https://doi.org/10.15218/ejnm.2023.03 Erbil j. nurs. midwifery, Vol. 6, No. (1), May 2023 Original Article Knowledge, Attitudes, and Barriers of Blood Donation among Students of Soran Technical College: A Cross-Sectional Study ABSTRACT Background: Safe and effective blood transfusion is a vital component in improving health and preventing the spread of blood-borne diseases worldwide. The current study aimed to assess knowledge, attitudes, and barriers toward blood donation among Soran tech- nical college students. Methods: A cross-sectional study was conducted from 25th February 2022 to 7th May 2022. A non-probability convenience sampling method included 200 students; it was di- vided into medical and non-medical students. A self-administered questionnaire with closed-ended questions was used to collect information concerning socio-demographic characteristics, knowledge, attitude, and practice regarding blood donation. Results: More than half of the study samples (59.5%) were within the age group of less than 20 years. The majority (68%) were female. And nearly half of the students came from an urban area. The majority of respondents (90.5%) had a fair level of knowledge, while 7% had good knowledge of blood donation. However, 59% of the students had a positive attitude toward blood donation. The most common motivators that encouraged blood donors were 72.5% getting subsidies and vacations, and 71% getting free laboratory exam- inations. Common barriers for blood donors were worried about sanitation and getting infectious diseases, and the side effects (58.7%) and (54.5%), respectively. Conclusion: Despite most of the students having a favorable attitude toward blood dona- tion but unexpectedly having a fair level of knowledge, the major barrier perceived by stu- dents was fear of acquiring an infectious disease. Keywords: Knowledge; Blood donation; Barriers; University Students. Sarud Manaf Ahmed; Department of Nursing, College of health and Medical Techniques/ Shekhan, Duhok Polytechnic University, Duhok, Iraq. Arazoo Issa Tahir; Department of Public Health, College of health and Medical Techniques/ Shekhan, Duhok Polytechnic University, Duhok, Iraq. (Correspondence: arazoo.tahir@dpu.edu.krd). Magroom Esmail Seniar; Department of Nursing, Soran Technical College, Erbil Polytechnic University, Erbil, Iraq. 22 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Received: 05/10/2022 Accepted: 10/01/2023 Published: 30/5/2023 mailto:arazoo.tahir@dpu.edu.krd?subject=arazoo.tahir@dpu.edu.krd%20 https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.03 Erbil j. nurs. midwifery, Vol. 6, No. (1), May 2023 Original Article Human blood is a vital component of life, and there are currently no substitutes for blood components. The donation of blood or blood products into the recipient's bloodstream is known as a blood transfu- sion. Replacing blood cells or blood prod- ucts lost by bleeding with accident injuries, surgical conditions, malignancies, pregnan- cy issues, or other medical disorders is a life-saving strategy in both normal and emergencies (1). An essential part of en- hancing healthcare delivery and halting the global spread of blood-borne infections is safe and effective blood transfusion. Even though blood transfusions save millions of lives each year, there is considerable inter- est in the quality and safety of this proce- dure, particularly in hospitals in developing nations (2). According to the World Health Organization, 3-5% of people should do- nate blood annually (3). When blood is di- vided into its parts, one unit (450 mL) that is donated has the potential to save at least three lives. Global efforts are ongoing to maintain an adequate number of blood donors to assure a sufficient, safe, and timely blood supply that is adequate to ful- fill clinical demand. (4,5). Due to the in- crease in chronic illnesses, surgeries, trau- mas, cancers, and automobile accidents, fresh blood is urgently needed, particularly during the first 24 hours of therapy (6). Although it is believed that 60% of people in developing nations have sufficient knowledge about blood donation, the blood donation rate in low-income coun- tries is far lower than that of middle- and high-income countries. Due to misconcep- tions, inadequate information, and a nega- tive attitude toward donation, the blood donation percentage was less than desira- ble. Additionally, it was discovered that sex, age, and educational status were pre- dictors of voluntarily giving blood (7). Young people represent a significant por- tion of the population and represent the future and present sources of a safe blood supply (1). University students, who may make up a larger share of the young popu- lation and are healthy, active, dynamic, resourceful, and receptive, need to be in- spired, motivated and urged to donate blood willingly. Students studying health sciences can become future blood donors as well as community role models and mo- tivators if the right techniques are created and put into practice to enhance knowledge and attitude. Therefore, the study aimed to assess knowledge, atti- tudes, and barriers toward blood donation among Soran Technical College students. A descriptive cross-sectional study was conducted from 25th February 2022 to 7th May 2022. A non-probability conven- ience sampling procedure was used to se- lect 200 students, medical and non- medical students from Soran Technical Col- lege. Previously informed consent was ob- tained for the conduction of the study. The researcher used relevant English-language literature reviews to create the question- naire, which was then translated into Kurd- ish and completed by the students in 15-20 minutes. A self-administered questionnaire consists of socio-demographic data (age, gender, residency, department, etc.). Knowledge of the student was measured with 19 questions that were rated by three options (poor, fair, and good) which gave two scores for the correct question, a score of 1 for the correct answer, and a score of 0 for incorrect responses. The sum of the score for all 19 items was calculated as the total knowledge score on blood do- nation, which ranged from 0 to 19. Scoring was categorized as poor knowledge 0-5, fair knowledge 6- 12, and good knowledge13-19.Student’s attitude toward 23 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. METHODS INTRODUCTION https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.03 Erbil j. nurs. midwifery, Vol. 6, No. (1), May 2023 Original Article blood donation was measured by 12 ques- tions with two responses of (agree=1 score, disagree=0 score), the total scores were categorized as negative attitude (0- 6) and positive attitude (7-12). And finally, statements related to reasons and barriers of blood donation with 2 responses yes (agree) and no (disagree). Part one rea- sons for blood donation (5 statements) and the second is the barrier to blood do- nation (6 statements). The study has been approved by Soran Technical College and the scientific committee of Akre Technical Institute. The data was entered into Statis- tical Package for Science Services (SPSS version 25), Descriptive statistical analyses were used to report frequencies with per- centages for categorical variables. While for figures Excel and SPSS have been used. The result shows that the majority (59.5%) of study samples were within the age group of less than 20 years and the high- est percentage (68%) of them were female while (32%) of them were male. The high- est percentage (48.5%) of the study sam- ple was from urban and 28% from rural. It is clear from this table that most (64%) of the study participants were in the second stage and Less than half percentage (41%) of them had O+ blood group and Rh- positive while (2.5%) of them had A- blood group and Rh-negative as shown in Table 1. 24 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. RESULTS Table 1. Distribution of study sample ac- cording to socio-demographic character- istics (N=200) Variable No. (%) Age group <20 years 20-24 years >24 years )59.5(119 )38(76 )2.5(5 Gender Male Female )32(64 )68(136 Residency Urban Suburban Rural )48.5(97 )23.5(47 )28(56 Stage First Second )36(72 )64(128 Blood group& Rh A+ B+ O+ A- B- O- )34(68 )13(26 )41(82 )2.5(5 )3.5(7 )6(12 Total 022 https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.03 Erbil j. nurs. midwifery, Vol. 6, No. (1), May 2023 Original Article The Figure 1. Shown highest percentage (90.5%) of study samples had a fair level of knowledge about blood donation and only (7%), (2.5%) of them had good and poor levels of knowledge respectively. The majority (59.5%) of study samples had a positive attitude toward blood donation while (40.5%) of them had a negative atti- tude as shown in Table 2. Receiving a subsidy and having free tests were the main reasons for donating blood, accounting for 72.5% and 71%, respective- ly. While (43%) cited receiving souvenirs as a motivation for giving blood. Additionally, (65%), (63%) of the study's participants said that giving blood is beneficial to one's health and useful for using blood in thera- peutic settings, respectively Figure 2. Most of the students (58.5%) reported that worries about sanitation and getting infec- tious diseases were the main barrier to blood donation. While only (21.5%) of them mentioned opposition from family as a barrier to blood donation. In addition, (54.5%), and (42%) of study students de- clared that blood donation would affect health and that no time for blood donation was a barrier to blood donation respective- ly Table 3. 25 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Figure 1. Distribution of study sample regarding the level of knowledge about blood donation. Table 0. Distribution of study sample re- garding attitude toward blood donation Attitudes N (%) Positive )59.5(119 Negative )40.5(81 Figure 2. Distribution of study samples regarding the reason for blood donation. Barriers N (%) No time for blood donation )42(84 Opposition from family )21.5(43 Fear of needle pain )40.5(81 Worry about sanitation and getting an infectious disease )58.5(117 Blood donation would affect health )54.5(109 I do not be fit to donate blood )29(58 Table 3. Distribution of study sample regarding barriers to blood donation. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.03 Erbil j. nurs. midwifery, Vol. 6, No. (1), May 2023 Original Article 26 similar factors in fear of infectious disease and not being fit to donate blood (19) and in Qatar (20). Inadequate knowledge was prevalent among a vast majority of university stu- dents in Soran while the majority of study samples had a positive attitude toward blood donation. The primary motivation for donating blood was to receive benefits like subsidies, vacation days, and free la- boratory tests. Additionally, the greatest barrier to refusing blood donation was the fear of acquiring an infectious disease and its adverse outcomes. The findings sug- gest that providing workshops and lec- tures about blood donation for students to increase their level of knowledge, atti- tude, and practice about blood donation. The author reports no conflict of interest. [1] World Health Organization. Towards 100% voluntary blood donation: a global frame- work for action. World Health Organization; 2010. [2] WHO and International Federation of Red Cross and Red Crescent Societies. World Health. Vol. 123. Geneva, Switzerland: WHO; 2010. Towards 100% Voluntary Blood Donation. A Global Framework for Action. [3] Alsalmi MA, Almalki HM, Alghamdi AA, Aljasir BA. Knowledge, attitude, and prac- tice of blood donation among health pro- fessions students in Saudi Arabia; A cross- sectional study. Journal of family medicine and primary care. 2019 Jul;8(7):2322. [4] Mugion, R.G.; Pasca, M.G.; Di Di Pietro, L.; Renzi, M.F. Promoting the propensity for blood donation through the understanding of its determinants. BMC health services research.2021, 21, 127. Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Maintaining a sufficient and secure blood supply is an essential matter that worries health planners, Particularly, because of the rise in demand. Therefore, recognizing knowledge, attitudes, and barriers associ- ated with blood donation customs are crucial (8). The study results illustrated that students had poor (7%) knowledge regarding blood donation. This finding was lower than studies in Thailand and Ethiopia (80%), (79.4%) respectively (9, 10). Also, our students had lower knowledge than medical students in Kollam, Kerala (35%) (11). On the other hand, it is nearly in line with studies done among health Science students of Mani- pur (9%) (12). This variance may be the result of students' limited access to blood donation education programs and differ- ences in socio-demographic characteris- tics, this wide gap should be minimized. In this study, about (59.5%) of the study participants had a positive attitude to- ward blood donation. This finding is in agreement with studies conducted in Iraq (68.7%) (13), (67.9) among university stu- dents in Pakistan (14), and In Ethiopia (57.8%) of the study participants had posi- tive attitudes (15). Also, it is higher than that reported among students in Pakistan (42%) (16), and Ambo University students in Ethiopia (47.4%) (17). this distinction may come as a result of the studying pop- ulations' instructional characteristics and sociocultural contrasts (18). In the present study, the main barrier was the fear of being infected with an infectious disease and the consequences of blood donation. Comparable to a study conducted in Ne- pal, the main reason was fear of weakness and not being asked to donate blood (8). On the other hand, other factors were more common in other nations (11). In addition, a study done in Pakistan showed DISCUSSION Conclusion CONFLICT OF INTEREST REFERENCES https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.03 Erbil j. nurs. midwifery, Vol. 6, No. (1), May 2023 Original Article 27 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. [5] Lownik E, Riley E, Konstenius T, Riley W, McCullough J. Knowledge, attitudes and practices surveys of blood donation in devel- oping countries. The International Journal of Transfusion Medicine. 2012 Jul;103(1):64-74. [6] Roberts DJ, Field S, Delaney M, Bates I. Prob- lems and approaches for blood transfusion in the developing countries. Hematology/ Oncology Clinics. 2016 Apr 1;30(2):477-95. [7] Alfouzan N. Knowledge, attitudes, and moti- vations towards blood donation among King Abdulaziz Medical City population. Interna- tional Journal of family medicine. 2014;2014. [8] Amatya M. Study on knowledge, attitude, and practice of blood donation among stu- dents of different colleges of Kathmandu, Nepal. International Journal of Pharmaceuti- cal and Biological Archives. 2013;4(3):424-8. [9] Wiwanitkit V. Knowledge about blood dona- tion among a sample of Thai university stu- dents. The International Journal of Transfu- sion Medicine. 2002;83:97-9. [10] Gebresilase HW, Fite RO, Abeya SG. Knowledge, attitude, and practice of stu- dents towards blood donation in Arsi Univer- sity and Adama Science and technology uni- versity: a comparative cross-sectional study. BMC Hematology. 2017;17:20. [11] Aslami AN, Jobby A, Simon S, Nazarudeen N, Raj P, Ramees M, et al. Assessment of knowledge, attitude, and practice (KAP) of blood donation among MBBS students of a medical college in Kollam, Kerala. Journal of Evolution of Medical and Dental Sciences. 2015 Apr 30;4(35):6086-95. [12] Syiemlieh AJ, Akoijam BS, Kumar S. Assess- ment of Knowledge, Perception & Practice of Voluntary Blood Donation among Health Professional Students in RIMS, Imphal, Mani- pur. Journal of Dental and Medical Science. 2016;15(10):26–30. [13] Al-Asadi JN, Al-Yassen AQ. Knowledge, atti- tude, and practice of blood donation among university students in Basrah, Iraq: a com- parison between medical and non-medical students. Asian Journal of Medical Sciences. 2018 Oct 29;9(6):62-7. [14] Rasool AG, Saud N, Kamal A, Amjad N, Sha- hid N, NIZAM M. Socio-Demographic Factors Affecting Knowledge, Attitude and Practice towards Blood Donation among University Students in Lahore, Pakistan. Pakistan Jour- nal of Medical and Health Sciences. 2021;15 (3):638-41. [15] Nigatu A and Demissie DB. Knowledge, attitude, and practice on voluntary blood donation and associated factors among Ambo University regular students, Ambo Town, Ethiopia. Journal of Community Medicine and Health Education. 2014;4:315.doi:10.4172/21610711.1000 315. [16] Shamebo T, Gedebo C, Damtew M, Woldegeorgis T, Girma E, Terefe D. As- sessment of knowledge, attitude, and practice of voluntary blood donation among undergraduate students in Awada campus, Hawassa University, Southern Ethiopia. Journal of Blood Disorders and Transfusion. 2020;11(1):431. [17] Javaeed A, Kousar R, Farooq A, Hina S, Ghauri SK, Tabbasum T. Knowledge, atti- tude, and practice of blood donation among undergraduate medical students in Azad Kashmir. Cureus. 2020 Apr 19;12 (4). [18] Ibrahim AA, Koç M, Abdallah AM. Knowledge level, motivators, and barri- ers of blood donation among students at Qatar University. Healthcare. 2021 Jul 22 (Vol. 9, No. 8, p. 926). MDPI. https://creativecommons.org/licenses/by-nc-sa/4.0/