Perspectives and insight of Al-Baha city population toward blood donation after pandemics: knowledge, attitude, and practice

Introduction

Blood donation is a simple medical procedure in which blood is collected from the donor under specific medical conditions. It helps save lives, particularly for people who have lost blood due to surgery and trauma, those planning to undergo organ transplant surgeries, those suffering from complicated malignancies, or those who are severely anemic (1). Furthermore, blood donation has several benefits for the donor’s health, including enhancing blood circulation and promoting the production of new blood cells and platelets (2). Recent studies demonstrate that blood donation decreases the risk of tumors and circulatory diseases (4). Pandemics significantly impact life and people, and they also affect blood donation worldwide (3). Consequently, this influences the availability of blood in hospitals and donation centers (4,5). After pandemics such as COVID-19, many people have viewed these situations as severe threats to their lives, leading to a reluctance to donate blood, even as the demand for blood increases. The shortage in blood donation can result in difficulties supplying blood to patients who require regular transfusions, those planning surgery, or those with injuries or bleeding disorders (6).

In addition, COVID-19 is a highly contagious virus that poses challenges to organizations and medical institutions regarding blood donation behavior. The transmissible risk and tightening restrictions reduce the ability and willingness to donate blood. Furthermore, COVID-19 is a long-term issue that requires persistent support from individuals and organizations, such as volunteer assistance, blood donations, and financial support (5,6).

Other factors must be carefully considered to ensure the safety of the blood donation procedure during pandemics. Health practitioners, voluntary donors, and visitors should follow pandemic guidelines, such as wearing face masks. Maximum care should be taken to screen voluntary donors to ensure that no symptoms of illness appear. All equipment required for the blood donation procedure must be sterilized, and most should be for single use. Additionally, six feet of distance is required between donors in the waiting area and between blood donation cots (2).

Therefore, many safety precautions must be taken, particularly at blood donation centers, to prevent COVID-19 transmission. A recent study conducted in Hong Kong and China demonstrated that anxiety and fear of infection with COVID-19 were common factors that prevented people from donating blood (3,7). Obstructions to the blood donation process may have serious consequences for healthcare systems globally; these should be prevented through careful tracking of blood stocks and demands during and after the pandemic period (8).

The aim of this study is to evaluate the awareness, perception, and concepts related to blood donation after the COVID-19 pandemic in the Saudi Arabian population. We present this article in accordance with the SURGE reporting checklist (available at https://jlpm.amegroups.org/article/view/10.21037/jlpm-25-3/rc).

Methods

Study design and setting

A cross-sectional study was conducted in 2023 on the Saudi population. An online survey was employed to engage individuals from different population categories. The total sample size consisted of 203 participants. Those who attended blood donation and provided consent, meeting inclusion and exclusion criteria, completed the survey on an iPad. Confidentiality and privacy of participants were maintained throughout the study. Patients were given a survey to fill out while donating blood after they consented to participate. The inclusion criterion was that participants must be above 18 years old; those under this age were excluded from the study.

A pilot study was conducted with 15 participants to assess the clarity, applicability, and responsiveness of the questionnaire. The tools were examined and validated by a panel of three experts from Al-Baha University. The reliability of the tools was tested using Cronbach’s Alpha, yielding a reliability coefficient of 0.875.

Data collection

The survey comprised four sections. The initial section encompassed sociodemographic variables such as age, marital status, occupation, health, and education level. The second section evaluated participants’ awareness regarding blood donation using eleven questions, some of which were yes or no questions, while others were multiple-choice questions. For every response that demonstrated a positive attitude, participants received one point; for every response that demonstrated a negative attitude, they received zero points. Scores in this section ranged from 0 to 11, with 11 being the maximum score possible. The third section consisted of twelve questions aimed at assessing participants’ knowledge, with one point awarded for a correct response and zero for an incorrect response. The total score for this questionnaire ranged from 0 to 12, with 12 indicating the maximum score. Lastly, part four of the survey focused on practices and comprised seven questions to assess participants’ engagement in blood donation-related activities. Each activity was assigned one point if it was related to blood donation; a lack of engagement resulted in zero points. The scoring range for this section was from 0 to 7, with 7 points representing the highest possible score.

The questionnaire was evaluated in accordance with prior research to ensure the relevance and clarity of the questions, as well as to ascertain the amount of time required to answer all questions. A small random sample was also used for a pilot test to ensure that the format, language, order, comprehension, and length of questions were appropriate. The questionnaire was evaluated in accordance with prior research in order to guarantee the questions’ relevancy and clarity as well as to ascertain the amount of time required for answering all questions. A small random sample was also used for a pilot test of the questionnaire to ensure that its format, language, order, question comprehension, and length were all appropriate.

Data analysis

Version 26 of SPSS was used for all statistical analyses. Table 1 displays continuous data reported as mean ± standard deviation (SD). Numbers and percentages were used to express categorical data. The mean was used as the cutoff point to express knowledge, attitude, and practice scores. A participant was deemed to have strong knowledge about blood donation if their score was equal to or higher than the mean score (7.66±1.83); scores below this were considered low knowledge. In addition, participants were deemed to have a positive attitude if their attitude scores matched or exceeded the mean score (7.49±1.8). The same approach was used for practice; participants were considered to have a good level of practice if their practice scores were at least as high as the mean. The parameters linked to blood donation behavior were determined using logistic regression analyses at a 95% confidence interval (CI) to evaluate the degree of coexistence and interaction between dependent and independent variables, accounting for confounding variables such as age, gender, marital status, education, and discipline. A two-sided p-value of less than 0.05 was deemed statistically significant. Parameters linked to blood donation behavior were analyzed using correlational analyses after accounting for the mentioned confounding variables.

Ethical statement

The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The approval of this study was obtained by Ethical Research Committee on Publication Ethics at King Fahd Hospital at Al-Baha city (KFH/IRB0901202024/1). Data were collected anonymously, and after a full explanation of the aim of the study, participants were educated about the target and benefits of the analysis. Participation in the survey was voluntary. In addition, written consent (i.e., in the form of a question) was provided first. Respondents must agree and give their consent to proceed with the survey. The confidentiality of the data collected was ensured for the participants.

Results

Sociodemographic characteristics provide information about the average age of participants, which fell within the range of 20 to 30 years old, accounting for approximately 83.3% of the total study population. Furthermore, the majority of participants were women, constituting 78.7% of the sample. All participants had a 100% educational level. Approximately 77.3% of the research participants were not employed in the medical field.

The possession of sound knowledge, practice, and attitude is determined by the ability to provide correct answers to most knowledge questions. Tables 1,2 present knowledge, attitude, and practice regarding blood donation during COVID-19. Logistic regression for knowledge, attitude, and practice as factors associated with blood donation, adjusted by sociodemographic factors (N=203), is presented in Table 3. Table 4 presents the relationship of overall scores of knowledge, attitude, and practice with sociodemographic factors related to blood donation.

Discussion

This study aimed to assess awareness, perception, and concepts related to blood donation after the COVID-19 pandemic in Saudi Arabian society. The data could help blood transfusion centers design targeted programs to encourage donors and increase their numbers. Most participants in this study were young individuals aged 20–30 years, accounting for 82.3% of all participants. The same age group has been reported by several studies in Saudi Arabia (8,9). A possible explanation for this predominance is that young individuals are generally more motivated, enthusiastic, and healthier than other age groups.

In the present study, the overall knowledge of participants about blood donation after the pandemic was abundant, with more than half of the participants demonstrating this knowledge. Our findings align with previous studies to some extent, as most participants were more inclined to donate blood during the pandemic, leading to a significant increase in awareness (8,10).

Surprisingly, despite positive attitudes toward blood donation, 86.2% of participants did not donate blood after the pandemic, and only 14% of respondents had donated blood. The most common reason for this was concern about acquiring the COVID-19 infection during blood donation (59.1% of participants). Another possible explanation is that a majority of participants were female (87.7%), and the number of female donors is limited due to common reasons that prevent them from donating blood, such as anemia and pregnancy.

However, this finding contrasts with a previous study that found 43% of participants donated blood during the COVID-19 pandemic (11). Another study conducted in India found that most participants expressed their willingness to donate blood during the ongoing pandemic to help COVID-19 patients with severe illnesses who required blood components (8). Similar observations were reported in a study in the USA, where 91% of medical students expressed their willingness to donate blood despite the pandemic. These previous studies indicate an increased awareness of the importance of blood donation during the COVID-19 pandemic (12).

On the motivational front, the most prevalent reason cited by participants in this study as a motivating factor for blood donation was a sense of social responsibility. This outcome contrasts with other research that identified important motivators for blood donation, such as having a family member or friend who needed a transfusion and appeals from social media (13,14).

More than 80% of participants felt safe donating blood in hospitals compared to blood centers and mobile units. It may be easier to maintain hygiene and social distancing in hospitals compared to blood centers or mobile units. Participants may have received most of their information about blood donation from hospitals, reflecting the weak role of blood centers in educating individuals about blood donation. However, this finding contradicts Tripathi et al. (2022), who found that 45% of participants felt safe donating blood at blood centers (10), while a study by Almalki et al. (2021) reported that 65% of participants preferred mobile blood collection sites for blood donation (14).

This is the first study using logistic regression models to determine the significant relationship between knowledge, attitude, and practice regarding blood donation after the COVID-19 pandemic. Interestingly, the results indicated a significant association between knowledge and attitude with practice, suggesting that increasing knowledge and positive attitudes led to significant increases in practice. Despite this, blood banks and transfusion agencies should design strategies to promote and motivate communities to donate blood, as well as provide rehabilitation courses to educate people about the blood donation process and precautions to prevent infectious diseases.

In conclusion, this study examined blood donation awareness and practices in Saudi Arabia after the COVID-19 pandemic. While many young participants showed a strong understanding of blood donation, actual donation rates were low, with only 14% having donated. The main barrier was fear of COVID-19 infection, particularly among female participants who faced additional challenges.

Despite a sense of social responsibility as a motivator, safety perceptions varied, with participants feeling more secure donating in hospitals than in blood centers or mobile units. The findings highlight the need for targeted educational programs to address misconceptions and promote donation safety. Efforts should focus on engaging male participants and understanding their perspectives to increase overall donation rates and ensure a stable blood supply.

Further studies focusing more on male participants are suggested for a fair comparison. Additionally, there is a lack of information about the reasons for refusing blood donation after the pandemic, which could enhance the findings of this study.

Limitations

The online survey has a lower response rate compared to the physical survey. Bias may be present. The convenience sampling method for participant selection is another source of selection bias. The higher proportion of females participating in the study limits the generalizability of the results. Additionally, the participants were self-selected, which may compromise the generalizability of the results. Moreover, owing to the cross-sectional study design, no conclusions regarding causality can be drawn; it is only used to generate a hypothesis.

Acknowledgments

We would like to acknowledge all participants who took part in this study and filled out the questionnaire. We also thank the Al-Baha Health Cluster for approving this study, as well as the ethical committee team at King Fahad Hospital and all members of the blood bank for their organization and support.

Footnote

Reporting Checklist: The authors have completed the SURGE reporting checklist. Available at https://jlpm.amegroups.com/article/view/10.21037/jlpm-25-3/rc

Data Sharing Statement: Available at https://jlpm.amegroups.com/article/view/10.21037/jlpm-25-3/dss

Peer Review File: Available at https://jlpm.amegroups.com/article/view/10.21037/jlpm-25-3/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jlpm.amegroups.com/article/view/10.21037/jlpm-25-3/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The approval of this study was obtained by Ethical Research Committee on Publication Ethics at King Fahd Hospital at Al-Baha city (KFH/IRB0901202024/1). Data were collected anonymously, and after a full explanation of the aim of the study, participants were educated about the target and benefits of the analysis. Participation in the survey was voluntary. In addition, written consent (i.e., in the form of a question) was provided first. Respondents must agree and give their consent to proceed with the survey. The confidentiality of the data collected was ensured for the participants.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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