Perceived Knowledge, Motivating Factors, and Deterring Factors of Voluntary Blood Donation Practices Among Medical Students

1. Introduction

The World Health Organization (WHO, 2023) recognizes blood and blood components as essential medicines in the management of conditions such as severe anemia, traumatic injuries, and cancer (Essential Medicines (EML), 2023; Myers & Collins, 2024). As there is no artificial substitute for blood, its availability depends on the willingness of individuals to donate voluntarily (Graf et al., 2023). Although high-income countries account for only about 16% of the world’s population, they contribute roughly 40% of global blood donations. In contrast, many low- and middle-income countries report an average of just six donations per 1,000 individuals, falling short of the WHO-recommended target of ten (Barnes et al., 2022). Shortages impact obstetrics, pediatrics, and surgery; for example, peripartum hemorrhage causes 25% of maternal deaths in sub-Saharan Africa, and delayed pediatric transfusions raise mortality (Jacobs et al., 2024). These shortages hinder progress on the United Nations Sustainable Development Goals (SDGs).

The Republic Act No. 7719, Philippine National Blood Services Act (1994) created the National Voluntary Blood Services Program (NVBSP) to encourage voluntary blood donation nationwide, aiming for donations from 1% of the population annually, matching WHO goals (Department of Health, 2024) . The law promotes voluntary donations, especially in schools, to raise youth awareness. However, only 53% of the national target was reached between 2017–2020, with a drop of 365,000 units in 2020 (Philippine Red Cross, 2020). Awareness is high, but regular donors are few (Mappala et al., 2023), making it essential to address motivators and barriers (Antonio, 2023). Enacted in 2019, the Universal Health Care Act (Republic Act No. 11223)  promotes equitable access to safe and affordable blood services, aligning with Sustainable Development Goal 3 on health, while also reinforcing SDG 4 on education and SDG 17 on partnerships (THE 17 GOALS | Sustainable Development, n.d.). 

Although studies on youth’s high awareness on blood donation predominates in most literature, knowledge about factors influencing their behavior remains limited particularly among medical students. Medical students have greater knowledge and motivation (Gebresilase et al., 2017), making them potential advocates for blood transfusion. As future healthcare providers, analyzing these data are essential in  improving their knowledge, correcting misconceptions, and encouraging advocacy can help strengthen the blood supply. This study examined the perceived level of knowledge, motivating factors, and deterring factors among medical students with the aim of informing curriculum enhancement and fostering health advocacy, community involvement, and altruistic values.

The main objective of this study was to assess medical students’ perceived knowledge and their views on factors that encourage or discourage voluntary blood donation across their sociodemographic variations during the academic year 2024–2025. This study offers insights to improve blood donation programs by incorporating students’ perspectives, addressing their motivations, knowledge gaps, and misconceptions. Findings can guide targeted outreach by NVBSP, Professional Regulation Commission (PRC), and other agencies, while the institution can use them in curricula and activities to foster a culture of giving. For students, results support informed choices and advocacy. The findings of this study also offer a foundation for future investigations into blood donation behaviors among medical students in diverse contexts.

2. Method

A descriptive correlational design was used to examine perceived knowledge, motivating and deterring factors that influenced voluntary blood donation practices among medical students during the academic year (A.Y.) 2024–2025. The study was conducted at a private nonsectarian medical institution in Mandaue City, Cebu, Philippines for A.Y. 2024-2025. Respondents were medical students aged 18+, enrolled in Excel-MED through Level 4 for stratified analysis. Clerks, residents, and non-medical students were excluded. Using proportionate stratified random sampling, 200 of 539 students were selected: 19 Excel-MED (9.3%), 81 Level 1 (40.8%), 53 Level 2 (26.4%), 31 Level 3 (15.8%), and 16 Level 4 (7.8%). Sample size was based on Mappala et al. (2023), with a ±5% margin of error at 95% confidence and finite population correction.

A  modified self-administered questionnaire adapted from Mappala et al. (2023)  collected sociodemographic data, donation practices, and perceived knowledge, motivators, and deterrents. The 57-item modified questionnaire underwent expert validation by two medical technologists and one psychometrician. A pilot test with 25 conveniently selected students confirmed acceptable to excellent reliability (Perceived Knowledge α=0.83; Deterring Factors α=0.84; Motivating Factors α=0.93). The questions on perceived knowledge were modified from "I am aware..." to "I know..." since the original questionnaire was designed for the general population, while the present study focused on post-graduate medical students. Additionally, subdomains included in the original instrument were removed to simplify the questionnaire and focus solely on the primary factors affecting blood donation practices. Multiple-choice questions were used for sociodemographic profile and level of blood donation practice, while sections on perceived knowledge, motivating, and deterring factors include 4-point Likert-type questions. The Likert scales were interpreted as follows: "Strongly agree" for 4, "Agree" for 3, "Disagree" for 2, and "Strongly disagree" for 1 with the following categories for the three domains: highly perceived  for score range 3.26-4.00; moderately perceived for score range 2.51-3.25; slightly perceived for score range 1.76-2.50; and no perception at all for score range 1.00-1.75.

Each respondent gave informed consent for their participation. Recruitment used privacy-compliant email (“Bcc”) and Facebook Messenger reminders. Responses were verified via screenshots, coded for anonymity, and data destroyed after three years. Data analysis in IBM SPSS Statistics 23 used descriptive statistics and Chi-square tests (5% significance level) with Phi or Cramer’s V for effect size, merging categories when assumptions were violated.

The study was ethically approved by the Institutional Ethics Review Committee and assigned to protocol code 2024-174-Medino III-VoluntaryBloodDonation. All collected data were anonymized and securely stored in a password-protected Google Drive that was accessible only to the research team and was eventually destroyed in accordance with the disposal protocol.

3. Results

The sociodemographic profile as shown in Table 1 consists of 200 medical students with 100% response rate for A.Y. 2024–2025 that most were aged 24–26 (67%), female (69.5%), and single. Socioeconomically, 39.5% were from rich households, Roman Catholic (82%). A large majority (95%) had a health-related pre-med background, and nearly all were Filipino (98%).

Table 1: Sociodemographic profile of the medical students

Results showed that most medical students (67.5%) had never donated blood. Among medical students who had donated, the largest proportion (63.1%) reported doing so only when there was an urgent or immediate need, while smaller proportions donated annually (24.6%) or twice per year (12.3%).

The majority of participants (167, 83.5%) indicated a high level of perceived knowledge regarding voluntary blood donation. Item analysis on perceived knowledge in Table 2 shows that awareness of health history screening questions ranked highest, followed by knowledge of health restrictions, while understanding of donation intervals ranked lowest.

Table 2: Item Analysis on the Level of Perceived Knowledge of Voluntary Blood Donation among medical students

Most students reported a slight (88, 44%) to moderate (82, 41%) perception of motivating factors for blood donation, indicating generally low to moderate motivation among respondents. Item analysis on motivating factors in Table 3 shows that personal need, especially helping relatives, was the primary motivator, followed by social awareness, while peer pressure ranked lowest.

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Table 3: Item Analysis on the Level of Perception of Motivating Factors of Voluntary Blood Donation among medical students

Most respondents (110, 55%) reported no perception of deterring factors to blood donation, indicating that most do not view these factors as significant barriers. Item analysis in Table 4 shows that time constraints were the main deterrent, followed by health concerns, while fear of blood ranked lowest.

Table 4: Item Analysis on the Level of Perception of Deterring Factors of Voluntary Blood Donation among medical students

Non-donors outnumbered donors across most sociodemographic groups (Table 5). Older students (30+) had the highest donation rate (83.3%), followed by males (49.2%), married students (60%), higher-income students (53.8%), and those from health-related pre-med programs (33.3%). Roman Catholics formed the largest donor group, though other religions had the highest proportional rate (60%).

Table 5: Blood Donation Practice across the sociodemographic profile of medical students

Perceived knowledge showed a weak but statistically significant association with blood donation among medical students (37.1%, p=0.002, φ=0.222). However, most highly knowledgeable students did not donate. Motivation exhibited a weak, non-significant link to donation (20.8%–39.8%; p=0.118, V=0.146) with emotional and social drivers, such as altruism appearing more influential. Perceived deterrents were similarly weak and non-significant (p=0.197, V=0.127) with fears having less impact than enabling factors such as medical knowledge.

4. Discussion

The study investigated the factors influencing voluntary blood donation practices among medical students by understanding their perceived knowledge, motivating factors, and deterrent factors. Overall, the high perceived knowledge with favorable motivating factors and minimal deterring factors did not translate into regular blood donation behavior. Despite being knowledgeable, particularly on pre-donation health screenings, altruism was the main motivation to donate blood. Nevertheless, lack of time mostly hinders medical students from donating blood. The association indicates that knowledge and motivation alone may not be sufficient to promote voluntary blood donation among medical students. This study informs policymakers on the importance in addressing the motivational and deterring factors on blood donation for future healthcare workers. 

Medical students are knowledgeable and consider themselves adequately informed about blood donation. These findings indicate that students are confident in existing safety protocols and in responsible donation practices. However, perceived knowledge may not always correspond to an accurate understanding of donor eligibility and procedures. Similar knowledge gaps, particularly regarding eligibility criteria, have been documented among health professional students in other countries (Mussema et al., 2024; Nannono et al., 2025). Although students in health-related fields generally demonstrate better knowledge and more positive attitudes, previous studies show that many are still unaware of basic requirements such as minimum age and weight limits (Eltewacy et al., 2024; Ratnakar et al., 2023). Additionally, most highly knowledgeable students did not donate, indicating other factors beyond knowledge may have a behavioral impact (Gebresilase et al., 2017; Kagoya et al., 2024; Murtagh & Katulamu, 2021). These gaps may reflect the misconceptions among the future healthcare professionals and the challenges in effectively educating the community and promoting voluntary blood donations. 

Motivations were generally low to moderate and mostly driven by personal or altruistic reasons. Medical students are characteristically altruistic in nature and empathize to the needs of their patients. Similar to Athanasaki et al. (2025), medical students are academically exposed to cases that need blood transfusion and issues on blood shortages (Eltewacy et al., 2024; Mussema et al., 2024). Therefore, being physically and psychologically prepared for blood donation, they hold themselves morally and socially accountable in donating (Kagoya et al., 2024). Their decisions were not influenced by peer pressure but may have been contributed by encouragement from friends and their sense of social responsibility (Basavarajegowda et al., 2020).  Comparable trends have been observed in other countries, where the primary motivation for donation was the desire to help family members or friends when the need arises (Eltewacy et al., 2024; Terzieva, 2021).  Broader altruistic factors, such as civic and ethical responsibility alongside a sense of moral fulfillment for saving lives, were  likewise noted among students globally(Kagoya et al., 2024; Masongsong, 2023; Naranja et al., 2021). The free medical tests performed prior to donating may have served as an opportunity for students to learn one’s health status (i.e. HIV and Hepatitis B) (Kagoya et al., 2024). The results indicate that despite personal intentions being the main intrinsic drivers for the students to donate, some factors such as accessible and efficient services in donation facilities may have translated intentions into actual practice (Zaheer et al., 2023). 

Donation practices may be hampered by time constraints due to overwhelming workloads both academically and clinically, long turnaround time in blood donation process, and lack of workforce assigned to the task (Bumanglag et. al.,2020). These findings mirror local and global studies, where busyness or lack of direct invitation were key barriers (Alanazi et al., 2023; Mappala et al., 2023; Ratnakar et. al., 2023).  The medical students’ knowledge of the blood donation processes may have been associated with high self-efficacy and ability to control their actions, particularly their fear of blood, needles,  pain,  and fainting. However, voluntary blood donation remained low (Lakew et al., 2026). Similarly, in some contexts,  health-related misinformation persists and mistrust in donation safety appears to be increasing (Kagoya et al., 2024; Naranja et al.,2021). The results may reflect  weaknesses on blood donation processes and the value in enhancing accessibility, quality of service, and workforce in donation facilities.

Older students tended to donate more, likely due to maturity and social responsibility (Eltewacy et al., 2024; Kagoya et al., 2024; Sparrow et al., 2021; Thorpe et al., 2021), though some studies found no age effect (Zhang et al., 2021). Males donated more than females, reflecting physiological and sociocultural factors (Alkalash et al., 2024; Ashipala & Joel, 2023; Halawani, 2024),  despite females’ higher empathy (Çiftçi et al., 2021; France et al., 2022; Saud et al., 2021). Singles donated less, consistent with findings globally (Daneshi et al., 2021; Saeed et al., 2024; Siekierska et al., 2023), though other studies show no association (Li et al., 2021). Higher-income students donated more, possibly due to better access and flexibility (Jaffry et al., 2019; Zucoloto et al., 2019), though results are mixed (Alkalash et al., 2024; Mappala et al., 2023). Despite church drives, Roman Catholics donated less, suggesting motivation outweighs charitable causes associated with affiliations (Valera et al., 2019; Zucoloto et al., 2020). However, tailored faith-based campaigns may also help (Avera, 2023). Health-related students donated more, likely due to greater exposure (Eltewacy et al., 2024; Mussema et al., 2024), but knowledge may co-occur with supportive opportunities and culture. Lower rates among Filipino students compared to non-Filipinos reflect cultural and systemic influences (Fung et al., 2023), underscoring the value of localized, culturally sensitive strategies (Antonio, 2023; Avera, 2023).

As future healthcare professionals, knowledge and good motives to donate blood may not be sufficient to address the global shortages of blood supply, but through the actual practice of donating blood, which is contributed largely by the potential young advocates. The results reveal the intention-behavior gap that shows knowledge and good intentions may not always translate into action due to environmental factors (Conner & Norman, 2022). The study may have denoted a systemic and organizational weakness in the blood donation process and facilities rather than personal intentions. Targeted education may benefit in aligning confidence with accurate and comprehensive understanding, promoting a proactive and consistent donor behavior (Antonio, 2023). Strengthening both interpersonal and community-level motivators by improving accessibility through mobile blood drives directly to the community and institutions with extended operational hours, short turnaround time, efficient and quality service may facilitate an increase in voluntary blood donation rates and encourage repeat donors (Antonio, 2023; Bumanglag et. al., 2020).  Establishing external linkages and organizing well-promoted campus blood drives may be more effective in increasing participation than awareness campaigns alone (Antonio, 2023; Viwattanakulvanid & Oo, 2021).

This study acknowledges several limitations. The reliance on self-reported data through survey questionnaires may introduce the potential for response bias, as respondents may overestimate or underestimate their knowledge, motivations, or perceived barriers. The findings may have limited generalizability due to its confinement to a single institution, thereby restricting the applicability of results to medical students from other universities or geographic locations. External variables such as individual health conditions or the influence of public health campaigns were beyond the researchers’ control. It may have impacted respondents’ attitudes or behaviors related to blood donation. While these limitations were considered in the analysis and interpretation, they may nonetheless affect the depth and generalizability of the study findings.

5. Conclusion

This study showed that medical students are generally knowledgeable, particularly about donor screening, and altruistically driven. However, potential weaknesses particularly regarding time constraints may hinder blood donation practices. This indicates that voluntary blood donation is associated with factors beyond knowledge and personal intentions, which include accessibility and quality of service in blood donation facilities. This study reveals a potential intention-behavior gap and informs policy makers in developing tailored approach strategies encouraging voluntary blood donation and donation repeats, ensuring adequate blood supply available for the community’s health needs. Furthermore, future studies should focus on monitoring donation patterns over time, evaluating peer-led interventions, and identifying key motivators and barriers to guide the development of targeted and scalable strategies that guarantees safe and adequate blood supply.

Author Contributions: Conceptualization, R.M.M.; Methodology, R.M.M., J.A.G.; Software, T.S., Z.G.B.; Validation, R.M.M., T.S., G.N.; Formal Analysis, R.M.M., T.S.; Investigation, R.M.M., T.S., R.J.M., G.N., A.D.O., F.S., G.F.T., M.K.C.Y.; Resources, R.M.M., G.N.; Data Curation, R.M.M., T.S.; Writing – Original Draft Preparation, R.M.M., T.S., J.A.G., Z.G.B., R.J.M., G.N., A.D.O., F.S., G.F.T., M.K.C.Y.; Writing – Review & Editing, R.M.M., J.B.; Visualization, R.M.M.; Supervision, J.B.; Project Administration, J.B.; Funding Acquisition, G.F.T., J.B.

Funding: This research received no external funding

Conflicts of Interest: The authors declare no conflict of interest

Informed Consent Statement/Ethics approval: All subjects gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Institutional Ethics Review Committee and assigned to protocol code 2024-174-Medino III-VoluntaryBloodDonation.

Acknowledgments: The research group would like to extend our gratitude to Dr. Gracia Niña R. Bongabong, research coordinator, for her organizational support and for facilitating a conducive research environment. Special thanks to Dr. Jocelyn B. Gerra, Dr. Maria Cecilia A. Alvarez-Espino, Dr. Maria Cecilia V. Ledesma, and Rosalie R. Michael, for their insightful feedback and constructive criticism, which greatly enhanced the quality of our work.  Likewise to Dr. Enrico B. Gruet, MD, Dean, Cebu Doctors’ University College of Medicine  for recognizing and supporting our endeavor, allowing us to begin opening doors to global platforms.

Declaration of Generative AI and AI-assisted Technologies: The author used the assistance of Google AI Overview to help identify relevant background literature. However, the authors take full responsibility for the integrity and accuracy of the scientific content.