Blood Donation Behaviours and Challenges: Insights from University Students in Saudi Arabia

There are currently no substitutes for the components of human blood that are essential for life. To ensure the best therapeutic outcomes, appropriate and safe blood and blood products practices should be followed and blood and its products should be easily accessible for usage in specific medical situations [1,2]. Blood transfusions are most frequently required for surgery, trauma, haematology disorders and problems associated to pregnancy, thus necessitating voluntary and regular donations for ensuring an adequate supply of blood for all blood types [3,4]. Thus, blood banks look for donors, screen for infectious diseases, process blood and keep it refrigerated for medical requirements [5,6].

Worldwide, more than 100 million units of blood are donated annually [7,8]. However, Saudi Arabia's average blood donation rate (13.8 per 1000) is lower than that of high-income nations (32.6 per 1000) mainly due to limited awareness and misconceptions about blood donation [9,10]. Previous studies revealed that a substantial number of the populace views blood donation and its social value negatively [2,11]. Among the Middle Eastern countries, Saudi Arabia is most affected by sickle cell anaemia and beta-thalassemia [3], with high prevalence in Al-Qunfudah (135.7% per 1000 Saudis) compared with Makkah (30.3%) and the Western region (28.5%) respectively [4]. Limited public awareness of the prevalence of these conditions and their frequent need for blood transfusions remains a significant issue. Blood unviability is common in many healthcare settings due to an imbalance between the growing need for safe blood and blood products and the inability to arrange a regular supply of blood because of misunderstandings, perceived dangers and harms and low donor motivation [6]. This study aimed to assess the knowledge, attitudes and practices related to blood donation among university students in Saudi Arabia. The findings are intended to shed light on the challenges faced by students in this context, potentially guiding the development of effective solutions. Additionally, the results may contribute to raising awareness and promoting healthy blood donation practices within the university student population.

Study Objectives

This study aimed to:

• Assess the knowledge level about blood donation among university students in Saudi Arabia
• Evaluate attitudes towards blood donation among the study population
• Investigate current blood donation practices among university students
• Identify major barriers and challenges to blood donation
• Provide evidence-based recommendations for promoting blood donation awareness and participation

A descriptive cross-sectional study was performed on 385 university students using questionnaire (developed using Google Forms, Google, Mountain View, CA, USA) as a tool for data collection that was distributed through electronic social media. The research data was collected over a period of two months, from February 2025 to March 2025. Students of both genders were included in the study. The minimum required sample size of 385 was determined using an online calculator (Qualtrics), with a 5% margin of error and a 95% confidence level. All participant information remained confidential, with no names or identification details collected. Participation was entirely voluntary, allowing participants to withdraw from the survey at any time. The study employed convenience sampling, which is acknowledged as a limitation that may affect the generalizability of findings to the broader student population. A self-structured pre-validated questionnaire was designed for collection of the data based on earlier studies [10,11]. After designing the questionnaire, it was rechecked by a panel of 3 specialists for the approval of its validity. Following pilot validation with 30 participants, the questionnaire's internal consistency was assessed using Cronbach's alpha. The alpha values for knowledge (" = 0.78) and attitude (" = 0.82) sections demonstrated good reliability.

The survey was divided into 5 parts.

• Part 1: Included 6 questions about the sociodemographic data of the participants as well as general information regarding blood transfusion
• Part 2: Consisted of 16 questions related to the participant’s knowledge about blood donation knowledge. A three-point Likert scale (Yes, No and Don’t Know) was used for evaluation. Each correct response was awarded one point, while incorrect and "Don’t Know" responses received zero points. The total score and percentage were calculated for each participant. Knowledge levels were categorized as follows:
• Good knowledge: 13-16 correct answers
• Moderate knowledge: 9-12 correct answers
• Poor knowledge: Less than 9 correct answers
• Part 3: Contained 7 items to assess participant’s attitude towards blood donation. Participants were categorized as having either a positive or negative attitude based on their responses. Each statement assessed a specific attitude, with response options of "Agree," "Disagree," and "Neutral." A positive attitude was indicated by a specific response, while the remaining two responses were classified as representing a negative attitude
• Part 4: Included 4 statements regarding the practices of the participants related to blood donation
• Part 5: Included the barriers related to blood donation among the students

Ethical Approval and Informed Consent

The study was approved by the Local Committee of Bioethics (decision no. 6/25/H dated 27/01/2025) at Northern Border University, Arar, Saudi Arabia. Completing the survey was considered as providing informed consent. Participants who did not complete the survey were excluded from the study.

Ethical Compliance with Human Study

This study was conducted in compliance with the ethical standards of the University on human subjects as well as with the Helsinki Declaration. This study was conducted and reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for cross-sectional studies.

Data Analysis

For Data analysis, SPSS 26.0 (IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY, USA: IBM Corp) was used. Descriptive statistics was performed using frequencies and percentages for categorical variables. Chi square test was used to assess the relationship between sociodemographic factors and knowledge and attitude of the students towards blood donation. A p-value of <0.05 was considered statistically significant All assumptions for chi-square testing were verified prior to analysis, ensuring that expected cell frequencies were ≥5 in at least 80% of cells and no expected frequency was <1. Fisher's exact test was used when chi-square assumptions were not met.

Characteristics of the study population are outlined in Table 1. The survey included 385 individuals, predominantly aged 18-24 years. Gender distribution was fairly balanced. In terms of education, more than half of the participants were enrolled in non-health-related courses, while remaining were health professional students. Most participants were unmarried. High level of awareness regarding voluntary blood donation was identified, although a minority remained unaware. Moreover, familial attitudes on blood donation were mostly positive, with majority of the participants expressing encouragement from their families.

Table 1: Demographic Details and General Information

The data in Table 2 provides insights into participants' knowledge about blood donation. A total of 16 items were included in the assessment. Most participants correctly believed they can donate blood to someone with the same blood group and recognized the necessity of laboratory tests before donation. A significant awareness was observed among the participants about health-related limitations towards blood donation, particularly regarding anemia and Hepatitis C as contraindications. Nevertheless, some misconceptions were also identified regarding appropriate donation frequency and eligibility criteria. Awareness of the risks and benefits of blood donation varied among the participants, with some recognizing that excessive donation may contribute to anemia and that donation can stimulate bone marrow activity, while others remained unaware. The findings indicate uncertainty among the participants regarding eligibility of blood donation, including smoking status, minimum weight requirements, standard donation volume and temporary deferral due to fever. Additionally, there was notable confusion about the eligibility of individuals with chronic conditions such as diabetes and hypertension. The data indicates good knowledge in certain domains, yet it also uncovers notable deficiencies that could be addressed through targeted educational programs.

Table 2: Items for Assessing Knowledge About Blood Donation

Table 3 illustrates the distribution of participants' knowledge levels concerning blood donation and was classified as good, moderate or poor. Furthermore, it analyses the correlation between knowledge levels and various factors, such as gender, age, educational attainment and the marital status of the participants. Overall, a substantial proportion of participants exhibited poor knowledge, while merely a small fraction demonstrated good knowledge. Age was not significantly associated with knowledge levels, though older participants showed slightly better awareness than younger ones. Similarly, gender differences were not statistically significant, however, a slightly higher proportion of females demonstrated good knowledge as compared to males. The educational background had an impact on knowledge levels, as evidenced by health professional students exhibiting better understanding than those in other fields. Marital status showed no significant correlation with knowledge levels. In short, none of the examined explanatory variables demonstrated a statistically significant correlation with knowledge regarding blood donation, indicating that knowledge levels may be affected by other unassessed factors.

Table 3: Association Between Knowledge and Explanatory Variables

To assess students' attitudes toward blood donation, seven statements were provided and students indicated their responses by choosing "agree," "disagree," or "neutral." The results presented in Table 4 indicate that majority of the students exhibited a favorable attitude towards promoting donations among others. Furthermore, more than half were against religious discrimination in blood donation. Most students expressed a favorable view of blood donation as a responsebility and opposed the idea that blood donation should be limited to relatives. A large proportion expressed a willingness to undergo training on blood donation and indicated a readiness to donate in instances of blood shortages and to engage in blood donation campaigns organized by the university. The findings of our study gives an insight about accentuating motivation, responsibility and readiness to engage in donation activities among students.

Table 4: Items for Assessing Attitude Towards Blood Donation

Table 5 shows students attitude towards blood donation. Furthermore, it examines the correlation between sociodemographic variables and individuals' attitude regarding blood donation. The analysis indicated that the vast majority of participants had a positive attitude toward blood donation. Age, gender and educational background did not have a statistically significant effect on attitude, although older and health professional students tended to be slightly more positive. Marital status was identified as a significant variable, with married individuals exhibiting a more favorable attitude compared to unmarried participants. In summary, although positive attitude towards blood donation was prevalent, marital status emerged as the sole variable significantly associated with attitude levels.

Table 5: Association between attitude and explanatory variables

Table 6 provides a summary of the blood donation practices among participants. Only a minority of participants reported having donated blood, whereas the majority had not done so or were unable to recall their donation status. Of the individuals who donated, contributions ranged from a single donation to multiple donations Furthermore, less than half of the participants reported having attended a lecture on the significance of blood donation, while most of them had not attended such a lecture or were unable to recall. Despite the low rate of past donation, participants’ intentions to donate in the future were generally favorable, with most expressing willingness to contribute. The findings indicate a discrepancy between knowledge and practice, underscoring the necessity for enhanced awareness campaigns to convert willingness into action.

Table 6: Practices Adopted Regarding Blood Donation

Table 7 displays several obstacles to blood donation faced by students. The presence of a chronic disease was identified as the main reason followed by the fear of infection and the fear of fainting. Additional barriers consisted of a lack of awareness regarding the donation process and apprehension about appearing weak. Although these barriers indicated concerns that hinder blood donation, a significant portion of participants either did not express these fears or remain uncertain about the donation process.

Table 7: Obstacles to Blood Donation

Blood transfusions save millions of lives worldwide each year and enable a variety of complex procedures that extend the lifespan of patients with severe acute and chronic disorders [2,5,7,12]. The shortage of blood and blood products can be somewhat lessened by students’ availability in the teaching universities as source of voluntary blood donors. Despite having a positive attitude and comparatively excellent understanding about voluntary blood donation, some studies have revealed that students do not follow the guidelines regarding the blood donation well [6,8,10]. Our study findings suggested that while there were variations in knowledge levels about blood donation across different demographic groups, none of these differences reached statistical significance. This indicates that sociodemographic factors may not be strong predictors of knowledge about blood donation practices in health profession student’s population. Further research may be needed to explore other potential factors influencing knowledge levels, such as socio-economic status or exposure to blood donation campaigns.

Our survey included 385 individuals, predominantly aged 18-24 years. This demographic knowledge gives an insight that like earlier studies younger populations were more interested and had been willing to participate in voluntary blood donation programs. The high level of awareness about voluntary blood donation among health profession students in our study is encouraging. This highlights an opportunity for targeted educational campaigns about blood donation within non-health academic settings to enhance awareness and participation among the students who are taking other non-health related courses.

The majority of our participants in the present study were unmarried, which was in agreement with earlier study highlighting that single individuals may have different motivations or find easy to overcome the barriers regarding blood donation compared to married individuals [1].

Previous studies on blood donation practices among health professional students have provided valuable insights into their understanding of key concepts and common misconceptions [13-15]. Our study revealed mixed knowledge levels regarding donor eligibility and safety. While the majority of participants recognized that individuals with anemia should not donate and understood the importance of laboratory tests prior to donation, reflecting awareness of donor safety but still some gaps persisted. For instance, only a portion correctly understood that a person infected with Hepatitis C cannot donate, highlighting the need for increased awareness of infectious disease transmission risks. Similarly, fewer participants appreciated that excessive blood donation can lead to anemia, indicating limited understanding of the potential health impacts of frequent donations. Most participants demonstrated good knowledge of blood compatibility, correctly identifying that they could donate to someone with the same blood group. However, misconceptions remained regarding donation frequency and minimum hemoglobin levels, with a notable number believing that donations should occur every three months or holding incorrect assumptions about hemoglobin requirements.

Our study findings regarding perception, practices and myths related to blood donation were similar to the findings seen in few other studies [13-16]. A vast majority of participants in our study believed that blood donation improves blood circulation and stimulates bone marrow to produce new blood cells which were found to be similar to early study results [14,15]. However, there was confusion among few participants regarding other eligibility criteria for blood donation, such as minimum weight limit for donation and whether individuals with fever or diabetes can donate blood. There were also notable misconceptions, particularly regarding smokers' eligibility for donating blood and the amount of blood taken during donation. This indicates a need for better education on these topics. A minority of participants in our study believed that people donate blood solely out of religious purposes. This indicates that the majority do not view religious beliefs as the primary motive for blood donation. These findings align with the findings of other studies [14-16].

In the present study it was found that only a minority of participants have donated blood, whereas the majority had not done so or were unable to recall their donation status. This is in line with previous studies where majority of students have never donated blood in their lives [15,16]. In order to encourage voluntary blood donation and foster a positive attitude toward voluntary blood donation campaign, students should be given opportunities through frequent blood donation awareness programs and helping to encourage them to participate in blood donation camps. Furthermore, only less than half of the participants in the present study reported having attended a lecture on the significance of blood donation, while most of them had not attended such a lecture or were unable to recall. Earlier studies have shown that not many students have attended lectures on the importance of blood donation [13-15,17,18]. This indicates a gap in educational outreach, as nearly half of the participants in our study also have not received formal information on the blood donation topic, suggesting a need for more engaging and memorable experiences about participating in blood donation campaign after getting adequate knowledge and awareness by educational interventions.

The analysis of obstacles to blood donation among health professional students revealed several key concerns. The presence of a chronic disease was identified as the main reason followed by the fear of infection and the fear of fainting. Additional barriers consisted of a lack of awareness regarding the donation process and apprehension about appearing weak, reflecting misconceptions about blood donation practices. These beliefs may stem from a lack of accurate information or misunderstandings about donation guidelines. Understanding the barriers among student population may also help in developing effective strategies to encourage more blood donations. Educational campaigns by providing information about the safety of the procedure and tips for ensuring a comfortable donation experience could also help alleviate these fears among students.

Our study results give an insight that by providing clear, accessible information about the safety and benefits of blood donation, as well as addressing specific fears, organizations can work to overcome these barriers and encourage to contribute to voluntary blood donation among students.

The present study indicates a generally high level of interest for blood donations among health profession education students. However, there were significant gaps in knowledge about specific eligibility criteria for blood donation and the health implications of blood donation. Addressing these misconceptions through targeted educational initiatives can enhance overall understanding and encourage more students to participate in blood donation programs.

Recommendations

Based on the study findings, a multifaceted, evidence-based approach is recommended to enhance blood donation awareness and participation among university students in Saudi Arabia. Comprehensive, student-focused educational programs should be implemented to address misconceptions about eligibility, donation frequency, procedures and health effects, using interactive workshops, seminars and digital platforms. Universities should strengthen institutional support by organizing regular on-campus blood donation drives in collaboration with blood banks and health authorities, ensuring convenient access, mobile units during peak periods and adequate pre- and post-donation medical support. Targeted strategies are needed to reduce key barriers such as fear of infection, fainting and chronic illness, through reassurance about safety protocols, enhanced support for first-time donors and testimonial campaigns featuring student donors. Blood donation education should be integrated into orientation programs, curricula and wellness initiatives, supported by institutional policies that recognize donor contributions and facilitate participation.

Conflicts of Interest

The authors declare no conflicts of interest.

Ethical Approval and Informed Consent

The study was approved by the Local Committee of Bioethics (decision No. 6/25/H dated 27/01/2025) at Northern Border University, Arar, Saudi Arabia. Completing the survey was considered as providing informed consent. Participants who did not complete the survey were excluded from the study.

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