HARAMAYA UNIVERSITY

COLLEGE OF HEALTH AND MEDICAL SCIENCE

SCHOOL OF PUBLIC HEALTH

Annex 1: Information sheet and Consent Form

We are 4th year public health students of Haramaya University college of health and medical
science. We are going to undertake a prospective research entitled “knowledge, attitude,
practice and associated factors to ward voluntary blood donation among first and second
HUCHMS students in 2023". We prepare questionnaires to distribute among first and second
year students to asses KAP and Associated factors toward voluntary blood donation among
health science students. The information from this study will not be used for other purposes by
any of the institutions and individuals without your agreement and the information will be
completely confidential.

Confidentiality

All information collected on forms will be entered into computers with only the study
identification number. All information that will be collected from you will be protected. The
study will not include details that directly identify you, such as your name. Only a participant
identification number will be used in the survey. Only a small number of researchers/ Research
Assistants will have direct access to the survey. the results of the current study will be
published or presented in a scientific meeting, names and other information that might identify
you will not be used.

Risks -As the study will be conducted through self-administered questionnaire, the individual
student will not be subjected to any harm.

Rights to Withdraw and Alternatives

Taking part in this study is completely your choice. You are free to skip any question if you
feel uncomfortable to disclose information.

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You can stop participating in this study at any time, even if you have already given your
consent. Refusal to participate, or withdrawal from the study, will not involve penalty or loss of
any benefits to which you are otherwise entitled.

Benefits- There are no direct benefits to you; But we hope that the results of the study will
provide valuable information on blood donation.

As a result, we kindly request you to participate in genuinely answering the question.

Are you willing to participate? A) YES_________ (proceed)

B) NO ________:

I have read the participant information sheet. I have clearly understood the purpose of the
research, the procedure the risk and benefits, issue of confidentiality the right of participants. I
have been given the opportunity to ask questions for things that may have been un clear. I was
informed that participants have the right to withdraw from the study at any time or not to
answer any questions that I do not want.

Signature…………

Date ……………

Questionnaire code no…………….

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 HARAMAYA UNIVERSITY
COLLEGE OF HEALTH AND MEDICAL SCIENCE
SCHOOL OF PUBLIC HEALTH

Annex 2: Survey Questionnaire

Questionnaire used to assess knowledge, attitude, practice and associated factors towards blood
donation among HUCHMS first and second year students in 2023.

Part I: Socio-demographic Characteristics

S.NO VARIABLE RESPONSE
101 Department ---------------
102 What class year are you attending ……………
103 Age __________ year
104 Sex 1. Male 2. Female
105 Place of birth 1. Urban 2. Rural
106 Religion 1. Orthodox 2. Muslim 3. Protestant
4. Catholic 5.
Others(specify)_____________
107 Marital status 1. Single 3. Divorced
2. Married 4. widowed
108 Family monthly income(ETB) 1.Low income [<2000]
2. Middle income [2001-500]
3.High income [>5000]
Part II: Knowledge questions
201 Have you heard or seen about blood 1. Yes
donation? 2. Never

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202 If your answer to Q. # 201 is “yes”, from 1.Health professionals/facility
where did you hear or see those messages? 2.Print media (Newspaper, leaflet, brusher,
billboard)
(More than one answer is possible.) 3. Electronic media (TV, Radio)
4.School/University
5. Friends/ Family, relatives
6. Religious worship place
7 others (specify)………..
203 The place where blood is donated( more 1. Hospital 3. Mobile blood donation
than one answer is possible ) centers

2. Health center 4. Red Cross center

5. Others, specify___________

204 Is blood donation harmful to the donor? 1. Yes 2. No 3. No idea

205 What is the goal of blood donation 1. Save the life of relatives 3. get health
insurance
2. Save someone’s life 4. I Don’t know
206 What is suitable age of blood donation in a 1.18-30 2. 31-44 3. >45 4 .I don’t know
year?

207 Minimum weight of a donor to donate 1.<45 Kg 2.45Kg 3.>45Kg 4. I Don’t know
blood

208 What is the maximum volume of blood a 1. 250ml 3. 450ml

donor can donate once? 2. 350ml 4. Don’t know

209 At what minimum interval a person donate 1. Every 3 months 3. Once in a year
blood? 2. Every 6 months 4. Don’t know

210 Can blood be stored? 1.Yes 2.No 3 .I don’t know

211 Do you know about blood group? 1. Yes 2. No

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212 If “ No” for #210 skip ,Which blood 1. A 2. B 3. AB 4. O
group type is the commonest one?

213 Do you know your blood group 1 yes 2 No

214 If” yes” for #213 , What is your blood 1.A+ 2. A- 3. B+

group? 4.B-5. AB + 6. AB- 7. O+
8.O-
215 Can people with any blood group donate 1 Yes 2. No 3. I Don’t know
blood?

216 What is the duration of a donation process? 1.20 min 2.20-60min 3.don’t know

217 Can a female during menstruation donate? 1. Yes 2. No 3. I don’t know

218 Can a cigarette smoker donate blood? 1. Yes 2. No 3. No idea

219 Can a pregnant woman donate blood? 1. Yes 2. No 3. Don’t know

220 Can a person donate when blood 1. Yes 2. No 3. Don’t know

pressure is low?

221 Can a person with high blood pressure 1. Yes 2. No 3. Don’t know
donate?

222 Is donated blood screened for HIV/AIDS 1 Yes 2 .No 3 .Don’t know
and blood born disease

223 Can HIV infected person donate blood? 1. Yes 2. No 3. Don’t know

224 Can a person be infected by receiving 1. Yes 2. No 3. Don’t know

blood transfusion?

225 What disease can be transmitted by blood 1. TB 2. HBV 3. Tb and malaria

transfusion? 4. Malaria 5. Don’t know 6. Malaria and
HBV
7. TB and HBV

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 Part III: Attitude question

301 What do you think about blood donation? 1.good 2. bad 3. no idea

302 Do you think blood donation is life saving 1.Yes 2. No

3 no idea
303 What do you think is the best source of blood 1. Voluntary 3. Remunerated/paid
donation? 2. Replacement 4. Don’t know

304 Can something harmful happen to a blood 1. Yes 2. No 3. I don’t know

donor during or after blood donation?

305 Blood donation makes you sick and weak 1. Yes 2. No 3. No idea

306 What happen to blood donors during and 1.Contact infection 2. Temporary weakness
after donation?
3. Nothing will happen 4 I don’t know

307 Blood donation can lead to anemia? 1.Yes 2. No 3. I don’t know

308 Do you encourage blood donation to your 1.Yes 2. No

relative?

309 Would you like to donate blood to only family 1.Yes 2.No
members and friend?

310 Will you donate blood to anonymous patients? 1.Yes 2. No

311 Should donors be giving a gift/money for 1. Yes 2 .No

donation?

312 Do you feel that donation is important for 1. Yes 2. No

community?

313 Do you think being a health profession student, 1. Yes 2 .No

encourages you to donate blood?

Part IV: Practice of blood donation questions

401 Have you ever donated blood before 1. Yes 2. Never

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 402 If your answer to Q.#401 is “Yes”, how 1. Once 2. Twice 3.3 times 4. >3 times

many times do you donate?

403 If your answer to Q. no.401 is “Yes”, what 1. A sick person needed

prompted you? (More than one answer is 2. Moral satisfaction, altruism
Possible.) 3. Earning profit in cash / kind
4. For free health checkup
5. Motivated by friend /family donor
6.Media appeal
7.others(specify
404 If your answer to Q. #401 is “No”, what 1. I have no information
was the reason? (More than one answer is 2. Fear of blood donation
Possible.) 3. Medically unfit
4. Under age
5. Cultural or religious rejection
6. Lack of time
7. It takes long time
8. Inaccessibility of the service
9. Never thought of it
10. Parental or peer opposition
11. Never had the opportunity
12. My blood will be sold
13. Others specify…………………
405 If you get an opportunity would you like to 1.Yes 2.No
donate a blood?
406 Have you taken part in Blood donation 1.Yes 2. No
campaigns?
407 Would you like to be a regular blood donor 1.Yes 2.No
in the future?
408 Would you like to advice your family and 1.Yes 2.No
friends for blood donation?

Thank you Very much for your voluntary participation!!!!!

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Name of data collector---------------signature ---------- Date-----------