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Year : 2021  |  Volume : 6  |  Issue : 1  |  Page : 6-14

Assessment of knowledge, attitude, and practice among health professionals in an oncological hospital on voluntary blood donation - Investigating their participation in programs to promote blood donation

Department of Blood Transfusion, General Oncology Hospital of Kifissia "Agioi Anargyroi", Greece

Date of Submission23-Nov-2020
Date of Decision02-Mar-2021
Date of Acceptance19-Mar-2021
Date of Web Publication29-May-2021

Correspondence Address:
Mrs. Eugenia Kouka
Department of Blood Transfusion, General Oncology Hospital of Kifissia "Agioi Anargyroi"
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/GJTM.GJTM_107_20

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Background and Objectives: Greece, despite its relative blood sufficiency and high international ranking in terms of the number of blood donors compared to its population, faces significant challenges due to the low rate of voluntary blood donors, as well as the demographic aging of the population in the medium to longer term. The purpose of the study is to evaluate the knowledge, attitudes, and practices (KAP) of health professionals at the Oncological Hospital “Metaxa” in Greece, regarding voluntary blood donation (VBD). The objective of this research is to investigate the effect of sociodemographic characteristics of health professionals as regards KAP on VBD and to find factors related to their participation in VBD promotion policies. Methods: The study was based on the review of the relevant literature, followed by empirical research employing the KAP model. The study was conducted on 254 health professionals of the Oncological Hospital “Metaxa.” in the period December 20, 2019 to March 3, 2020, using a questionnaire. The data were analyzed using SPSS version 21 with P value set at 0.05 for statistical significance. Results: The research findings indicate a high score in the knowledge and attitudes of health professionals regarding blood donation (BD), but low performance in the practice. BD correlates to knowledge and attitudes as well as gender. The majority of the health professionals responded positively in terms of their participation in BD programs. Gender, age, professional position, and years of service were associated with participation in BD programs. Conclusions: The results of the research justify the possibility of activating health professionals in policies to promote VBD, to the extent that due to their knowledge and positive attitude regarding BD, they can promote VBD in different population groups and ultimately contribute to an increase in the size of blood supply.

Keywords: Attitude, blood donation, knowledge, practice

How to cite this article:
Kouka E. Assessment of knowledge, attitude, and practice among health professionals in an oncological hospital on voluntary blood donation - Investigating their participation in programs to promote blood donation. Glob J Transfus Med 2021;6:6-14

How to cite this URL:
Kouka E. Assessment of knowledge, attitude, and practice among health professionals in an oncological hospital on voluntary blood donation - Investigating their participation in programs to promote blood donation. Glob J Transfus Med [serial online] 2021 [cited 2022 Aug 18];6:6-14. Available from: https://www.gjtmonline.com/text.asp?2021/6/1/6/317118

  Introduction Top

According to the World Health Organization, approximately 118.5 million blood donations (BDs) are collected globally. Demographic changes and advanced medical procedures have increased the need for blood transfusions. Greece, despite having relative blood adequacy and high international performance in terms of blood collection in relation to its population, faces significant challenges related to the low percentage of voluntary blood donors, and the demographic aging of the population. Based on Eurostat's[1] baseline projections, the Greek population group aged 18–65, who are the main pool of blood donors, is estimated to decrease by 24% in the period 2019–2050, while the group over 65 will increase by 38%. According to Greinacher et al., the future blood supply correlates closely with the demographic characteristics of a population.[2] The population structure in most countries in Europe and North America is shifting from younger to older age groups because of an increase in life expectancy and the aging of previous high-birth-rate cohorts, aggravated by a sustained decrease in birth rates.[2] Borkent-Raven et al. reported that blood demand depends on the extent to which effects, such as optimal blood use, e.g., due to medical practice, will offset the effects of an aging population and patients in need of transfusions.[3]

In Greece, BD behavior is considered particularly satisfactory. Greece ranks first in terms of the number of blood donors in relation to its population, with 35 blood donors per 1000 inhabitants, compared to 24.3 (median) among 30 European countries, according to EDQM.[4] Nevertheless, Greece is included in the group of countries worldwide that rely on replacement donors to meet their blood needs. The blood units collected annually in Greece correspond almost to 5% of the population. In 2018, 566,327 blood units were collected in Greece, out of which 4% were imported from the Swiss Red Cross. Voluntary blood donations (VBDs) correspond to 63.1% of the domestic supply and 35.1% from replacement donors, according to the National Blood Donation Center. The development of a strategy that involves both the adequacy of blood supply and the increase of voluntary blood donors, requires the involvement of stakeholders in the field of health. The participation of health professionals in health programs, according to the review of the international literature, leads to a significant improvement in the results of the respective actions. Witjes et al., in a review related to interventions aimed at health-care professionals to increase the number of organ donors, found significant improvement in several programs.[5] In addition, according to Venkatesh and Sinha, several studies have identified that the intervention-counseling role of health professionals increases the rate of smoking cessation of their patients.[6]

The implementation of strategies designed to mobilize health professionals regarding VBD, presupposes the evaluation of their knowledge, attitudes, and practices (KAP), for this issue. KAP surveys provide a context-specific evidence base for the development of informational material, communication strategies, and interventions to promote voluntary, nonremunerated blood donors, an essential component of safe blood supply in any setting.[7] According to Nwogoh et al., there are lots of publications assessing the knowledge, attitude, and practice of VBD; however, very few studies have been published which assess the same on the health-care workers.[8],[9] The present study was based on a literature review of 15 relevant KAP studies[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22] in health professionals [Table 1]. Most KAP studies on health professionals found overall satisfactory levels of knowledge and positive attitude toward BD among respondents, but low participation in BD. The study focuses on VBD in the context of the KAP evaluation of health professionals and their participation in policies to enhance blood adequacy and promote its voluntary nature. The research questions of the study are expressed as follows: (a) how the KAP of health professionals toward BD are evaluated, (b) what is the correlation of sociodemographic characteristics to KAP as regards VBD, and (c) which sociodemographic factors related to the involvement of health professionals in policies promoting VBD.
Table 1: Knowledge, attitudes, and practices studies of health professionals for blood donation

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  Materials and Methods Top

The study was conducted in the Greek Oncological Hospital of Piraeus “Metaxa” between December 2019 and March 2020. The study population consisted of health professionals working at this hospital. The hospital operates as a specialized center for the prevention, diagnosis, and treatment of cancer, and is one of the 118 public hospitals of the Greek National Health Service. The number of staff working at the hospital as of December 2019 was 744, concerning employees in the medical service (doctors, paramedical staff, and other scientific staff), in the nursing service, as well as in the administrative and technical service. The sample size N was determined based on the total number of Hospital's employees (n = 744), the (z-score) at the confidence level of 95%, the proportion of the sample as an unknown parameter was defined at 0.5, and the margin of error at 0.5%. The calculation type for the sample size (N), is as follows:

n: Population size = 744

z: Z-score = 1.96

e: Margin of error = 0.5%

p: Sample ratio = 0.5

The mathematical formula is as follows:

The required sample size was determined at 254 health professionals. The research framework of the survey is based on the development of the KAP model. A questionnaire was used which includes 32 questions and consists of four sections (sociodemographic characteristics, knowledge on BD, attitude toward BD, and BD practice). The questions arose from the review of the relevant literature.[8],[9],[10],[11],[12],[13] Data analysis was performed with the use of SPSS version 21 (IBM Corp. Armonk, NY, USA). Percentages and means were calculated for the data. Chi-square test, crosstabs, and ANOVA were applied wherever necessary and a P < 0.05 was considered as statistically significant.


The Scientific Council and the Board of Directors (BoD) of the hospital approved the research. The study did not impose any financial burden on the participants and an informed and written consent was obtained.

  Results Top

Sociodemographic characteristics of the study participants

The majority of the participants were women (76%), mainly aged 36–55 years. Regarding the level of education, it was found that six out of ten were graduates of higher education, out of which one in four had a master's or doctoral degree. Regarding their marital status, most respondents stated that they were married (62.2%). Regarding their employment position, 53.1% belonged to the nursing service, 27.6% to the medical service, 12.6% to the administrative service, and 6.7% to the technical service. In addition, a large percentage of health professionals (30.3%) stated + 25 years of total employment. The sociodemographic characteristics of the respondents are depicted in [Table 2].
Table 2: Sociodemographic parameters of respondents

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Knowledge about blood donation

The research findings indicate a high score for the knowledge of health professionals on BD, which stood at 77.1%. The estimation of the overall level of knowledge was based on Bantayehu methodology and determined by summing up the correct answers of each individual response (each correct answer received one point and each incorrect answer received zero points).[10] Regarding questions related to knowledge, in particular, 63% of the respondents knew how often an individual could donate blood, 76% knew the duration of a single donation process, and 78% knew the volume of blood collected during each donation. Moreover, the majority of the respondents (92.5%) had a good knowledge of the ABO group system and 89.7% knew their blood group. Furthermore, 89.2% knew that blood is tested for HIV, hepatitis B virus, and hepatitis C virus before transfusion. Respondent's knowledge about BD is depicted in [Table 3].
Table 3: Knowledge of blood donation

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Attitudes toward blood donation

The overwhelming majority of respondents had a positive attitude toward BD. Based on Bantayehu methodology (respondents who indicated a positive attitude over 3 out of the first 6 questions related to the attitude section),[10] 96.9% of the respondents were considered to have a positive attitude. More specifically, all the respondents considered BD as positive, 93.7% of respondents chose voluntary, unpaid BD as the best source of blood supply, and 90.6% reported that the relatives of the patient should be asked to donate. Finally, only 51.2% of the respondents believe that they have sufficient information on VBD. Respondent's attitudes toward BD are depicted in [Table 4].
Table 4: Attitude of blood donation

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Practice of blood donation

As far as the BD practice of respondents is concerned, 142 (55.9%) have donated blood at least once. Additionally, 57% of the blood donors stated that they donated blood voluntarily, 19% to meet the need of a family member/friend, while 21% mentioned both of the above reasons. Almost 23% of the overall donors are regular blood donors since they donate blood two or more times every year. The main reason for nondonation by those who have not donated is related to health issues (82.1%), followed by “not approached to donate” (9.8%). On whether the telephone reminder or the appointment for the next BD would encourage blood donors to donate blood more regularly, 63.4% of blood donors answered positively. Regarding the encouragement of their acquaintances to donate blood, the vast majority of respondents answered positively (89.2%). Respondent's practices for BD are depicted in [Table 5]. Regarding the participation of health professionals in programs and strategies aiming at blood adequacy and achievement of 100% VBD, 74.1% of participants answered positively. The proposed program regarding “the acquisition and recommendation of new volunteer blood donors” was the main option of all respondents with 46.9%, followed by “shift of replacement blood donors to regular volunteer blood donors” by 30.3% and “participation as volunteer blood donors” with 28.7% [Table 5].
Table 5: Practice of blood donation

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Factors associated with knowledge, attitudes, and practices toward blood donation

The study revealed that the knowledge of health professionals presented a significant correlation with educational level (P = 0.011) and profession (P < 0.0001). On the other hand, the emergence of high performance on the positive attitude toward BD did not make clear the finding of a sociodemographic variable that shows a correlation with attitudes. Furthermore, gender has a strong correlation with BD practices (P < 0.001), with men being more likely to be blood donors than women. Additionally, a correlation was found with the frequency of BD. Knowledge and attitudes also have a strong correlation with BD practices, with P = 0.011 and P = 0.012, accordingly. Regarding the sociodemographic factors related to the participation of the respondents in programs and strategies for BD, it was found that gender (P = 0.039) and age (P = 0.046) were correlated with the positive answers, with younger ages having a higher participation rate. Furthermore, the correlation was found with the profession (P = 0.033), with the highest positive response concerning the other scientific staff of the health sector (87.5%), followed by nursing (82.4%) and medical staff (79.2%). Moreover, a correlation was found in the participation in BD programs and the years of service (P = 0.003 < 0.05), with higher rates in service 1–5 years (94.7%) and 12–17 years (83.7%). The majority of respondents (38.6%) chose one program while two programs were selected by 20.1%.

  Discussion Top

The findings of the present study, regarding the sufficient knowledge and positive attitude toward BD, but also the low levels of BD are found in most of KAP surveys[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22] among health professionals [Table 1]. The expected finding of the current study, i.e., that blood donors have better levels of knowledge about BD than nonblood donors (average blood donors score 79.8% and 73.9% of nonblood donors) was also noted by Lownik et al., and Sousos et al.[7],[11] Insufficient knowledge could influence the attitudes of respondents and their practice. The statistically significant association of educational level and knowledge (higher performance in higher education graduates and postgraduates), is noted also by Tadesse et al.[14] The high rate of health professionals (93.7%) who believe that volunteer donors are the best source of blood, is also found by relevant KAP studies by Nwogoh et al., with 80.7%, Sousos et al., with 89.3%, and Ahmed et al., with 85.5%.[8],[11],[12] It is noteworthy that the current study's level of a positive attitude for specific questions (i.e., perception of BD and VBD and whether the relatives of patients should be asked to become blood donors) is higher among 5 surveys with the same structure.[8],[9],[10],[12],[13] The finding of an association between attitudes and BD practices is also noted by Tadesse et al., Arage et al., and Abera et al.[14],[15],[16] Nevertheless, despite the high performance of a positive attitude toward VBD found in most of the studies, there is a significant discrepancy in relation to the rates of VBD.

The percentage of blood donors in the present study (55.9%) is one of the highest among the relevant KAP studies,[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22] while voluntary blood donors' percentage (32%) presents the highest level [Table 1]. The statistically significant correlation between BD practices and gender, with men being more likely to be blood donors than women, was also found by Nwogoh et al., Bantayehu, Ahmed et al., and Praveen et al.[9],[10],[12],[17] According to Nwogoh et al., this is quite understandable since women within the donor age range usually may have one factor or another interfering with their chances of being suitable to donate. Factors such as their frequent menstrual cycles, pregnancy, and lactation may prevent them from the donation.[9] In the present study, the main reason for abstaining from BD was health problems, which was also pointed out by Sousos et al., and Abera et al.[11],[16]


The research focuses exclusively on the health professionals for whom there is interest in generalizing the findings of the study, so the results cannot be extended to the general population. The research was conducted on a population group that has particular characteristics, such as its familiarity with issues related to blood needs because of their professional status. In addition, the generalization for all health professionals is limited due to the special characteristics of the Oncological Hospital “Metaxa.” The fact that it serves mainly patients with malignant diseases that often need blood or blood products for their treatment, may affect the behaviors of the hospital's personnel. Furthermore, the limited number of KAP studies for health professionals on volunteer BD, as well as the lack of research on their participation in BD programs, makes for a precarious generalization of the conclusions. It is, therefore, necessary to further investigate a larger sample of hospitals that will allow the conclusions to be used with significantly increased safety.

  Conclusions Top

Regarding BD Greek health authorities face two main challenges, responding at the same time to the increasingly strict regulatory requirements for blood safety: Ensuring blood sufficiency and enhancing VBD as part of the action for 100% VBD. Achieving the above goals presupposes an increase in the frequency of donations from existing donors, the attraction of new blood donors, and the conversion of replacement blood donors into regular volunteer blood donors. The findings of this study provide insights for KAP's research on BD among health professionals and their possible involvement in BD programs. The activation of health professionals is considered necessary taking into consideration the results of the research, which justify the possibility of activating health professionals in policies to promote VBD. Due to their knowledge and positive attitude regarding BD, they can promote VBD in the general population and ultimately contribute to an increase in the size of blood supply. Furthermore, the significant number of health professionals employed in Greek hospitals (100,662 in 2018, source: OECD), could be both an important pool of blood donors, and also a pole for attracting new blood donors through the implementation of BD programs. Furthermore, the perception of insufficient information on VBD, as well as the low percentage of blood donors, requires the implementation and the coordination of actions and programs focusing on donation. Systematic information is a prerequisite in order to remove barriers that affect the practices of health professionals for VBD, as well as the understanding of the needs for attracting and activating volunteer blood donors from the general population.

Ethics approval and consent to participate

The Scientific Council and the BoD of the Oncological Hospital of Piraeus “Metaxa” approved the research on December 2019. The purposes and the importance of the study were explained with a letter by the author to the study participants and also written informed consent was secured from each participant. Confidentiality was maintained at all levels of the study by keeping the data in secure places.


I would like to thank my MSc thesis supervisor Dr. Anastasia Kadda for her guidance, great support, and kind advice and Mr. Dimitris Morakeas for his help and advice in the SPSS analysis. Finally, I would like to thank all study participants who participated in this study and their commitment to fill up and complete all the questions in the questionnaires.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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