The majority of participants in this study were male, similar to gender distribution reported by the world health organization (WHO) and from other Asian countries [14, 15]. The blood collection at blood centres reduced considerably worldwide due to the Covid-19 pandemic [2, 3, 7]. Almost half of the donors (47.5%) during the study period were first time WB donors. This is similar to the study in the Netherlands reporting increase in new donor registration during the Covid-19 pandemic . Donors who come forward to help following a disaster are likely to be first-time donors or previously lapsed donors, which may be the case with Covid-19. The transfusion services should retain first-time donors to sustain blood supply considering the long duration of this pandemic . A good proportion of the donors were aware of the blood shortage during the pandemic, and more than 50% accepted the constant need for blood. This is similar in line with reported increased general awareness for blood donation during the Covid-19 pandemic .
Transfusion transmission of the SARS-CoV-2 virus is yet to be determined. In this study, 43.1% of donors believed that SARS-CoV-2 virus transmission through transfusion was unlikely compared to a study in Cameroon, in which 74.9% of donors claimed that Covid-19 could be transmitted to blood recipients . The Indian national regulatory agencies issued recommendations for accepting blood donations and organizing VBDC during the Covid-19 pandemic . We surveyed blood donors' awareness and attitudes toward blood donation during the pandemic timeframe for this study. 40% of donors were aware of the national guidelines. The unawareness of these guidelines among the majority may be attributed to the lack of publicity and access to specialised websites that are not well recognised beyond scientific communities and healthcare workers. The clinical governance principle to improve healthcare quality advocates patient participation in their care plan by making them reasonably aware . The same principle can be applied to the donors to create awareness of their eligibility, deferral criteria, and national guidelines to improve their participation, resulting in improved trust and better transfusion services. It is advisable to raise public consciousness about national guidelines. It can be achieved by print, social media, blood centres, or non-governmental organisations (NGOs) launching awareness campaigns. The knowledge of national guidelines available to guide transfusion services for adapting to new normal may assure donors and build their confidence in transfusion services.
According to the study participants, most people were hesitant for blood donation due to fear of infection. Previous studies have also identified fear as the most common impediment to blood donation [18, 20, 21]. A recent study from India also reported fear of infection as a single most important deterrent for blood donation . A fear among donors during viral epidemics impacting transfusion services is not new to Covid-19 [5, 8], and the perceived risk of infection among donors did not vary from non-donors . A lack of motivation and a smaller number of VBDCs, and travel restrictions due to government lockdown and financial crisis also contributed to the same. It is normal to fear the unknown, especially if it affects our and our family members' health and has been reported in the general population and health professionals impacting their lives [24,25,26]. The diminishing finances and restricted social interactions may alter donors' intention to donate blood . The donor's concern for the safety of blood donation and VBDCs reflect generalized uncertainty during the pandemic, which multiply continuously for individuals and policymakers . This uncertainty can be attributed to the fact that scientific evidence is still uncertain, emergent, and evolving . The dissemination of inaccurate scientific information, coupled with misleading rumours that has the potential to grow exponentially, can become sources of fear, prejudice, and inappropriate behaviour .
Regarding safety during blood donation, around 50% of blood donors felt safe themselves at the of blood donation and had excellent experience during their current donation. They would like to donate blood voluntarily after 3–4 months, even in the same pandemic situation. This can be attributed to the fact that those who fear more for infection are very less likely to become blood donors as reported earlier . The association between Covid-19 related thoughts, intention for blood donation and behaviour are reported to be more complex than just a fear or perceived risk deferring donors to donate . The fact that blood donation could involve some risk to the donor thus inducing fear and awaiting others to consent appear to play a key role in determining intention to donate . The motivation for contribution to public health has also been reported as a factor determining donor registration and subsequent donation .
Forty-five percent of the participants felt safe donating blood at blood centres in comparison to VBDC drives. Almalki et al. had described that 65% of participants preferred mobile blood collection sites for blood donation . This is different from our study findings, where only 15% had preferred VBDC for blood donation. It is easy to maintain hygiene and social distancing in blood centres compared to VBDC drives. Our tertiary care hospital, which was not involved in direct Covid-19 patient care, may also be one of the reasons for the donor to donate at our blood centre. More than 70% of respondents believed it is important to take safety precautions like social distancing, hand hygiene, and wearing a mask by blood centre staff and blood donors. Around 65% believed that blood centre staff take these safety precautions. This is in concurrence with 70% satisfaction of participants with the measures initiated to reduce Covid-19 infection . The staff adherence to the Covid related protocol during blood collection and post-donation care helped gain donors' confidence. The blood collection facility has been advised to ensure steps to reduce infection risk, which can help achieve donors' trust . Despite this, almost 40% of respondents were not sure of organising VBDC drives in this pandemic, probably due to safety issues. Although 60% of respondents agreed to help organise VBDC drives, mainly because most did not believe that VBDC staff of blood centres can transmit the infection to the community, one-third of them put forth the condition of acceptance by their society or office colleagues. Healthcare workers (HCWs) are often stigmatized as a source of infection during a widespread outbreak of infectious diseases. The HCWs were feared, avoided, shunned, and ostracized by communities to fear that HCWs were infected with Covid-19 as potential sources of infection [31, 32].
More than 80% of donors in our study were willing to notify blood centres if they experienced Covid-19 symptoms within 14 days of donating blood. It suggests that donors were concerned with those who will receive donated blood, which is close to the response-efficacy of coping assessment .
On the motivational front, the patients/ relatives approaching with blood donation request followed by family/ friend need and social media appeal were the three main motivating factors for blood donation. This signifies that if important people to donor approve blood donation, chances of blood donation are stronger . Social media now plays an increasingly significant role in communicating information and news ; However, McFadden reported social media as the least trusted source of information. Still, social media has been reported as an important donor recruitment tool in recent times, both before and during the current pandemic [33, 34]. The new donor registration peaks in the Netherlands coincided with an appeal for blood donation in social and print media . Social media was the preferred mode of information source during the Covid-19 pandemic in Saudi Arabia . It can also be boosted by government assistance in ensuring complimentary and hassle-free transportation of blood donors via public transportation or staff vehicles. The appeal by a public figure or celebrity did not seem to affect donation decisions in most donors. Politically motivated actions such as seeking to downplay or dismiss the risks of exposure to Covid-19 creates distrust . This may be the possible reason for not getting influenced by public figures.
The most important emphasis should be to provide comprehensive public health knowledge about the disease and its transmission mechanisms [18, 32]. The blood centres should build and maintain trust on a priority basis through sincere communications based on truth and scientific facts that assure blood donor well-being . This can enhance coping appraisals, including self-efficacy, determining intention to donate .