

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We acknowledged FIDAS and Forlanini San Camillo Hospital and Veronica Orlandi for promoting the data collection.

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RGM had the original idea for the study and designed the quantitative research. LDP designed and collected data for the qualitative study. RGM and MGP analysed the quantitative data, LDP and MGP analysed the qualitative data. All authors contributed to the interpretation of datasets. RGM wrote the first draft of the paper, MGP, LDP and MFR commented on subsequent drafts. All authors have read and approved the final manuscript.

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The paper is aimed at understanding the main antecedents related to the blood donation propensity related to both donors and non-donors. With our research, we will analyse the two perspectives to identify similarities and differences concentrating on the Italian context.

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Guglielmetti Mugion, R., Pasca, M.G., Di Di Pietro, L. et al. Promoting the propensity for blood donation through the understanding of its determinants. BMC Health Serv Res 21 , 127 (2021). https://doi.org/10.1186/s12913-021-06134-8

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Baş, S., Carello, G., Lanzarone, E., Ocak, Z., Yalçındağ, S. (2016). Management of Blood Donation System: Literature Review and Research Perspectives. In: Matta, A., Sahin, E., Li, J., Guinet, A., Vandaele, N. (eds) Health Care Systems Engineering for Scientists and Practitioners. Springer Proceedings in Mathematics & Statistics, vol 169. Springer, Cham. https://doi.org/10.1007/978-3-319-35132-2_12

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A systematic review of incentives in blood donation

Affiliations.

• 1 Research and Development, Australian Red Cross Blood Service, Kelvin Grove, QLD, Australia.
• 2 Research and Development, Australian Red Cross Blood Service, St Kilda, VIC, Australia.
• 3 School of Psychology, McElwain Building, The University of Queensland, St Lucia, QLD, Australia.
• PMID: 29106732
• DOI: 10.1111/trf.14387

Background: Incentives are often used to enhance the effectiveness of recruitment and retention campaigns targeting blood donors. However, the degree to which incentives succeed in attracting and facilitating repeat donation is unclear. A systematic literature review, following PRISMA guidelines, investigated the existing empirical evidence regarding the use of monetary and nonmonetary incentives within blood donation.

Study design and methods: A comprehensive search of relevant databases identified a total of 71 papers for inclusion in the review for defining and operationalizing incentives (Objective 1), of which nine papers empirically investigated attitudes toward incentives (Objective 2), 31 papers investigated the impact on blood donation behavior (Objective 3), and eight papers investigated the impact on blood safety (Objective 4).

Results: Overall, research into the use of incentives in blood donation is limited, characterized by comparatively few studies, predominantly focused on whole blood donors, that are confounded by current operating context (paid or voluntary). No incentive has been identified that all segments of the nondonor and donor panel report positive attitudes toward, that has a positive impact on behavior, and that has no negative impact on blood safety. Certain incentives (i.e., discounts, tickets, gifts, and paid time off work) have the strongest evidence base for potential inclusion within voluntary nonremunerated (VNR) donation systems.

Conclusion: Due to the limited nature of the existing literature (particularly for apheresis donors) and inconsistencies observed within the results, additional research investigating the likely impact of introducing (or removing) monetary or nonmonetary incentives in VNR donor recruitment or retention is essential.

© 2017 AABB.

Publication types

• Systematic Review
• Blood Donors / psychology*
• Blood Safety
• Motivation*
• Program Evaluation
• Remuneration
• Volunteers / psychology

ORIGINAL RESEARCH article

Assessment of beliefs, behaviors, and opinions about blood donation in telangana, india—a cross sectional community-based study.

• 1 Volunteering Researcher in the Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
• 2 Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
• 3 Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Al-Madinah, Saudi Arabia
• 4 Pharmaceutical Care Division, King Saud Medical City, Riyadh, Saudi Arabia

Background and Objectives: Blood is an essential body fluid primarily required for regulating the body's systems and maintaining homeostasis. In developed and developing countries, concern about the demand and supply for blood is increasing. The current study aims to assess the beliefs, behaviors, and opinions of the public toward blood donation.

Methods: This was a cross-sectional study in which a self-created questionnaire with 17-items was used for data collection. The self-administered questionnaire was disseminated between November 2019 and January 2020 through social media (WhatsApp© and Facebook©). Data was analyzed using SPSS program version 26.

Results: A total of 356 questionnaires were completed with a response rate of 89%. The majority of participants were male 253 (71.1%), 336 (94.4%) considered blood donation important, 350 (98.3%) believed that blood donation saves lives, and 254 (71.3%) agreed to receive blood from voluntary donors. One-hundred sixty-seven (49.4%) were willing to donate blood voluntarily. The barriers to blood donation were fear of needles 86 (24.2%), fear of contracting a chronic disease 84 (23.6%), and lack of time 40 (11.2%). One day off (91.9%) and receiving a token 73.6% were common motivational factors for blood donation. Overall, 57% of the participants had favorable attitudes toward blood donation and 41.9% were knowledgeable. Favorable attitudes were significantly associated with being married ( P = 0.018) and having university level of education ( P = 0.005). Younger participants (18–29 years) had a statistically significant better knowledge than older participants (≥30 years).

Conclusion: The respondents displayed positive beliefs, opinions, and motivation toward blood donation. Additionally, most of them considered blood donation an important act and a national duty of every individual and are willing to donate in the future.

Blood is an essential body fluid primarily required for regulating the body's systems and maintaining homeostasis ( 1 ). However, the demand for a safe supply of blood is increasing on a daily basis internationally, and India is no exemption ( 2 , 3 ). Although previous studies reported that blood transfusions save millions of lives each year, the quality and safety of blood remain a serious concern, particularly in developing countries ( 2 – 4 ). Indeed, concern about the demand and supply for blood is increasing in developed and developing countries ( 5 , 6 ). However, out of 195 nations, the blood supply of 119 (61%) nations were found inadequate for healthcare needs ( 5 , 7 ). Interestingly, early findings indicated that India has the world's largest shortage of blood supply. Conversely, the prevalence of blood borne diseases in India is on the rise as blood is essential for the treatment of various diseases (e.g., sickle cell anemia), bleeding disorders (e.g., hemophilia), and cancer. Evidence indicates that India is home to major surgical procedures, such as ~230,000,000 operations, 331,000,000 cancer procedures, and 10,000,000 pregnancy-related operations, every year. Such procedures require a large amount of blood ( 7 , 8 ).

Blood donation is a pillar of modern medicine and saves millions of lives every year ( 7 , 8 ). Nevertheless, many hospitalized patients in low- and middle-income countries lack access to safe and free supply of blood in a timely manner. Previous studies estimated that out of the demand for 303 million units of blood worldwide in 2017, only ~272 million units were supplied. In the 119 countries with insufficient blood supply, the shortfall reached 100 million units ( 7 , 8 ).

Moreover, previous studies conducted in India evaluated the attitudes and motivational factors of the public toward blood donation and reported false beliefs among individuals regarding the effects of blood donation, such as infertility, loss of strength, early aging, and anemia ( 2 , 6 ). Similarly, studies from developed countries like America and Japan also reported similar barriers toward blood donation ( 9 , 10 ). However, another study by Shah et al. at a blood bank in a tertiary hospital in Mumbai reported laziness and fear of infection as the major factors for blood donation hesitation ( 11 ). In developed countries, published reports demonstrated that lack of access to blood donation centers was the main factor for blood donation hesitation ( 12 – 16 ). Additionally, barriers are different between genders. Failing to meet the eligibility requirements has been reported commonly by females while most males reported that they were never asked to donate blood ( 17 , 18 ).

According to estimates from the Central Drugs Standard Control Organization (CDSCO), the National Regulatory Authority (NRA) of India, Telangana has 151 blood banks comprised of both private and governmental blood banks, with Hyderabad having the most. Healthy adults between the ages of 18 and 75 who fulfill the donor eligibility requirements can donate blood ( 19 – 21 ). All blood banks are easily accessible to the general public, whether by walk-ins or by appointment ( 20 , 21 ). Additionally, the city has mobile blood banks making blood donation convenient for all citizens and aims to save lives by connecting donors to blood banks ( 22 ).

A dearth of literature exists in this regard, particularly in Telangana, a state in India. Furthermore, international studies on blood donation and its acceptance among the public are limited and evaluating public attitudes and motivations toward blood donation using different methods is required. In addition, the availability of a safe blood supply in healthcare centers is another challenge. Research focused on the attitudes, opinions, and motivations toward blood donation can provide an overall picture of the state of blood supply to healthcare centers not only in India but also across the world. Therefore, the aim of this study was to assess the beliefs, behaviors, and opinions of the general public toward blood donation in Hyderabad, the capital city of Telangana, India.

Materials and Methods

Participants and design.

A cross-sectional web-based community study was conducted among adults from November 2019 and January 2020 using a structured, self-administered questionnaire. The study included individuals from Hyderabad city, Telangana state, India who aged more than 18 years, who can read and understand the English language.

Sample Size Determination

The sample size ( N ) was based on the previous number of blood donors in India (89.5%) ( 2 ) and calculated as follows:

where N is the minimum sample size; z denotes the level of confidence according to the normal standard distribution that corresponds to the 95% confidence interval ( z = 1.96); p stands for the prevalence rate of blood donors (0.895); q = (1 – p ); and d pertains to the desired degree of accuracy or tolerated margin of error (5%; 0.05). Substituting these values into the equation, the following equation is derived:

Therefore, N = 356.

Questionnaire Design

A structured, self-administered questionnaire in the English language was prepared through an extensive literature review ( 12 – 15 ). The questionnaire was composed of the following demographics: age, gender, level of education, and employment status. The second part was intended to collect data on the attitudes, opinions, and motivations toward blood donation using 17 items with binary answers and multiple-choice questions. The questionnaire was assessed for the level of comprehensiveness, clarity, avoidance of ambiguity, and content validity by two senior researchers and one clinical pharmacy professor who were experts in the field. A pilot study was conducted on 10 randomly selected individuals who did not mention any suggestions or corrections related to the wording, length, and format of the questionnaire. The pilot results were excluded from the main findings. The reliability of the final questionnaire was assessed using internal consistency. The Cronbach's alpha value was 0.71, indicating an acceptable reliability of each item.

Data Collection

The final questionnaire Google Forms ® link was sent to the participants through WhatsApp© and Facebook© prefaced by the eligibility requirements of participation such as consent and age restrictions. The snowball technique was used to collect data, that is, one participant was requested to refer other individuals to participate. An invitation link containing the questionnaire was sent randomly to the participants without previous measures. First, the research team targeted friends and family members, explained the objective of the study through phone calls and messages, and invited them to fill and forward the questionnaires to family, friends, acquaintances, and any other eligible individual currently living in Telangana. Complete responses to the survey were considered written informed consent as the survey included a statement on consent. To facilitate completion, the respondents were sent frequent reminders about the importance of their participation and requested to submit the completed questionnaire.

Data Extraction

The submitted questionnaires were checked for accuracy and completeness. Missing or incomplete responses were excluded ( Figure 1 ).

Figure 1 . Flowchart of responses.

Data Analysis

Data were further extracted to exclude bias in sample selection, which was limited to only the central region, and analyzed using Microsoft Excel followed by a descriptive analysis. Categorical data were calculated as frequencies and percentages. The Statistical Package for the Social Sciences version 22.0 (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. A chi-square test was used to identify associations between variables. A difference with a P -value of >0.5 was considered statistically significant.

Participant Demographics

A total of 400 questionnaires were returned, out of which 44 (9%) were incomplete and thus excluded. Therefore, the final number of respondents was 356 for a response rate of 89%. The gender-wise greater proportion of the respondents were male 253 (71.1%), and the majority 291 (81.7%) were aged between 18 and 29 years. Of the 356 respondents, 233 (65.4%) were single, and slightly more than half 186 (52.2%) were unemployed. Most of the study participants, 282 (79.9%), were University graduates. Table 1 provides the demographics of the respondents.

Table 1 . Demographics of the participants ( n = 356).

Attitudes Toward Blood Donation

The majority of respondents 336 (94.4%) recognized the importance of blood donation. Nearly all the participants 350 (98.3%) stated that blood donation can help save lives, whereas 254 (71.3%) agreed to receive blood from voluntary donors. In terms of blood donation being a national duty, 203 (57%) agreed to the statement. However, slightly less than half of the respondents 167 (46.9%) would voluntarily donate blood if needed, whereas 171 (48%) may donate blood to friends and families in the future. Table 2 provides detailed information of the respondents' attitudes.

Table 2 . Attitudes and opinions toward blood donation ( n = 356).

Barriers Toward Blood Donation

Figure 2 describes the fears and misconceptions that prevent individuals from donating blood. Approximately one-fourth of the respondents 86 (24.2%) avoid donation for fear of needles, 101 (29%) reported no specific reasons, whereas 84 (23.6%) reported a fear of contracting chronic diseases. However, only 40 (11.2%) reported lack of time as the main barrier to blood donation ( Figure 2 ).

Figure 2 . Fears and misconceptions preventing donors from donating blood.

Knowledge and Motivational Factors

Approximately 49.7% of the respondents reported that a healthy person may donate once a year, whereas 14 and 11.3% answered twice and thrice a year, respectively. The majority (73.8%) preferred to donate in blood banks, whereas 83.1% of the subjects were not rejected for blood donation in the past year. Regarding motivational factors, the majority (91.9%) agreed that a 1-day leave should be provided as compensation, whereas 73.6 and 25% preferred that a token and money should be given as rewards, respectively. Furthermore, the majority (93%) agreed that blood donation is an important valuable act and reported satisfaction in donating blood as a means of helping friends and family members. Tables 3 , 4 provide detailed descriptions of the responses.

Table 3 . Knowledge and motivations about blood donation ( n = 356).

Table 4 . Factors motivating blood donation.

Married individuals had a statistically significant favorable attitude compared to single participants ( P = 0.018). Participants with a university level of education had statistically significant favorable attitudes compared to those with high school education ( P = 0.005) ( Table 5 ).

Table 5 . Cross-tabulation between demographic characteristics and attitudes categories.

Younger participants (18–29 years) had a statistically significant better knowledge than older participants (≥30 years). A statistically significant differences in knowledge categories were also reported among marital status ( P = 0.003), educational status ( P = 0.001) and employment status ( P < 0.001) ( Table 6 ).

Table 6 . Cross-tabulation between demographic characteristics and knowledge categories.

The respondents indicated positive beliefs, behaviors, and opinions toward blood donation. Furthermore, the majority agreed that blood donation is an important act and helps save lives. Additionally, nearly all respondents indicated willingness to donate if asked, and ~47% would donate blood as volunteers. The current results are better than those of previous studies conducted in the capital of India, where the authors reported that 69% of the respondents displayed positive attitudes toward blood donation and considered blood donation as the duty of every individual to the community ( 23 ). Joshi and Meakin conducted a study among Indian non-donors living in England and reported a variety of attitudes, but generally positive ones ( 4 ). Olaiya surveyed citizens in Nigeria, a developing country, and reported that 92.9% of the participants donated blood and demonstrated positive attitudes toward blood donation ( 24 ). However, Majdabadi et al. reported moderate attitudes among medical students in Tehran ( 6 ). Additionally, other previous studies proposed that increased awareness and motivational factors were associated with good knowledge and attitudes toward blood donation ( 6 , 12 , 24 – 26 ).

Previously published studies indicated an association between good knowledge, attitudes, and opinions toward blood donation and the availability and safe supply of blood in transfusion centers ( 12 – 15 ). This objective can be achieved further through increased awareness about blood donation and its importance and in-depth research on the motivational factors that encourage donors to donate. The present study found that one's fear of needles, fear of contracting chronic diseases, and lack of time were potential barriers that limit blood donation among the respondents. However, Shah et al. argued that fear of infection (21%), fear of needles (15%), and laziness were the major factors (46%) for the blood donation hesitancy ( 11 ). Similarly, a recent population-based study by Alfouzan et al. pointed to lack of time (45%) and access to blood donation centers (41.3%) ( 12 ). Karim et al. reported fear among Bangladeshi population ( 26 ). Interestingly, Dubey et al. reported that respondents were not requested to donate blood, which was considered the main potential barrier among respondents ( 2 ). Moreover, Abdurrahman and Saleh identified the side effects of receiving blood or blood components, health problems, fear of blood, medical errors, time restraints, lack of required conditions for donation, and fear of acquiring infections (e.g., HIV) as barriers among donors ( 13 ). The different types of fear among subjects, as reported by the present and previous studies, should be addressed by highlighting the importance of blood donation through programs that promote awareness, whereas misconceptions regarding infections due to blood donation should be elucidated through various educational programs about donation.

The current study demonstrated that the respondents held positive attitudes, opinions, and motivations toward blood donation in India. The findings were consistent with those of previous studies conducted in developed and developing countries and found overall positive and attitudes and perceptions toward blood donation ( 2 , 11 – 13 ). In the current study, however, the majority of participants were willing to donate blood if asked and nearly half would donate as volunteers. These findings supported Dubey et al., who stated that most potential donors (57.25%) would donate only if required for family or friends with self-sacrifice as a lesser priority (16%) ( 2 ). However, Abdurrahman and Saleh reported that 61.2% of participants revealed that their main goal for donation is helping others and saving lives, even individuals they do not know ( 13 ). Additionally, Dubey et al. found that 13.5% of the respondents were non-donors, where 7.75% agreed to donate to gain awareness about their HIV status ( 2 ). Lastly, non-monetary incentives, if carefully targeted, can attract and retain donors ( 2 , 15 ).

In the current study, the majority of respondents suggested a token, leave from work, and cash money as motivational incentives for donating blood. The results were comparable to those of Alfouzan et al. who reported 1 day off (81.4%), tokens (31.5%), and money (18.9%) as motivating factors ( 12 ). Similarly, Baseer et al. surveyed university students and identified that saving lives (98.4%), serving humanity (96.9%), and helping family and friends (95.3%) were the main motivations for donation ( 14 ). Karim et al. reported that family background, physical status, urgency for family, awareness/knowledge, and maturity level were the factors that increased participant willingness to donate ( 26 ). Irrespective of gender and age, individuals hold personal beliefs and misconceptions about donating and accepting blood anonymously ( 2 , 13 ). However, the respondents of the present study agreed with importing blood from abroad. Additionally, previous studies proposed that socio-demographic, organizational, physiological, and psychological factors may influence the decision of individuals to donate and accept blood ( 13 – 16 ). Many studies reported that blood donation is a religious duty, whereas the current results revealed that blood donation is a national duty ( 13 – 16 ). An encouraging fact observed in the study is that individuals are motivated to donate blood.

In this study being younger, educated, married, and employed were shown to have superior knowledge, whereas married individuals and those with higher education had more favorable attitudes scores. Melku et al. revealed similar findings in Ethiopia, with younger people being found to have more knowledge ( 27 ). Similarly, according to Javaeed et al., being a female gender was found to have a high level of understanding about blood donation ( 28 ). In Bangladesh, Karim et al. found that a parent's education was substantially related to the study participants' blood donation behaviors ( 26 ). This data revealed that the participants' education and age were important determinants in their blood donation decisions.

As such, creating awareness in the community and shedding light on the misconceptions about blood donation can aid healthcare facilities and the public in ensuring the availability of blood when needed. Such outcomes demand the need for additional educational and awareness programs specific to blood donation in Asian communities. In addition, this study proposes that increased knowledge about blood donation through education and awareness campaigns may encourage and motivate the general community and subsequently establish a sufficient supply of viable blood based on voluntarism, which is essential to the healthcare setting.

This study has strengths that should be mentioned. It is one of the first studies to be conducted in Telangana's capital, Hyderabad, which has the most blood donation centers. Secondly, it explored the motivations, perceptions, barriers, and possible strategies to mitigate blood donation hesitancy in one of the world's largest developing countries.

This study has some limitations. First, the study is limited to Hyderabad and included a small sample size; therefore, the findings are not generalizable to the entire state of Telangana. Second, the findings are reliant on the completion of the questionnaire, which may generate false answers and introduce the possibility of bias. Additionally, the study did not assess a full scope of motivational factors for blood donation (such as religion, socioeconomic status), also, the study did not collect past experiences with blood donation or transfusion, as participants who previously donated or received blood may have different attitude and knowledge compared to naïve donors. Lastly, most of the participants are young, and college educated, hence extrapolation to older generation and people with less than university education is limited. Given these limitations, the study suggests that future research should employ a larger sample size from various regions throughout India and reaching wider socioeconomic classes with a greater focus on the opinions, attitudes, and motivations as well as barriers toward blood donation. Future questionnaires should include additional motivational factors for donation and perceptions from historical donors.

The findings provide insight into the beliefs, behaviors, opinions, and motivations that are likely to encourage blood donation in Hyderabad. Importantly, the findings represent positive attitudes and motivation toward blood donation, which can provide reference for healthcare systems and blood banks in improving their supply and for supporting the development of programs that aim to ensure a sufficient supply of viable blood in a timely manner. Therefore, education programs that promote motivation and ensure a safe and healthy supply of blood should be advocated at both the national and global levels.

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics Statement

Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. The patients/participants provided their written informed consent to participate in this study.

Author Contributions

SW: conceptualization, data curation, formal analysis, and visualization. SS: writing—original draft preparation and review and editing. IS: funding acquisition and writing—review and editing. MM: formal analysis and writing—review and editing. GB and MA: writing—review and editing. All authors have read and agreed to the published version of the manuscript.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Acknowledgments

The authors extend their appreciation to the Deanship of Scientific Research at King Saud University for funding the work through the research group project No. RG-1441- 367. In addition, the authors thank the Deanship of Scientific Research and RSSU at King Saud University for their technical support.

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Keywords: attitudes, motivation, blood donation, Indian adults, fear for needle

Citation: Samreen S, Sales I, Bawazeer G, Wajid S, Mahmoud MA and Aljohani MA (2021) Assessment of Beliefs, Behaviors, and Opinions About Blood Donation in Telangana, India—A Cross Sectional Community-Based Study. Front. Public Health 9:785568. doi: 10.3389/fpubh.2021.785568

Received: 29 September 2021; Accepted: 15 November 2021; Published: 09 December 2021.

Reviewed by:

Copyright © 2021 Samreen, Sales, Bawazeer, Wajid, Mahmoud and Aljohani. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Syed Wajid, wali@ksu.edu.sa

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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Original research

Knowledge of blood donation and associated factors in ethiopia: a systematic review and meta-analysis, addisu getie.

1 Nursing, Woldia University, Woldia, Ethiopia

Adam Wondmieneh

Melaku bimerew, getnet gedefaw.

2 Midwifery, Woldia University, Woldia, Ethiopia

Asmamaw Demis

Associated data.

bmjopen-2020-044343supp001.pdf

All data relevant to the study are included in the article or uploaded as supplementary information.

To assess the level of knowledge about blood donation and associated factors in Ethiopia.

Systematic review and meta-analysis.

Both published and unpublished cross-sectional studies on the level of knowledge about blood donation in Ethiopia were included. Articles from different databases such as PubMed/MEDLINE, HINARI, EMBASE, Scopus, Google Scholar and African Journals Online were searched. Cochrane I 2 statistics were used to check for heterogeneity. Subgroup and sensitivity analyses of evidence of heterogeneity were carried out. Egger’s test with funnel plot was conducted to investigate publication bias.

Twenty cross-sectional studies with a total of 8338 study participants (4712 men and 3626 women) were included. The overall nationwide level of knowledge about blood donation was 56.57% (95% CI 50.30 to 62.84). Being in secondary school and above (adjusted OR=3.12; 95% CI 2.34 to 4.16) and being male (adjusted OR=1.81; 95% CI 1.44 to 2.28) were the factors associated with level of knowledge about blood donation.

More than half of the study participants were knowledgeable about blood donation. Sex and educational status were the factors significantly associated with level of knowledge about blood donation in Ethiopia. Therefore, there is a need for education and dissemination of information about blood donation among the general population to build adequate knowledge and maintain regular blood supply.

Strengths and limitations of this study

• This study highlights the nationwide level of knowledge about blood donation in Ethiopia.
• This study covers a wide area and investigates different articles, making the review more accurate.
• Subgroup and sensitivity analyses were carried out to investigate the heterogeneity of the included studies.
• All included studies were cross-sectional in design, which may limit investigation of the cause–effect relationship.

Introduction

Blood donation is life-saving for people in different emergency conditions, such as road traffic accidents, surgical procedures, pregnancy and delivery complications, chemotherapy, and diseases such as malaria, anaemia and intestinal parasites. 1 Blood donation is a noble practice of saving the life of millions of people. Donating safe and adequet blood can safe up to three lives of a patient who need blood. 2

Although the demand for adequate and safe blood is significantly increasing, there is a serious and critical shortage of blood stocks in low-income and middle-income countries. In low-income and middle-income countries, family replacement and paid blood donors are the most common sources of blood transfusion. 3 The availability of blood for transfusion in low-income countries is very limited due to the low level of knowledge, unwillingness to donate blood and poor blood donation practices. Meanwhile, patients suffer from lack of blood transfusion due to increased need from different medical and surgical conditions 4

While every blood donor is considered a hero, the amount of blood collected from donors and the average rate of blood collection in low-income countries including Ethiopia are low compared with the demand for blood. 5 The act of family replacement therapy is a common blood donation practice than collecting from volunteer blood donors, which is a common predisposing factor for misconception towards blood donation practice. 6

As different studies have shown, the prevalence of level of knowledge regarding blood donation ranged from 32.4% to 40.45%. 7 4 8 Education, sensitisation of blood donation, increasing public awareness, and campaign through the internet and media are recommended strategies to increase awareness, attitude and motivational practice of blood donation. 9–11 Fear of the different health risks after blood donation and lack of information on where, when and how to donate blood are the most common factors that hinder blood donation. 12 Even though beliefs, attitudes and behaviours regarding blood donation differ, adequate knowledge is needed among non-donors. There is a gap between willingness to donate blood and the number of donors in most populations around the world, which affects the practice of blood donation. 13 There is a need to spread awareness on blood donation among the general population to maintain an adequate and safe blood supply, which can be done through well-designed communication strategies to overcome the problem. 7

While there is a very high need for blood supply in Ethiopia, there is a serious shortage of blood stocks in the country. Thus, identifying the different factors that hinder knowledge about the practice of blood donation is essential. This systematic review and meta-analysis aims to review the different studies conducted so far on the level of knowledge about blood donation and associated factors in Ethiopia.

Methods and materials

Study protocol.

In this meta-analysis, the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines for reporting of findings were used 14 ( online supplemental table S1 ).

Supplementary data

Databases and search strategy.

Different databases such as PubMed/MEDLINE, Hinari, EMBASE, Google Scholar and African Journals Online were used to search for available articles. Both published and unpublished articles from the repository of Ethiopian universities were also searched. The search date was from 1 January 2000 up to 1 May 2021. Articles reporting on knowledge about blood donation and associated factors in Ethiopia were included in the final analysis. The search items were “knowledge” OR “awareness” AND “blood donation” OR “volunteer blood donation” AND “associated factors” OR “determinant factors” AND “Ethiopia”. These search strings were developed using “AND” and “OR” Boolean operators ( table 1 ).

Search of different databases for studies about level of knowledge and associated factors regarding blood donation in Ethiopia

Search and eligibility of studies

All retrieved articles were exported to EndNote reference software V.8 citation manager (Thomson, Stamford, Connecticut, USA) to sort and delete duplicates. Two investigators (AG and AD) independently evaluated each article by title and abstract, assessed the eligibility of the articles, and critically reviewed the selected articles. Extraction was done by author name, publication year, region where the study was conducted, study subjects, sampling method, method of survey, study period, sample size, study design, level of education, level of knowledge regarding blood donation and factors associated with level of knowledge about blood donation.

Eligibility criteria

Both published and unpublished cross-sectional studies conducted on the level of knowledge about blood donation among populations in Ethiopia were included, whereas qualitative studies, different trials, case reports, review articles, updates and news were excluded from the analysis. Furthermore, articles not reporting on the outcome of the study and those without full texts were excluded.

Outcome measurement of the study

There are two main outcomes, namely level of knowledge about blood donation and the factors associated with it. Level of knowledge was measured using the mean score on the knowledge assessment questions. Study participants who scored with a mean score and above on the knowledge assessment items were considered knowledgeable about blood donation, whereas those who scored below the mean score were considered not knowledgeable.

Quality assessment

Two authors (AG and AD) independently assessed the quality of the studies using the Newcastle-Ottawa Scale for cross-sectional studies. 15 Methodological quality, comparability, outcome and statistical analysis of the studies were the main assessment tools used to determine quality. Studies that scored ≥7 out of 10 were considered to be of high quality. During quality appraisal of the articles, any discrepancies between the two authors were resolved. All authors independently assessed the eligibility of the articles to be considered in the final analysis.

Data processing and analysis

In this systematic review and meta-analysis, a weighted inverse variance random-effects model at 95% CI was used to calculate the pooled prevalence of level of knowledge about blood donation and the associated factors. 16 After extraction and cleaning using Microsoft Excel spreadsheets, the data were exported to STATA V.11 statistical software for analysis. The heterogeneity of the studies was assessed using the Cochrane Q-test and I 2 with the corresponding p value. I 2 values of 25%, 50% and 75% represent low, moderate and high heterogeneity, respectively. 17 The source of heterogeneity was examined through subgroup analysis based on region, study subjects, study setting and sample size. Sensitivity analysis was also carried out to confirm the presence or absence of influential studies. The presence of publication bias was evaluated using Egger’s test and presented with funnel plots. 18 For associated factors, log OR was used to decide on the association between the associated factors and the level of knowledge about blood donation. A statistical test with a p value of less than 0.05 was considered statistically significant. 19

Patient and public involvement

It was not appropriate or possible to involve the patients or the public in the design, conduct, reporting or dissemination plans of our research.

Six hundred and ninety-four articles were retrieved. Of these retrieved articles, 284 were excluded due to duplication. Three hundred and sixty-eight articles were further excluded after reviewing the titles and abstracts. Furthermore, 22 articles which did not fulfil the inclusion criteria were excluded. Finally, 20 articles were used in the analysis ( figure 1 ).

Flow chart of selection of studies for the systematic review and meta-analysis of the level of knowledge about blood donation and associated factors in Ethiopia.

Characteristics of the studies and study participants

Twenty cross-sectional studies with a total of 8338 study participants (4712 men and 3626 women) were involved. Of the included articles, eight were from the Amhara region, 1 12 20–25 five from the Oromia region, 4 26–29 two from the Addis Ababa city administration, 5 30 two from Southern Nations, Nationalities and Peoples Region, 31 32 two from Tigri region, 33 34 and the remaining was from the Afar region. 35 The sample size of the included studies ranged from 218 to 845 ( table 2 ).

Characteristics of studies included in the review and meta-analysis of knowledge about blood donation and associated factors in Ethiopia

SNNPR, South Nations, Nationalities and Peoples Region.

Knowledge about blood donation

The overall pooled prevalence of level of knowledge about blood donation in Ethiopia was 56.57% (95% CI 50.30 to 62.84) ( figure 2 ).

Forest plot of the pooled prevalence of knowledge about blood donation and associated factors in Ethiopia. ES, Effect Size.

Heterogeneity and publication bias

In this systematic review and meta-analysis, heterogeneity was identified within the studies (I 2 =97.3%, p<0.001). The funnel plot showed an asymmetrical distribution of studies included in the review and a statistically significant Egger’s test (p=0.02), suggesting the presence of publication bias ( figure 3 ).

Funnel plot with 95% confidence limits of the pooled prevalence of knowledge about blood donation and associated factors in Ethiopia. sep; standared error of prevalence.

Subgroup analysis

Subgroup analysis was done by region, study subjects, study setting and sample size. The highest pooled prevalence of level of knowledge about blood donation was reported by healthcare workers (65.28%, 95% CI 55.16 to 75.40). Similarly, the level of knowledge about blood donation was higher among studies done in institutions (institution-based) (60.45%, 95% CI 51.05 to 69.83) than studies conducted in the community ( table 3 ).

Subgroup analysis of the level of knowledge about blood donation and associated factors in Ethiopia (n=20)

Other: Addis Ababa, Eastern Ethiopia.

Sensitivity analysis

As shown in table 4 , all of the point’s estimates are within the overall 95% CI, which confirms that omission of any of the studies included in this systematic review and meta-analysis does not affect the overall prevalence of the level of knowledge about blood donation.

Sensitivity analysis of knowledge about blood donation and associated factors in Ethiopia

Factors associated with knowledge about blood donation

In this study, participants’ sex and level of education were significant factors associated with level of knowledge about blood donation. The odds of level of knowledge were 1.81 times more likely among men than women (adjusted OR (AOR)=1.81; 95% CI 1.44 to 2.28) ( figure 4 ). Similarly, the odds of level of knowledge were 3.12 times more likely among participants whose educational status was above secondary school than those who did not attend any formal education (AOR=3.12; 95% CI 2.34 to 4.16) ( figure 5 ).

Overall pooled OR of the association between sex and level of knowledge about blood donation in Ethiopia. AOR, adjusted OR.

Overall pooled OR of the association between educational status and level of knowledge about blood donation in Ethiopia. AOR, adjusted OR.

In this systematic review and meta-analysis, the pooled prevalence of good knowledge about blood donation is 56.57% (95% CI 50.30 to 62.84), which indicates that there is a lack of adequate knowledge about blood donation in the country. This might be due to the absence of regular blood donation programmes, less media coverage, limited campaign and limited educational access with regard to blood donation in the country.

The level of knowledge in this study is lower than the studies conducted in Malaysia (98%), 2 Barabanki, India (90%), 36 and Benin City, Nigeria (92.65 %). 37 This variation might be due to differences in study participants. In Malaysia, the study participants were nursing students; in Benin City, Nigeria the study participants were healthcare workers; and in Barabanki, India the study participants were undergraduate medical students. In contrast, this study targeted all populations in the country. This variation might also be due to the status and level of media coverage and the educational status of people in Ethiopia; Ethiopia is one of the low-income countries with very limited education coverage and media accessibility. There is an almost similar finding with regard to knowledge about blood donation with a study done among students of a tertiary institution in Nigeria. 9 However, the finding of this study is higher than the studies conducted in Kerala, India (35%) 7 and in Nepal (32%), 8 which may be due to time variations, where the previous studies were conducted before 7 and 5 years, respectively.

In the subgroup analysis, there was no significant variation with regard to the prevalence of knowledge about blood donation within the region where the studies were done. However, there were variations with regard to knowledge prevalence within study participants, study setting and sample size categories. Accordingly, the highest prevalence of knowledge was reported among healthcare workers. This is because healthcare workers have formal education on blood donation and know more about human physiology than others. Healthcare workers may also have experience with blood donation. This agreed with a study conducted in developing countries where regular donors had good knowledge compared with non-donors. 13 Studies conducted in institutions (institution-based) showed a higher prevalence of knowledge than studies conducted in the community (community-based). This is due to the populations in institutions having more access to information. 7

In this systematic review and meta-analysis, the odds of knowledge about blood donation were 1.81 times more likely among men than women. This might be due to women being more prone to different physiological conditions such as menstruation and bleeding during pregnancy and delivery, which deter them from donating blood. As a result they have poor blood donation practices when compared with men. This poor practice may indirectly affect women’s knowledge about blood donation. 3 Educational status also had a significant association with knowledge about blood donation. The odds of knowledge about blood donation were 3.12 times more likely among participants who had a level of education above secondary school compared with illiterates. 11 This is because formal education is the cornerstone of acquiring knowledge. Therefore, participants who reached secondary school and above have more access to information than participants who did not have any formal education.

Limitations of the study

All studies included in this systematic review and meta-analysis were cross-sectional studies, which may limit the generation of a cause–effect link between independent and dependent variables.

More than half of the study participants were knowledgeable about blood donation. Sex and educational status were significantly associated with level of knowledge about blood donation in Ethiopia. Therefore, there is a need for education and dissemination of information about blood donation among the general population to build adequate knowledge and maintain regular blood supply.

Supplementary Material

Contributors: AG and MB designed the study, as well as designed and run the literature search. AG, AW, MB, GG and AD acquired the data, screened the records, extracted the data and assessed the risk of bias. AG and AD did the statistical analyses and wrote the report. All authors provided critical conceptual input, analysed and interpreted the data, and critically revised the report. All authors read and approved the final manuscript.

Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed.

Supplemental material: This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Data availability statement

Ethics statements, patient consent for publication.

Not required.