A STUDY TO ASSESS THE BARRIERS AND FACILITATORS OF BLOOD DONATION AMONG UNIVERSITY STUDENTS OF SOUTH INDIA

Voluntary non-remunerated blood donation is the cornerstone of a safe and secure blood supply, yet many countries, including India, face a substantial gap between demand and supply due to factors such as misconceptions, perceived risks, and lack of motivation. India is estimated to need 85 donations per 1000 eligible people but had about 31 per 1000 in 2018, indicating a large deficit. University and medical college students constitute a readily available pool of potential donors for affiliated hospitals, but prior studies have reported low levels of awareness and suboptimal donation practices, with especially lower prevalence among females. Factors promoting donation include altruism and social responsibility, while deterrents include fear of needles, fear of infection, and anticipated adverse effects. This study aimed to evaluate knowledge, attitudes, and practices regarding blood donation and to ascertain factors that positively or negatively affect donation among students at a South Indian university campus.

Background literature highlights that WHO promotes voluntary, non-remunerated blood donation (VNRBD) as the safest approach, yet developing countries struggle to meet needs due to anemia prevalence and organizational barriers. Past Indian data show challenges in recruiting voluntary donors and gaps in blood bank availability across districts. Studies identify altruism and social responsibility as major motivators, with fear of needles, fear of contracting infections, and perceived side effects as leading barriers. Research among students frequently shows reasonable knowledge but poor practice; female students often donate less due to physiological and hemoglobin-related deferrals. Evidence suggests that improving knowledge can enhance attitudes and practices, potentially increasing regular donation. Engagement with NGOs and community volunteerism is associated with enhanced social responsibility and greater likelihood of donating.

Design and setting: Descriptive cross-sectional study conducted at Manipal Academy of Higher Education (Manipal campus), Karnataka, India, from January 2018 to January 2019. Population and sampling: Current students on the Manipal campus were eligible. Convenience sampling recruited 354 participants; volunteers from sister campuses and those not consenting were excluded. Instrument: A structured questionnaire in two parts. Part A captured demographics and volunteering: gender, age, year of study, membership in NGO/Rotary/Volunteer organizations (including VSO), total volunteer service hours, type of family, and frequency of voluntary work. Part B assessed knowledge, attitudes, and practices regarding blood donation. Knowledge assessment: Six items on eligibility age, minimum weight, blood volume per donation, minimum interval between donations, whether blood is screened prior to transfusion, and awareness of transfusion-transmissible disease risk from unscreened blood. Scoring: 1 point per correct answer; total 0–6; categorized as below average (<4), average (4), and above average (>4). Attitude assessment: Eight items including interest in donating, reasons people donate, fear of needles, perceived risk/benefit balance, willingness to donate if incentivized, belief about acquiring disease during donation, anticipated side effects, and perceived adverse effects. Practices and barriers: Seven items on prior donation, frequency of donation, procedural difficulties, recommending donation, reasons for not donating (e.g., fear of needles, lack of knowledge, perceived procedural complexity, lack of exposure, other), and two open-ended prompts on what would encourage donation and how to improve camps. Data collection and analysis: Interviewer-administered survey. Categorical variables summarized as frequencies and percentages. Adjusted associations estimated using logistic regression with odds ratios, 95% confidence intervals, and p<0.05 for significance. Open-ended responses were coded (in vivo), categorized into themes, and summarized by frequency/percentage. Analyses were performed in R (version 4.0.1). Ethics: Approved by Institutional Research Committee and Institutional Ethics Committee (IEC-813/2017), Manipal Academy of Higher Education; no personal identifiers were collected; confidentiality maintained.

- Sample characteristics: 354 students; 38.41% male (n=136) and 61.58% female (n=218). Most were aged 20–25 years (62.14%, n=220). - Donation prevalence: 38.98% (n=138) had donated at least once. Among males, 55.8% (76/136) had donated; among females, 28.44% (62/218) had donated. - Knowledge: Above-average knowledge in 46.89% (n=166), average in 30.22% (n=107), and below average in 22.88% (n=81). - Attitudes and perceptions: 26.55% reported fear of needles; 59.89% believed one could acquire disease while donating; 80.51% would donate if incentives were provided; 98.31% would recommend blood donation to others. - Barriers (self-reported): Fear of needles, anticipated weakness, lack of awareness, complicated procedure, no exposure to donation, low hemoglobin, underweight, and medical conditions (e.g., diabetes, hypotension, medications) were cited. - Encouragement factors: Incentive-related motivators were common; categories included attendance/leave, half-day, monetary or gift incentives, and other suggestions for improving camps. - Adjusted associations (logistic regression): • Gender: Females had higher odds of donating than males (OR 3.39; 95% CI: 2.06–5.68; p<0.001). • NGO membership: Non-members had 53% lower odds of donating vs members (OR 0.47; 95% CI: 0.25–0.88; p=0.020). • Frequency of voluntary work: Volunteering once in 6 months vs once a week associated with lower odds (OR 0.32; 95% CI: 0.11–0.88; p=0.030). Other frequencies were not statistically significant. • Fear of needles: Associated with lower odds of donation (OR 0.54; 95% CI: 0.29–0.96; p=0.039). • Belief in acquiring disease during donation: Associated with lower odds (OR 0.56; 95% CI: 0.33–0.94; p=0.030). • Knowledge score and willingness to donate if incentivized were not significant predictors in adjusted models.

The study sought to identify barriers and facilitators influencing university students’ blood donation. Despite nearly half demonstrating above-average knowledge, donation prevalence remained under 40%, indicating a knowledge–practice gap. Consistent with prior literature, motivators centered on social responsibility and altruism, while barriers included fear of needles, perceived side effects, and misconceptions about infection risk. Engagement in organized volunteerism (e.g., NGO membership and frequent volunteering) emerged as significant facilitators, likely reflecting a stronger sense of civic responsibility and prosocial orientation. The observed association between fear-related beliefs (needles, disease acquisition) and lower donation odds underscores the critical role of targeted educational interventions to dispel myths and reduce anxiety. Comparisons with other regions show similar or slightly higher donation rates among students elsewhere, suggesting room for improvement on Indian campuses through awareness, structured volunteer programs, and supportive policies. Translating knowledge into practice will require addressing risk perceptions, improving the donation experience, and offering practical facilitators that resonate with students.

Most participants possessed good knowledge, but attitudes and practices lagged. NGO affiliation and engagement in voluntary activities appear to foster a prosocial mindset that facilitates blood donation among youth. Incentivization (e.g., health credits, screenings, event tickets, discount coupons) may further motivate students. Educational programs and digital campaigns targeting misconceptions—especially among women and specific age groups—are recommended, alongside institutional collaborations to integrate donation awareness into curricula and improve camp organization. Strengthening these efforts could enhance the student donor pool and help meet blood supply needs.

- Convenience sampling and a relatively small sample size limit generalizability. - Cross-sectional design precludes causal inference. - Self-reported data may be subject to recall and social desirability biases. - Single-campus setting may not reflect broader student populations.