Hematological Diseases and Therapies (ISSN: 2577-1418)

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Motivating and Demotivating Factors for Blood Donation of Young People in Bulgaria

Krasimira Terzieva*, Rumen Popov

Center of Transfusion Hematology, Military Medical Academy, Bulgaria

*Corresponding author: Krasimira Terzieva, Center of Transfusion Hematology, Military Medical Academy, Sv. Georgi Sofiiski Str. 3, 1606 Sofia, Bulgaria

Received Date: 29 March, 2021; Accepted Date: 05 April, 2021; Published Date: 09 April, 2021,

Citation: Terzieva K, Popov R. (2021) Motivating and Demotivating Factors for Blood Donation of Young People in Bulgaria. Hem Disease Therapies 6: 131. DOI: 10.29011/2577-1418.000131


Maintaining an adequate level of safe blood ensures saving human lives. Young people are a great resource for recruiting blood donors and this paper presents the identified incentives and disincentives for blood donation in a survey targeting high school students. Among the factors that could motivate the studied group are universal values such as altruism, humanism, friendship. Raising their own self-esteem is also a good incentive for donation. As disincentives stand anxiety and uneasiness - on one hand caused by various fears related to their own safety and on the other hand related to lack of knowledge regarding the blood donation procedure and distrust of medical professionals. Knowing the factors that influence the intention for donating blood is important for recruiting and retention young people as regular voluntary blood donors.


Blood donation; Young blood donors; Motivating and demotivating factors; Bulgaria


Gratuitous and voluntary blood donation is based on lasting human values such as humanism, solidarity, generosity, wanting to help those in need, individual responsibility to society [1,2].

Each unit of donated blood can save several lives, as it is used to prepare various blood products, most often - erythrocyte concentrate, fresh frozen plasma and platelet concentrate. Blood products are used in cardiovascular and other surgical interventions, transplantations, treatment of patients with acute blood loss due to trauma, treatment of severe burns, malignancies, hemophilia, obstetric invasive procedures and in neonatology. The need for a blood transfusion can occur at any time. Therefore, it is necessary to maintain an adequate level of safe blood. This can be provided through regular, voluntary, unpaid blood donors. They are the safest group of donors because the prevalence of blood transmissible infections is the lowest among them [3]. Students over the age of 18, as well as university students, are a great resource for recruiting blood donors and more and more efforts are being made to recruit them. They are particularly appealing because they are usually in good health and can donate for a long time [4]. It is crucial to know what influences young people’s intentions to donate blood, which factors determine the low level of donation among this group, which motives and incentives would encourage them to donate blood in order to develop targeted interventions. Blood centers and organizations involved in the promotion of blood donation need to know how to influence the motivating factors of blood donation [5]. Work to promote donation among students is especially needed [6]. An analysis of information in literature concerning intentions and motivation for blood donation among young people shows that appeals for blood donation usually emphasize altruism, but the attractiveness of self-interest may be more effective in increasing blood donation intentions among young people [7,8]. Next is the motivation for blood shortages in the community [7], followed by incentives such as: encouragement from a partner, peers and family; blood tests and medical specialist examinations [5,7]. There is evidence that young donors respond with little effect to the medical examination offered for blood donation [7]. The reasons that demotivate people not to donate are various: medical contraindications, fear of needles, simple lack of interest in donating blood and time constraints [9]. The role of fear and anxiety has been raised in a number of studies: such fears include anxiety about the blood donation process itself, fear of needles or seizures, fear of the unknown, and concerns about the risk of adverse health effects such as infections [10-12]. Among high school donors, fear of blood has a direct negative effect on their retention as a donor and an indirect negative effect by increasing the risk of vasovagal reactions. Accordingly, targeted efforts to reduce donor fear may be particularly effective in promoting longterm donor loyalty among younger donors [13].

Materials and Methods

The research covers a study among 160 high school students - future voluntary and gratuitous blood donors (from 18 SU “William Gladstone”, Sofia, and High School for Teaching Foreign Languages, Pleven, Bulgaria). Among the surveyed students 102 (63.75%) are girls and 58 (36.25%) are boys. 70 (43.75%) of the participants are 18 years old and 90 (56.25%) are 17 years old (turning 18 in the same calendar year). Participation in the survey is voluntary and anonymous. The collected information is summarized and analyzed.

For this purpose, a questionnaire was developed, which collected information about the motivating factors and incentives for donation and the fears, anxieties and other demotivating factors for blood donation among the studied age group. Understanding why young people do not donate blood and what can motivate them to donate can help create an effective strategy to encourage blood donation behavior. This understanding can lead to more effective blood donor recruitment interventions, and ultimately to production of more blood units.


Various studies have reported that blood donation among young people is declining at an alarming rate compared to older populations [14,15]. At the Center for Transfusion Hematology, MMA, in Sofia, Bulgaria, donors aged 18-20 make up on average 2% of the total number of blood donors. Donors from the age group of 31-40 years predominate.

The results obtained in the study of motivating and demotivating factors for blood donation in young people are presented in Table 1.


Blood donors are not a homogeneous group of people in terms of their reasons for donating. The decision to donate blood is a rational decision-making process. The decision is made under the influence of internal (emotional) and external factors. Psychology literature states that an important motive for helping others is the desire to act in accordance with universal values [16]. Altruism and concern for others are the most important factors for blood donation [17]. Both women and men cite altruistic reasons for donation, but they are more often cited by women [18]. 75% of the young people surveyed in the present study, regardless of gender, would donate blood motivated by humanism, compassion, to help a person in need of a blood transfusion. Altruism, synonymous with humanity, is a willingness to act for the benefit of others. Researchers believe that helping someone may be based on selfishness. Motivation mechanisms for helping differ depending on whether they are based on selfishness or altruism. The helping mechanism based on selfish reasons is driven by a feeling of emotional discomfort. For an egoist, the main emotion in helping others is emotional discomfort (disorder, anxiety, excitement), hence the selfish motivation: calming oneself, which leads to helping behavior, the purpose of which is one’s own calming [16]. Donating blood to ensure that there would be enough if one is in need is a selfish motive for blood donation indicated by 14.4% of the surveyed students, as well as donation for two days of leave from school - 5.6%, for remuneration - 3.8% and a snack - 1.3%.

For an altruist, the main emotion is empathy, expressed in sympathy and compassion for a person in need. Altruistic motivation manifests itself in helping people in need [16]. The fact that almost the entire group of respondents (94.4%) would donate to friends or loved ones in need of blood and blood products is explained by empathy and strength and the importance of friendship at a young age.

The intention to donate blood is the most common predictor of making a donation [19,20]. Self-efficacy has the biggest impact on the level of intention to donate blood [21]. A psychological factor stimulating general supportive behavior is the desire to strengthen self-esteem and self-confidence [16]. The survey found that young people in Bulgaria also define blood donation as increasing their self-esteem due to: the feeling that blood donation saves lives - 91.3% and overcoming the fear of the procedure - 68.8%. Psychologists believe that earning approval is also an important factor in helping [16]. A study in the United States shows that young donors under the age of 25 are the most likely group to cite recognition from family and friends as a motivator for blood donation [22]. In our survey, 38.1% share that it is important for them to receive recognition and gratitude from society.

The power of consciousness is a significant predictor of the intention to donate blood [23,24]. The perception of blood donation as a duty has an additional influence [14]. In the survey, 11.9% define the feeling of duty to society as a motivating factor for blood donation.

Regarding the negative factors for the intention to donate blood, anxiety and worry related to fear of needles and pain are quite influential [23]. This is confirmed by the results of the present study, according to which the various fears stand out as demotivating factors: in first place - fear of needles (72.5%); fear of the sight of blood (50.6%); fear of nausea, vomiting, dizziness (67.5%); fear of infection (64.4%); fear that blood donation will adversely affect their health (41.3%) and fear of the medical environment (37.5%). Next, as having a negative impact on the motivation for blood donation, young people determine distrust and ignorance: 53.8% of respondents distrust the medical team - in terms of competence, professionalism, suspicion of blood abuse; 50.6% do not know or doubt what the donated blood is used for. In addition, an unkempt blood center, rude staff and an unfamiliar environment would also prevent the study group from donating blood. A link has been established between having knowledge about blood donation and blood donation intentions [25]. For 50% of the surveyed, information about the blood donation procedure is in sufficient, and 33.8% lack information about the need for blood and blood products.

As other reasons for not donating blood, young people identify: selfishness and lack of interest - 52.5%; that no one contacted them with an invitation for blood donation - 16.3%, and that blood donation is not paid - 11.3%.

According to social psychologists, people tend to help when they notice that someone else is also showing helpful behavior and if they have free time [16]. Inconveniences related to the time and place of blood donation can also be a barrier to blood donation [17] and 26.9% of our group of respondents believe that it takes a long time to get to the blood center. To save time, mobile blood collection teams can be located in places convenient for young people - at school, universities, parks, shopping centers, etc.

Symbolic gifts, snacks and covering travel expenses are considered compatible with voluntary and gratuitous blood donation [1]. Such tokens of gratitude were assessed by the surveyed students as incentives for blood donation. Good incentives for young people are receiving a thank you letter after the donation and the opportunity to get medical tests done - hemoglobin level, blood type and screening for transmissible infections. Among the weak and medium incentives for blood donation, students place receiving gifts such as a badge, T-shirt, cup, keychain, hat, pen, etc., as well as the opportunity to receive tickets - for public transport, cinema and others. These results mainly confirm the altruistic motivation for blood donation among young people in Bulgaria.


According to the results of the study, the main motivating factors for young people in Bulgaria are universal human values such as humanity and altruism; empathy and the desire to help a person in need, especially a relative or a friend. An extremely important factor at this age is the ability to increase one’s selfesteem and self-efficacy through blood donation, through overcoming the fear of the procedure and the thought that a human life is being saved.

The results of other studies on the leading fears and demotivating factors such as fear of needles, nausea and hospital environment, are also confirmed. Distrust of the medical team is clear. The role of the staff in each blood center and the whole transfusion system is to work to dispel and eliminate these concerns, to gain the trust of potential blood donors, to ensure safety and to create a favorable attitude towards blood donation, as it has been found that people who have not donated blood but have a favorable attitude are more likely to become blood donors than those who have an unfavorable one [4]. In addition, satisfaction with previous donations is an important determinant of following donations [26,27].

Retention of young donors remains a challenge [28]. At the same time, professionalism, patience, attention and friendly attitude of the staff are needed [29,30]. It is important to inform young people about blood donation and blood transfusion, to use the motivating factors for blood donation, to stimulate their sense of social significance in saving lives. And to express gratitude!

Conflict of Interest: The author declares no conflicts of interest.

“Motivating and demotivating factors for blood donation






1. What would motivate you to donate blood?

Humanism, compassion – to help people in need of blood transfusions





To help friends, relatives in need of blood transfusions





To ensure that there would be enough blood if I am ever in need





Duty to society





Authority in society





Medical leave from school for 2 days










A snack





2.Do you think these factors can increase your self-esteem through donating blood:

By overcoming the fear of the procedure





The feeling you have saved a life





Recognition and gratitude from society





3. In your opinion what makes people NOT donate blood?

Fear of needles





Fear of blood





Fear of nausea, vomiting, dizziness





Fear of hospital environment





Fear of infections





Fear that donating blood will have negative consequences on health





Distrust in the medical staff





Not knowing / concern how the donated blood is treated





Not enough information about the blood donation procedure





Not enough information about the need for blood





Disinterest, selfishness





Blood donation is not paid





No one contacted them to ask them to donate





It takes a lot of time to go to the Blood donation center





4. Rate from 0 to 4 the following small tokens of gratitude as an incentive to donate blood (0: not an incentive, 1: weak, 2: moderate, 3: good, 4: very good incentive)

Badge, T-shirt, mug, keychain, hat, pen

Weak to moderate

Public transport ticket, cinema ticket discount

Weak to moderate

Thank you letter

Good incentive

Blood tests - hemoglobin level; blood type; markers for HIV, syphilis, hepatitis B and hepatitis C

Good incentive

Table 1: Motivating and demotivating factors for blood donation in young people.


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