Assessment of knowledge, attitude and practice regarding blood donation among the residents in the urban field practice area of Bangalore Medical College and Research Institute: a community based cross sectional study

INTRODUCTION

Blood donation is an essential component of modern healthcare, serving as a lifeline for millions of individuals annually.¹ Despite its critical importance, the accessibility of safe blood for transfusions remains a challenge for many patients in need.² Globally, an astounding 118.5 million blood donations are collected each year, with lower-middle-income countries exhibiting a donation rate of 6.6 donations per 1000 people.³

Of particular note is the fact that 79 countries heavily rely on voluntary unpaid donors for over 90% of their blood supply. In 2015, reporting blood banks worldwide amassed a total of 11,645,791 units of blood, with 71.9% stemming from voluntary donations. However, a significant shortfall of 1 million units of blood per year in India highlights the pressing need for enhanced donation efforts.⁴ To meet the clinical demand in India, an estimated 36.3 donations per 1000 eligible individuals would be required to satisfy the demand for whole blood and its components.⁵ The health department data from Karnataka indicates that around 8 lakh individuals in the state require blood transfusions annually. Additionally, during the 2022-23 period, a remarkable 9.7 lakh units of blood were collected to address this substantial need.⁶

Furthermore, misconceptions and false beliefs about blood donation, such as concerns about physical weakness, premature aging, anaemia, and infection, have been identified among the public.⁷ Understanding these attitudes and motivations is pivotal in addressing these misconceptions and ensuring a robust and sustainable blood supply, not only in India but on a global scale.

The objective of the study was to assess the level of knowledge, attitudes, and practices related to blood donation among urban residents in Bangalore and also to identify common misconceptions, motivators and barriers for guiding public health strategies to promote blood donation.

METHODS

A cross-sectional study was conducted to assess the knowledge attitude and practice regarding blood donation among the residents of urban field practice area of Bangalore Medical College and Research institute for a period of 5 months from March 2024 to July 2024.

Sample size

According to study done by Samreen et al, the expected proportion of participants with favourable attitudes towards blood donation was 57%.⁷ Sample size was calculated using the formula, n=Z²p(1-p)/d² with the standard table value for a 95% confidence interval (1.96) and the relative precision (10% of the p). After adding 10% attrition to the initial sample size of 147.12, the final sample size was rounded to 148.

Methodology of data collection

After obtaining approval and clearance from the Institutional Ethics Committee of Bangalore Medical College and Research Institute (approval number: BMCRI/EC/16/2024), and permission was received from the concerned authorities. A community-based cross-sectional study was conducted in the urban field practice area of Bangalore Medical College and Research Institute, Bengaluru.

The field practice area is divided into 12 urban slum areas with a total population of 43,168. Using the simple random sampling method, one of the urban slum areas was selected, and the residents of the area (18 years of age and above) were randomly chosen using a random number generator and interviewed after obtaining consent. After covering the residents of the selected area, another urban slum area was selected using the same method, and the process was repeated until the necessary sample size was reached.

The subjects who meet the inclusion criteria were enrolled for the study after obtaining informed consent. Data was collected using a pre-tested semi-structured questionnaire comprising of five components (sociodemographic details, knowledge about blood donation, attitude related to the blood donation, practice of blood donation, previous experience on blood donation). Three-point Likert’s scale was used for assessing the responses of the study participants. For knowledge, a score of 0-6 was considered as poor knowledge, 7-13 as fair knowledge and more than 13 as good knowledge. For attitude, a score of 0-4 was considered as unfavourable attitude, score of 5-8 as favourable attitude. For practice, a score of 0-2 was considered as poor practice, 3-5 as fair practice and more than 5 as good practice.

Inclusion criteria

Adults aged 18 years and above residing in the selected urban slum areas who provided informed consent.

Exclusion criteria

Individuals who were not willing to participate or unable to give consent were excluded.

Statistical analysis

The data collected was entered in Microsoft Excel and analysed using SPSS version 26.0. Sociodemographic data was presented using descriptive statistics. Non-parametric test was used to determine the significant association between the categorical variables. Data was presented in the form of tables and figures.

RESULTS

The present study assessed the knowledge, attitude, and practice of blood donation among 148 participants in the urban field practice area of Bangalore Medical College and Research Institute.

Table 1 shows the socio-demographic characteristics of the study participants. Majority of the participants belonged to 30-44 years age group (44.59%). Gender distribution showed a higher proportion of females (62.8%). The majority of participants were married (79.7%). The predominant religion was Hinduism (81.1%). 33.8% of the participants were illiterate. 38.5% of the study participants were unskilled workers while 29.7% were semi-skilled workers. 59.5% fell into the upper lower socioeconomic status.

Knowledge

The knowledge of the blood donation was assessed based on a questionnaire. The responses of the study participants for each questions assessing knowledge are mentioned in Table 2. Based on the analysis, it was found that 5.05% (9 participants) demonstrated good knowledge, 92.56% (137 participants) demonstrated fair knowledge, and 1.35% (2 participants) demonstrated poor knowledge. These results indicate that the majority of participants have a fair understanding of blood donation.

Attitude

The attitude of the blood donation was assessed based on a questionnaire. The responses of the study participants assessing attitude towards blood donation are mentioned in Table 3. The analysis revealed that 70.94% (105) of the participants held a favourable attitude towards blood donation, while 29.05% (43) demonstrated an unfavourable attitude. It is noteworthy that a significant majority of the participants displayed a positive outlook on blood donation.

Practice

The practice of blood donation was assessed based on a questionnaire, and the willingness to donate blood by the study participants and responses for each answer are mentioned in Table 4. Out of 148 participants only 21 (14.2%) had donated Blood whereas 127 (85.8%) had not donated blood. The low percentage of actual donors highlights a gap between positive attitudes and actionable practices. Gender disparities were evident, with only 5.3% of female participants having donated blood. Despite the low donation rates, a significant proportion of females expressed a positive attitude towards blood donation.

Table 5 shows educational status significantly influences knowledge (p<0.001) and attitude (p=0.017) towards blood donation. Gender shows a significant association with donation practices (p<0.001), with poorer practices observed among married females (p=0.006) compared to males.

Motivators to donation

The data reveals that the most prominent motivator appears to be inspiration from others who have donated blood (34.5%). Setting a good example follows closely behind, with 45 respondents (30.4%) motivated by this factor (Figure 1).

Barriers and misconceptions towards blood donation

The Figure 2 highlights various barriers and misconceptions regarding blood donation among the study participants. The most significant barrier is a lack of information (28.2%), followed by ineligibility (18.3%) and lack of time (10.6%).

Misconceptions also play a significant role, with 16.2% believing that blood donation causes weakness, 5.4% fearing it leads to anemia, 5.4% concerned about the misuse of blood, and 2.3% worrying about the wastage of blood (Figure 3).

DISCUSSION

In Sameer et al study, 356 participants showed a high level of awareness about blood donation, with 94.4% considering it important and 98.3% believing it saves lives. Despite this, only 49.4% were willing to donate voluntarily, with common barriers including fear of needles (24.2%) and concerns about contracting diseases (23.6%). Motivational factors included receiving a day off (91.9%) and a token (73.6%).⁷ Dubey et al study found that 40.75% of non-donors didn’t donate because they weren’t asked. Voluntary donors had a better experience and a higher likelihood of donating again (89.5%). Non-donors had lower knowledge and more misconceptions, with television being the most effective awareness medium.⁸ According to study done by Urgesa et al, comprehensive knowledge about voluntary blood donation was 43.5%. 32.9% study participants had positive attitude toward voluntary blood donation and majority of them were college graduates. Practice rate was found to be low (only 22.6%).⁹ According to study done by Chatham et al, mean knowledge score of participants was 74.4% and 91% study participants felt that people should donate blood and were themselves willing to donate blood but only 22.9% had donated blood.¹⁰ Similarly, the current study showed 92% of the study participants had fair knowledge. 70.9% had a favourable attitude towards blood donation, but only 14.2% had actually donated blood.

The study by Mussema et al, showed the similar finding of favourable attitude and male participants were more likely to donate blood. (AOR: 2.53; 95% CI: 1.54, 4.15).¹¹ In the study done by Sreeranga showed that more than 90% of the participants had good knowledge and 253 (88.8%) respondents considered blood donation as good practice and 205 (71.9%) believed it was safe to donate blood but in practice only 116 (40.7%) had ever donated blood. Male workers were more likely to donate blood (p<0.0001).¹²

The study done by Mohammed et al shows majority of the participants were motivated by personal need (90.3%) and positive staff (83.4%). Deterrents included poor staff attitude (63.7%), privacy issues (54.6%), and fears of blood being sold (50.9%).¹³ In current study, primal motivators were inspiration from other blood donors (34.5%) and setting a good example (30.4%). The potential barriers of present study were lack of information (28.2%), ineligibility (18.3%), and lack of time (10.6%). This contrast may be attributed to differences in the education level and gender distribution of the sample population. The current study found highly significant association between educational status and knowledge towards blood donation (p<0.001).

Additionally, the gender significantly impacts the blood donation practices (p<0.001), with females showing poorer practices compared to males. Similarly, the study by Alsalmi et al, in Saudi Arabia revealed an association between knowledge and academic level, as well as between gender and blood donation practices.¹⁴

According to a study in Indian adults done by Verma et al, there was a statistically significant association between age and attitude towards voluntary blood donation and feeling of weakness after donating blood, fear about needle pricks, anaemia, prevalent beliefs, customs, lifestyle fear and hesitation were identified as barriers.¹⁵

The findings of the study may not represent the entire urban population of Bangalore because the researchers used convenience sampling or other non-random sampling methods. This could limit the applicability of the results. Data on knowledge, attitudes, and practices regarding blood donation were likely collected through self-reported surveys, which are susceptible to biases such as social desirability bias or recall bias. Participants may provide answers that they believe are socially acceptable rather than reflecting their true beliefs or behaviours. Since this was a cross-sectional study, the data were collected at a single point in time, providing a snapshot of the population’s characteristics and behaviours. This design does not allow for the assessment of changes over time or the establishment of causal relationships between variables. The study may not have comprehensively captured all relevant factors influencing blood donation behaviour, such as cultural differences, which could affect the interpretation of the results. Furthermore, the findings of the study may be influenced by specific contextual factors related to the urban area in Bangalore, limiting the generalizability of the results to other settings. Additionally, as the study was conducted during working hours, this could have influenced the interpretation of the outcome.

CONCLUSION

The study’s findings offer valuable insights into the level of knowledge, attitudes, and practices, as well as common misconceptions, motivations, and barriers related to blood donation within the study population. Notably, the majority of respondents demonstrated fair knowledge and a positive attitude toward blood donation. However, the findings also indicate that the actual practice of blood donation among the population is not very common, with only 14.2% reporting having donated blood. It is clear that efforts need to be made to address this disparity and encourage more frequent blood donation.

Recommendations

Adequate information about blood donation and its benefits, organization of outreach or awareness camps are all crucial to encourage more people to donate blood. It is also important to identify and minimize potential barriers that may hinder the blood donation process. It is also essential to expand health education coverage and effectively address anemia in females, a common reason for their ineligibility to donate blood. Additionally, counselling on alcoholism and the prevention of sexually transmitted diseases such as HIV and hepatitis B is vital. Furthermore, increasing the frequency of blood donation camps at workplaces can help to reach the individuals who are willing to donate; but were unable to donate due to the lack of time, ultimately improving accessibility.

ACKNOWLEDGEMENTS

We would like to thank the college administration for their sincere help and support.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee of Bangalore Medical College and Research Institute (approval number: BMCRI/EC/16/2024)

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