Blood transfusion services are an integral component of modern medical care, supporting life-saving interventions in trauma, obstetric emergencies, major surgeries, hematological disorders, and oncology care. The World Health Organization (WHO) advocates that all countries should achieve 100% voluntary non-remunerated blood donation to ensure safety, sustainability, and equity in blood supply [1]. Despite significant progress, low- and middle-income countries continue to face challenges in maintaining adequate and safe blood inventories. India requires an estimated 14–15 million units of blood annually; however, collection often falls short of this demand [2]. Voluntary blood donors contribute significantly to the safety of transfusion services, as they demonstrate lower prevalence of transfusion-transmissible infections compared to replacement or paid donors [3]. Medical students, owing to their scientific background and early exposure to health-care systems, are considered an ideal target group for promoting voluntary blood donation. Knowledge, attitude, and practice (KAP) studies serve as effective tools to assess awareness levels, beliefs, and behavioral patterns within specific populations. While medical students are expected to possess sound knowledge regarding blood donation, studies from various regions have reported discrepancies between knowledge and actual donation practices [4–6]. Factors such as fear, misconceptions, lack of motivation, and absence of organized donation opportunities often act as deterrents. Understanding the determinants of blood donation behavior among medical students is critical, as they are future health-care providers who will counsel patients and the public. Positive personal experiences with blood donation during undergraduate training can significantly influence their professional advocacy in later years [7]. Moreover, addressing misconceptions at an early stage may help cultivate a culture of voluntary donation within medical institutions. This study was undertaken to assess the level of knowledge, attitude, and practice regarding blood donation among undergraduate medical students at a tertiary care teaching hospital and to identify barriers preventing voluntary blood donation. The findings aim to inform targeted educational strategies and institutional policies to enhance voluntary blood donation rates.

Study Design and Setting A descriptive cross-sectional study was conducted over a period of three months at a tertiary care medical college attached to a teaching hospital in India. Study Population The study population comprised undergraduate medical students (MBBS) from first year to final year, including interns. Students who were absent during data collection or unwilling to participate were excluded. Sample Size Based on previous studies reporting blood donation practice rates of approximately 40% among medical students [6], the sample size was calculated using a confidence level of 95% and precision of 5%, yielding a minimum sample size of 369. Accounting for non-response, 420 students were approached. Study Tool Data were collected using a pre-validated, structured, self-administered questionnaire, adapted from previously published KAP studies and WHO guidelines [8,9]. The questionnaire consisted of four sections: 1. Demographic details: age, gender, year of study 2. Knowledge: 15 multiple-choice questions covering eligibility criteria, donation interval, volume of blood donated, and transfusion-transmissible infections 3. Attitude: 10 statements assessed on a 5-point Likert scale 4. Practice: 8 questions regarding donation history, frequency, motivation, and barriers A pilot study was conducted among 30 students (excluded from final analysis) to assess clarity and reliability (Cronbach’s alpha = 0.81). Data Collection After obtaining institutional ethical clearance, questionnaires were distributed during lecture hours with prior permission. Written informed consent was obtained, and anonymity was ensured. Scoring System • Knowledge scores ≥70% were considered adequate • Positive attitude was defined as agreement with ≥70% of favorable statements • Practice was assessed based on history of voluntary blood donation Statistical Analysis Data were entered into Microsoft Excel and analyzed using SPSS version 26.0. Descriptive statistics were expressed as frequencies and percentages. Associations between variables were tested using chi-square test and independent t-test. A p-value <0.05 was considered statistically significant.

As shown in Table 1, a total of 402 undergraduate medical students participated in the study, with a modest male predominance (53.2%). Female students constituted 46.8% of the sample, indicating balanced gender representation. More than half of the participants (56.2%) were from clinical years, while 43.8% belonged to pre-clinical years. This distribution ensured adequate representation across different stages of medical training, allowing meaningful comparison of knowledge, attitude, and practice patterns between junior and senior students. Table 1: Demographic Distribution of Participants (n = 402) Variable Frequency (%) Male 214 (53.2) Female 188 (46.8) Pre-clinical (1st–2nd year) 176 (43.8) Clinical (3rd–Final year & Interns) 226 (56.2) The assessment of knowledge parameters, as detailed in Table 2, revealed that 78.6% of students demonstrated adequate knowledge regarding blood donation. Awareness was highest for transfusion-transmissible infections (92.3%) and minimum age criteria (82.6%). However, comparatively lower correct responses were observed for volume of blood collected and permissible donation intervals. These findings suggest that while students were well informed about safety aspects, gaps persisted in operational and eligibility-related knowledge Table 2: Knowledge regarding Blood Donation Knowledge Parameter Correct Response (%) Minimum age for donation 82.6 Minimum weight requirement 76.1 Interval between donations 71.4 Volume of blood collected 69.8 TTIs screened 92.3 Attitudinal assessment presented in Table 3 showed a predominantly positive outlook towards blood donation, with 84.1% of students expressing favorable attitudes. A large majority perceived blood donation as a social responsibility (89.6%) and believed it to be a safe procedure (81.4%). Additionally, 85.7% agreed that medical students should donate blood regularly. These findings indicate strong ethical awareness and professional responsibility among participants, irrespective of their donation history. Table 3: Attitude towards Blood Donation Attitude Statement Agree (%) Blood donation is a social responsibility 89.6 Donating blood is safe 81.4 Medical students should donate regularly 85.7 Despite adequate knowledge and positive attitudes, actual blood donation practices were limited, as shown in Table 4. Only 38.3% of students had donated blood at least once, and a smaller proportion (15.9%) were repeat donors. Among those who donated, voluntary donation was the predominant mode (91.6%), reflecting altruistic motivation. The relatively low practice rates highlight a significant gap between awareness and behavioral implementation among medical students. Table 4: Practice of Blood Donation Practice Variable Frequency (%) Ever donated blood 154 (38.3) Donated more than once 64 (15.9) Voluntary donation 91.6 Replacement donation 8.4 The barriers to blood donation among non-donors are summarized in Table 5. Fear of needle pain was the most frequently reported barrier (31.4%), followed by lack of opportunity (28.6%). Nearly one-fifth of students expressed concerns regarding post-donation weakness or anemia. Parental discouragement and lack of motivation were less common. These findings indicate that psychological apprehensions and logistical constraints play a major role in limiting blood donation practices. Table 5: Barriers to Blood Donation (n = 248 non-donors) Barrier Percentage Fear of needle/pain 31.4 Lack of opportunity 28.6 Fear of weakness/anemia 19.8 Parental discouragement 11.2 Lack of motivation 9.0

The present study evaluated the knowledge, attitude, and practice regarding blood donation among undergraduate medical students and revealed a significant gap between awareness and actual donation behavior. Although nearly four-fifths of participants demonstrated adequate knowledge and a positive attitude, less than half had donated blood, highlighting a persistent knowledge-practice disconnect. The high level of knowledge observed aligns with studies conducted among medical students in India and other developing countries, where exposure to basic medical sciences and transfusion medicine enhances awareness [4,10]. Awareness regarding transfusion-transmissible infections was particularly high, reflecting effective integration of blood safety concepts into the medical curriculum. Attitude towards blood donation was overwhelmingly positive, with most students recognizing it as a social and professional responsibility. Similar findings have been reported by Kowsalya et al. and Devi et al., who emphasized altruism as a major motivating factor among medical students [11,12]. Positive attitudes are essential, as they form the foundation for sustainable voluntary donation behavior. However, actual blood donation practice remained suboptimal. Only 38.3% of students had donated blood, which is comparable to rates reported in previous Indian studies (30–45%) but remains inadequate for meeting national blood demands [6,13]. Clinical-year students demonstrated significantly higher donation rates, likely due to increased exposure to transfusion services, patient care, and blood bank postings. Fear of pain and weakness were the most commonly cited barriers, despite adequate knowledge, suggesting that emotional and psychological factors play a crucial role. These findings are consistent with WHO reports emphasizing fear and misconceptions as major deterrents among young adults [1]. Lack of opportunity further underscores the need for regular, well-organized blood donation camps within medical institutions [14-16]. Parental discouragement, though less frequent, highlights socio-cultural influences on health behavior in the Indian context. Addressing these concerns through counseling and awareness programs may help overcome familial resistance. The findings emphasize the need for targeted interventions, such as incorporating motivational sessions, peer-led campaigns, and experiential learning in transfusion medicine. Early exposure to blood donation during the pre-clinical years may help normalize the practice and reduce apprehension.[16-20]

The present study demonstrates that while undergraduate medical students possess satisfactory knowledge and a positive attitude towards blood donation, actual donation practices remain inadequate. Psychological fears, misconceptions, and lack of structured opportunities were identified as key barriers. Bridging the gap between knowledge and practice requires sustained educational interventions, institutional support, and early engagement of medical students in voluntary blood donation activities. Encouraging regular blood donation among medical students not only ensures a reliable donor pool but also fosters lifelong advocacy for safe and voluntary blood donation within the community.

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