Evaluation of Blood Donation Awareness Level: A Cross-Sectional Study

Introduction: This study aimed to evaluate the knowledge, attitudes, and behaviors of individuals regarding blood donation. Methods: A questionnaire study was conducted with 644 individuals aged 18 and older who applied to a university hospital outpatient clinic between May 15, 2023, and August 15, 2023. Foreign nationals under the age of 18 were excluded from the study. The first six questions of the questionnaire were about sociodemographic characteristics. The other 28 questions were designed to assess knowledge, attitudes, and behaviors related to blood donation. The data obtained were analyzed with the SPSS 29 program. Categorical data were summarized as frequencies and percentages, and the relationship between variables was evaluated by the chi-square test, post hoc Bonferroni test, and Fisher’s Exact Test. Results: Among the participants, 55% (n=354) were married, 57.1% (n=368) were female, 44.4% (n=286) were university graduates, and 24.8% (n=160) were between the ages of 18 and 24. There was a significant relationship between gender and age and individuals’ responses to the question about their previous blood donation status. Similarly, there was a significant relationship between the accuracy of answers and educational status and age in the question about the place of blood donation. There was a significant relationship between marital status, educational status, and age and responses to the question about those who were unable to donate blood or diseases that may be caused by blood donation. Conclusion: Individuals’ knowledge, attitudes, and behaviors toward blood donation were found to be influenced by sociodemographic factors. Sociodemographic characteristics should be taken into account in activities to encourage blood donation and in the education of the community. It is believed that our study will shed light on future studies in this regard.


Introduction
Blood donation is a practice that enables the transfer of blood from healthy individuals to those in need, and plays a life-saving role in many diseases and emergencies [1].The demand for blood and blood products is constantly increasing, and to meet the need, regular and voluntary blood donation is of great importance [1].In developed countries, 82% of blood donations come from voluntary blood donors, and donor blood is subjected to all screening tests.In developing countries, blood is obtained in different ways (such as blood for blood or forced transfusion) and only 50% are subjected to screening tests [2,3].In addition, some complications such as weakness, fainting, and dizziness may occur during the blood donation process [4].This condition is more common in young individuals, females, those who give blood for the first time, and those with low blood volume [4].consent was obtained.The inclusion criteria were determined as being 18 years of age or older and being willing to participate in the study with written consent.On the other hand, foreign nationals, pregnant women, those under 18 years of age, and illiterates were excluded from the study.
Within the scope of this study, a 34-question questionnaire form, which evaluates knowledge, attitudes, and behaviors related to blood donation, which was created by reviewing the current literature, was used (Appendices).The first six questions of the questionnaire were descriptive questions about age, gender, educational status, marital status, monthly income, and blood type.In this section, only age was an openended question.Information questions such as where blood donation can be done, the appropriate age, weight status for blood donors, complications that may arise from being a donor, and possible infectious diseases that may develop in blood donors were asked.In total, 13 questions were intended to measure the level of knowledge, and five of them were presented for evaluation as yes, no, no idea, and the remaining information questions were of multiple choices.The remaining 15 questions in the remaining part of the questionnaire were aimed at measuring attitudes and behaviors toward blood donation.It consisted of questions that questioned their behavior of donating blood to family members and/or strangers in case of need, the side effects they experienced, if any, when they donated blood before, and their suggestions for increasing blood donation.In question 28, participants were asked whether they had ever donated blood before.If their answer was no, they were asked to skip directly to the 34th question and complete the questionnaire; if their answer was yes, they were asked to end the questionnaire by answering the first 33 questions.
Approval for the study was obtained from the Karabük University Non-Interventional Clinical Research Ethics Committee (Number: E-77192459-050.99-81109and Subject: 2021/ 717).All participants gave written informed consent.
The data obtained from the questionnaire were analyzed using SPSS 29 (IBM, Armonk, USA) statistical software.The chi-square test was applied to understand the distribution of the data and it was determined that it was compatible with non-parametric distribution.Categorical data were summarized as frequencies and percentages and the relationship between variables was evaluated by chi-square test, post hoc Bonferroni test, and Fisher's Exact Test.A value of p<0.05 was considered statistically significant.

Results
The sociodemographic characteristics of the participants in our study are listed in Table 1.Among the participants, 55% (n=354) were married, 57.1% (n=368) were female, 44.4% (n=286) were university graduates, 24.8% (n=160) were between 18 and 24 years of age, and 35.7% (n=230) had A Rh (+) blood type.The relationship between the sociodemographic characteristics of the participants and their answers to the question "Have you ever donated blood before?" is evaluated in  The relationship between the sociodemographic characteristics of the participants and their answers to the question "Where should blood be donated?" is shown in Table 3.There was no statistically significant relationship between the participants' responses to the question and marital status (p>0.05) and gender (p>0.05).There was a statistically significant relationship between the participants' responses to the question (to all Red Crescent branches throughout the country, to any hospital, to the Red Crescent mobile trucks, and to hospitals with blood donation centers) and their educational status (p<0.05).The participants were grouped by educational status, and the chi-square post hoc Bonferroni correction revealed that the high school and graduate groups differed (p<0.05) with the response "To hospitals with blood donation centers" compared to other education groups (p<0.05).There was a statistically significant relationship between the participants' answers to the question "Where to donate blood?" and age (p<0.005The relationship between the sociodemographic characteristics of the participants and the answers to the question "Who cannot donate blood?" is shown in Table 4.There was no statistically significant relationship between the participants' responses to the question and gender (p>0.05).Chi-square and post hoc Bonferroni correction revealed a statistically significant relationship between the participants' responses to the question (those with contagious diseases and those who have had any surgery) and marital status (p<0.05).There was a statistically significant relationship between the participants' responses to the question (those with contagious diseases, those on medication, and those on aspirin) and educational status (p<0.05).The participants were grouped by educational status, and chi-square post hoc Bonferroni correction revealed that the high school group differed with the response "those with contagious diseases, those on medication, and those on aspirin" and the graduate group differed with the response "those with contagious diseases" compared to the other education groups (p<0.05).There was a statistically significant relationship between the participants' responses to the question (those with contagious diseases and those who have had any surgery) and age (p<0.05).The participants were grouped by age, and the chi-square post hoc Bonferroni correction revealed that the 18-24 age group differed from the other age groups with the response "those with contagious diseases and those who have had any surgery" (p<0.05).
The relationship between participants' sociodemographic characteristics and answers to questions such as "Do you think blood donation may cause the following conditions or diseases?" is shown in Table 5.There was no statistically significant relationship between the participants' responses to the question and gender (p>0.05).There was a statistically significant relationship between the participants' responses to the question (AIDS and increased appetite) and marital status using chi-square post hoc analysis with Bonferroni correction (p<0.05).There was a statistically significant relationship between the participants' responses to the question (AIDS) and educational status (p<0.05).The participants were grouped by educational status, and Bonferroni correction using the chi-square post hoc revealed that the postgraduate group differed with the response "AIDS" compared to other education groups (p<0.05).There was a statistically significant relationship between the participants' responses to the question (AIDS, hepatitis, and fever) and age (p<0.05).The participants were grouped by age, and chi-square post hoc Bonferroni correction revealed that the 18-24 age group differed with the response "AIDS and Fever" and the 31-38 age group differed with the response "Hepatitis" compared to the other age groups (p<0.05).

Discussion
This study was conducted with 644 people, of whom 57.1% were female, 55% were married and 24.8% were between the ages of 18-24.It was found that marital status and education level did not affect the participants' previous blood donation status.Age and gender were found to be significant parameters in blood donation.Marital status and gender were not significant factors in indicating blood donation centers.However, there was a difference in the answer to this question according to age and education level.Education level, age, and marital status were significant in determining the diseases and conditions that prevented blood donation, while no difference was found due to gender.Similarly, marital status, age, and educational status were significant parameters for diseases that may develop as a result of blood donation, but no difference was found in this question depending on gender.
In this study, whether the participants had donated blood before was analyzed within the framework of sociodemographic characteristics.As a result, it was determined that age and gender parameters affected the blood donation behavior of the participants, but marital status and education level did not.Tadesse et al.'s study, which included multiple regression analysis with 556 healthcare workers in Ethiopia, found that 266 people donated blood at least once in their lives.In the same study, a significant relationship was found between factors affecting blood donation and being over 30 years old, being married, and having a high socio-cultural level [6].Adıgüzel et al.'s study involving 446 university staff and students found that there was a significant relationship between genders in terms of blood donation status, with men donating blood at a higher rate [7].Malako et al. conducted a study among hospital workers in Ethiopia, and very few of the participants reported having donated blood in their lifetime.It was also found that the practice of blood donation was more common among male participants [8].In his research with the participation of 402 university students, Özpulat found that 14.7% of female students and 34.5% of male students had donated blood before [9].Bourne et al.'s study conducted with 200 students at the Jamaica University of Technology found that although students had high knowledge and awareness about blood donation, they donated less blood [10].In Altındiş et al.'s study conducted with 451 participants, it was revealed that 63% of the participants had never donated blood before [11].In their study with 176 teacher participants, Hablemitoğlu et al. found that blood donation status and age were important predictors [12].In his study of individuals living in rural areas of Thailand, Wiwanitkit found that education, especially depending on the school system, is an important factor affecting blood donation [13].In Özbeşer et al.'s study conducted with 451 participants, it was determined that 44.2% of the participants had donated blood before, education level did not affect blood donation status, and men donated more blood than women [14].In a study of 5353 donors in the Canary Islands, Romero Dominguez et al. found that women, teenagers, and college graduates tended to donate more [15].Tscheulin and Lindenmeier's study with 210 participants in Germany discovered that blood donors were young women or highly educated men [16].In their study with 1055 primary care users in Brazil, Zucoloto et al. found that women, young people, and people with low socioeconomic and educational levels were less likely to donate blood [17].When the results obtained in this study are compared with some studies in the literature, it is thought that the sociodemographic characteristics that affect blood donation behavior differ according to sample size, and ethnic and cultural characteristics.
In this study, it was determined that marital status and gender parameters were not significant in determining the places where participants could donate blood, but age and education level were significant.Similarly, as per Marantidou et al.'s study, at the event where 1600 blood donors were present in Greece, the participants stated that they could donate blood at any hospital in Greece [18].Özpulat stated that 84% of the students donated blood in Red Crescent centers and 9.9% in public hospitals [9].Tulunay, in his research with 2281 bank employees, stated that 39.1% of the participants made their first blood donation in the hospital, and the most blood donation was in the hospital.It was determined that the intended place was the Red Crescent Blood Center (53.8%) [19].It is thought that especially age and education parameters are effective in choosing Red Crescent and hospitals as blood donation centers.
In this study, it was determined that education level, age, and marital status were significant in determining the diseases and conditions that prevent blood donation, but the gender parameter was not significant.It was also found that there was a significant relationship between the educational level of the participants and the responses of those with infectious diseases, those using medication, and those using aspirin.Saleh et al. similarly found that factors preventing individuals from donating blood were the donor's medical conditions and nutritional deficiencies [20].Oh et al. found in their study that people using low doses of aspirin (81 mg) could donate blood as long as their coagulation status was not significantly impaired [21].Consistent with findings from comparable studies, health problems may be considered an important factor preventing individuals from donating blood.
In this study, it was determined that education level, age, and marital status were significant in determining the diseases and conditions that prevent blood donation, and there was no significant difference according to gender.Similarly, it was determined that the parameters of marital status, age, and education level were significant in diseases that may develop as a result of blood donation, but there was no difference according to gender.In their study with 86 people who gave blood samples before experiencing symptoms of the disease and a matched 256 control group, Kokkonen et al. found that cytokines, cytokine-related factors, and chemokines were elevated in donors before the onset of rheumatoid arthritis (RA) [22].Olaiya et al. found that 52.4% of blood donors were concerned about HIV and/or hepatitis infection.The study found that many donors have misconceptions about the risks of donating blood, such as weight loss, sexual failure, and high blood pressure [23].Özbeşer et al. found that 19.7% of participants were afraid of contracting AIDS after donating blood [14].In the study conducted by Yaşar et al. with 100 physicians, it was found that 7% of donors avoided donating blood due to fear of contracting an infectious disease [24].Altındiş et al. found that 34.1% of participants experienced fear of infection when donating blood [11].Ryhan et al. in their study where 35,256 donors donated blood, it was determined that 1928 donors experienced negative effects and age and gender were effective in this effect [25].The results obtained in this study and similar studies suggest that the responses to diseases that blood donation may cause, education level, age, and marital status have a positive impact on individuals' awareness.
Limitations of the study: It is a single-centered study, thus the results cannot be generalized due to this situation, the validity and reliability of the survey questions in Turkish have not been conducted, and the Cronbach alpha number has not been calculated.

Conclusions
This study revealed that knowledge, attitudes, and behaviors toward blood donation are affected by sociodemographic characteristics.In addition, it was seen that there was a significant lack of information in society about where to donate blood, who can be a blood donor, and complications that may occur due to blood donation, and awareness was raised.In order to increase blood donation and provide motivation in this regard, the public can be encouraged to donate blood, with healthcare professionals taking the lead in donating blood.Among the patients followed in primary care, those who are eligible to be donors can be supported by their family physicians to become donors.Additionally, increasing the number of mobile devices can positively affect blood donation.It is thought that the research can contribute to the studies on this subject and be a guide in this regard.

Table 2
Yes or No) to the question and marital status (p>0.05) or educational status (p>0.05).
. There was a statistically significant relationship between the participants' responses (Yes or No) to the question and gender (p<0.05) and age (p<0.05).There was no statistically significant relationship between the participants' responses (

TABLE 3 : Evaluation of the Relationship Between the Sociodemographic Characteristics of the Participants and Their Responses to the Question "Where to Donate Blood?"
*p<0.05; Chi-square Test; a,b: Bonferroni Test

TABLE 4 : Evaluation of the Relationship Between the Sociodemographic Characteristics of the Participants and Their Responses to the Question "Who Cannot Donate Blood?"
*p<0.05; Chi-square Test; a,b,c,d: Bonferroni Test

TABLE 5 : Evaluation of the Relationship Between the Sociodemographic Characteristics of the Participants and Their Responses to the Question "Do you think blood donation can cause the following conditions or diseases?"
*p<0.05; Chi-square Test; a,b,c,d: Bonferroni Test Do you pay attention to announcements about blood donation in public places (subway, hospital, dormitory, etc.)?Is there any medicine that can be given to a patient in need of blood in case blood is not available?Where was the place where you donated blood?(More than one option can be selected) •Because I don't trust health personnel • I do not feel healthy enough to give blood 2023 Korkut et al.Cureus 15(10): e47318.DOI 10.7759/cureus.4731814 of 16