Factors Influencing Blood Donation Intentions among Adults in the East Gojjam Zone, Northwest Ethiopia

Factors Influencing Blood Donation Intentions among Adults in the East Gojjam Zone, Northwest Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors Influencing Blood Donation Intentions among Adults in the East Gojjam Zone, Northwest Ethiopia Nigusie Gashaye Shita, Awoke Fetahi Woudneh, Metadel Azeze Mekonnen, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6433089/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background: Blood donation is a critical component of health systems, yet many countries, including Ethiopia, face ongoing challenges in maintaining an adequate and safe blood supply. Understanding the factors influencing individuals' intention to donate blood is essential for designing effective public health interventions. This study examined the socio-demographic, psychological, and contextual determinants of blood donation intention among adults in the East Gojjam Zone, Ethiopia. Methods: A cross-sectional community-based survey was conducted among 1,332 adults selected through multistage cluster sampling. Data were collected using a structured, pre-tested questionnaire. Descriptive statistics summarized participants' characteristics and donation intentions. Binary logistic regression identified significant predictors of donation intention. Structural Equation Modeling (SEM) was employed to explore the pathways linking beliefs, attitudes, and behavioral intention. Results: Among the respondents, 74.8% (95% CI: 72.5%–77.1%) reported an intention to donate blood. Significant socio-demographic predictors included male gender, higher educational attainment, employment in the healthcare or education sectors, and higher income levels. Psychological factors—positive attitudes toward blood donation (β = 0.46), self-efficacy (β = 0.53), and knowledge of donation practices (β = 0.38)—were strongly associated with intention. Common barriers included fear of needles, perceived discomfort, and lack of awareness. SEM analysis revealed that positive family influence (β = 0.28) also significantly contributed to the intention to donate. Conclusions: Intention to donate blood is shaped by a complex interplay of socio-demographic, psychological, and social factors. Public health strategies should focus on increasing awareness, addressing psychological barriers, and strengthening family and community support systems. Special attention should be given to women, older adults, individuals with lower educational levels, and those outside the healthcare and education sectors. Strengthening these targeted efforts is essential for promoting voluntary blood donation and ensuring a sustainable blood supply in Ethiopia. Blood donation Donation intention Socio-demographic factors Psychological determinants Structural Equation Modeling Ethiopia Public health intervention Introduction Blood donation is a cornerstone of public health, providing a vital lifeline for individuals in need of blood transfusions due to trauma, surgical procedures, pregnancy complications, and chronic conditions [1-3]. In low-resource settings, where healthcare infrastructure is often underdeveloped, access to safe blood remains a significant challenge [4]. According to the World Health Organization, voluntary, non-remunerated blood donation is essential for ensuring the availability of safe blood for medical treatments [5, 6]. However, many developing countries, including Ethiopia, continue to face a gap in voluntary blood donation, limiting their ability to meet the growing demand for blood and blood products [1, 3, 7]. Globally, blood donation rates are disproportionately low in low- and middle-income countries. While high-income countries, which represent only 16% of the world’s population, contribute 40% of global blood donations, low-income nations, including Ethiopia, have significantly lower donation rates. In Ethiopia, studies report blood donation rates ranging from 16% to 33% [1, 3]. This deficiency is especially concerning in sub-Saharan Africa, where maternal mortality due to hemorrhage is a leading cause of death among women during pregnancy and childbirth [8]. The availability of blood is crucial in preventing such deaths, yet it remains insufficient to meet the demand, particularly in rural areas. Despite the importance of blood donation in saving lives, the intention to donate blood remains low in many communities. Factors such as lack of awareness, misconceptions about blood donation, fear, and cultural attitudes often influence individuals' willingness to donate [9-13]. Previous studies have identified some of these barriers, but few have systematically explored the factors influencing individuals’ intention to donate blood, particularly in Ethiopia’s underserved regions, such as the East Gojjam Zone. Theories like the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB) suggest that psychological and social factors, including perceived benefits, attitudes, and social norms, significantly shape individuals’ intentions to donate blood [14-17]. However, the specific determinants of blood donation intention in East Gojjam have remained underexplored. This study aims to address this gap by investigating the psychosocial, demographic, and contextual factors influencing the intention to donate blood among adults in the East Gojjam Zone, Northwest Ethiopia. Using robust statistical methods, the research identifies key predictors of blood donation intentions, including knowledge, attitudes, perceived benefits, self-efficacy, and social influence. The findings of this study contribute to the development of targeted health promotion interventions and policies that can effectively address the barriers to blood donation. Ultimately, by increasing voluntary blood donations, this research supports efforts to ensure a stable and sufficient blood supply, which is critical for saving lives and improving maternal and child health outcomes in Ethiopia. Methods Study Area and Population This study was conducted in East Gojjam Zone, located in the Amhara Region of Ethiopia. The zone is bordered by Oromia to the south, West Gojjam to the west, South Gondar to the north, and South Wollo to the east. The Abay River forms a natural boundary along the northern, eastern, and southern edges. A community-based cross-sectional study was carried out from April 23 to September 23, 2024, across three randomly selected districts: Debre Markos, Amanuale, and Dejene. These districts were chosen using a lottery method to ensure a representative sample of the population. The target population consisted of adults aged 18–65 years who had resided in the selected districts for at least six months. Individuals who were seriously ill, unable to hear, or had contraindications to blood donation (e.g., HIV, hepatitis) were excluded for safety and ethical considerations. The sample size was determined using a single population proportion formula, assuming a 16.1% prevalence of blood donation [2], a 95% confidence level, and a 3% margin of error. After adjusting for a 16% non-response rate and a design effect of 2, the final sample size was 1,339 participants. Sampling Procedure A multistage sampling technique was employed. In the first stage, three districts were randomly selected from East Gojjam Zone. In the second stage, four kebeles were selected from Debre Markos, and one Kebele each from Amanuale and Dejene. Finally, households within each Kebele were selected using systematic random sampling, with proportional allocation based on the population size. If more than one eligible individual was present in a household, one participant was selected using a lottery method. Data Collection Both primary and secondary data sources were utilized in this study. Secondary data, including the total number of households and the adult population in the selected areas, were obtained from local administrative records to support sample allocation and planning. Primary data were collected using a structured questionnaire designed to capture comprehensive information on socio-demographic, economic, and psychosocial characteristics, as well as knowledge, attitudes, behaviors, and practices related to blood donation. Prior to the main data collection, the questionnaire underwent pre-testing, and a pilot study involving 5% of the sample size was conducted in a non-selected woreda within the East Gojjam Zone. This process helped assess the tool’s clarity, consistency, and validity. Revisions were made based on feedback from the pilot. Internal consistency was evaluated using Cronbach’s alpha, which yielded a value greater than 0.7, indicating acceptable reliability [18]. Trained data collectors conducted face-to-face interviews using the finalized questionnaire. Support was provided to participants with reading or writing difficulties to ensure full participation. The survey instrument is provided as a supplementary document. Variables and Measurement The primary outcome variable, intention to donate blood, was measured using three items on a 5-point Likert scale ranging from “completely unwilling” to “totally willing” [19]. Participants with a combined score of 8 or higher were classified as having the intention to donate blood. Knowledge of blood donation was assessed through 10 items adapted from previous studies [19-21]. Participants who correctly answered at least five items were classified as knowledgeable. Behavioral constructs (attitudes, subjective norms, and self-efficacy) were measured on a 5-point Likert scale. Scores were computed by summing positive items and subtracting scores for negative items. Alternatively, a deterministic principal component analysis (PCA) approach was used, as recommended in similar studies [19, 22, 23]. We also included open-ended questions to explore beliefs about blood donation, including behavioral and normative beliefs. Additional covariates, such as demographic, socio-economic, and psychological characteristics, were also collected. Ethical Considerations This study was conducted in accordance with the Declaration of Helsinki and the National Research Ethics Review Guideline of Ethiopia. Ethical approval was obtained from the Institutional Review Board (IRB) of Debre Markos University (Approval No: RTTD/844/10/2024) on June 4, 2024. Written informed consent was obtained from all participants after clearly explaining the study’s objectives, procedures, potential risks, and benefits. Participants were assured of their right to withdraw at any time without penalty. To ensure confidentiality, no personal identifiers were collected; all data were anonymized, securely stored, and accessible only to the research team. Statistical Analysis Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarize the socio-demographic, behavioral, and other relevant characteristics of the study participants. To identify factors associated with the intention to donate blood, binary logistic regression analysis was employed. The dependent variable was binary, coded as yes for individuals who intended to donate blood and No for those who did not. Initially, bivariate logistic regression analyses were conducted, and variables with a p-value ≤ 0.20 were considered for inclusion in the multivariate logistic regression model. In the multivariate analysis, variables with p-values ≤ 0.10 were retained in the final model to control for potential confounding effects [24-26]. The logistic regression model was specified as follows: Where is the binary response variable, is the intercept term, , , are explanatory variables, and , , , are the corresponding coefficients. Positive values indicate a higher likelihood of intending to donate blood, while negative values indicate the opposite. In addition to logistic regression, structural equation modeling (SEM) was conducted to assess the complex relationships between behavioral constructs and intention to donate blood. The SEM incorporated composite scores of behavioral determinants and intention scores to examine direct and indirect associations. The goodness-of-fit of the SEM was evaluated using metrics such as the Standardized Root Mean Square Residual (SRMR) and the Adjusted Goodness-of-Fit Index (AGFI), which demonstrated that the model adequately fit the observed data. Model parameters for both logistic regression and SEM were estimated using maximum likelihood estimation (MLE). The performance and adequacy of the logistic regression model were assessed using the Hosmer-Lemeshow goodness-of-fit test and the Likelihood Ratio Test (LRT) [24, 26]. For model comparison and selection, the Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) were used, with lower values indicating better model fit and reduced risk of overfitting [27, 28]. All statistical analyses were conducted at a 95% confidence level and a p-value less than 0.05 was considered statistically significant. Results Demographic Characteristics of Study Participants A total of 1,332 participants from East Gojjam Zone were included in the study. Of these, 46.8% were male and 53.2% were female. The majority of respondents (91.9%) had attained college or university-level education, while only 8.1% had completed lower levels of education. In terms of employment, 82.9% were civil servants or health professionals, and the remaining 17.1% were engaged in various other occupations. Religiously, most participants identified as Orthodox Christians (95.5%), followed by Muslims (2.7%) and Protestants (1.8%). Regarding marital status, 63.1% were married. Importantly, 74.8% of the participants reported having the intention to donate blood, and 86.5% were found to be knowledgeable about blood donation. Participants ranged in age from 21 to 58 years, with a mean age of 33.8 years (standard deviation (SD) = 8.27). Monthly income varied between 1,000 and 20,000 Ethiopian Birr (ETB), with an average income of 5,622.68 ETB (SD = 2,948.91) (Table 1). Table 1: Demographic Characteristics of Participants Characteristic Category Frequency (Percent) Gender Male 624 (46.8%) Female 708 (53.2%) Education Level College/University Graduate 1224 (91.9%) Other 108 (8.1%) Job Status Civil Servant or Health Professional 1104 (82.9%) Other 228 (17.1%) Religion Orthodox 1272 (95.5%) Islam 36 (2.7%) Protestant 24 (1.8%) Marital Status Married 840 (63.1%) Others 492 (36.9%) Intention to Donate Blood Yes 996 (74.8%) No 336 (25.2%) Knowledge of Blood Donation Have Knowledge 1152 (86.5%) Have No Knowledge 180 (13.5%) Age Mean ± standard deviation 33.80 ± 8.273 Monthly Income Mean ± standard deviation 5622.68 ± 2948.905 Motivations, Knowledge, and Barriers to Blood Donation Among participants intending to donate blood (74.8%), the predominant motivation was a desire to help others, with 42.2% citing altruism as their primary reason for donating. However, a significant proportion of non-intended donors (42.2%) identified a lack of awareness as the main barrier to donation. Health-related concerns, particularly fear of needles, were reported by 34.9% of intended donors and 35.7% of non-intended donors, indicating that fear remains a common deterrent across both groups. Financial incentives were an influential factor, with 45.8% of intended donors and 35.7% of non-intended donors stating they would be more likely to donate if provided with incentives. Religious teachings were also a key motivator, with 47.0% of intended donors and 42.9% of non-intended donors referencing this as a factor influencing their decision to donate. Cultural influences played a particularly strong role in the intentions to donate blood, with 100% of intended donors acknowledging cultural norms as a motivating factor, compared to only 66.7% of non-intended donors. This finding underscores the importance of integrating cultural sensitivity into blood donation campaigns to effectively engage communities. Regarding knowledge, intended donors demonstrated significantly higher levels of awareness about blood donation (94.0%) compared to non-intended donors (64.3%). This disparity emphasizes the critical role that education and targeted awareness campaigns play in enhancing blood donation rates and addressing barriers to donation (Table 2). Table 2: Cross-tabulation of Blood Donation Intention with Associated Factors Variable Category Intention (No) (n = 336) Intention (Yes) (n = 996) Have you ever donated blood before? No 252 (75.0%) 696 (69.9%) Yes 84 (25.0%) 300 (30.1%) What motivates you to donate blood? To help those in need 156 (46.4%) 432 (43.4%) Personal satisfaction 0 (0.0%) 24 (2.4%) Social responsibility 12 (3.6%) 72 (7.2%) Family/friends' encouragement 0 (0.0%) 24 (2.4%) Other 36 (10.7%) 84 (8.4%) Family/friends' encouragement influence Great impact 108 (32.1%) 252 (25.3%) Some effect 24 (7.1%) 276 (27.7%) No effect 84 (25.0%) 288 (28.9%) Lack of awareness impact Yes 132 (39.3%) 420 (42.2%) No 120 (35.7%) 396 (39.8%) Unsure 72 (21.4%) 168 (16.9%) Reason preventing donation Fear of needles/blood 36 (10.7%) 96 (9.6%) Health concerns 120 (35.7%) 348 (34.9%) Lack of awareness 48 (14.3%) 144 (14.5%) Lack of trust 36 (10.7%) 84 (8.4%) Health unfit 48 (14.3%) 132 (13.3%) Other 24 (7.1%) 132 (13.3%) Incentive impact on donation likelihood High 120 (35.7%) 456 (45.8%) Slight rise 12 (3.6%) 132 (13.3%) No change 144 (42.9%) 300 (30.1%) Unsure 60 (17.9%) 108 (10.8%) Religious teachings impact Positive 144 (42.9%) 468 (47.0%) Negative 36 (10.7%) 180 (18.1%) Unsure 156 (46.4%) 348 (34.9%) Perceived ease of blood donation process Strongly Disagree 12 (20.0%) 48 (57.1%) Disagree 12 (50.0%) 36 (37.5%) Neutral 48 (50.0%) 24 (20.0%) Agree 24 (66.7%) 156 (38.2%) Strongly Agree 36 (30.0%) 132 (45.8%) Environmental culture influence Positive 12 (66.7%) 36 (100.0%) Negative 12 (20.0%) 48 (57.1%) Unsure 12 (20.0%) 24 (28.6%) Knowledge of blood donation Yes 216 (64.3%) 936 (94.0%) No 120 (35.7%) 60 (6.0%) Factors Predicting Blood Donation Intention The diagnostic evaluation of the binary logistic regression model assessing blood donation intention in East Gojjam Zone confirmed the model’s adequacy and robustness, as evidenced by a non-significant Hosmer-Lemeshow goodness-of-fit test, indicating a good fit (Table 3). Table 3: Homer and Lemeshow Test Step Chi-square Degrees of freedom P-value 1 0.53 8 0.999 Multivariable analysis identified several significant predictors of intention to donate blood (Table 4). Table 4: Binary Logistic Regression Results for Intention to Donate Blood Variables Categories B AOR S.E. P-value Age Continuous -0.218 0.804 0.087 0.012 Gender Male vs. Female 3.254 25.894 1.068 0.002 Education Level Degree Graduate or More vs. Others 5.027 152.475 3.214 0.000 Job Status Health or Teachers vs. Others 4.171 64.780 1.900 0.000 Marital Status Married vs. Others 2.948 19.068 0.877 0.001 Monthly Income Continuous 0.001 1.001 0.0001 0.000 Influence of Family/Friends on Blood Donation Decision No Effect vs. Great Impact -0.748 0.473 0.843 0.375 Some Effect vs. Great Impact -13.154 0.0001 3.180 0.000 Lack of Awareness Prevents Blood Donation No vs. Yes -7.312 0.001 2.467 0.003 Not Sure vs. Yes -1.228 0.293 1.480 0.407 Influence of Religious Teachings on Blood Donation Negative vs. Not Sure -2.619 0.073 1.126 0.020 Positive vs. Not Sure 3.909 49.849 3.064 0.004 Influence of Environmental Culture on Blood Donation Negative vs. Not Sure -0.087 0.917 0.871 0.920 Positive vs. Not Sure 3.732 41.763 2.417 0.000 Importance of Blood Donation Strongly Disagree vs. Strongly Agree -47.162 0.000 8620.187 0.996 Disagree vs. Agree -4.242 0.014 4.399 0.335 Neutral vs. Agree -4.973 0.007 1.974 0.012 Strongly Agree vs. Agree 1.894 6.646 1.335 0.156 Perceived Ease of Blood Donation Strongly Disagree vs. Agree -43.872 0.0001 8620.186 0.996 Disagree vs. Agree -10.428 0.0001 3.414 0.002 Neutral vs. Agree -8.815 0.0001 2.283 0.000 Strongly Agree vs. Agree 4.084 59.383 2.210 0.000 Constant - 7.114 1229.054 12664.643 0.997 AOR= , B=estimates, S.E=standard error, P-value=probability value Older age (AOR = 0.804, p = 0.012) and lack of awareness (AOR = 0.001, p = 0.003) were significantly associated with a lower likelihood of intending to donate blood. In contrast, males (AOR = 25.894, p = 0.002), individuals with higher educational attainment (AOR = 152.475, p = 0.001), those employed in the health or education sectors (AOR = 64.780, p = 0.001), and married individuals (AOR = 19.068, p = 0.001) were significantly more likely to intend to donate blood. Higher income levels (AOR = 1.001, p = 0.001) were also positively associated with donation intention. Behavioral and psychosocial factors significantly influenced intention as well. Positive influence from religious teachings (AOR = 49.849, p = 0.004), supportive cultural environment (AOR = 41.763, p=0.001), and the perception that blood donation is easy (AOR = 59.383, p=0.001) were all strong predictors of increased intention. Conversely, disagreement with the importance of blood donation (AOR = 0.007, p = 0.012) and the perception that the process is difficult (AOR = 0.000, p = 0.002) significantly decreased the likelihood of donation. These findings highlight the complex interplay of demographic, social, and cognitive factors influencing blood donation intention and underscore the importance of awareness, accessibility, and positive cultural reinforcement in promoting voluntary blood donation. Path Analysis of Blood Donation Behavior The diagnostic evaluation of the structural equation model assessing the relationship between blood donation beliefs and donation intention in East Gojjam Zone confirmed the model’s adequacy and robustness. This was evidenced by meeting all recommended goodness-of-fit criteria (Table 5), indicating an acceptable model fit. Table 5. Goodness-of-Fit Indices for the Structural Equation Model Fit Index Value Root Mean Square Error of Approximation (RMSEA) 0.046 Standardized Root Mean Square Residual (SRMR) 0.034 Comparative Fit Index (CFI) 0.98 Tucker-Lewis Index (TLI) 0.97 Goodness-of-Fit Index (GFI) 0.95 Adjusted Goodness-of-Fit Index (AGFI) 0.92 Normed Fit Index (NFI) 0.96 Path analysis results showed that self-efficacy (β = 0.53), positive attitudes toward donation (β = 0.46), and knowledge about blood donation (β = 0.38) were the strongest predictors of intention to donate. External factors , such as participation in donation campaigns (β = 0.43) and exposure to donation drives (β = 0.40), also positively influenced intention. In contrast , psychological barriers like fear of anemia (β = -0.25) and perceived discomfort (β = -0.31) had significant negative effects. Family influence (β = 0.28) was also a positive contributor (Table 6). Table 6. Path Coefficients for the Blood Donation Intention and Behavior Model Variable Path Coefficient (β) Standard Error (SE) P-value Self-Efficacy 0.53 0.068 0.000 Attitude 0.46 0.119 0.001 Knowledge 0.38 0.098 0.001 Family Influence 0.28 0.091 0.003 Fear of Anemia -0.25 0.085 0.004 Psychological Barriers -0.31 0.111 0.005 Social Influence 0.40 0.130 0.002 Campaign Participation 0.43 0.111 0.001 Discussions This study aimed to examine the prevalence and determinants of blood donation intentions in East Gojjam zone, revealing prevalence rate of 74.8% (95% CI: 72.5%–77.1%). This finding is notably higher than those reported in some countries, such as the Philippines (48%) [29] and India (53.1%) [30], but more closely aligns with rates found in other regions of Ethiopia [31] and Australia [32]. However, the prevalence observed in this study is lower than that seen in Nigeria, where blood donation campaigns have been notably successful in boosting donation rates [33]. This discrepancy suggests a need for more targeted and effective national campaigns to increase blood donation intentions in Ethiopia. The variation in prevalence rates across studies may be attributed to differences in healthcare infrastructure, public awareness, cultural norms, study settings, and access to blood donation programs. These findings underscore the importance of tailored public health interventions to enhance blood donation rates in diverse regional contexts. A key predictor of blood donation intention in this study was self-efficacy. Participants who expressed confidence in their ability to donate were more likely to intend to donate, supporting previous research [16], which emphasized the role of self-efficacy in blood donation behavior. Public health campaigns should therefore focus on boosting individuals' confidence by providing educational materials that demystify the donation process and reassure potential donors about its safety and simplicity. Addressing misconceptions and fears surrounding the process is essential to ensure that intentions translate into actual donations. Attitudes toward blood donation were also strongly associated with intentions to donate, consistent with the Theory of Planned Behavior [15]. Positive attitudes were strongly linked to higher intentions to donate [34]. Therefore, public health campaigns should aim to foster positive attitudes by emphasizing the life-saving impact of blood donation and highlighting its altruistic nature. Correcting misconceptions and reinforcing the social value of blood donation can reshape attitudes and increase donation intentions. Interestingly, participants who did not perceive lack of awareness as a barrier had 99.9% lower odds of intending to donate compared to those who did. This underscores the pivotal role of awareness in shaping donation intentions. Previous studies support this, showing that limited knowledge significantly hinders donation [35], while informed individuals are more likely to donate—88.4% in one study reported positive intentions [36]. Altruism, cited by 99.7% of donors, and community motivation further reinforce the importance of awareness. These findings highlight the need for targeted educational campaigns to bridge knowledge gaps. However, personal fears and time constraints may still limit donation despite awareness [37], indicating the importance of comprehensive strategies that address both informational and personal barriers. Knowledge about blood donation was another crucial factor influencing intentions. Participants with a better understanding of the donation process and its benefits were more likely to express an intention to donate. This finding aligns with previous research [38], which found that improved knowledge increases donation intentions. Public health campaigns should prioritize the dissemination of accurate information about the safety, benefits, and necessity of blood donation. Such information can be shared through community outreach, educational programs in schools, and online platforms to ensure widespread access. Long-term educational interventions, rather than short-term programs, are essential for fostering sustained behavior change, as previous studies have shown that awareness campaigns can significantly enhance willingness to donate [39]. Fear and perceived health risks associated with blood donation emerged as significant barriers. Concerns about anemia or potential side effects deterred individuals from intending to donate, mirroring prior findings [40]. To overcome these concerns, public health campaigns should focus on educating the public about the rigorous health screenings conducted prior to donation and the minimal, temporary risks involved. Sharing testimonials from previous donors can help alleviate fears and build trust in the donation process. Social influence played an important role in shaping blood donation intentions. Participants who had been encouraged by family members, friends, or community leaders were more likely to express an intention to donate. This finding is consistent with previous research [16], which emphasized the influence of social networks in promoting blood donation. Public health campaigns can capitalize on these social connections by encouraging individuals to involve their social circles in donation drives, thereby fostering a community-based approach to blood donation. Strengthening social norms and cultivating a culture of giving can further encourage individuals to follow through on their donation intentions. Family support is a strong predictor of blood donation intentions, aligning with findings from studies on social networks study [41]. Participants perceiving strong social support from family and friends were significantly more likely to donate. These findings reinforce the importance of incorporating social influence and personal motivations into blood donation campaigns, as family and friends can have a powerful impact on donation behavior. The study reveals that individuals who viewed religious teachings positively were 49.849 times more likely to intend to donate blood, supporting the Theory of Planned Behavior [42]. Positive religious beliefs can foster supportive attitudes toward donation, while negative views often stemming from ethical dilemmas or religious conflicts (e.g., Jehovah's Witnesses) [43] can create barriers. Thus, incorporating religious leaders and beliefs into public health campaigns could enhance donation intentions, as seen in other studies [44]. Additionally, cultural perceptions about blood donation were found to play a significant role. Participants who viewed blood donation as an easy process were 59.383 times more likely to donate compared to those who did not perceive it as easy. This is consistent with previous research that emphasized the importance of perceived ease in motivating individuals to donate [45]. Campaigns should emphasize the simplicity of the donation process, alleviate concerns, and highlight the ease of participating in donation drives. The study highlights the significant impact of perception on donation intentions. Individuals who viewed blood donation as important were more likely to express an intention to donate. This finding supports previous research, which suggests that individuals who acknowledge the altruistic value of blood donation are more likely to donate [45]. Therefore, campaigns should focus on emphasizing the importance of blood donation, particularly its life saving potential, to shift neutral or indifferent perceptions and increase donation intentions. Significant socio-demographic differences were observed in blood donation intentions. Older individuals were less likely to intend to donate, a finding consistent with previous studies [46, 47]. This may be due to concerns about the physical risks of donation as individual’s age. Public health campaigns targeting older populations should focus on emphasizing the safety of blood donation for this group, highlighting that age alone is not a barrier to donation. Additionally, promoting the health benefits of blood donation, such as its potential positive effects on cardiovascular health, could encourage older individuals to donate. Gender differences were also observed, with men showing higher intentions to donate than women, in line with prior findings [48, 49]. These gender disparities may be influenced by societal norms, perceptions of health risks, or the physical demands of blood donation. To address these disparities, campaigns should focus on reassuring women about the safety and minimal health impact of donating blood, particularly during menstruation or after childbirth. Educational attainment was positively correlated with blood donation intentions, a finding echoed with prior results [50, 51], who found that individuals with higher levels of education were more likely to intend to donate blood. This suggests that greater health literacy may enable individuals to better understand the importance of blood donation and its safety [47, 52]. Public health campaigns should ensure that information about blood donation is accessible to individuals at all education levels, tailoring messaging to suit different literacy and comprehension levels. Marital status also influenced blood donation intentions, with married individuals more likely to intend to donate. This finding aligns with prior research [53, 54], who suggested that individuals with strong family ties are more likely to engage in socially responsible behaviors. Campaigns could leverage this by promoting family-based donation initiatives, encouraging couples or families to donate together and reinforcing the collective responsibility of community-based health initiatives. Occupation was another significant factor, with individuals employed in health-related or teaching sectors being more likely to intend to donate blood. Specifically, those in these sectors were found to be 64.8 times more likely to express an intention to donate. This finding may be due to their greater exposure to information about the importance of blood donation and the societal need for blood [55, 56]. However, even healthcare professionals sometimes hesitate to donate due to concerns about health risks [57, 58], highlighting the need for reassurance and information about the safety of blood donation for those in these professions. Income level emerged as a determinant of blood donation intentions, with higher-income individuals more likely to express an intention to donate. This finding is consistent with pervious study [59], who noted that wealthier individuals typically face fewer logistical or financial barriers to donating. To increase participation from lower-income individuals, donation sites should be made more accessible in underserved areas, with transportation or financial incentives where possible. Public health policies should also aim to eliminate logistical barriers, such as long waiting times or difficult access to donation centers, which may disproportionately affect lower-income groups. While this study offers valuable insights into blood donation intentions, it has several limitations. The cross-sectional design limits our ability to infer causal relationships or examine changes in blood donation behavior over time. Longitudinal studies would be beneficial in tracking changes in donation intentions and behaviors. Additionally, the reliance on self-reported data may introduce bias due to recall or social desirability effects. Future research should consider using objective data, such as actual donation records, to validate self-reported intentions. Finally, the generalizability of the findings may be limited by the specific population studied. Future studies should explore blood donation intentions in more diverse cultural and geographic settings, particularly focusing on the role of digital platforms and social media in shaping donation behaviors. Conclusion and Recommendations This study offers valuable insights into the determinants of blood donation intentions among residents of East Gojjam Zone. Despite the encouraging finding that 74.8% of participants reported an intention to donate blood, this intention has not consistently translated into practice. Altruism and religious teachings emerged as the most compelling motivators, underscoring the importance of moral and spiritual values in shaping health-related behaviors. In contrast, significant barriers such as fear of needles, misconceptions about health risks, and a general lack of awareness continue to inhibit actual donation. Demographic factors were also influential: men, individuals with higher educational attainment, those employed in the health or education sectors, and higher-income groups were more likely to express a willingness to donate. Beyond demographics, psychosocial and cognitive determinants played a central role. Path analysis revealed that self-efficacy; positive attitudes toward blood donation, and adequate knowledge were the strongest predictors of intention. Cultural norms and exposure to donation campaigns further influenced intention, either by fostering social support or increasing familiarity with the donation process. Based on these findings, several targeted strategies are recommended to improve voluntary blood donation in the region. First, awareness-raising campaigns should be prioritized, especially in rural and underserved communities. These initiatives should focus on correcting misconceptions, reinforcing altruistic and religious motivations, and educating the public about the safety and necessity of blood donation. Second, psychological barriers must be actively addressed. Clear and empathetic communication about the donation procedure, pre-donation counseling, and the creation of donor-friendly environments can reduce fear and anxiety. Testimonials from repeat donors and visual demonstrations of the donation process may also help build trust and comfort. Third, enhancing accessibility is crucial. Expanding mobile donation units, establishing more permanent donation sites, and coordinating donation drives with local events and workplaces can improve convenience. Recognizing and celebrating regular donors through non-financial incentives may also help cultivate a community-based culture of donation. Finally, the development of a sustainable and robust blood donation system requires a multisectoral approach. Collaboration between government health institutions, non-governmental organizations, religious and educational institutions, and community leaders is essential. By leveraging existing cultural strengths and systematically addressing barriers, these stakeholders can foster an enabling environment that supports consistent and voluntary blood donation, ultimately improving the region’s health resilience. Declarations Ethical approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki and the National Research Ethics Review Guideline of Ethiopia. Ethical approval was obtained from the Institutional Review Board (IRB) of Debre Markos University (Approval No: RTTD/844/10/2024) on June 4, 2024. Written informed consent was obtained from all participants after clearly explaining the study’s objectives, procedures, potential risks, and benefits. Participants were assured of their right to withdraw at any time without penalty. To ensure confidentiality, no personal identifiers were collected; all data were anonymized, securely stored, and accessible only to the research team. Consent for publication Not applicable. Funding This study was funded by the College of Natural and Computational Sciences, Debre Markos University. The funder had no role in the study design, data collection, analysis, interpretation of data, or manuscript preparation. Availability of data and materials The datasets used and analyzed during the study are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Authors' contributions N.G. conceived the study, designed the research, conducted data analysis, and drafted the manuscript. M.A., M.K., A.F., F.G., and M.G. contributed to the study’s conception, interpretation of results, and critical review of the manuscript. All authors have read and approved the final version of the manuscript for submission. Acknowledgements We sincerely thank the College of Natural and Computational Sciences, Debre Markos University, for their generous financial support of this research. Our heartfelt appreciation goes to the local administrations of Debre Markos, Dejen, and Amanuale towns for their essential cooperation and assistance throughout the data collection process. References Getie, A., et al., Blood Donation Practice and Associated Factors in Ethiopia: A Systematic Review and Meta-analysis. BioMed research international, 2020. 2020 . Jemberu, Y.A., A. Esmael, and K.Y. Ahmed, Knowledge, attitude and practice towards blood donation and associated factors among adults in Debre Markos town, Northwest Ethiopia. BMC hematology, 2016. 16 (1): p. 1-8. Arage, G., S. Ibrahim, and E. Adimasu, Blood donation practice and its associated factors among health professionals of University of Gondar Hospital, Northwest Ethiopia: a cross sectional study. BMC research notes, 2017. 10 (1): p. 1-6. Jayaram, A., et al., Alternative strategies for emergency blood transfusion in low-resource settings: A scoping review. Transfusion, 2024. 64 (7): p. 1350-61. Gasparovic Babic, S., A. Krsek, and L. Baticic, Voluntary Blood Donation in Modern Healthcare: Trends, Challenges, and Opportunities. Epidemiologia, 2024. 5 (4): p. 770-784. Haddad, A., et al., Blood donations mode: Assessment of the Lebanese model. Transfusion Clinique et Biologique, 2019. 26 (4): p. 341-345. Mussema, A., et al., Voluntary blood donation knowledge, attitude, and practice among adult populations of Hosanna Town, South Ethiopia: a community-based cross-sectional study. Frontiers in Public Health, 2023. 11 : p. 1141544. Kassie, A. and S. Birara, Practice of Blood Donation and Associated Factors among Adults of Gondar City, Northwest Ethiopia: Bayesian Analysis Approach. Journal of Blood Medicine, 2020. 11 : p. 525. Mecha, A. and B. Erchafo, Blood donation intentions and predictors among Hosanna town dwellers, south nation nationality peoples region, Ethiopia. Journal of Family Medicine and Primary Care, 2022. 11 (9): p. 5320-5326. Eltewacy, N.K., et al., Unveiling blood donation knowledge, attitude, and practices among 12,606 university students: a cross-sectional study across 16 countries. Scientific Reports, 2024. 14 (1): p. 8219. Sreeranga, A., et al., Assessment of Knowledge, Attitude and Practice Regarding Blood Donation among Paramedical Personnel in a Teaching Hospital, Hassan, Karnataka. Indian Journal of Public Health Research & Development, 2021. 12 (4): p. 11-17. Alreshidi, M.A. and I. Sula, A comparison of the knowledge, attitude, practice and motivation towards blood donation among Albanian, Saudi and Turkish Citizens. Journal of Blood Medicine, 2022: p. 603-610. Mussema, A., et al., Knowledge, attitude, practice and associated factors about voluntary blood donation among regular undergraduate students of Wachemo University, Southcentral Ethiopia: a cross-sectional study. Frontiers in Public Health, 2024. 12 : p. 1485864. Supadmi, F.R.S., Faktor-Faktor Yang Mempengaruhi Niat Untuk Berdonor Darah Secara Reguler Di Unit Tranfusi Darah Palang Merah Indonesia Kabupaten Gunungkidul. Jurnal Ilmu Kesehatan Bhakti Setya Medika, 2018. 3 : p. 1-10. Hu, H., T. Wang, and Q. Fu, Psychological factors related to donation behaviour among Chinese adults: results from a longitudinal investigation. Transfusion Medicine, 2017. 27 (5): p. 335-341. Liu, J. and H. Han, Applying a modified and extended theory of planned behavior to predict blood donation intentions among Chinese university students: An empirical investigation. Heliyon, 2023. 9 (8). White, K.M., L.C. Starfelt Sutton, and X. Zhao, Charitable donations and the theory of planned behaviour: A systematic review and meta-analysis. Plos one, 2023. 18 (5): p. e0286053. Tavakol, M. and R. Dennick, Making sense of Cronbach's alpha. Int J Med Educ, 2011. 2 : p. 53-55. Kassie, A., T. Azale, and A. Nigusie, Intention to donate blood and its predictors among adults of Gondar city: Using theory of planned behavior. PloS one, 2020. 15 (3): p. e0228929. Melku, M., et al., Knowledge, attitude, and practice of adult population towards blood donation in Gondar Town, Northwest Ethiopia: a community based cross-sectional study. Journal of blood transfusion, 2016. 2016 . Jemberu, Y.A., A. Esmael, and K.Y. Ahmed, Knowledge, attitude and practice towards blood donation and associated factors among adults in Debre Markos town, Northwest Ethiopia. BMC hematology, 2016. 16 : p. 1-8. Jalalian, M., et al., Development of a questionnaire for assessing factors predicting blood donation among university students: a pilot study. Southeast Asian J Trop Med Public Health, 2010. 41 (3): p. 660-6. Aschale, A., et al., Intention to voluntary blood donation among private higher education students, Jimma town, Oromia, Ethiopia: Application of the theory of planned behaviour. PLoS One, 2021. 16 (3): p. e0247040. Hosmer Jr, D. and S. Lemeshow, Applied Survival Analysis [Análisis de Supervivencia Aplicado]. Nueva York: Wiley, 1999. Collett, D., Modelling survival data in medical research . 2023: Chapman and Hall/CRC. Hosmer Jr, D.W., S. Lemeshow, and R.X. Sturdivant, Applied logistic regression . 2013: John Wiley & Sons. Akaike, H., A new look at the statistical model identification. IEEE transactions on automatic control, 1974. 19 (6): p. 716-723. Schwarz, G., Estimating the dimension of a model. The annals of statistics, 1978. 6 (2): p. 461-464. De Leon, M., et al., Willingness to blood donation among the residents of Bustos, Bulacan, Philippines: a prevalence study. Int J Chem Res, 2018. 11 (8): p. 70-79. Samreen, S., et al., Assessment of beliefs, behaviors, and opinions about blood donation in Telangana, India—a cross sectional community-based study. Frontiers in Public Health, 2021. 9 : p. 785568. Kebede, A.A., et al., Willingness to donate blood and associated factors among patient caregivers at the University of Gondar Comprehensive Specialized Hospital, northwest Ethiopia. Clinical Epidemiology and Global Health, 2022. 13 : p. 100953. Clackett, S., et al., Attitudes and willingness to donate blood among gay and bisexual men in Australia. Transfusion, 2020. 60 (5): p. 965-973. Abduljaleel, A., T. Amole, and L.K. Olatunji, A community survey of the willingness, perceptions and practice of blood donation among adults in Kano Metropolis. Int J Public Heal Epidemiol Res, 2019. 5 (2): p. 100-107. Kaplan, M., Sosyal pazarlama ve gönüllülük: Kan bağışı üzerine bir araştırma. İşletme Araştırmaları Dergisi, 2020. 12 (4): p. 3291-3309. Klinkenberg, E., et al., Blood donation barriers and facilitators of Sub‐Saharan African migrants and minorities in Western high‐income countries: A systematic review of the literature. Transfusion Medicine, 2019. 29 : p. 28-41. Fogarty, H., et al., Motivators and barriers to blood donation among potential donors of African and Caucasian ethnicity. Blood Transfusion, 2022. 21 (1): p. 13. Reid, M. and A. Wood, An investigation into blood donation intentions among non‐donors. International Journal of Nonprofit and Voluntary Sector Marketing, 2008. 13 (1): p. 31-43. Mantari, A.A., et al. Raise of Awareness for Blood Donation Campaigns on University Campuses in Lima, Peru . in 2018 Congreso Internacional de Innovación y Tendencias en Ingeniería (CONIITI) . 2018. IEEE. Sahiti, S., et al., Change in the Knowledge, Attitude and Practices towards Blood Donation Before and After Awareness Programme. J Clin Biomed Sci, 2024. 14 (1): p. 19-22. Singh, A.A., M. Kaur, and A. Singh, An evaluation of barriers to blood donation from a tertiary care teaching institution. Journal of Integrated Health Sciences, 2018. 6 (1): p. 18-21. Ma, M., et al., Factors associated with blood donation among college and university students in Wuhan, China: structural equation model. BMC Public Health, 2024. 24 (1): p. 1847. Charsetad, P., Role of religious beliefs in blood donation behavior among the youngster in Iran: A theory of planned behavior perspective. Journal of Islamic Marketing, 2016. 7 (3): p. 250-263. Aranda, A. and L. Tabas, Religious Influences Upon Blood Transfusion Therapy: Best Practices for Nursing Care During Ethical Dilemmas Regarding Treatment Refusal Among Jehovah’s Witnesses. 2024. Dogan, V. and M.A. Tiltay, Caring about other people’s religiosity levels or not: how relative degree of religiosity and self-construal shape donation intention. Current Psychology, 2020. 39 : p. 33-41. Griffin, D., D. Grace, and A. O'Cass, Blood donation: comparing individual characteristics, attitudes, and feelings of donors and nondonors. Health marketing quarterly, 2014. 31 (3): p. 197-212. Zeleke, A.M. and Z.N. Azene, Willingness and its associated factors for blood donation in Gondar town, northwest Ethiopia: a community-based cross-sectional study. Hygiene, 2022. 2 (4): p. 212-225. Jibril, A.D., et al., Knowledge, attitude, practice and associated factors of adult population towards blood donation in Jigjiga town, Somali region, Ethiopia. 2020. Carver, A., et al., What motivates men to donate blood? A systematic review of the evidence. Vox sanguinis, 2018. 113 (3): p. 205-219. Vuletić Čugalj, D., Gender-Based Favoritism in Blood Donations: Evidence from a Field Experiment. CERGE-EI Working Paper Series, 2019(639). Ugwu, N.I., et al., Effect of blood donor educational intervention on the knowledge and attitude towards voluntary blood donation among medical students at a Nigerian University. Nigerian Medical Journal, 2020. 61 (3): p. 163-168. Ahmed, I., et al., Evaluation of the Effect of a Health Education Program on Knowledge and Attitude towards Blood and Plasma Donation among Medical Students at Port Said University. The Egyptian Journal of Community Medicine, 2024. Abd Hamid, N.Z., R. Basiruddin, and N. Hassan, The intention to donate blood: an analysis of socio-demographic determinants. International Journal of Social Science and Humanity, 2013. 3 (6): p. 503. Xu, J.-l. and Y. Guo, Marital Status is an Independent Prognostic Factor in 7 Sites of Squamous Cell Carcinoma: A Propensity-Adjusted SEER Database Analysis. 2021. Jia, H. and E.I. Lubetkin, Life expectancy and active life expectancy by marital status among older US adults: Results from the US Medicare Health Outcome Survey (HOS). SSM-Population Health, 2020. 12 : p. 100642. Tadesse, T., et al., Blood donation practice and associated factors among health professionals in Tigray regional state public hospitals, northern Ethiopia. BMC research notes, 2018. 11 : p. 1-6. Arage, G., S. Ibrahim, and E. Adimasu, Blood donation practice and its associated factors among health professionals of University of Gondar Hospital, Northwest Ethiopia: a cross sectional study. BMC research notes, 2017. 10 : p. 1-6. Shrivastava, S.R., P.S. Shrivastava, and J. Ramasamy, Thank you for saving my life: Blood donation matters. Journal of Research in Medical Sciences, 2016. 21 (1): p. 23. Darouiche, M.H., et al., Occupational blood exposure among health care personnel and hospital trainees. The International Journal of Occupational and Environmental Medicine, 2014. 5 (1): p. 57. Lin, F., et al., Research on the socioeconomic factors that influence the development of voluntary, non‐remunerated blood donation in China—A correlation and regression analysis based on data from 2012 to 2018. Health Science Reports, 2023. 6 (7): p. e1341. Additional Declarations No competing interests reported. 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According to the World Health Organization, voluntary, non-remunerated blood donation is essential for ensuring the availability of safe blood for medical treatments [5, 6]. However, many developing countries, including Ethiopia, continue to face a gap in voluntary blood donation, limiting their ability to meet the growing demand for blood and blood products\u0026nbsp;[1, 3, 7].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGlobally, blood donation rates are disproportionately low in low- and middle-income countries. While high-income countries, which represent only 16% of the world’s population, contribute 40% of global blood donations, low-income nations, including Ethiopia, have significantly lower donation rates. In Ethiopia, studies report blood donation rates ranging from 16% to 33%\u0026nbsp;[1, 3]. This deficiency is especially concerning in sub-Saharan Africa, where maternal mortality due to hemorrhage is a leading cause of death among women during pregnancy and childbirth\u0026nbsp;[8]. The availability of blood is crucial in preventing such deaths, yet it remains insufficient to meet the demand, particularly in rural areas.\u003c/p\u003e\n\u003cp\u003eDespite the importance of blood donation in saving lives, the intention to donate blood remains low in many communities. Factors such as lack of awareness, misconceptions about blood donation, fear, and cultural attitudes often influence individuals' willingness to donate [9-13]. Previous studies have identified some of these barriers, but few have systematically explored the factors influencing individuals’ intention to donate blood, particularly in Ethiopia’s underserved regions, such as the East Gojjam Zone. Theories like the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB) suggest that psychological and social factors, including perceived benefits, attitudes, and social norms, significantly shape individuals’ intentions to donate blood [14-17]. However, the specific determinants of blood donation intention in East Gojjam have remained underexplored.\u003c/p\u003e\n\u003cp\u003eThis study aims to address this gap by investigating the psychosocial, demographic, and contextual factors influencing the intention to donate blood among adults in the East Gojjam Zone, Northwest Ethiopia. Using robust statistical methods, the research identifies key predictors of blood donation intentions, including knowledge, attitudes, perceived benefits, self-efficacy, and social influence. The findings of this study contribute to the development of targeted health promotion interventions and policies that can effectively address the barriers to blood donation. Ultimately, by increasing voluntary blood donations, this research supports efforts to ensure a stable and sufficient blood supply, which is critical for saving lives and improving maternal and child health outcomes in Ethiopia.\u003c/p\u003e"},{"header":"Methods","content":"\u003ch2\u003eStudy Area and Population\u003c/h2\u003e\n\u003cp\u003eThis study was conducted in East Gojjam Zone, located in the Amhara Region of Ethiopia. The zone is bordered by Oromia to the south, West Gojjam to the west, South Gondar to the north, and South Wollo to the east. The Abay River forms a natural boundary along the northern, eastern, and southern edges. A community-based cross-sectional study was carried out from April 23 to September 23, 2024, across three randomly selected districts: Debre Markos, Amanuale, and Dejene. These districts were chosen using a lottery method to ensure a representative sample of the population.\u003c/p\u003e\n\u003cp\u003eThe target population consisted of adults aged 18\u0026ndash;65 years who had resided in the selected districts for at least six months. Individuals who were seriously ill, unable to hear, or had contraindications to blood donation (e.g., HIV, hepatitis) were excluded for safety and ethical considerations. The sample size was determined using a single population proportion formula, assuming a 16.1% prevalence of blood donation [2], a 95% confidence level, and a 3% margin of error. After adjusting for a 16% non-response rate and a design effect of 2, the final sample size was 1,339 participants.\u003c/p\u003e\n\u003ch2\u003eSampling Procedure\u003c/h2\u003e\n\u003cp\u003eA multistage sampling technique was employed. In the first stage, three districts were randomly selected from East Gojjam Zone. In the second stage, four kebeles were selected from Debre Markos, and one Kebele each from Amanuale and Dejene. Finally, households within each Kebele were selected using systematic random sampling, with proportional allocation based on the population size. If more than one eligible individual was present in a household, one participant was selected using a lottery method.\u003c/p\u003e\n\u003ch2\u003eData Collection\u003c/h2\u003e\n\u003cp\u003eBoth primary and secondary data sources were utilized in this study. Secondary data, including the total number of households and the adult population in the selected areas, were obtained from local administrative records to support sample allocation and planning.\u003c/p\u003e\n\u003cp\u003ePrimary data were collected using a structured questionnaire designed to capture comprehensive information on socio-demographic, economic, and psychosocial characteristics, as well as knowledge, attitudes, behaviors, and practices related to blood donation.\u003c/p\u003e\n\u003cp\u003ePrior to the main data collection, the questionnaire underwent pre-testing, and a pilot study involving 5% of the sample size was conducted in a non-selected woreda within the East Gojjam Zone. This process helped assess the tool\u0026rsquo;s clarity, consistency, and validity. Revisions were made based on feedback from the pilot. Internal consistency was evaluated using Cronbach\u0026rsquo;s alpha, which yielded a value greater than 0.7, indicating acceptable reliability [18].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTrained data collectors conducted \u003cstrong\u003eface-to-face interviews\u003c/strong\u003e using the finalized questionnaire. \u003cstrong\u003eSupport was provided to participants\u003c/strong\u003e with reading or writing difficulties to ensure full participation. The survey instrument is provided as a \u003cstrong\u003esupplementary document.\u003c/strong\u003e\u003c/p\u003e\n\u003ch2\u003eVariables and Measurement\u003c/h2\u003e\n\u003cp\u003eThe primary outcome variable, intention to donate blood, was measured using three items on a 5-point Likert scale ranging from \u0026ldquo;completely unwilling\u0026rdquo; to \u0026ldquo;totally willing\u0026rdquo; [19]. Participants with a combined score of 8 or higher were classified as having the intention to donate blood.\u003c/p\u003e\n\u003cp\u003eKnowledge of blood donation was assessed through 10 items adapted from previous studies\u0026nbsp;[19-21]. Participants who correctly answered at least five items were classified as knowledgeable.\u003c/p\u003e\n\u003cp\u003eBehavioral constructs (attitudes, subjective norms, and self-efficacy) were measured on a 5-point Likert scale. Scores were computed by summing positive items and subtracting scores for negative items. Alternatively, a deterministic principal component analysis (PCA) approach was used, as recommended in similar studies [19, 22, 23].\u003c/p\u003e\n\u003cp\u003eWe also included open-ended questions to explore beliefs about blood donation, including behavioral and normative beliefs. Additional covariates, such as demographic, socio-economic, and psychological characteristics, were also collected.\u003c/p\u003e\n\u003ch2\u003eEthical Considerations\u003c/h2\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki and the National Research Ethics Review Guideline of Ethiopia. Ethical approval was obtained from the Institutional Review Board (IRB) of Debre Markos University (Approval No: RTTD/844/10/2024) on June 4, 2024. Written informed consent was obtained from all participants after clearly explaining the study\u0026rsquo;s objectives, procedures, potential risks, and benefits. Participants were assured of their right to withdraw at any time without penalty. To ensure confidentiality, no personal identifiers were collected; all data were anonymized, securely stored, and accessible only to the research team.\u003c/p\u003e\n\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\n\u003cp\u003eDescriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarize the socio-demographic, behavioral, and other relevant characteristics of the study participants. To identify factors associated with the intention to donate blood, binary logistic regression analysis was employed. The dependent variable was binary, coded as yes for individuals who intended to donate blood and No for those who did not. Initially, bivariate logistic regression analyses were conducted, and variables with a p-value \u0026le; 0.20 were considered for inclusion in the multivariate logistic regression model. In the multivariate analysis, variables with p-values \u0026le; 0.10 were retained in the final model to control for potential confounding effects\u0026nbsp;[24-26].\u003c/p\u003e\n\u003cp\u003eThe logistic regression model was specified as follows:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cimg width=\"137\" height=\"34\" src=\"data:image/png;base64,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\" alt=\"image\"\u003e\u0026nbsp;\u003cimg width=\"471\" height=\"21\" src=\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAsMAAAAgCAYAAAD3w3VHAAAAAXNSR0IArs4c6QAAAAlwSFlzAAAWJQAAFiUBSVIk8AAAABl0RVh0U29mdHdhcmUATWljcm9zb2Z0IE9mZmljZX/tNXEAABA9SURBVHhe7Z1dcFTlGcefPXvOpsMNnfGmNlxVlhDAO5OQ+EFnBAMJBJwCU+RCIIDA2LIh1GoHN9kFxCKgQrWyST+8ECIEBRQQ7YWQZEMDolbDIgGZTuWq40zAjzab7G6f9z0fezY5Z7MLLHbgv46jw3PO//8+v+d9T16enD1HDYVChA8IgAAIgAAIgAAIgAAI3IkE1DsxaeQMAiAAAiAAAiAAAiAAAoIANsOYByAAAiAAAiAAAiAAAncsAWyG79jSI3EQAAEQAAEQAAEQAAFshjEHQAAEQAAEQAAEQAAE7lgC2AzfsaVH4iAAAiAAAiAAAiDw/0vgsbKx8e1bGrXPHv2M/u0t9S3uDw/mM9pFY4/HJ7dP1p7/bSOpqqeov6ct7nQ+NsP5UMWxIAACIAACIAACIAACBSUQDD4W3zWtVJvYXEZbD/VSaUmJr78tv42wGODeq9W+3t+Njb+4ZbK2O7F14PMTG8irKkVt4XDGphib4YKWE+IgAAIgAAIgAAIgAAK5EggGy+JrfKXa7vt+T73xACmq4uPNq2tHeFHZlXh9Xa/26D8+JG+p6usfduze01d9r548P1A6bZLvXl+M3v7vawPlwWBRj21DjM1wrtXBcSAAAiAAAiAAAiAAAgUjYHaEI0NL6OCJtVk3wsFFvGmur+Pu8RAlU5U0L8uowuE9RcEThwZiRXW+eT8vpc9PBgZ+xhtis0OMzXDBSgphEAABEAABEAABEACBnAkce4Eao0kq39ZI6/94ie8RbhvRERab4F07tmjqxOO0dFk5UVc3UWoy+cd7qISN2lzMwuHTReu2lg+0Nq737Tj2JH2l+ajSOBab4ZwrhANBAARAAARAAARAAAQKQcDsCicTy+iZX/mpRPNSW3ik07Ftm+hc6TN0brCG/MoHpL0+m3YncxvR+LUbaPlTdbR7yx9kd9g7U+8OYzOcGz8cBQIgAAIgAAIgAAIgUCgCF49QezRFyfo6qlt/yRe6a2RXWFifLq723X3tLLVtOkvi/mL+Iy3XIYnu8JwlQwMtre2+Y32/JtWryFOxGc6VII4DARAAARAAARAAARAoCIGLR/ZRNJWkqaV++lrsTvsLYkP+SVXk8XRT+7E+9vHSYmyGCwMaqiAAAiAAAiAAAiAAArkT6DsX5Xt/iSb776ExJdzsdbv5N3dJxyPHT5jCm+FT1B27SHzjMIkbh9EZvkGoOB0EQAAEQAAEQAAEQOD6Cej3C2/UUqkyKvV75Oa0QI1h4tYwTfV4qKO3j3rFfcPqzKK8N8M84NTL9/spEK2il4520dXTYY+Zvow98TgFIkQrOVZsi4ljyq4cT9VEolT1Uh9VX91jnWfHV2h94VVoj0LrI4c7Zy4ZtU6+fP8ETyBaKddcoIaUUCjMf3+WcznJa85jrrmILSbi5VeOJ2dFop6qly5QNOC3zhu25tL6RzpZ36OEwg76HIvYYsaaTtayfmUWfWucD3AOXZyDk8eqJZ7A7hStzObxopGDMbYRObB+A+vvMPTD9hxYv4H1V1ynvpnDTiMHJ4+dIodIipa/q3My/SWnr44na1uZ047sOdwU/eJPvKFYzPHrJMHg4sTOB/yKqIPIofg7jzcWC8tjZWzV44qZwwxbzKh1orYlqsgcXDx4PrJ+CetPddDn2KolOeh/wfoTOAd9XMM/0uNB9ugUHh2cg2LLwebxTgfNqOVYOK1z35XjiTmcw9QdOXp0VdCOd5iTTUf6m3k4erzHHqeUih3nqYHzMPkOm696Dq76S5lTkpZfp75Rz6GdD07wmh7R7xV1SiycsGKrl3gD/K0j4dFvixm1Hprd0u2t2H6exo37lM+LyfMyc1gs9Rs4h23MaBxrcK6G/mNDO1cv9Tawfn1W/Rjrl1jjcqj10M6HJnobOsvZo4M9vC4eJzkHb4YO7zeMHNw9uJaDux6aqAaE/uEOfhmDV+vvCQ8Z631w1+qlqmBUf/gkTbHFDEaDc1q71fJtMRrrvaxV9vfI8xxyyOKxiD3q1UAkQcsOnaR7XT3OscdE9tDHllkH1nhoktrQyS+n4BwmsUaPlQPH1tSrDbsTtPTQCRrzpeq7y/YGN/75EJ/d2q2Vv3CObxdQHJ/cYLCQL8Bo6BAeJ0llnX5DR25i1yzTpMdB9ihhD9vLMbgO8Tr2KBvFw4ndrfyzvDfDxDc47+NONlGUAgePUajYNlwR482u+ESGxfgm59QTniYZi+47Qq93BVN7wumNtKVSaH1hVGiPQusjhztnLslaH6V93WLvq685ohr+N6QvGRFrSa85eywYLE8+oTTJv3RG9x2lC6m1ST8FMzZploapf4j1a1nfkBf6+039YTFe06zf7JEjE/pJ1vc46Bvj3M9fjJA5OHlEuvTrhoPHKtNj/xG6sDaQ9AedcjhC++Vv2KLUwBoNnEPIyoFjfF1K8T+j63MOTvq2NefmIa59qVSKWrhGLTXsb1zUBCeRg/j1X1Tm4OJhXDekPms02DTkNStX/c61iU88vMm1bQKt6+uld+X12/SgGd9Z4yQRs3vYYpxDYpW3WbFycPMQ4+S55KgvYjyXLEau+kfpiw5/YoIS9PJfKEZuiFlHzCXd4z3KyEHETA+eBy3f19rqcB/nEFK4RFyH3Dwo1S3nE9l0RC3kmhC1dvVIUTevib92+hMLnPIwcnDX5/VwI/qi4Jd0TpZH//c0ZYoxE0RMrDnDg3eSVoxrPbRaDXlFnbp5vn7RGRj6VPGoPJ8yN8Q8X+SaY0brBCPWCJn6Vh2SkpG7/lE63zlhqEQJqlzrERtuwVp8oUr34FoP82iXtRYeeszMLzMH9ujwD132BjV+yULmZtKcS0L/MI/zXyqFzGdt2XMQsSkcS6/pwdVaWE0lBSOhv3bwsnfmSH3juiHnq8np3rQO9fH1tbWLUskktQpOthjnMLjG8jhGsY4JgxM5B+aUmYPQ6E7yc3a7qXGYBvXpczWZTLA+MxrzJYXu0pPgnw/8YouwJnNoP0qxk4G4ogadX25hfrFNemTqyBqZHoLTmBKbh3h5xkYtmYuHdZH6Yf4n/83w+FpaWBWgqOgMz5vFneHT6ZGL2Eq+AVp0hjlGthh/g88zb2VVKiI6wwtryXEjLJQKrX8rPJDD6HVGHXJbD5JTDS2sFGuOu6q8rkTnjsh43oyIrXjTWnMRWywc7lEeXVGV5DXnqVpYQxM86Y5yxuXGrj+X9Xen5YX3AtbvEmuaYxFbjNe0Mm9FZbJFdIaFvuKib+SwgK8bXaIz7OTB140u0Rl28JjLHiKHygW1eg4OnWFx3VhQ1UDRriraYeiHzUfyiNjK/RQVneFR9dNd8RGXZLmu3T0WCg/RGeYaMS6zQiQ4zV3OOXBnuErm4OJh1xd1tmnI62Ku+u3trp1humd2Ogf24M4wxcyRipjNgzvDVoxz8HIOiQh3VWUObh5inJXruA7ceR6uL2Ir0ozc9Wuo5IDHtTOs13oddXUKj5miM5zOQcTYo0vUgWs9o5YoZsyDcPiMt2751ESL6G4vyNGDO9wvsk6xTUf6Gx5iPo30qGCPU8pUXhOfch5tTh1uMwdX/XbOISnn63Xpi8l7j74mugwP7gynYYgY17qLu57CgzvDVoxrrdbVTx2KcGd4Ktd6w4F2x86wmEuiDqLW21mDO8PEnWF92UhG7bzmuPOcVb+Gnj3gce0MC535VY2y1tvnzhSd4QyP+ewhcljOMe4Mu+TAHm+lu+KZ1z7ByNCvmyU6w9Tf05ORg9TnGHeGrRgz0uqWVQy2cGdYzKXAK++7dob1+WrmMMzDz9fX5Qe41gmqZ07cGc7wmMMeEekxixpeURw7wyQ0KtdTtLOCtrIGd4apx8zBL+rwFteBu7bMiDvD/JcGvUb888FXt7Qizvpa5fwamvvqRdfOsF6H9dTVUckeM0VnmLgzbHGav4JzEB7MiTvD1r2+zMk3Z2l5nDlpFaN5/DB7YMs1780wv8XDQ9UhClWTuEUiY/gyVlytd2SGxcSB/DgMT0ieuMc17ULr65MAOaAONz5Xb8VcMjwUqm621pzV8dTnsmJfc/aYOLenuJpvjRBrbq9Yto4fqWHqn9lIoTPpwzL0h8WMNa00j6Jv5fAI5/AID8XJ46eP6NeNbB7XOAeHZ07a9ZtZ/xprhIfnwPrNN6Cfs0eznoPdX3IaV600N3MdbjSHXPSvuf9UCYff8BLXweRkP1TGBCfDIzZMhq/fXisHFw+eL6zf5KLPsZz026g6aw6sM4M9Zohab6LMHGweH22i2EeZSZzhHJpkHfLwYJ1rNh2Zo5mHo8dM9pgpPWLZOJk5OOrP0Otwnfr6fH1DtTixjtm0tWJ3pz3Gjay1Kjl9w99gGj4RjGNN/SauwzdinDYNZqQS6zcZObjrv+mqb6w5laYHqWm68NicxWMzXY8Hj1Oz9M9uzqAgY2YOHOsfyUgLNglGnEOWT3aPvewxnZrEL82zeuxzdQiHWWP6sxRkRt+yhrGVl8fL2E+mU1DqPzdCg38++GQO37rrG3Xw0cPs8bDwyNTh/HyWx8cc+zjTRjwG7dkcPcomDsU9nd1arC8lGsxkNLGz8r2uYN85OsW/+UhN9tOkOe8XhSp78Jzh6wKJk0AABEAABEAABEAABG4aAfHIM+JHnvX2XaKvLyvykWeF+Fy88Lm8XauydDx9fS//RqG/B0+TKARoaIIACIAACIAACIAACOROYHztQqpa/3fqiPVRKu/WcC/1XUzR5dLR/cQj3FKpSpo/y88v3eBbPvgXIHnfJjG6DY4AARAAARAAARAAARAAgTwImPcm/+kwvT3wWrxEc/lCn02y79hBauUvUSbJeInGB6VZO8r8xcSBNUWqL1kxn2b5Fb5PXL/FGZvhPOqEQ0EABEAABEAABEAABG4+AXH/cfDpZfHGaKu2ZVejeNyb48Y2uGhsfNrkRq1jMEH6M8r0T3fjJPGfeBO/RWM5PwJu+GPeRPDiy5uoNcGPsnvmSVr3N6WosicsXueMzfDNLycUQQAEQAAEQAAEQAAE8iYw6ze0verP1LB+u2t3OLz3qu/hDUHi7/O5fxy+zKd3hTf6EuXbaN0sVe8KG984RGc470rhBBAAARAAARAAARAAgZtNQHaHTxyOx3x12rxppeINcfFfBke/XWK0cfDLQQZ2TZvkiwwuoYMfrqV/qkoRP3dadoXRGR6NHuIgAAIgAAIgAAIgAAK3jIB4PvGr8Vi8lN96N8XXTlsP/SX+418Gff22N9vlM5hFZXxbhTZR6yhbSofir5GmejM2wtgM50MTx4IACIAACIAACIAACBScgHx+MT/b+PzTY+Pbt0zWkk/9J/4j3hDbX/WcyyCCZVfivi1XtOff7qVfqJ6ij5/bbHWD7efjNolcaOIYEAABEAABEAABEACBW0pgz+mrvrv5xSt0dgv/m791+HSxb4N8IUn2l6NgM5w/W5wBAiAAAiAAAiAAAiBwmxDAZvg2KSTSAAEQAAEQAAEQAAEQyJ8ANsP5M8MZIAACIAACIAACIAACtwkBbIZvk0IiDRAAARAAARAAARAAgfwJ/A8QPOxT0HKyfQAAAABJRU5ErkJggg==\" alt=\"image\"\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cimg width=\"120\" height=\"30\" 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alt=\"image\"\u003e\u0026nbsp;\u003cimg width=\"484\" height=\"21\" 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\" alt=\"image\"\u003e\u003c/p\u003e\n\u003cp\u003eWhere\u0026nbsp;\u003cimg width=\"12\" height=\"21\" src=\"data:image/png;base64,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\" alt=\"image\"\u003e\u0026nbsp;is the binary response variable,\u0026nbsp;\u003cimg width=\"16\" height=\"21\" src=\"data:image/png;base64,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\" alt=\"image\"\u003e\u0026nbsp;is the intercept term,\u003cimg width=\"17\" height=\"21\" src=\"data:image/png;base64,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\" alt=\"image\"\u003e,\u003cimg width=\"21\" height=\"21\" src=\"data:image/png;base64,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\" alt=\"image\"\u003e,\u003cimg width=\"38\" height=\"21\" src=\"data:image/png;base64,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\" alt=\"image\"\u003e\u0026nbsp;are explanatory variables, and\u0026nbsp;\u003cimg width=\"15\" height=\"21\" src=\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAABcAAAAgCAMAAADOixOHAAAAAXNSR0IArs4c6QAAAGxQTFRFAAAAAAAAAAA6AABmADpmADqQAGa2OgAAOgA6OjpmOma2OpC2OpDbZgAAZjoAZjo6ZpCQZpDbZrbbZrb/kDoAkNv/tmYAtmY6ttvbttv/tv//25A627Zm27aQ2////7Zm/9uQ/9u2//+2///b9N5yagAAAAF0Uk5TAEDm2GYAAAAJcEhZcwAAFiUAABYlAUlSJPAAAAAZdEVYdFNvZnR3YXJlAE1pY3Jvc29mdCBPZmZpY2V/7TVxAAAAvUlEQVQoU82RzRaCIBBGGbMsC/ozy1BQeP93DAeGcxxbtoiNhwt83pkR4i+Xf1YAh467OVl2YpKb9/LAN0g03JfcwmkGOn7y8k3xmDctuz9WWxOw4/kxxjc8Ht8PqsSwZbyTxXUtP8f3Vc0OLOy+WZK2BbTq9/SbNtojHxRQM0hbhzhbG008VxWfZW4BjkZMKjUn8xYuZwjNf0VN4qnH2Z24k6i34qmqFWfDCLO44Z1UVbzvZDAANjbez5/sP3MhC9oXC624AAAAAElFTkSuQmCC\" alt=\"image\"\u003e, \u003cimg width=\"16\" height=\"21\" src=\"data:image/png;base64,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\" alt=\"image\"\u003e,\u003cimg width=\"14\" height=\"21\" src=\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAABUAAAAgCAMAAADKfsO6AAAAAXNSR0IArs4c6QAAADNQTFRFAAAAAAAAAAA6ADqQAGa2OgAAOpDbZgAAZrb/kDoAkGY6kLb/tmY62////9uQ//+2///bq/N1pgAAAAF0Uk5TAEDm2GYAAAAJcEhZcwAAFiUAABYlAUlSJPAAAAAZdEVYdFNvZnR3YXJlAE1pY3Jvc29mdCBPZmZpY2V/7TVxAAAANElEQVQoU2NgGAXUCgEBTiZuoFkCXEwcICN5GNlAFB8rIwuC4mdnZOYFKcKqllouGTnmAABv4wES0g5VyAAAAABJRU5ErkJggg==\" alt=\"image\"\u003e,\u003cimg width=\"17\" height=\"23\" src=\"data:image/png;base64,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\" alt=\"image\"\u003e\u0026nbsp;are the corresponding coefficients. Positive\u0026nbsp;\u003cimg width=\"14\" height=\"21\" src=\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAABUAAAAgCAMAAADKfsO6AAAAAXNSR0IArs4c6QAAAGxQTFRFAAAAAAAAAAA6AABmADpmADqQAGa2OgAAOjpmOma2OpC2OpDbZgAAZjoAZjo6ZpCQZpDbZrbbZrb/kDoAkNv/tmYAtmY6ttvbttv/tv/btv//25A627Zm27aQ2////7Zm/9uQ/9u2//+2///bKZ/lnAAAAAF0Uk5TAEDm2GYAAAAJcEhZcwAAFiUAABYlAUlSJPAAAAAZdEVYdFNvZnR3YXJlAE1pY3Jvc29mdCBPZmZpY2V/7TVxAAAAvUlEQVQoU82QyxbCIAxESVvFB/WF1CoqLfz/P1rI1ANduzAbSE4yuRkh/iZCJ4k2fcnjVdOLUdWPvBx0yi1d8qqjfUwtP4igq2v8mqJ3kKv3VPSlLgsEXcqmyVfbJJlc1qvqtISNsk+5LcqO1hmXwSnAdBRHgk48EybTcnWOGdOyEOJ7QxyxBGhHtHuLsYUXWGboeKDJ3BsvYXG4CDmv2Dav8tWDZItxA3otUy6sNvW9i924Ab1OVueM+tffD1D2Cy23pvLrAAAAAElFTkSuQmCC\" alt=\"image\"\u003e\u0026nbsp;values indicate a higher likelihood of intending to donate blood, while negative values indicate the opposite.\u003c/p\u003e\n\u003cp\u003eIn addition to logistic regression, structural equation modeling (SEM) was conducted to assess the complex relationships between behavioral constructs and intention to donate blood. The SEM incorporated composite scores of behavioral determinants and intention scores to examine direct and indirect associations. The goodness-of-fit of the SEM was evaluated using metrics such as the Standardized Root Mean Square Residual (SRMR) and the Adjusted Goodness-of-Fit Index (AGFI), which demonstrated that the model adequately fit the observed data.\u003c/p\u003e\n\u003cp\u003eModel parameters for both logistic regression and SEM were estimated using maximum likelihood estimation (MLE). The performance and adequacy of the logistic regression model were assessed using the Hosmer-Lemeshow goodness-of-fit test and the Likelihood Ratio Test (LRT) [24, 26]. For model comparison and selection, the Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) were used, with lower values indicating better model fit and reduced risk of overfitting [27, 28]. All statistical analyses were conducted at a 95% confidence level and a p-value less than 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003eDemographic Characteristics of Study Participants\u003c/h2\u003e\n\u003cp\u003eA total of 1,332 participants from East Gojjam Zone were included in the study. Of these, 46.8% were male and 53.2% were female. The majority of respondents (91.9%) had attained college or university-level education, while only 8.1% had completed lower levels of education. In terms of employment, 82.9% were civil servants or health professionals, and the remaining 17.1% were engaged in various other occupations. Religiously, most participants identified as Orthodox Christians (95.5%), followed by Muslims (2.7%) and Protestants (1.8%). Regarding marital status, 63.1% were married.\u003c/p\u003e\n\u003cp\u003eImportantly, 74.8% of the participants reported having the intention to donate blood, and 86.5% were found to be knowledgeable about blood donation. Participants ranged in age from 21 to 58 years, with a mean age of 33.8 years (standard deviation (SD) = 8.27). Monthly income varied between 1,000 and 20,000 Ethiopian Birr (ETB), with an average income of 5,622.68 ETB (SD = 2,948.91) (Table 1).\u003c/p\u003e\n\u003cp\u003eTable 1:\u0026nbsp;Demographic Characteristics of Participants\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFrequency (Percent)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e624 (46.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e708 (53.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eEducation Level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCollege/University Graduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1224 (91.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e108 (8.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eJob Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCivil Servant or Health Professional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1104 (82.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e228 (17.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eReligion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOrthodox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1272 (95.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIslam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eProtestant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMarital Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e840 (63.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e492 (36.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eIntention to Donate Blood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e996 (74.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e336 (25.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eKnowledge of Blood Donation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHave Knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1152 (86.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHave No Knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e180 (13.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Mean \u0026plusmn;\u0026nbsp;standard deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33.80 \u0026plusmn; 8.273\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMonthly Income\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn;\u0026nbsp;standard deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5622.68 \u0026plusmn; 2948.905\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch1\u003eMotivations, Knowledge, and Barriers to Blood Donation\u003c/h1\u003e\n\u003cp\u003eAmong participants intending to donate blood (74.8%), the predominant motivation was a desire to help others, with 42.2% citing altruism as their primary reason for donating. However, a significant proportion of non-intended donors (42.2%) identified a lack of awareness as the main barrier to donation. Health-related concerns, particularly fear of needles, were reported by 34.9% of intended donors and 35.7% of non-intended donors, indicating that fear remains a common deterrent across both groups.\u003c/p\u003e\n\u003cp\u003eFinancial incentives were an influential factor, with 45.8% of intended donors and 35.7% of non-intended donors stating they would be more likely to donate if provided with incentives. Religious teachings were also a key motivator, with 47.0% of intended donors and 42.9% of non-intended donors referencing this as a factor influencing their decision to donate.\u003c/p\u003e\n\u003cp\u003eCultural influences played a particularly strong role in the intentions to donate blood, with 100% of intended donors acknowledging cultural norms as a motivating factor, compared to only 66.7% of non-intended donors. This finding underscores the importance of integrating cultural sensitivity into blood donation campaigns to effectively engage communities.\u003c/p\u003e\n\u003cp\u003eRegarding knowledge, intended donors demonstrated significantly higher levels of awareness about blood donation (94.0%) compared to non-intended donors (64.3%). This disparity emphasizes the critical role that education and targeted awareness campaigns play in enhancing blood donation rates and addressing barriers to donation (Table 2).\u003c/p\u003e\n\u003cp\u003eTable 2: Cross-tabulation of Blood Donation Intention with Associated Factors\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIntention (No) (n = 336)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIntention (Yes) (n = 996)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHave you ever donated blood before?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e252 (75.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e696 (69.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e84 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e300 (30.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWhat motivates you to donate blood?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTo help those in need\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e156 (46.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e432 (43.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePersonal satisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSocial responsibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e72 (7.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFamily/friends\u0026apos; encouragement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e84 (8.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFamily/friends\u0026apos; encouragement influence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGreat impact\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e108 (32.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e252 (25.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSome effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e276 (27.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e84 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e288 (28.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLack of awareness impact\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e132 (39.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e420 (42.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e120 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e396 (39.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnsure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e72 (21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e168 (16.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eReason preventing donation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFear of needles/blood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e96 (9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHealth concerns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e120 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e348 (34.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLack of awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e144 (14.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLack of trust\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e84 (8.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHealth unfit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e132 (13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e132 (13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIncentive impact on donation likelihood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e120 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e456 (45.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSlight rise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e132 (13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e144 (42.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e300 (30.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnsure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e60 (17.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e108 (10.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eReligious teachings impact\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e144 (42.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e468 (47.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e180 (18.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnsure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e156 (46.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e348 (34.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePerceived ease of blood donation process\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrongly Disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48 (57.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e156 (38.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrongly Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36 (30.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e132 (45.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEnvironmental culture influence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48 (57.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnsure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eKnowledge of blood donation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e216 (64.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e936 (94.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e120 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e60 (6.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003eFactors Predicting Blood Donation Intention\u003c/h2\u003e\n\u003cp\u003eThe diagnostic evaluation of the binary logistic regression model assessing blood donation intention in East Gojjam Zone confirmed the model\u0026rsquo;s adequacy and robustness, as evidenced by a non-significant Hosmer-Lemeshow goodness-of-fit test, indicating a good fit (Table 3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3: Homer and Lemeshow Test\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"301\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eStep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eChi-square\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eDegrees of freedom\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMultivariable analysis identified several significant predictors of intention to donate blood (Table 4).\u003c/p\u003e\n\u003cp\u003eTable 4: Binary Logistic Regression Results for Intention to Donate Blood\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"649\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 257px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eCategories\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eAOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eS.E.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 257px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eContinuous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e-0.218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.804\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 257px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eMale vs. Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e3.254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e25.894\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 257px;\"\u003e\n \u003cp\u003eEducation Level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eDegree Graduate or More vs. Others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e5.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e152.475\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e3.214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 257px;\"\u003e\n \u003cp\u003eJob Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eHealth or Teachers vs. Others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e4.171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e64.780\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1.900\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 257px;\"\u003e\n \u003cp\u003eMarital Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eMarried vs. Others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e2.948\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e19.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.877\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 257px;\"\u003e\n \u003cp\u003eMonthly Income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eContinuous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 257px;\"\u003e\n \u003cp\u003eInfluence of Family/Friends on Blood Donation Decision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eNo Effect vs. Great Impact\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e-0.748\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.473\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.843\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.375\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eSome Effect vs. Great Impact\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e-13.154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e3.180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 257px;\"\u003e\n \u003cp\u003eLack of Awareness Prevents Blood Donation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eNo vs. Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e-7.312\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e2.467\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eNot Sure vs. Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e-1.228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1.480\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.407\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 257px;\"\u003e\n \u003cp\u003eInfluence of Religious Teachings on Blood Donation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eNegative vs. Not Sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e-2.619\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1.126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003ePositive vs. Not Sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e3.909\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e49.849\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e3.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 257px;\"\u003e\n \u003cp\u003eInfluence of Environmental Culture on Blood Donation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eNegative vs. Not Sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e-0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.917\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.871\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.920\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003ePositive vs. Not Sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e3.732\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e41.763\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e2.417\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 257px;\"\u003e\n \u003cp\u003eImportance of Blood Donation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eStrongly Disagree vs. Strongly Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e-47.162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e8620.187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.996\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eDisagree vs. Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e-4.242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e4.399\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.335\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eNeutral vs. Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e-4.973\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1.974\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eStrongly Agree vs. Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e1.894\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e6.646\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1.335\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.156\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 257px;\"\u003e\n \u003cp\u003ePerceived Ease of Blood Donation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eStrongly Disagree vs. Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e-43.872\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e8620.186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.996\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eDisagree vs. Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e-10.428\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e3.414\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eNeutral vs. Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e-8.815\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e2.283\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eStrongly Agree vs. Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e4.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e59.383\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e2.210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 257px;\"\u003e\n \u003cp\u003eConstant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e7.114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1229.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e12664.643\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.997\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAOR=\u003c/strong\u003e\u003cimg width=\"17\" height=\"22\" src=\"data:image/png;base64,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\" alt=\"image\"\u003e\u003cstrong\u003e, B=estimates, S.E=standard error, P-value=probability value\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOlder age (AOR = 0.804, p = 0.012) and lack of awareness (AOR = 0.001, p = 0.003) were significantly associated with a lower likelihood of intending to donate blood. In contrast, males (AOR = 25.894, p = 0.002), individuals with higher educational attainment (AOR = 152.475, p = 0.001), those employed in the health or education sectors (AOR = 64.780, p = 0.001), and married individuals (AOR = 19.068, p = 0.001) were significantly more likely to intend to donate blood. Higher income levels (AOR = 1.001, p = 0.001) were also positively associated with donation intention. Behavioral and psychosocial factors significantly influenced intention as well. Positive influence from religious teachings (AOR = 49.849, p = 0.004), supportive cultural environment (AOR = 41.763, p=0.001), and the perception that blood donation is easy (AOR = 59.383, p=0.001) were all strong predictors of increased intention. Conversely, disagreement with the importance of blood donation (AOR = 0.007, p = 0.012) and the perception that the process is difficult (AOR = 0.000, p = 0.002) significantly decreased the likelihood of donation. These findings highlight the complex interplay of demographic, social, and cognitive factors influencing blood donation intention and underscore the importance of awareness, accessibility, and positive cultural reinforcement in promoting voluntary blood donation.\u003c/p\u003e\n\u003ch2\u003ePath Analysis of Blood Donation Behavior\u003c/h2\u003e\n\u003cp\u003eThe diagnostic evaluation of the structural equation model assessing the relationship between blood donation beliefs and donation intention in East Gojjam Zone confirmed the model\u0026rsquo;s adequacy and robustness. This was evidenced by meeting all recommended goodness-of-fit criteria (Table 5), indicating an acceptable model fit.\u003c/p\u003e\n\u003cp\u003eTable 5. Goodness-of-Fit Indices for the Structural Equation Model\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFit Index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eValue\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRoot Mean Square Error of Approximation (RMSEA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStandardized Root Mean Square Residual (SRMR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eComparative Fit Index (CFI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTucker-Lewis Index (TLI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGoodness-of-Fit Index (GFI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAdjusted Goodness-of-Fit Index (AGFI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNormed Fit Index (NFI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ePath analysis results showed that \u003cstrong\u003eself-efficacy\u003c/strong\u003e (\u0026beta; = 0.53), \u003cstrong\u003epositive attitudes\u003c/strong\u003e toward donation (\u0026beta; = 0.46), and \u003cstrong\u003eknowledge\u003c/strong\u003e about blood donation (\u0026beta; = 0.38) were the strongest predictors of intention to donate. \u003cstrong\u003eExternal factors\u003c/strong\u003e, such as participation in donation campaigns (\u0026beta; = 0.43) and exposure to donation drives (\u0026beta; = 0.40), also positively influenced intention. In contrast\u003cstrong\u003e, \u003cstrong\u003epsychological barriers\u003c/strong\u003e\u0026nbsp;\u003c/strong\u003elike fear of anemia (\u0026beta; = -0.25) and perceived discomfort (\u0026beta; = -0.31) had significant negative effects. \u003cstrong\u003eFamily influence\u003c/strong\u003e (\u0026beta; = 0.28) was also a positive contributor (Table 6).\u003c/p\u003e\n\u003cp\u003eTable 6. Path Coefficients for the Blood Donation Intention and Behavior Model\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePath Coefficient (\u0026beta;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStandard Error (SE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSelf-Efficacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAttitude\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eKnowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFamily Influence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFear of Anemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePsychological Barriers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSocial Influence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCampaign Participation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussions","content":"\u003cp\u003eThis study aimed to examine the prevalence and determinants of blood donation intentions in East Gojjam zone, revealing prevalence rate of 74.8% (95% CI: 72.5%–77.1%). This finding is notably higher than those reported in some countries, such as the Philippines (48%) [29] and India (53.1%)\u0026nbsp;[30], but more closely aligns with rates found in other regions of Ethiopia\u0026nbsp;[31]\u0026nbsp;and Australia\u0026nbsp;[32]. However, the prevalence observed in this study is lower than that seen in Nigeria, where blood donation campaigns have been notably successful in boosting donation rates\u0026nbsp;[33]. This discrepancy suggests a need for more targeted and effective national campaigns to increase blood donation intentions in Ethiopia. The variation in prevalence rates across studies may be attributed to differences in healthcare infrastructure, public awareness, cultural norms, study settings, and access to blood donation programs. These findings underscore the importance of tailored public health interventions to enhance blood donation rates in diverse regional contexts.\u003c/p\u003e\n\u003cp\u003eA key predictor of blood donation intention in this study was self-efficacy. Participants who expressed confidence in their ability to donate were more likely to intend to donate, supporting previous research\u0026nbsp;[16], which emphasized the role of self-efficacy in blood donation behavior. Public health campaigns should therefore focus on boosting individuals' confidence by providing educational materials that demystify the donation process and reassure potential donors about its safety and simplicity. Addressing misconceptions and fears surrounding the process is essential to ensure that intentions translate into actual donations.\u003c/p\u003e\n\u003cp\u003eAttitudes toward blood donation were also strongly associated with intentions to donate, consistent with the Theory of Planned Behavior\u0026nbsp;[15]. Positive attitudes were strongly linked to higher intentions to donate [34]. Therefore, public health campaigns should aim to foster positive attitudes by emphasizing the life-saving impact of blood donation and highlighting its altruistic nature. Correcting misconceptions and reinforcing the social value of blood donation can reshape attitudes and increase donation intentions.\u003c/p\u003e\n\u003cp\u003eInterestingly, participants who did not perceive lack of awareness as a barrier had 99.9% lower odds of intending to donate compared to those who did. This underscores the pivotal role of awareness in shaping donation intentions. Previous studies support this, showing that limited knowledge significantly hinders donation [35], while informed individuals are more likely to donate—88.4% in one study reported positive intentions [36]. Altruism, cited by 99.7% of donors, and community motivation further reinforce the importance of awareness. These findings highlight the need for targeted educational campaigns to bridge knowledge gaps. However, personal fears and time constraints may still limit donation despite awareness [37], indicating the importance of comprehensive strategies that address both informational and personal barriers.\u003c/p\u003e\n\u003cp\u003eKnowledge about blood donation was another crucial factor influencing intentions. Participants with a better understanding of the donation process and its benefits were more likely to express an intention to donate. This finding aligns with previous research\u0026nbsp;[38], which found that improved knowledge increases donation intentions. Public health campaigns should prioritize the dissemination of accurate information about the safety, benefits, and necessity of blood donation. Such information can be shared through community outreach, educational programs in schools, and online platforms to ensure widespread access. Long-term educational interventions, rather than short-term programs, are essential for fostering sustained behavior change, as previous studies have shown that awareness campaigns can significantly enhance willingness to donate [39].\u003c/p\u003e\n\u003cp\u003eFear and perceived health risks associated with blood donation emerged as significant barriers. Concerns about anemia or potential side effects deterred individuals from intending to donate, mirroring prior findings \u0026nbsp;[40]. To overcome these concerns, public health campaigns should focus on educating the public about the rigorous health screenings conducted prior to donation and the minimal, temporary risks involved. Sharing testimonials from previous donors can help alleviate fears and build trust in the donation process.\u003c/p\u003e\n\u003cp\u003eSocial influence played an important role in shaping blood donation intentions. Participants who had been encouraged by family members, friends, or community leaders were more likely to express an intention to donate. This finding is consistent with previous research\u0026nbsp;[16], which emphasized the influence of social networks in promoting blood donation. Public health campaigns can capitalize on these social connections by encouraging individuals to involve their social circles in donation drives, thereby fostering a community-based approach to blood donation. Strengthening social norms and cultivating a culture of giving can further encourage individuals to follow through on their donation intentions.\u003c/p\u003e\n\u003cp\u003eFamily support is a strong predictor of blood donation intentions, aligning with findings from studies on social networks study [41]. Participants perceiving strong social support from family and friends were significantly more likely to donate. These findings reinforce the importance of incorporating social influence and personal motivations into blood donation campaigns, as family and friends can have a powerful impact on donation behavior.\u003c/p\u003e\n\u003cp\u003eThe study reveals that individuals who viewed religious teachings positively were 49.849 times more likely to intend to donate blood, supporting the Theory of Planned Behavior [42]. Positive religious beliefs can foster supportive attitudes toward donation, while negative views often stemming from ethical dilemmas or religious conflicts (e.g., Jehovah's Witnesses)\u0026nbsp;\u003cstrong\u003e[43]\u003c/strong\u003e can create barriers. Thus, incorporating religious leaders and beliefs into public health campaigns could enhance donation intentions, as seen in other studies\u0026nbsp;[44].\u003c/p\u003e\n\u003cp\u003eAdditionally, cultural perceptions about blood donation were found to play a significant role. Participants who viewed blood donation as an easy process were 59.383 times more likely to donate compared to those who did not perceive it as easy. This is consistent with previous research that emphasized the importance of perceived ease in motivating individuals to donate \u0026nbsp;[45]. Campaigns should emphasize the simplicity of the donation process, alleviate concerns, and highlight the ease of participating in donation drives.\u003c/p\u003e\n\u003cp\u003eThe study highlights the significant impact of perception on donation intentions. Individuals who viewed blood donation as important were more likely to express an intention to donate. This finding supports previous research, which suggests that individuals who acknowledge the altruistic value of blood donation are more likely to donate [45]. Therefore, campaigns should focus on emphasizing the importance of blood donation, particularly its life saving potential, to shift neutral or indifferent perceptions and increase donation intentions.\u003c/p\u003e\n\u003cp\u003eSignificant socio-demographic differences were observed in blood donation intentions. Older individuals were less likely to intend to donate, a finding consistent with previous studies [46, 47]. This may be due to concerns about the physical risks of donation as individual’s age. Public health campaigns targeting older populations should focus on emphasizing the safety of blood donation for this group, highlighting that age alone is not a barrier to donation. Additionally, promoting the health benefits of blood donation, such as its potential positive effects on cardiovascular health, could encourage older individuals to donate.\u003c/p\u003e\n\u003cp\u003eGender differences were also observed, with men showing higher intentions to donate than women, in line with prior findings [48, 49]. These gender disparities may be influenced by societal norms, perceptions of health risks, or the physical demands of blood donation. To address these disparities, campaigns should focus on reassuring women about the safety and minimal health impact of donating blood, particularly during menstruation or after childbirth.\u003c/p\u003e\n\u003cp\u003eEducational attainment was positively correlated with blood donation intentions, a finding echoed with prior results [50, 51],\u0026nbsp;who found that individuals with higher levels of education were more likely to intend to donate blood. This suggests that greater health literacy may enable individuals to better understand the importance of blood donation and its safety [47, 52]. Public health campaigns should ensure that information about blood donation is accessible to individuals at all education levels, tailoring messaging to suit different literacy and comprehension levels.\u003c/p\u003e\n\u003cp\u003eMarital status also influenced blood donation intentions, with married individuals more likely to intend to donate. This finding aligns with prior research [53, 54], who suggested that individuals with strong family ties are more likely to engage in socially responsible behaviors. Campaigns could leverage this by promoting family-based donation initiatives, encouraging couples or families to donate together and reinforcing the collective responsibility of community-based health initiatives.\u003c/p\u003e\n\u003cp\u003eOccupation was another significant factor, with individuals employed in health-related or teaching sectors being more likely to intend to donate blood. Specifically, those in these sectors were found to be 64.8 times more likely to express an intention to donate. This finding may be due to their greater exposure to information about the importance of blood donation and the societal need for blood [55, 56]. However, even healthcare professionals sometimes hesitate to donate due to concerns about health risks [57, 58], highlighting the need for reassurance and information about the safety of blood donation for those in these professions.\u003c/p\u003e\n\u003cp\u003eIncome level emerged as a determinant of blood donation intentions, with higher-income individuals more likely to express an intention to donate. This finding is consistent with pervious study [59], who noted that wealthier individuals typically face fewer logistical or financial barriers to donating. To increase participation from lower-income individuals, donation sites should be made more accessible in underserved areas, with transportation or financial incentives where possible. Public health policies should also aim to eliminate logistical barriers, such as long waiting times or difficult access to donation centers, which may disproportionately affect lower-income groups.\u003c/p\u003e\n\u003cp\u003eWhile this study offers valuable insights into blood donation intentions, it has several limitations. The cross-sectional design limits our ability to infer causal relationships or examine changes in blood donation behavior over time. Longitudinal studies would be beneficial in tracking changes in donation intentions and behaviors. Additionally, the reliance on self-reported data may introduce bias due to recall or social desirability effects. Future research should consider using objective data, such as actual donation records, to validate self-reported intentions. Finally, the generalizability of the findings may be limited by the specific population studied. Future studies should explore blood donation intentions in more diverse cultural and geographic settings, particularly focusing on the role of digital platforms and social media in shaping donation behaviors.\u003c/p\u003e"},{"header":"Conclusion and Recommendations","content":"\u003cp\u003eThis study offers valuable insights into the determinants of blood donation intentions among residents of East Gojjam Zone. Despite the encouraging finding that 74.8% of participants reported an intention to donate blood, this intention has not consistently translated into practice. Altruism and religious teachings emerged as the most compelling motivators, underscoring the importance of moral and spiritual values in shaping health-related behaviors. In contrast, significant barriers such as fear of needles, misconceptions about health risks, and a general lack of awareness continue to inhibit actual donation.\u003c/p\u003e\n\u003cp\u003eDemographic factors were also influential: men, individuals with higher educational attainment, those employed in the health or education sectors, and higher-income groups were more likely to express a willingness to donate. Beyond demographics, psychosocial and cognitive determinants played a central role. Path analysis revealed that self-efficacy; positive attitudes toward blood donation, and adequate knowledge were the strongest predictors of intention. Cultural norms and exposure to donation campaigns further influenced intention, either by fostering social support or increasing familiarity with the donation process.\u003c/p\u003e\n\u003cp\u003eBased on these findings, several targeted strategies are recommended to improve voluntary blood donation in the region. First, awareness-raising campaigns should be prioritized, especially in rural and underserved communities. These initiatives should focus on correcting misconceptions, reinforcing altruistic and religious motivations, and educating the public about the safety and necessity of blood donation.\u003c/p\u003e\n\u003cp\u003eSecond, psychological barriers must be actively addressed. Clear and empathetic communication about the donation procedure, pre-donation counseling, and the creation of donor-friendly environments can reduce fear and anxiety. Testimonials from repeat donors and visual demonstrations of the donation process may also help build trust and comfort.\u003c/p\u003e\n\u003cp\u003eThird, enhancing accessibility is crucial. Expanding mobile donation units, establishing more permanent donation sites, and coordinating donation drives with local events and workplaces can improve convenience. Recognizing and celebrating regular donors through non-financial incentives may also help cultivate a community-based culture of donation.\u003c/p\u003e\n\u003cp\u003eFinally, the development of a sustainable and robust blood donation system requires a multisectoral approach. Collaboration between government health institutions, non-governmental organizations, religious and educational institutions, and community leaders is essential. By leveraging existing cultural strengths and systematically addressing barriers, these stakeholders can foster an enabling environment that supports consistent and voluntary blood donation, ultimately improving the region’s health resilience.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthical approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki and the National Research Ethics Review Guideline of Ethiopia. Ethical approval was obtained from the Institutional Review Board (IRB) of Debre Markos University (Approval No: RTTD/844/10/2024) on June 4, 2024. Written informed consent was obtained from all participants after clearly explaining the study\u0026rsquo;s objectives, procedures, potential risks, and benefits. Participants were assured of their right to withdraw at any time without penalty. To ensure confidentiality, no personal identifiers were collected; all data were anonymized, securely stored, and accessible only to the research team.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the College of Natural and Computational Sciences, Debre Markos University. The funder had no role in the study design, data collection, analysis, interpretation of data, or manuscript preparation.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe datasets used and analyzed during the study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026apos; contributions\u003c/h2\u003e\n\u003cp\u003eN.G. conceived the study, designed the research, conducted data analysis, and drafted the manuscript. M.A., M.K., A.F., F.G., and M.G. contributed to the study\u0026rsquo;s conception, interpretation of results, and critical review of the manuscript. All authors have read and approved the final version of the manuscript for submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe sincerely thank the College of Natural and Computational Sciences, Debre Markos University, for their generous financial support of this research. Our heartfelt appreciation goes to the local administrations of Debre Markos, Dejen, and Amanuale towns for their essential cooperation and assistance throughout the data collection process.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGetie, A., et al., \u003cem\u003eBlood Donation Practice and Associated Factors in Ethiopia: A Systematic Review and Meta-analysis.\u003c/em\u003e BioMed research international, 2020. \u003cstrong\u003e2020\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eJemberu, Y.A., A. Esmael, and K.Y. Ahmed, \u003cem\u003eKnowledge, attitude and practice towards blood donation and associated factors among adults in Debre Markos town, Northwest Ethiopia.\u003c/em\u003e BMC hematology, 2016. \u003cstrong\u003e16\u003c/strong\u003e(1): p. 1-8.\u003c/li\u003e\n\u003cli\u003eArage, G., S. Ibrahim, and E. Adimasu, \u003cem\u003eBlood donation practice and its associated factors among health professionals of University of Gondar Hospital, Northwest Ethiopia: a cross sectional study.\u003c/em\u003e BMC research notes, 2017. \u003cstrong\u003e10\u003c/strong\u003e(1): p. 1-6.\u003c/li\u003e\n\u003cli\u003eJayaram, A., et al., \u003cem\u003eAlternative strategies for emergency blood transfusion in low-resource settings: A scoping review.\u003c/em\u003e Transfusion, 2024. \u003cstrong\u003e64\u003c/strong\u003e(7): p. 1350-61.\u003c/li\u003e\n\u003cli\u003eGasparovic Babic, S., A. Krsek, and L. Baticic, \u003cem\u003eVoluntary Blood Donation in Modern Healthcare: Trends, Challenges, and Opportunities.\u003c/em\u003e Epidemiologia, 2024. \u003cstrong\u003e5\u003c/strong\u003e(4): p. 770-784.\u003c/li\u003e\n\u003cli\u003eHaddad, A., et al., \u003cem\u003eBlood donations mode: Assessment of the Lebanese model.\u003c/em\u003e Transfusion Clinique et Biologique, 2019. \u003cstrong\u003e26\u003c/strong\u003e(4): p. 341-345.\u003c/li\u003e\n\u003cli\u003eMussema, A., et al., \u003cem\u003eVoluntary blood donation knowledge, attitude, and practice among adult populations of Hosanna Town, South Ethiopia: a community-based cross-sectional study.\u003c/em\u003e Frontiers in Public Health, 2023. \u003cstrong\u003e11\u003c/strong\u003e: p. 1141544.\u003c/li\u003e\n\u003cli\u003eKassie, A. and S. Birara, \u003cem\u003ePractice of Blood Donation and Associated Factors among Adults of Gondar City, Northwest Ethiopia: Bayesian Analysis Approach.\u003c/em\u003e Journal of Blood Medicine, 2020. \u003cstrong\u003e11\u003c/strong\u003e: p. 525.\u003c/li\u003e\n\u003cli\u003eMecha, A. and B. Erchafo, \u003cem\u003eBlood donation intentions and predictors among Hosanna town dwellers, south nation nationality peoples region, Ethiopia.\u003c/em\u003e Journal of Family Medicine and Primary Care, 2022. \u003cstrong\u003e11\u003c/strong\u003e(9): p. 5320-5326.\u003c/li\u003e\n\u003cli\u003eEltewacy, N.K., et al., \u003cem\u003eUnveiling blood donation knowledge, attitude, and practices among 12,606 university students: a cross-sectional study across 16 countries.\u003c/em\u003e Scientific Reports, 2024. \u003cstrong\u003e14\u003c/strong\u003e(1): p. 8219.\u003c/li\u003e\n\u003cli\u003eSreeranga, A., et al., \u003cem\u003eAssessment of Knowledge, Attitude and Practice Regarding Blood Donation among Paramedical Personnel in a Teaching Hospital, Hassan, Karnataka.\u003c/em\u003e Indian Journal of Public Health Research \u0026amp; Development, 2021. \u003cstrong\u003e12\u003c/strong\u003e(4): p. 11-17.\u003c/li\u003e\n\u003cli\u003eAlreshidi, M.A. and I. Sula, \u003cem\u003eA comparison of the knowledge, attitude, practice and motivation towards blood donation among Albanian, Saudi and Turkish Citizens.\u003c/em\u003e Journal of Blood Medicine, 2022: p. 603-610.\u003c/li\u003e\n\u003cli\u003eMussema, A., et al., \u003cem\u003eKnowledge, attitude, practice and associated factors about voluntary blood donation among regular undergraduate students of Wachemo University, Southcentral Ethiopia: a cross-sectional study.\u003c/em\u003e Frontiers in Public Health, 2024. \u003cstrong\u003e12\u003c/strong\u003e: p. 1485864.\u003c/li\u003e\n\u003cli\u003eSupadmi, F.R.S., \u003cem\u003eFaktor-Faktor Yang Mempengaruhi Niat Untuk Berdonor Darah Secara Reguler Di Unit Tranfusi Darah Palang Merah Indonesia Kabupaten Gunungkidul.\u003c/em\u003e Jurnal Ilmu Kesehatan Bhakti Setya Medika, 2018. \u003cstrong\u003e3\u003c/strong\u003e: p. 1-10.\u003c/li\u003e\n\u003cli\u003eHu, H., T. Wang, and Q. Fu, \u003cem\u003ePsychological factors related to donation behaviour among Chinese adults: results from a longitudinal investigation.\u003c/em\u003e Transfusion Medicine, 2017. \u003cstrong\u003e27\u003c/strong\u003e(5): p. 335-341.\u003c/li\u003e\n\u003cli\u003eLiu, J. and H. Han, \u003cem\u003eApplying a modified and extended theory of planned behavior to predict blood donation intentions among Chinese university students: An empirical investigation.\u003c/em\u003e Heliyon, 2023. \u003cstrong\u003e9\u003c/strong\u003e(8).\u003c/li\u003e\n\u003cli\u003eWhite, K.M., L.C. Starfelt Sutton, and X. Zhao, \u003cem\u003eCharitable donations and the theory of planned behaviour: A systematic review and meta-analysis.\u003c/em\u003e Plos one, 2023. \u003cstrong\u003e18\u003c/strong\u003e(5): p. e0286053.\u003c/li\u003e\n\u003cli\u003eTavakol, M. and R. Dennick, \u003cem\u003eMaking sense of Cronbach\u0026apos;s alpha.\u003c/em\u003e Int J Med Educ, 2011. \u003cstrong\u003e2\u003c/strong\u003e: p. 53-55.\u003c/li\u003e\n\u003cli\u003eKassie, A., T. Azale, and A. Nigusie, \u003cem\u003eIntention to donate blood and its predictors among adults of Gondar city: Using theory of planned behavior.\u003c/em\u003e PloS one, 2020. \u003cstrong\u003e15\u003c/strong\u003e(3): p. e0228929.\u003c/li\u003e\n\u003cli\u003eMelku, M., et al., \u003cem\u003eKnowledge, attitude, and practice of adult population towards blood donation in Gondar Town, Northwest Ethiopia: a community based cross-sectional study.\u003c/em\u003e Journal of blood transfusion, 2016. \u003cstrong\u003e2016\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eJemberu, Y.A., A. Esmael, and K.Y. Ahmed, \u003cem\u003eKnowledge, attitude and practice towards blood donation and associated factors among adults in Debre Markos town, Northwest Ethiopia.\u003c/em\u003e BMC hematology, 2016. \u003cstrong\u003e16\u003c/strong\u003e: p. 1-8.\u003c/li\u003e\n\u003cli\u003eJalalian, M., et al., \u003cem\u003eDevelopment of a questionnaire for assessing factors predicting blood donation among university students: a pilot study.\u003c/em\u003e Southeast Asian J Trop Med Public Health, 2010. \u003cstrong\u003e41\u003c/strong\u003e(3): p. 660-6.\u003c/li\u003e\n\u003cli\u003eAschale, A., et al., \u003cem\u003eIntention to voluntary blood donation among private higher education students, Jimma town, Oromia, Ethiopia: Application of the theory of planned behaviour.\u003c/em\u003e PLoS One, 2021. \u003cstrong\u003e16\u003c/strong\u003e(3): p. e0247040.\u003c/li\u003e\n\u003cli\u003eHosmer Jr, D. and S. Lemeshow, \u003cem\u003eApplied Survival Analysis [An\u0026aacute;lisis de Supervivencia Aplicado].\u003c/em\u003e Nueva York: Wiley, 1999.\u003c/li\u003e\n\u003cli\u003eCollett, D., \u003cem\u003eModelling survival data in medical research\u003c/em\u003e. 2023: Chapman and Hall/CRC.\u003c/li\u003e\n\u003cli\u003eHosmer Jr, D.W., S. Lemeshow, and R.X. Sturdivant, \u003cem\u003eApplied logistic regression\u003c/em\u003e. 2013: John Wiley \u0026amp; Sons.\u003c/li\u003e\n\u003cli\u003eAkaike, H., \u003cem\u003eA new look at the statistical model identification.\u003c/em\u003e IEEE transactions on automatic control, 1974. \u003cstrong\u003e19\u003c/strong\u003e(6): p. 716-723.\u003c/li\u003e\n\u003cli\u003eSchwarz, G., \u003cem\u003eEstimating the dimension of a model.\u003c/em\u003e The annals of statistics, 1978. \u003cstrong\u003e6\u003c/strong\u003e(2): p. 461-464.\u003c/li\u003e\n\u003cli\u003eDe Leon, M., et al., \u003cem\u003eWillingness to blood donation among the residents of Bustos, Bulacan, Philippines: a prevalence study.\u003c/em\u003e Int J Chem Res, 2018. \u003cstrong\u003e11\u003c/strong\u003e(8): p. 70-79.\u003c/li\u003e\n\u003cli\u003eSamreen, S., et al., \u003cem\u003eAssessment of beliefs, behaviors, and opinions about blood donation in Telangana, India\u0026mdash;a cross sectional community-based study.\u003c/em\u003e Frontiers in Public Health, 2021. \u003cstrong\u003e9\u003c/strong\u003e: p. 785568.\u003c/li\u003e\n\u003cli\u003eKebede, A.A., et al., \u003cem\u003eWillingness to donate blood and associated factors among patient caregivers at the University of Gondar Comprehensive Specialized Hospital, northwest Ethiopia.\u003c/em\u003e Clinical Epidemiology and Global Health, 2022. \u003cstrong\u003e13\u003c/strong\u003e: p. 100953.\u003c/li\u003e\n\u003cli\u003eClackett, S., et al., \u003cem\u003eAttitudes and willingness to donate blood among gay and bisexual men in Australia.\u003c/em\u003e Transfusion, 2020. \u003cstrong\u003e60\u003c/strong\u003e(5): p. 965-973.\u003c/li\u003e\n\u003cli\u003eAbduljaleel, A., T. Amole, and L.K. Olatunji, \u003cem\u003eA community survey of the willingness, perceptions and practice of blood donation among adults in Kano Metropolis.\u003c/em\u003e Int J Public Heal Epidemiol Res, 2019. \u003cstrong\u003e5\u003c/strong\u003e(2): p. 100-107.\u003c/li\u003e\n\u003cli\u003eKaplan, M., \u003cem\u003eSosyal pazarlama ve g\u0026ouml;n\u0026uuml;ll\u0026uuml;l\u0026uuml;k: Kan bağışı \u0026uuml;zerine bir araştırma.\u003c/em\u003e İşletme Araştırmaları Dergisi, 2020. \u003cstrong\u003e12\u003c/strong\u003e(4): p. 3291-3309.\u003c/li\u003e\n\u003cli\u003eKlinkenberg, E., et al., \u003cem\u003eBlood donation barriers and facilitators of Sub‐Saharan African migrants and minorities in Western high‐income countries: A systematic review of the literature.\u003c/em\u003e Transfusion Medicine, 2019. \u003cstrong\u003e29\u003c/strong\u003e: p. 28-41.\u003c/li\u003e\n\u003cli\u003eFogarty, H., et al., \u003cem\u003eMotivators and barriers to blood donation among potential donors of African and Caucasian ethnicity.\u003c/em\u003e Blood Transfusion, 2022. \u003cstrong\u003e21\u003c/strong\u003e(1): p. 13.\u003c/li\u003e\n\u003cli\u003eReid, M. and A. Wood, \u003cem\u003eAn investigation into blood donation intentions among non‐donors.\u003c/em\u003e International Journal of Nonprofit and Voluntary Sector Marketing, 2008. \u003cstrong\u003e13\u003c/strong\u003e(1): p. 31-43.\u003c/li\u003e\n\u003cli\u003eMantari, A.A., et al. \u003cem\u003eRaise of Awareness for Blood Donation Campaigns on University Campuses in Lima, Peru\u003c/em\u003e. in \u003cem\u003e2018 Congreso Internacional de Innovaci\u0026oacute;n y Tendencias en Ingenier\u0026iacute;a (CONIITI)\u003c/em\u003e. 2018. IEEE.\u003c/li\u003e\n\u003cli\u003eSahiti, S., et al., \u003cem\u003eChange in the Knowledge, Attitude and Practices towards Blood Donation Before and After Awareness Programme.\u003c/em\u003e J Clin Biomed Sci, 2024. \u003cstrong\u003e14\u003c/strong\u003e(1): p. 19-22.\u003c/li\u003e\n\u003cli\u003eSingh, A.A., M. Kaur, and A. Singh, \u003cem\u003eAn evaluation of barriers to blood donation from a tertiary care teaching institution.\u003c/em\u003e Journal of Integrated Health Sciences, 2018. \u003cstrong\u003e6\u003c/strong\u003e(1): p. 18-21.\u003c/li\u003e\n\u003cli\u003eMa, M., et al., \u003cem\u003eFactors associated with blood donation among college and university students in Wuhan, China: structural equation model.\u003c/em\u003e BMC Public Health, 2024. \u003cstrong\u003e24\u003c/strong\u003e(1): p. 1847.\u003c/li\u003e\n\u003cli\u003eCharsetad, P., \u003cem\u003eRole of religious beliefs in blood donation behavior among the youngster in Iran: A theory of planned behavior perspective.\u003c/em\u003e Journal of Islamic Marketing, 2016. \u003cstrong\u003e7\u003c/strong\u003e(3): p. 250-263.\u003c/li\u003e\n\u003cli\u003eAranda, A. and L. Tabas, \u003cem\u003eReligious Influences Upon Blood Transfusion Therapy: Best Practices for Nursing Care During Ethical Dilemmas Regarding Treatment Refusal Among Jehovah\u0026rsquo;s Witnesses.\u003c/em\u003e 2024.\u003c/li\u003e\n\u003cli\u003eDogan, V. and M.A. Tiltay, \u003cem\u003eCaring about other people\u0026rsquo;s religiosity levels or not: how relative degree of religiosity and self-construal shape donation intention.\u003c/em\u003e Current Psychology, 2020. \u003cstrong\u003e39\u003c/strong\u003e: p. 33-41.\u003c/li\u003e\n\u003cli\u003eGriffin, D., D. Grace, and A. O\u0026apos;Cass, \u003cem\u003eBlood donation: comparing individual characteristics, attitudes, and feelings of donors and nondonors.\u003c/em\u003e Health marketing quarterly, 2014. \u003cstrong\u003e31\u003c/strong\u003e(3): p. 197-212.\u003c/li\u003e\n\u003cli\u003eZeleke, A.M. and Z.N. Azene, \u003cem\u003eWillingness and its associated factors for blood donation in Gondar town, northwest Ethiopia: a community-based cross-sectional study.\u003c/em\u003e Hygiene, 2022. \u003cstrong\u003e2\u003c/strong\u003e(4): p. 212-225.\u003c/li\u003e\n\u003cli\u003eJibril, A.D., et al., \u003cem\u003eKnowledge, attitude, practice and associated factors of adult population towards blood donation in Jigjiga town, Somali region, Ethiopia.\u003c/em\u003e 2020.\u003c/li\u003e\n\u003cli\u003eCarver, A., et al., \u003cem\u003eWhat motivates men to donate blood? A systematic review of the evidence.\u003c/em\u003e Vox sanguinis, 2018. \u003cstrong\u003e113\u003c/strong\u003e(3): p. 205-219.\u003c/li\u003e\n\u003cli\u003eVuletić Čugalj, D., \u003cem\u003eGender-Based Favoritism in Blood Donations: Evidence from a Field Experiment.\u003c/em\u003e CERGE-EI Working Paper Series, 2019(639).\u003c/li\u003e\n\u003cli\u003eUgwu, N.I., et al., \u003cem\u003eEffect of blood donor educational intervention on the knowledge and attitude towards voluntary blood donation among medical students at a Nigerian University.\u003c/em\u003e Nigerian Medical Journal, 2020. \u003cstrong\u003e61\u003c/strong\u003e(3): p. 163-168.\u003c/li\u003e\n\u003cli\u003eAhmed, I., et al., \u003cem\u003eEvaluation of the Effect of a Health Education Program on Knowledge and Attitude towards Blood and Plasma Donation among Medical Students at Port Said University.\u003c/em\u003e The Egyptian Journal of Community Medicine, 2024.\u003c/li\u003e\n\u003cli\u003eAbd Hamid, N.Z., R. Basiruddin, and N. Hassan, \u003cem\u003eThe intention to donate blood: an analysis of socio-demographic determinants.\u003c/em\u003e International Journal of Social Science and Humanity, 2013. \u003cstrong\u003e3\u003c/strong\u003e(6): p. 503.\u003c/li\u003e\n\u003cli\u003eXu, J.-l. and Y. Guo, \u003cem\u003eMarital Status is an Independent Prognostic Factor in 7 Sites of Squamous Cell Carcinoma: A Propensity-Adjusted SEER Database Analysis.\u003c/em\u003e 2021.\u003c/li\u003e\n\u003cli\u003eJia, H. and E.I. Lubetkin, \u003cem\u003eLife expectancy and active life expectancy by marital status among older US adults: Results from the US Medicare Health Outcome Survey (HOS).\u003c/em\u003e SSM-Population Health, 2020. \u003cstrong\u003e12\u003c/strong\u003e: p. 100642.\u003c/li\u003e\n\u003cli\u003eTadesse, T., et al., \u003cem\u003eBlood donation practice and associated factors among health professionals in Tigray regional state public hospitals, northern Ethiopia.\u003c/em\u003e BMC research notes, 2018. \u003cstrong\u003e11\u003c/strong\u003e: p. 1-6.\u003c/li\u003e\n\u003cli\u003eArage, G., S. Ibrahim, and E. Adimasu, \u003cem\u003eBlood donation practice and its associated factors among health professionals of University of Gondar Hospital, Northwest Ethiopia: a cross sectional study.\u003c/em\u003e BMC research notes, 2017. \u003cstrong\u003e10\u003c/strong\u003e: p. 1-6.\u003c/li\u003e\n\u003cli\u003eShrivastava, S.R., P.S. Shrivastava, and J. Ramasamy, \u003cem\u003eThank you for saving my life: Blood donation matters.\u003c/em\u003e Journal of Research in Medical Sciences, 2016. \u003cstrong\u003e21\u003c/strong\u003e(1): p. 23.\u003c/li\u003e\n\u003cli\u003eDarouiche, M.H., et al., \u003cem\u003eOccupational blood exposure among health care personnel and hospital trainees.\u003c/em\u003e The International Journal of Occupational and Environmental Medicine, 2014. \u003cstrong\u003e5\u003c/strong\u003e(1): p. 57.\u003c/li\u003e\n\u003cli\u003eLin, F., et al., \u003cem\u003eResearch on the socioeconomic factors that influence the development of voluntary, non‐remunerated blood donation in China\u0026mdash;A correlation and regression analysis based on data from 2012 to 2018.\u003c/em\u003e Health Science Reports, 2023. \u003cstrong\u003e6\u003c/strong\u003e(7): p. e1341.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Blood donation, Donation intention, Socio-demographic factors, Psychological determinants, Structural Equation Modeling, Ethiopia, Public health intervention","lastPublishedDoi":"10.21203/rs.3.rs-6433089/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6433089/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eBlood donation is a critical component of health systems, yet many countries, including Ethiopia, face ongoing challenges in maintaining an adequate and safe blood supply. Understanding the factors influencing individuals' intention to donate blood is essential for designing effective public health interventions. This study examined the socio-demographic, psychological, and contextual determinants of blood donation intention among adults in the East Gojjam Zone, Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA cross-sectional community-based survey was conducted among 1,332 adults selected through multistage cluster sampling. Data were collected using a structured, pre-tested questionnaire. Descriptive statistics summarized participants' characteristics and donation intentions. Binary logistic regression identified significant predictors of donation intention. Structural Equation Modeling (SEM) was employed to explore the pathways linking beliefs, attitudes, and behavioral intention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAmong the respondents, 74.8% (95% CI: 72.5%–77.1%) reported an intention to donate blood. Significant socio-demographic predictors included male gender, higher educational attainment, employment in the healthcare or education sectors, and higher income levels. Psychological factors—positive attitudes toward blood donation (β = 0.46), self-efficacy (β = 0.53), and knowledge of donation practices (β = 0.38)—were strongly associated with intention. Common barriers included fear of needles, perceived discomfort, and lack of awareness. SEM analysis revealed that positive family influence (β = 0.28) also significantly contributed to the intention to donate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eIntention to donate blood is shaped by a complex interplay of socio-demographic, psychological, and social factors. Public health strategies should focus on increasing awareness, addressing psychological barriers, and strengthening family and community support systems. Special attention should be given to women, older adults, individuals with lower educational levels, and those outside the healthcare and education sectors. Strengthening these targeted efforts is essential for promoting voluntary blood donation and ensuring a sustainable blood supply in Ethiopia.\u003c/p\u003e","manuscriptTitle":"Factors Influencing Blood Donation Intentions among Adults in the East Gojjam Zone, Northwest Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-02 09:14:16","doi":"10.21203/rs.3.rs-6433089/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-08T13:36:25+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-24T14:24:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-23T06:16:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-22T11:41:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"88590791891741828449231797597165618967","date":"2025-06-12T03:57:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"257282051959695502292765565684320158723","date":"2025-06-11T13:23:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"40754851833738968610996318339838318923","date":"2025-06-09T18:55:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-28T10:35:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-27T10:22:17+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-16T07:54:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-14T14:22:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-04-14T14:21:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ebc88e01-02a5-454f-917a-cd0d16bb4e47","owner":[],"postedDate":"January 2nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-19T15:07:25+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-02 09:14:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6433089","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6433089","identity":"rs-6433089","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}