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KNOWLEDGE ATTITUDE AND PRACTICE OF BLOOD DONATION AMONG UNDERGRADUATES WITH A VIEW TO DEVELOP A CD-ROM

By VIJAYAKRISHNAN.R

A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING UNIVERSITY OF KERALA 2005

CERTIFICATE Certified

that

Mr.Vijayakrishnan.R,

this

is

College

of

a

bonafide

Nursing,

work

Medical

of

College,

Thiruvananthapuram submitted in partial fulfillment to the requirements for the Degree of Master of Science in Nursing form the University of Kerala.

Prof. (Mrs.) Prasannakumari.Y .MSc. (N) Principal Govt: College of Nursing Medical College Thiruvananthapuram

Thiruvananthapuram Date:

KNOWLEDGE ATTITUDE AND PRACTICE OF BLOOD DONATION AMONG UNDERGRADUATES WITH A VIEW TO DEVELOP A CD-ROM Advisors

Prof. (Mrs.) Prasannakumari.Y MSc. (N) Principal Govt. College of Nursing Medical College Thiruvananthapuram Mrs. Saleena Shah MSc. (N) Associate Professor Govt. College of Nursing Medical College Thiruvananthapuram Mrs. Geetha Kumari MSc (N) Senior Lecturer Govt.College of Nursing Medical College Thiruvananthapuram Dr. Meena D Associate Professor Department of Transfusion Medicine Medical College Thiruvananthapuram

A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING UNIVERSITY OF KERALA 2005

ACKNOWLEDGEMENT

The investigator praises and thanks Lord Krishna and Amma Devi for the abundant blessings which enabled him to complete the study successfully. At the outset the investigator expresses his deep sense of gratitude to Prof. Mrs. Prasnnakumari Y, Principal, Govt. College of Nursing, Thiruvananthapuram, for her generous support and guidance for the completion of the study. The existence of this report owes much to the support and encouragement which Dr. Kochuthresiamma Thomas Registrar, Kerala Nurses and Midwives Council, Thiruvananthapuram, has generously supplied. Special thanks are due to Prof. Dr. Bincy.R Professor, Govt. College of Nursing Thiruvananthapuram, who made many valuable suggestions and gave constructive advice. This work would not have been possible without the support and encouragement of my teacher and guide, Ms. Saleena shah, Associate professor, Govt. College of Nursing, Thiruvananthapuram, under whose supervision I chose this topic and completed the thesis. She had always lent a helping hand with scholastic suggestions and moral support during the whole period of the project. He also wish to express his appreciation to Mrs. Geeta Kumari, Senior Lecturer, Govt. College of Nursing, Thiruvananthapuram, for taking intense academic interest in this study as well as providing valuable suggestions that improved the quality of this study.

He places on record his appreciation to Dr. Meena D, Associate Professor Department of Transfusion Medicine for her valuable suggestion, guidance and support for fulfilling this study. He expresses his sincere gratitudes to Dr.Anuja U,Assistant Professor Community Medicine, Medical college, Thiruvananthapuram for her whole hearted and sincere

painstaking efforts in guiding the study and helping

morally from time to time in this study. He expresses his gratitude to Dr.Ommen p mathew Statistician population studies Kerala University Tiruvananthapuram, Mr. Muraleedharan Statistician Medical College Thiruvananthapuram for their valuable help in analysis of data.

The investigator extends his gratitude to the library staff, College of Nursing, Learning and Resource Centre Medical College for their valuable help and support for the study. The investigator expresses his sincere gratitude to brainwaves Computer works, Medical College, who gave the transcript with meticulous attention He wishes to convey his heart full thanks to the editor for this report to perfection. He is greatly indebted to his batch mates for their valuable corrections, prompt suggestion and support through out the course of this study. My special appreciation goes to my parents, Ramakrishnan.G and Vijayakumari B, who always kept me away from family responsibilities and encouraged me to concentrate on my study. Finally, I would like to express special thanks to my wife Abija V.S. She helped me to concentrate on completing this dissertation and supported mentally during the course of this work. Without her help and encouragement, this study would not have been completed.

CHAPTER1 INTRODUCTION

CONTENT

1.1 INTODUCTION 1.2 BACKGROUNG OF THE PROBLEM 1.3 NEED AND SIGNIFICANCE OF THE STUDY 1.4 THEORETICAL FRAMEWORK 1.5 STATEMENT OF THE PROBLEM 1.6 OPERATIONAL DEFINITIONS 1.7 ASSUMPTIONS 1.8 OBJECTIVES 1.9 METHODOLOGY 1.10 LIMITATIONS 1.11FORMAT OF THE REPORT

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1.1 INTRODUCTION “Every body has it, every body needs it”. There is a bond that links all men and women in the world so closely and intimately that every difference is insignificant besides it. Never varying in temperature more than five or six degrees, composed of 55 percent water, the life stream of blood that runs in the veins of every member of the human race proves that the family of man is a reality (Titmuss, 1971). This red liquid caries oxygen and nutrients to all parts of the body, and carries carbon dioxide and other waste products back to the lungs, kidneys and liver for disposal. It fights against infection and helps heal wounds, so we can stay healthy. There is no substitute for blood. If people lose blood from surgery or injury or if their bodies can’t produce enough, there is only one place to turn –‘Voluntary blood donors’. Blood has always held mysterious fascination for all and is considered to be the living force of our body. Ancient Egyptians recognized the life giving properties of blood and they used it for baths to resuscitate the sick, rejuvenate the old and infirm, and as a tonic for the treatment of various disorders. Today the use of whole blood is a well accepted and commonly employed measure without which many modern surgical procedures could not be carried out. Safe blood is a critical component in improving health care and in preventing the spread of infectious diseases globally. Millions of lives are

saved each year through blood transfusions, yet the quality and safety of blood transfusion is still a concern particularly in the developing countries. About 5 to 10 percent of new HIV infections worldwide are transmitted through unsafe blood transfusions. The reason for this includes blood collection from unsafe donors, poor laboratory procedures and inadequate testing of blood. Blood will be safe if there is a nationally coordinated blood transfusion service, non-remunerated donors, testing of blood for transfusion transmissible infection and by transfusion of the right blood to the right patient through the appropriate clinical use of blood (WHO, 2001).

1.2 BACKGROUND OF THE PROBLEM. The individuals now coming of age to donate blood are the “millennials” of generation Y. It is the largest birth cohort in American history, consisting of more than 78 million people born between 1977 and 1994. If blood collection agencies can establish these millennials as regular blood donors early on, it is hopeful that they will form a life long commitment to giving blood and will help stabilize the supply needs for years to come (Leo, 2003). A substantial body of research has illustrated that there are significant differences between the characteristics of blood donors and those who have not given blood before (Belda et al., 2004). The need for blood is growing day by day as a result of advancement in clinical medicine. In terms of need for blood transfusion, it is noted that in the

country, the death toll for road accidents has increased due to unavailability of blood transfusion services near the accident site (Gupta, 2000). While developed countries with advanced healthcare systems collect blood equivalent to 5 to 10 percent of their population, with less than 0.6 percent of its population donating blood, India lacks far behind (Prathama, 2007). The second largest country in the world, India in terms of population collects around 6 million units of blood in an year with over 40 percent of the donations being voluntary (Bhatia, 2005). The ability to transfuse blood and its separated components represent one of the greatest advances of modern medicine. It has made much of today’s surgery possible and safer and it has saved and prolonged countless lives in war and in peace. But it is not with perils. Every blood transfusion carries with it some calculated risks. It is now and probably will never be completely safe (Kellner, 1977). Voluntary blood donors are the bricks of the edifice called blood transfusion. The presence of professional blood sellers however cannot be ruled out among the replacement donor in the gab of relatives or friends. This Fact is supported by the WHO report which says, “All the countries admitted that the absence of paid blood sellers is not real. They exist in replacement donor category (Kaur, 2008).

Presently, a majority of blood donations are from friends and relatives of the patient. This practice is not recommended as sometimes family or replacement donors donate blood unwillingly under obligation or pressure and hide their high risk behaviour including their diseases (Mujeeb et al., 1996). Voluntary blood donors have no reason to give false information about life style factors that might place them at risk of transmitting infectious agents (Conteras, 1994). According to a cross-sectional study conducted by Singh Bir (2007) to assess the knowledge attitude and socio-demographic characteristics which differentiate donors from non donors among 434 households of an urban slum in New Delhi, India, there exist large lacunae in basic knowledge about blood donation alongside indigenous misconceptions which account for the low public initiative to donate blood in this population. This needs to be addressed through education, motivation, advocacy and the correction of culture specific misbeliefs

1.3 NEED AND SIGNIFICANCE OF THE STUDY. India with a population of about one hundred crore is naturally the country which requires lot of blood to save lives of its citizens. It has been quoted that there is a need of about 8 million units of blood every year in our country. Out of this, only half, that is around 4 million units, can be obtained

from voluntary blood donors. Rest all comes from replacement blood donation from relatives or paid donors (Ghosh, 1996). In India, at the moment there are 4 voluntary blood donors per thousand populations with some regions/states at a higher than the national average and some below the national average. If this national average can be raised to 8 voluntary blood donor per 1000 population, there would not be any shortage of blood for the country and none would die for want of blood for transfusion. According to a study conducted by Gilani et.al, 2003 to assess knowledge, attitude and practices (KAP) regarding voluntary blood donation prevalent in medical and paramedical personnel, concluded that there is an urgent need to create and strengthen programs for motivation, recruitment and retention of voluntary non-remunerated blood donors (VNDs). The major finding of the study was that among doctors, only 3.40 per cent were regular voluntary non-remunerated blood donors (VNDs), whereas no one was found amongst the paramedics. 40 per cent of non-donor doctors and 63.3 per cent of non-donor paramedics stated the reason for their non-donation as “no one had ever asked them to do so”. The overall estimated annual requirement of blood to be 6 million units in India, only 3 million units of blood were reported to be collected from professional, voluntary and replacement donors. Of this, 1.2 million units were

collected from paid professional donors. The estimated shortfall of three million units will go up to 4.2 million units annually (Dixit, 2003). Only 39.5percent of blood is donated voluntarily in Kerala, India the rest being replacement donations, with a national average of 5.2percent (National Aids Control Organization-NACO, 2003). As per the guidelines provided by Govt. of India (National Blood policy, 2002) blood is to be collected only from voluntary blood donors or relatives of the patient. Acceptance of blood from professional blood donors under any circumstances is strictly prohibited. The consequences of such blood are catastrophic as it can help in transmission of AIDS or hepatitis B. In general, malpractices in blood transfusion services are due to shortage of blood in the blood banks. There should be a planned programme to create awareness amongst the general public so as to ensure a regular supply of good quality blood without having to experience seasonal shortages. The educational programme, therefore, should be so designed that the community understands in depth the advantage of regular blood donation (NACO 2007). The community health nurse can play a pivotal role in promoting voluntary blood donation. Youth are healthy, active, dynamic, and receptive and constitute a greater proportion of population. Every year a large number of young adults are attaining the age of blood donation. Every year regular blood

donors are moving out from donor base owing to old age, ailment or change of residence. Blood donor motivation is, therefore, an ongoing process to change the behavioural pattern of non-donors. The work has no scope for respite. College students are healthy, enthusiastic and approachable as a group. These students if 'caught young' are future donors and motivators. In the scenario it is very important to understand their knowledge, attitude and practice regarding blood donation. Voluntary blood donation will reduce the risk of blood borne diseases getting transmitted to innocent poor patients. Imparting knowledge to this group will make them most vital motivators. A healthy attitude among college students will bring change, as they are the backbone of the country. They have to be encouraged, inspired and motivated to donate blood voluntarily. Moreover the researcher, found this problem as an important one from his own experience in the Medical College and near by hospitals such as Sree Chitra Tirunal Institute for Medical Sciences and Technology and Regional Cancer Center where lot of patients were admitted and are in need of blood for their existence. The researcher also observed that the young donors who came to donate blood, lacked adequate knowledge regarding blood donation. Many of the donors were replacement donors. Hence the researcher felt the need to take up this problem for the present study.

1.4 THEORETICAL FRAMEWORK Theoretical

framework

provides

a

foundation

for

formulating

relationship among variables. Theoretical frame work of the study is based and designed on the concept of Health promotion model of Becker extended by Nola Pender in 1987 which focuses on health promotion behaviour. The health promotion model (HPM) proposed by Nola. J. Pender 1982; revised in1996 was designed to be a “complementary counterpart to models of health protection.” It defines health as a positive dynamic state not merely the absence of disease. Health promotion is directed at increasing a client’s level of wellbeing. The health promotion model describes the multi dimensional nature of persons as they interact within their environment to pursue health. The model focuses on following three areas: •

Individual characteristics and experiences



Behavior-specific cognitions and affect



Behavioral outcomes

1.4.1 Application of Pender’s Health Promotion Model in the present study The health promotion model notes that each person has unique personal characteristics and experiences that affect subsequent actions. Prior behavior and inherited and acquired characteristics influence beliefs, affect, and enactment of health-promoting behavior-Regular voluntary blood donation.

The prior behaviour which has direct and indirect effects on donating blood is the students existing knowledge, attitude and the frequency of donating blood (Reported practice). The inherited characteristics (biologic factors) that influence the behaviour specific cognitions and affect are the age, sex and blood group. The psychological factors include motivation to donate blood and the socio cultural factors are the year of study, the educational subject, the place of residence, type of family, religion and the monthly family income. The set of variables for behavioral specific cognitions and affect have important motivational significance. These variables can be modified through nursing actions. The perceived benefits of action of regular voluntary blood donation are that the increased demand for blood can be met and one can ensure safe blood donation and blood transfusion. Lack of knowledge, attitude, fear and misconceptions regarding blood donation are the perceived barriers to the act of voluntary blood donation. Perceived self efficacy influences the barriers to action E.g. Student’s personal capacity to improve the knowledge attitude and practice of blood donation. Anxiety, fear of blood donation, feelings of satisfaction and improved self esteem are the activity related affect that occur before, during and after the process of blood donation. When positive emotions or affect are associated with a behavior, the probability of commitment and action is increased.

Undergraduate students are more likely to commit to and engage in voluntary blood donation when significant others model the behavior and provide assistance and support to enable the behavior. Situational influences in the external environment-facilities in blood bank, skill and behaviour of the health personnel- can increase or decrease commitment to or participation in health-promoting behavior. The greater the commitments to a specific plan of action- participation in the instructional CD -Rom presentation on blood and blood donation - more likely, health-promoting behaviors are to be maintained over time. Commitment to a plan of action is less likely to result in the desired behavior-to become a voluntary blood donor- when competing demands over which persons have little control require immediate attention. Commitment to a plan of action is likely to result in the desired behavior when other actions are less attractive and thus preferred to the target behavior- Regular voluntary blood donor. The undergraduate students gain adequate knowledge regarding blood, blood groups, blood donation, donated blood and blood safety through the instructional CD-Rom presentation and group teaching, develop a positive attitude towards voluntary blood donation and become a regular voluntary blood donor.

1.5 STATEMENT OF THE PROBLEM. A study to assess the knowledge, attitude and practice of blood donation among undergraduate in selected colleges of Thiruvananthapuram, with a view to developing a CD-Rom.

1.6 OPERATIONAL DEFINITIONS. 1.6.1 Knowledge The state of knowing, cognition or understanding. In this study knowledge refers to the respondents responses to the structured questionnaire regarding blood, blood groups, blood donation, Donated blood and blood safety. 1.6.2 Attitude Attitude is a settled opinion or way of thinking. In this study attitude refers to expressed feelings and views and the way of thinking of undergraduate students regarding blood donation which is measured by using an attitude scale. 1.6.3 Practice Performing the act of blood donation. In this study practice refers to the act of blood donation reported by the study subjects. 1.6.4 Blood Donation In this study blood donation refers to "unpaid, non-remunerated" donation of blood by undergraduate students of the selected colleges

1.6.5 Undergraduates Students studying full time for a first degree including Bachelor of Arts (BA), Bachelor of Science (BSc), in selected colleges of Thiruvananthapuram under the University of Kerala. 1.6.6 CD-Rom It is an audio visual learning material prepared by the investigator regarding blood and blood donation which can be used with a computer.

1.7 OBJECTIVES. 1. Assess the knowledge, attitude and practice of undergraduate students regarding blood donation. 2. Find association between socio-demographic factors which affect the knowledge, attitude and practice of blood donation. 3. Develop an instructional CD- Rom regarding blood and blood donation.

1.8 ASSUMPTIONS. 1. Knowledge attitude and practice of blood donation is poor among Undergraduate students 2. Knowledge regarding blood donation tend to affect their attitude and practice towards the same. 3. The instructional CD Rom will significantly improve the knowledge and attitude of Undergraduates regarding blood donation.

1.9 METHODOLOGY IN BRIEF. The present study was intended to assess the knowledge, attitude and reported practice regarding blood donation among undergraduates, studying in selected arts and science colleges of Thiruvananthapuram city with a view to develop an instructional CD-Rom on voluntary blood donation. The study was conducted in two phases. PHASE I:

Descriptive survey

The existing knowledge of samples was assessed using a structured questionnaire. PHASE II: The phase II of the study has two stages. Stage I: Preparation of instructional CD- Rom based on the results in phase I Stage II: Testing the effectiveness of the CD- Rom Population Undergraduate students studying in selected arts and science colleges of Thiruvananthapuram. Sample Phase I: 300 students from three randomly selected arts and science colleges. Phase II: 30 students from one of the colleges in phase I

1.10 LIMITATIONS. The study was limited to undergraduate students studying in selected arts and science colleges of Thiruvananthapuram only.

1.11 FORMAT OF THE REPORT The report is divided into five chapters Chapter I

-

Chapter II -

Introduction Review of literature includes materials pertaining to the different areas of the study.

Chapter III -

Deals with methodology of the study

Chapter IV -

Presents the analysis and interpretation of the data.

Chapter V -

Summary and conclusions of the study, followed by nursing implications together with suggestions and recommendations for further research.

CHAPTER II REVIEW OF LITEATURE CONTENTS

2.1 INTRODUCTION 2.2 LITERATURE RELATED TO BLOOD AND BLOOD GROUPS 2.2.1 HISTORICAL MILESTONES 2.2.2 BLOOD DONORS 2.3 LITERATURE RELATED TO BLOOD DONATION 2.4 LITERATURE RELATED TO KNOWLEDGE, ATTITUDE AND PRACTICE OF BLOOD DONATION 2.5 LITERATURE RELATED TO MOTIVATION FOR DONATION AND NON DONATION OF BLOOD 2.6 LITERATURE RELATED TO BLOOD SAFETY 2.7 LITERATURE RELATED TO EFFECTIVENESS OF EDUCATIONAL PROGRAMME

2.8 CONCLUSION

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2.1 INTRODUCTION A research literature review is a written summary of the state of evidence on a research problem (Polit, 2008). A literature review is a synthesis of the literature that describes what is known or has been studied regarding the particular research question or purpose (Macnee, 2008). An extensive review of literature was made by the investigator regarding blood, blood products and blood donation. It helped the investigator in the selection of topic, formulation of theoretical frame work, methodology, preparation of the tool, development of the instructional CD-Rom and in the analyses and interpretation of the data. This chapter presents a review of the brief account of the various citations from books and studies conducted by different investigators that were found to be relevant to different aspects of the present study. 2.2

LITERATURE RELATED TO BLOOD AND BLOOD GROUPS. Blood is a river of life that surges with in us, transporting nearly

everything that must be carried from one place to another (Marieb, 2006). Blood accounts for 7 percent of the human body weight, with an average density of approximately 1060 kg/m3, very close to pure water's density of 1000 kg/m3 (Bruce, 2005).

Blood can be divided into two main parts, the blood plasma and the blood cells. Blood is distributed throughout an organism by the circulatory system (Schaller, 2008). Blood is a complex fluid consisting of different blood cells suspended in yellowish liquid called plasma. The blood cells comprise a mixture of red cells (erythrocytes), white cells (leukocytes) and platelets (thrombocytes). The plasma contains many different proteins, chemical substances, clotting (coagulation) factors and numerous metabolic substances (WHO, 2001). Karl Landsteiner first described the ABO blood group in 1900, and it served the beginning of blood banking and transfusion medicine (Ali et al., 2005). Even after 100 years, the single most important test performed in blood banking services is determination of ABO blood groups to avoid morbidity and mortality (Honig and Bore, 1980). In the ABO blood group, individuals are divided into four major blood groups, A, B, AB and O, according to the presence of the antigens and agglutinins. Type A blood has type A antigens, type B blood has type B antigens, type AB blood has both types of antigens, and type O blood has neither A nor B antigens. In addition, plasma from type A blood contains type B antibodies, which act against type B antigens, whereas plasma from type B blood contains type A antibodies, which act against type A antigens. Type AB

has neither type of antibody and type O blood has both A and B antibodies (Seeley et al., 1998). In a study conducted at the University of Lagos, Nigeria for ABO Rh blood groups among one hundred and fifty (150) students, blood group O was the highest with the percentage frequency of 55.3%, followed by blood group A (25.3%), B (16.7%) and the least percentage frequency was blood group AB which is 2.7% The total percentage of Rh D positive was 94% and that of Rh D negative was found to be 6% (Oyenike,2006). According to a study by Latoo 2006, to determine the distribution frequency of ABO and Rhesus blood groups in Kashmiri donors and recipients concluded that 'O' was the most prevalent blood group (38.43%), while AB was the least prevalent group (6.55%). Majority 95.9per cent were Rhesus positive. Data showed that among the Rh +ve, 36.47 per cent were O +ve, 30.91percent B +ve, 22.16percent A +ve and 6.35 percent AB +ve. Break up of the Rh -ve, showed O –ve(1.95%), B -ve (1.14%), (0.79%)

A-ve, and 0.2 percent AB -

ve. 2.2.1 Historical milestones. Already in ancient times people realized that blood was a special liquid with special but somehow obscure and unexplainable properties. The Greeks had already realized the importance of blood and Hippocrates (460 BC- 370 BC), often referred to as the ‘Father of Medicine’ proposed that diseases are

based on an imbalance of four basic humors, blood, Phlegm, yellow bile and black bile, implying a physical cause of diseases and not a divine origin (Marieb, 2006). The English Physician Galen (129 BC - 200 BC) working in Rome, knew that the blood vessels carry blood and he identified venous and arterial blood and assigned them distinct and separate functions. The English Physician William Harvey (1578-1657) is credited to have been the first to describe correctly and in great detail, blood being pumped by the heart through the blood circulatory system. Already in ancient times first experiments dealing with blood transfusion have been described, but with little success. The first well documented and successful blood transfusion was performed by the French Physician Jean-Baptiste Denys (1625-1704) in 1667 using sheep blood and administering it to a 15 year old boy. The English Physician James Blundell (1791-1878) was the first to administer a successful human – to – human transfusion (in 1818) by extracting blood from the patient’s husband and then transfusing it to his wife. The observation of blood group substances and description of the ABO blood group system at the beginning of the twentieth century by the Austrian biologist and physician Karl Landsteiner (1868-1943) was great step in blood research and in blood transfusion.

Landsteiner was rewarded the Nobel Prize in physiology and Medicine in 1930 for his achievements. In addition, together with the American Physician, Alexander. S. Weiner (1907-1976) Landsteiner was also the first to identify the Rhesus factor in 1937. Despite the long list of several other blood groups discovered so far, the ABO blood group holds a respectable position in view of the safety of blood/ blood products transfusion to date (Calhoun 2001). 2.2.2 BLOOD DONORS Replacement of ancient glass-bottles by modern poly-bags, introduction of gamma ray-sterilized disposable transfusion sets, extended shelf life of blood, use of blood components and plasma products, technology of aphaeresis and modern laboratory technologies have changed the quality of blood banking and blood transfusion service. But one thing that has not changed since the dawn of first blood transfusion of modern era is the need of human volunteers to donate blood. According to the drugs and cosmetics rules of the government of India 1999 a "donor" means a person who voluntarily donates blood after he has been declared fit after a medical examination, for donating blood, on fulfilling the criteria given hereinafter, without accepting in return any consideration in cash or kind from any source, but does not include a professional or a paid donor.

Voluntary blood donors are the cornerstone of a safe and adequate supply of blood and blood products. The safest blood donors are voluntary, non-remunerated blood donors from low-risk populations (NACO, 2007). According to NACO,2007 a voluntary non-remunerated blood donor is a person who gives blood, plasma or other blood components of his/her own free will and receives no payment for it, either in the form of cash or in-kind which could be considered a substitute for money. This includes time off work, other than reasonably needed for the donation and travel. Small tokens, refreshments and reimbursement of the direct travel costs are compatible with voluntary, non-remunerated blood donation. A voluntary non-remunerated blood donor who has donated at least three times, the last donation being within the previous year, and continues to donate regularly at least once per year is a regular voluntary non –remunerated blood donor ( NACO, 2007) NACO 2007 defines a family / replacement donor as one who donates blood when it is required by a member of his/her family or community. This often involves coercion and/or payment which compromise the safety of the blood. A paid donor is who donates blood in exchange of money or other form of payment. The professional Blood donation is banned in India w.e.f.1st January 1998 (NACO, 2007).

A forced blood donor is a person who is not willing to donate blood on his/her own, but is being forced by their superiors or employer for donation. There is always a fear of losing ones own job or promotion (NACO, 2007). Aphaeresis donor, as defined by NACO 2007 is one who donates only one of their blood components through the process of cell separation. This donor may be either voluntary or replacement donor. 2.3

LITERATURE RELATED TO BLOOD DONATION. The donation of blood involves insertion of a needle into a blood vessel

of the arm followed by a loss of 10% of the total blood volume within few minutes (Goodnough, 1999). Blood donation can be viewed as an “opponent – affective process” in whom initial mildly aversive feelings lead to positive aftereffects. Research suggests that blood donation can be explained, in part, by a self serving addictive process (Zillmer et.al 2003). In a study by Surez et.al 2004, blood donation was understood in a rational and evaluative manner by the majority of blood donors but in an emotional, personalized and stereotyped manner by minority. Continual donation as a form of help was rationalized as a function of internal and external factors notably personal convenience in comparison to other helping behaviours and ease of access to collection points.

James & Mattews 1996, examined the interval between donations in group O, Rh negative blood donors by using survival analysis, they found that the likely hood of a subsequent donation attempt was associated with the interval between the first and second donations. The shorter the donation interval between the first two donations, the more likely the donor was to make subsequent donations. The proportion of repeat donors increased with education level. Rate of donation increased with age and education (Ownby, 1999). Recent studies evaluating the demographic characteristics of first time and return donors reveal that, those with a lower education level are less likely to donate blood than those with a higher educational level (Ownby, 1999). The World Health Organization (WHO) recommends that all countries should be self sufficient in all blood products and that all blood donation should be voluntary, anonymous and non- remunerated. Establishment of voluntary blood donation is an ideal mode to promote the blood donation for the whole society and an ideal way to ensue the continuous development of blood transfusion services (Li H.W 2008). Voluntary, non-remunerated blood donors have been shown to be less likely

to

carry

(Van der 2002).

transmissible

diseases

than

remunerated

donors

India, with a population of over a billion, has a meager availability of 2.5 million units of blood against a minimum modest annual requirement of approximately 6 million units (Jolly, 1994) In developing countries like India only 39% of blood donations are voluntary (Kapoor, 2000). Blood collected from voluntary (non-remunerated) blood donors all over the country demonstrated a definite rise in the year 2005, but it has yet to reach 50% in many of the states. The proportion of blood units collected through voluntary blood donations in the country for the year 2004 was 52.2%, 53.4 % in 2005 and 56.4% in year 2006 (NACO 2006). In the reporting period April to September 2008, total 34, 07,673 units of blood is collected out of which 20, 00,678 (58.7%) is through voluntary blood donation (NACO 2008). A study conducted in New Delhi, the capital city of India (Makroo and Kumar, 1991) reported that nearly 40% of all donations in this city were from paid donors. They reported that only 17% of all donations were voluntary while 43% were replacement donations. A study among heath professionals regarding voluntary blood donation in Greece found that 97% of respondents were aware of the shortage of blood and responded correctly to most questions regarding blood donation and

transfusion. The results also showed that women and young people donate the least in Greece and only 17% were volunteers (Kriebardis A.G 2008). The results of a Cross sectional study conducted in Delhi revealed that 22.4% of the subjects studied were not even aware that blood could be donated. Only 7.7% had been ever donors. Donor status was significantly associated with age, sex, literacy status, occupation and knowledge about other aspects of blood donation. Over half of all non-donors cited a culturally indigenous fear, "khoon ki kami" or having a volumetric deficiency of blood as the reason for non-donation. (Singh 2002) 2.4

LITERATURE RELATED TO KNOWLEDGE, ATTITUDE AND PRACTICE OF BLOOD DONATION. In a study conducted among a sample (n=400) of Thai university

students by Wiwanitkit 2002, to assess their knowledge of voluntary, nonremunerated blood donation, most participants (80%) knew about blood donation, only 11percent (n=44) had ever donated blood voluntarily. There was no significant correlation between demographic data (gender, age, educational level of subjects studied) and such knowledge or actual blood donation. Among the non-donor respondents, fear (n=305) was the most common reason for not donating blood. In a study on knowledge and attitude towards voluntary blood donation among Dhaka university students in Bangladesh, 82percent of the

participants showed a positive attitude towards blood donation, however, only 16 per cent of the respondents in this study had actually ever donated blood voluntarily. The results also showed that a high number of respondents (93%) had a negative attitude towards paid blood donation (Hosain, 1997). According to a recent Knowledge, attitude, and practice (KAP) study in Hanoi and nearby provinces by Quan et.al, 71.2% of the interviewees had poor knowledge and 21.6% of people had negative attitude towards blood donation. Lack of awareness of the need for donation, fear of donating blood related to perceived risk of contracting HIV, and loss of physical vitality after donation have been as potential reasons for ethnic and racial disparities in blood donation (Oswalt.R 1993). A study conducted in a city of Western China to assess the knowledge attitude and practice regarding blood donation. Knowledge about blood donation varied between the groups. Factors motivating blood donation includes social pressure; desire to know screening results and altruism. The inhibiting factors include fear of contracting an infection and other adverse health effects, including loss of vitality (Zaller.N .et al 2005). According to a study to assess the knowledge, attitudes, beliefs and motivations towards blood donations among 542 blood donors from Lagos State University Teaching Hospital, Nigeria by Olaiya et al in 2004, found that a large number of them (92.9%) donated because of the benefits they will

obtain from the hospital. Only 2.58 per cent donated for nothing. The study recommended that an intensive blood donation campaign should be maintained to allow people to be well informed, turning the positive attitude of saving life through blood donation to a regular practice. A Dutch study of young college age non donors found that perceived ability to donate, obligation or responsibility, and attitude toward donating blood were the most important correlates of the intention to become a blood donor(Lemmens et al; 2005). In a study conducted by Rajagopalan, 1998 to assess attitudes of medical and nursing students concluded that in a medically oriented population, donors and non donors do not differ significantly in their sentiments towards blood donation. 2.5

LITERATURE RELATED TO MOTIVATION FOR DONATION AND NON DONATION OF BLOOD. The results of a study undertaken by Ray (2005) to study the

motivational factors leading to voluntary blood donation and understanding the psychosocial variables among 300 blood donors at a blood bank of medical college, are that most of the voluntary donors were males (89.3%) and belonged to age group 16-25 years (48%). Most of the donors (93.46%) had studied upto high school and above and 84.33% of the donors belonged to the middle class. 27% of the donors had donated blood previously. The common

motivational factors to donate blood were for ‘a good cause’, ‘for the society’ and ‘to save a life’. 4.67% of them donated blood for self satisfaction. According to Leigh 2007, donors primarily find gratification from their altruistic acts through awareness of their contribution to saving lives. Receiving information on how each individual donation is used is seen as a powerful means of reinforcement. Prior donation frequency, intention to return, donation experience, and having a convenient location appear to significantly predict donor return (Schlumpf, 2008). Good donor care is an important way contributing to make a difference in awareness and changing people’s behaviour to voluntary blood donations (Quan, 2007). Specifically research demonstrates that established donors who have given blood several times report altruism and awareness of the need for blood as their main reasons for giving. In other words, a regular blood donor gives because they want to help others in need, and they act altruistically without expectation of reward (Glynn et al, 2002). According to the theory of planned behaviour by Armitage 1999, behavioral intention is the primary motivational determinant of individual behaviour; the more someone intends to engage in a particular behaviour, the

more likely this person will undertake it. A positive attitude toward donating blood makes deciding to register as a donor more likely. Comparatively, research has shown that individuals who have just donated for the first time often cite that they felt influenced by external factors such as social pressure from friends and family to donate or the promise of reward.

This external pressure is what motivated the persons behaviour

initially because he felt that it was expected of him were doing (Glynn etal, 2002). Strategies aimed at encouraging current donors to donate more frequently during the first year may help to establish a regular donation behavior (Schreiber et.al 2005) Data of the European Commission form the “Eurobarometer 41” study performed in 1994 showed that 52% of the Europeans thought people gave blood because it was the right thing to do. According to a study conducted by the department of community medicine in Sweden among blood donors, concluded that altruism was the most common general motive for donating blood and also for continuing to be an active blood donor. The most frequently reported reasons for giving blood the first time were influence from a friend (47.2%). The most commonly reported obstacle to becoming a regular blood donor was laziness (19.1%) followed by fear of needles (10.5%) (Sojka 2007)

A review of studies investigating correlates of blood donation found that although first time donors primarily report external motivations for donating blood (e.g. a supply shortage), experienced donors primarily report internal reasons for donating blood-e.g. it makes them feel good about themselves. (Ferguson 1996) A cross-sectional sample survey among active blood donors in Oslo Norway, by Misje et al (2005), the good habit of continued blood donation seems not to be exclusively linked to a high degree of reported other(altruistic) reasons, but also to a combination of motives, including some modestly self- regarding motives. Several surveys on blood donor recruitment show that most donors take the decisive step to become a donor and go to the blood centre, when another person (relative, friend and colleague) recommends this (Mikkelsen 2007). Friends and to a lesser extent, family members appear to have an impact on past, present and future donation behaviour patterns of undergraduates (McCombie 2006). Large proportion of young adults state that they are able and willing to donate blood and recruiting young people as voluntary blood donors seem generally positive. (Misje A.H. et.al 2007)

Female sex, black race and fear of hospitals are three major factors negatively associated with prior history of blood donation (Boulware .L.E 2001). “The greatest barrier that prevents people from donating is a lack of convenience and a lack of knowledge of the importance of donating” (AuBuchon.2003). Research also supports inconvenience as a barrier to donation (Schreiber 2006) The study in Grenada by Fernandez et.al, 1996 showed that the donors gave blood out of a sense of duty, pressure and family or personal benefits. It also showed that lack of information and fear were the principal discouraging factor non donors. The results of a study on blood donor satisfaction and intention of future donation using self administered survey to a convenience sample of 1000 first time and repeat blood donors at Blood Centers of the Pacific by Nguyen et al 2008 are that, blood donor satisfaction varies among demographic and donation history subgroups and is positively correlated with the intent to return for future donation. 75% of the donors rated the overall donation process at 9 or 10 on a scale of 10, with female, high school educated and first time donors giving higher satisfaction ratings than male college educated and repeat donors respectively.

The most important motivational factor for women to donate blood was sense of moral duty with a spiritual reward and the most important barriers for donating blood were anemia, fear, lack of time and difficulty in access to donation sites, and false beliefs about blood donation (Shahshahani 2005). The results of a study conducted in Greece showed that women and young people donate the least in Greece and also many donors do not donate because they are not reminded to (Marantidou et.al 2007). A major finding of a survey based questionnaire study by Weinberg et.al 2008 was that experienced blood donors comprised 71.9% of all donors and more donations were noted among men (p= 0.0013) In a study conducted by Hupfer et.al 2005 among 450 undergraduates in Canada, altruism dominated reasons for donating, whereas logistic factors accounted for the most variance in donation avoidance. Women were more concerned about adverse physical consequences and non donors expressed higher levels of groundless donation – related fears. When it comes to overall annual frequency of blood donations, men outpace women, donating an average of 1.68 times a year, compared to 1.53 times a year for women (American Red Cross 2003). Sociologist Robert D. Putnam has interpreted the decline in blood donation as a result of generational differences in socialization.

A study of university students showed that anxiety scores at the time of donation wee highest among new donors. In addition, the elation observed at the accomplishment of donation by new donors decreased with time after the donation (Breckler 1989). Ringwald et al.2007, concluded that reducing women’s anxiety of blood donation, reminding medical professions more intensively on blood donation and appealing to personal experience or a free health check may be the most promising approaches to increase Blood donors return rates. Never donors do not see blood donation as an important volunteer activity on par with others like volunteering at hospitals, schools, and support groups. Majority were unaware of the need for blood. Blood collection agencies should increase awareness that blood donation is a worthwhile and important volunteer activity. (Mathew et.al 2007) A Canadian population study concluded that intention to donate blood was mainly determined by perceived barriers and obstacles and suggests elimination of these barriers as an important recruitment strategy (Godin, 2005). 2.6 LITERATURE RELATED TO BLOOD SAFETY. ‘Safe’ donors are defined as those who provide a blood donation that was negative on all laboratory screening tests and who subsequently reported no behavioural risk in response to an anonymous survey. (Thomson 2002)

Repeat donors have consistently shown to have a lower incidence of infectious diseases and lower levels of unreported deferrable risks than first time donors (Glynn 2000). High priority should be given to the elimination of family/replacement and paid blood donor systems, which are associated with a significantly higher prevalence of TTIs. Voluntary non-remunerated blood donors from low-risk populations who give blood regularly are the foundation of a safe and adequate blood supply. Donors who give blood voluntarily and for altruistic reasons have the lowest prevalence of HIV, hepatitis viruses and other blood-borne infections, as compared to people who donate for family members or in lieu of payment (WHO, 2002). According to Van der 2002, paid donors are still more likely to donate blood than unpaid donors in the “Window Period” during which infectious donations escape detection by blood screening tests. Following a government sponsored study, which showed a high incidence of hepatitis-B among paid donor blood, the Supreme Court of India passed an order banning the payment of money to blood donors from 1st January 1998 (Mudur G, 1998). Those at high risk of becoming infected with HIV and donating in the window period are men who have sex with men (Musto 2007).

Advancements in safety of blood transfusion in clinical practice principally

relate

to

preventing

transfusion

–transmitted

infections.

(TTI).Exclusion of infected blood and their donors has remarkably reduced the risk of transmitting HBV, HCV, HIV-1/2, and HTLV-I/II infections. Nucleic acid tests (NAT) using enzymatic amplification of viral gene sequences have augmented risk reduction in “window period” infections that are undetectable by the serological tests. (Dodd et.al 2009) The National Blood Policy in India relies heavily on voluntary blood donors, as they are usually assumed to be associated with low levels of transfusion-transmitted infections (TTIs). In India, it is mandatory to test every unit of blood collected for hepatitis B, hepatitis C, HIV/AIDS, syphilis and malaria. Donors come to the blood bank with altruistic intentions. If donors test positive to any of the five infections, their blood is discarded. Although the blood policy advocates disclosure of TTI status, donors are not, in practice, informed about their results. The onus is on the donor to contact the blood bank (Choudhury &Tetali 2002). To fulfill the objective of safe blood to the patients, transfusion service ensures that blood is collected from voluntary donors and the units are tested for infectious markers, but facts like the window period and "incubation period" of diseases indicate that screening of collected units alone is not sufficient to ensure hundred percent safety. For further safeguard, it is

suggested that donors should be well informed and capable of self exclusion" if they fall in the high risk category. Well informed donors who are aware of the instructions are relatively safe donors (Kandaswamy 1997). The ability of testing to detect even very recent infection has steadily improved, with the implementation in an increasing number of countries of nucleic acid testing (NAT) being the most recent advance (Coste et al., 2005). Improvement of blood transfusion safety by many measures taken from collection to delivery including expansion of pathogen reduction technology to cellular blood components, population ageing ( as the proportion of transfused people increases exponentially with age ) and evidence of under-transfusion risks are the main key factors for modification in blood component prescription in the recent years ( Francois 2009). According to a cross sectional study conducted by Mitra et al., among different categories of health care providers (HCPs) in Kolkata, awareness about blood safety was least among group D but not satisfactory even among doctors and other HCPs. Trainee doctors were well aware about screening tests. Guidelines for blood donation were best known by 'other group' of staffs. Most were aware about needle safety but not about banning of professional donors. Most had positive attitude about blood donation except 'other group' of staff, less than 50% HCPs had ever donated blood and donor retention was variable.

Commonest reason for non donation was 'never approached by anybody'. Most were, however, willing to donate in future. A sufficient supply of safe blood is a key part of an effective health care system and essential for disease prevention. Safety of the blood supply is dependent on collecting blood from voluntary unpaid donors from low-risk populations, screening donated blood for transmissible infections and avoiding unnecessary transfusions. These activities need to be carried out by a wellcoordinated blood transfusion service with quality being controlled in all aspects. Sufficient supplies of safe blood can only be assured by regular donations from voluntary unpaid donors. The 2006 data reveals some improvements in such donations worldwide, but many developing and transitional countries still rely heavily on relatively unsafe family/replacement donors and paid donors (WHO, 2007). An estimated 260,000 new cases of HIV and 20 million cases of Hepatitis B are transmitted world wide annually due to unsafe injections of any kind (Groth 2004). Hepatitis B is one of most common infectious diseases of the world and has infected 2 billion people worldwide; including an estimated 400 million chronically infected cases (Schreiber 1996).

According to a study published by Brant et al., 2007, the increase in recently acquired syphilis, although low, indicates that risky sexual behaviours are increasing in the blood donor population, with implications for microbiological safety of blood. About 87 per cent of the blood banks in India screen blood for hepatitis B, 95 per cent for HIV, 94per cent for syphilis, 67 per cent for malaria, and only 6 per cent for hepatitis C. Testing for transfusion-transmitted infections are unsatisfactory and poorly regulated in India. Reporting of adverse events after transfusion is poor and no stringent donor deferral system exists (Kapoor, 2000). The findings of a study to evaluate the prevalence of markers of hepatitis B virus (HBV) and hepatitis C virus (HCV) and human immunodeficiency virus (HIV) among blood donors in Kolkata, underscore the significantly increasing endemicity of hepatitis viruses, syphilis and HIV among the voluntary blood donors of our community (Bhattacharya 2007). The proportion of blood obtained from committed repeat donors may be an effective strategy to improve the safety of blood supply (Piliavin 1991). A study by Bhatti 2005 shows that more than 17 percent of healthy, young blood donors in Pakistan are already exposed to HBV, with two thirds showing anti HBs level of greater than 100mlU per ml. One in 200 blood donors, who are HBs Ag negative; anti HBc positive, however have occult

HBV infection, with likelihood of transmission of hepatitis B in recipients of blood components derived from them. According to a survey by Stigum et al., 2001 the proportion who donated blood in order to be HIV tested was higher than expected, but the majority of the group did not have any identifiable HIV risk. The data from a large multicentre retrospective study to assess the possible risk of cancer transmission from blood donors to recipients through blood transfusion provide no evidence that blood transfusion from precancerous blood donors are associated with an increased risk of cancer among recipients compared with transfusions from non- cancerous donors (Edgren 2007). 2.7 EFFECTIVENESS OF EDUCATIONAL PROGRAMME. A study which was conducted in S.N.R college of arts and science CBE, showed that education can improve the knowledge of voluntary blood donation among youth by 32percent and the practice of blood donation by 40percent (Sudha Rani,2000). A study by Suja G. on the effectiveness of an educational programme using a CD- Rom in improving the reproductive awareness of adolescent girls in 2006 found that the CD-Rom was effective in improving the reproductive awareness of adolescent girls.

According to Kavitha (2007), educational programme using CD-Rom was found effective in improving the knowledge of first aid in primary school teachers. A study conducted by Rosser 2000, concluded that the CD-Rom tutorial effectively transfers cognitive information necessary for skill development. 2.8 CONCLUSION The review of the available literature enabled the researcher to have a proper insight into the problem and proceed with the study scientifically. This chapter covered the introduction, review related to blood and blood groups, blood donation, the knowledge attitude and practice of blood donation, the reasons to donate and not donate blood, blood safety, and literature regarding the effectiveness of the educational programme.

CHAPTER III METHODOLOGY CONTENTS

3.1 INTRODUCTION 3.2 RESEARCH DESIGN 3.3 SETTING OF THE STUDY 3.4 POPULATION 3.5 SAMPLE 3.6 SAMPLING TECHNIQUE 3.7 TIME AND DURATION OF THE STUDY 3.8 TOOL AND TECHNIQUE 3.9 PILOT STUDY 3.10 DATA COLLECTION PROCESS 3.11 PLANS FOR DATA ANALYSES 3.12 CONCLUSION

PAGE NO:

3.1 INTRODUCTION Research is a systematic inquiry that uses disciplined methods to answer questions to solve problems (Polit, 2008). Research is a careful investigation or inquiry for new facts in any branch of knowledge. Research is considered to be more formal, systematic and intensive process of carrying on a scientific method of analysis for the purpose of discovery and development of an organized body of knowledge (Treece and Treece, 1986). Research methodology is a way to systematically solve the research problem

( Kothari, 2004).

Several methods and procedures have been developed for research; the decision about the methods depends upon the nature of the problem selected and the data necessary for its solution. This chapter describes the scientific pathway through which the investigator proceeded for the conduct of the study.

3.2 RESEARCH DESIGN Research design of a study spells out the basic strategies that researchers adopt to develop evidence that is accurate and interpretable. The research design incorporates some of the most important methodologic decisions that researchers make. (Polit, 2008)

Research design is the conceptual framework in which research is conducted.

The study was conducted in two phases. Phase I: - Assessment of knowledge, attitude and reported practice of undergraduate

students

of

selected

arts

and

Science

colleges

of

Thiruvananthapuram, regarding blood donation using a survey approach

Phase II: The phase two of the study was done in two stages. Stage I - On the basis of phase I an Instructional CD- Rom, regarding voluntary blood donation, was prepared. Stage II – Testing the effectiveness of the CD Rom using a quasi experimental one group pre test post test design. The one group pre test and Post test design can be represented as O1

X

O2

O1

-

Pre test

X

-

Intervention

O2

-

Post test

3.3 SETTING OF THE STUDY The study was conducted among undergraduate students studying in three selected Arts and Science colleges in Thiruvananthapuram namely, 1. Mar Ivanios College, Nalanchira

2. Sree Narayana College, Chempazhanthy 3. St. Xaviour’s College, Thumpa

3.4 POPULATION All undergraduates studying in selected Arts and Science colleges, under the University of Kerala in Thiruvananthapuram District.

3.5 SAMPLE. Phase I 300 Undergraduates studying in three selected Arts and Science colleges under the University of Kerala in Thiruvananthapuram District. Phase II, Stage II 30 undergraduate students form one of the colleges selected in Phase I

Inclusion Criteria: - Undergraduates who are studying in Arts and Science colleges of Thiruvananthapuram under the University of Kerala. Undergraduates who are willing to participate in the study.

3.6 SAMPLING TECHNIQUE Phase I: - Simple random Sampling Among the Arts and Science colleges in Thiruvananthapuram District three colleges were selected by simple random sampling.

From each college, 100 students from a particular year (I, II, III) were selected by fixed interval method. The year of students to be selected from the three colleges were also selected by simple random method.

Phase II From the three colleges selected for phase I, Mar Ivanios College Nalanchira, was selected by lottery method for Phase II stage II 30 students were selected randomly and a pre test was done using the same questionnaire used in phase I.

3.7 TIME AND DURATION OF THE STUDY. The duration of the study was 6 months. The period for data collection was 6 weeks and data collection started from 15/1/09 to 28/2/09. The study hours were from 8am to 5pm.

3.8 TOOL The methods and procedures employed for the collection of data are called techniques and the instruments used are called tools. Phase I: - Structured questionnaire Phase II: - Structured Questionnaire used in phase I and Instructional CD- Rom . The questionnaire consists of IV sections

Section I: - Socio Demographic Data It consists of items for obtaining information about the selected background factors such as age, sex, subject, year of study, college, residence, type of family religion, family Income, blood group and membership in voluntary organization.

Section II: - Questions to assess knowledge The Knowledge assessment part of the questionnaire had objective type questions covering five areas of knowledge regarding blood donation. The areas included were questions to assess knowledge regarding Blood, Blood groups, Blood Donation, Donated blood and Blood safety. The questions were prepared in both English. There were 30 questions. Each questions carried one or more correct answers. Each question carried a weightage score of one. Hence the total score was 30.

Details of Section II Questions Score A.

Questions to assess knowledge regarding blood ,Q1 – Q5 5

B.

Questions to assess knowledge regarding blood groups,Q6 – Q8 3

C.

Questions to assess knowledge regarding blood donation, Q9 – Q20 12

D.

Questions to assess knowledge regarding donated blood. Q21 – Q25 5

E.

Questions to assess knowledge regarding blood safety. Q26 – Q30 5 Total 30

The knowledge score obtained by the subjects were graded as Grade

Percentage

Good Knowledge

>60%

Moderate knowledge

40-60%

Poor knowledge

< 40%

Section III: - Attitude Assessment Scale. The attitude scale developed by the investigator was used for assessing the attitude of undergraduate students regarding blood donation. A five point scale consisting of 14 statements with a total score of 70 was used. The attitude scale was framed with a number of statements that would reflect their inner feelings towards blood donation. They were requested to tell the extent of agreement or disagreement with the students scoring given below.

Strongly Agree

Agree

Undecided

Disagree

Strongly Disagree

Positive Items

5

4

3

2

1

Negative Items

1

2

3

4

5

The attitude scale was from 1-5 for an individual item and the total score ran from 14-70. The scores 3 to 1 for a +ve answer and for a –ve answer indicated negative attitude and score 4 and 5 indicated positive attitude. Therefore a total score of more than or equal to 56 was considered as positive attitude. The attitude score obtained by the subjects were graded as Grade

Percentage

Good attitude

80-100%

Moderate attitude

60-80%

Poor attitude

< 60%

CD-Rom An instructional CD-Rom to understand and promote blood donation was prepared on the basis of knowledge gap of undergraduate students regarding blood, blood groups, voluntary blood donation and Blood safety. The instructional CD Rom was validated by subject experts in Medicine, Sociology and Nursing

CONTENT VALIDITY In this study content validity of the tools was done by subject experts from

Medical

and

Nursing

Departments

of

Medical

College

Thiruvananthapuram, Government College of Nursing Thiruvananthapuram, Sree Chitra Tirunal Institute, Government College of Nursing Calicut, Samaritan College of Nursing and Al- Shifa College of Nursing.

3.9 PILOT STUDY A pilot study was conducted before the actual conduct of the study to know the feasibility of the entire study, to pretest the goodness, sequencing, wording etc of the questionnaire which was prepared after in depth discussion with expertised scientists and teachers of this field, referring to the literature and considering the objectives to be satisfied. After Pilot study modifications were made in the tool as per the analysis of results. Modifications were evaluated by subject experts and statistical experts.

3.10 DATA COLLECTION PROCESS. Data collection stated after getting approval from the human ethical committee of Medical College, Thiruvananthapuram. Prior permission for the conduct of the study was obtained from the Principals of concerned colleges. In phase I, after explaining the purpose of the study, questionnaire was given to students. Clarifications were given to students in between to obtain accurate data. On an average each student took around 30-40 minutes to

complete the proforma. In Phase II, stage II, the investigator distributed the questionnaire used in phase I to 30 selected undergraduate students for the Pretest. The subjects were then exposed to the instructional CD-Rom presentation with the help of Computer and an LCD projector for duration of 45 minutes. Lecture, discussion and clarification were given regarding voluntary blood donation during the presentation. After 7 days post test was done using the same questionnaire used for pre test.

3.11 PLAN FOR DATA ANALYSIS The data collected was analyzed by using appropriate statistical technique. A descriptive analysis was done for the demographic characteristics of the subjects. The attitude score was graded as Phase I – The data related to assessment of wariness and attitude were analysed in terms of descriptive statistics. Phase II – The effectiveness of the CD Rom was tested using paired t test

3.12 SUMMARY This chapter covers the research approach, research design, setting of the study, research tool and technique, Pilot study, data collection process and Plan of analysis.

CHAPTER IV ANALYSIS AND INTERPRETATION CONTENT 4.1

INTRODUCTION

4.2

SECTION I: SOCIO DEMOGRAPHIC DATA.

4.3

SECTION II: EXISTING LEVEL OF KNOWLEDGE AND ATTITUDE REGARDING BLOOD DONATION

4.4

SECTION III : EXISTING LEVEL OF PRACTICE OF BLOOD DONATION

4.5

SECTION IV: ASSOCIATION OF SELECTED DEMOGRAPHIC VARIABLES WITH EXISTING KNOWLEDGE

4.6

SECTION V: ASSOCIATION OF SELECTED DEMOGRAPHIC VARIABLES WITH EXISTING ATTITUDE

4.7

SECTION VI: EFFECTIVENESS OF EDUCATIONAL PROGRAMME ON KNOWLEDGE AND ATTITUDE

4.8

CONCLUSION

.

PAGE NO.

4.1 INTRODUCTION This chapter deals with analysis of data and interpretation of the results obtained from the sample. Analysis is a process of summarization, evaluation and interpretation of information collected in such a way that it provides answers to research problems. The data obtained in the two phases of the study, by descriptive survey and one group pre test post test design were analyzed by both descriptive and inferential statistics. The findings are presented under the following sections.

PHASE I Section I:

Socio Demographic data.

Section II:

Existing level of knowledge attitude regarding blood donation.

Section III: Existing level of practice of blood donation. Section IV: Association of selected demographic variables with existing knowledge. Section V:

Association of selected demographic variables with existing attitude.

PHASE II Section VI: Effectiveness of educational programme on knowledge and attitude.

PHASE I 4.2

SECTION I: SOCIO- DEMOGRAPHIC DATA.

4.2.1 Age Table: - 4.1 Distribution of undergraduate students according to age.

Age

Number

Percent

17-18

89

29.7

19-20

175

58.3

21+

36

12.0

Total

300

100

12.0

29.7

58.3

17-18

19-20

21+

Fig: – 4.1 Distribution of undergraduate students according to age

The table and figure shows that majority of students (58.3%) who participated in the study were between the age group 19 – 20, followed by the age group 17-18 (29.7%). The group of students aged 21+ was only 12 percent.

4.2.2 Gender Table 4.2: - Distribution of undergraduate students according to gender

Gender

Number

Percentage

Male

139

46.3

Female

161

53.7

Total

300

100.0

46.3 53.7

Male

Female

Fig 4.2: -Distribution of undergraduate students according to gender Table and Figure 4.2 clearly show that majority of the study subjects (53.7%) were females.

4.2.3 Subject of study Table 4.3:- Distribution of undergraduate students according to subject.

Subject

Number

Percentage

Science

139

46.3

Arts

125

41.7

Commerce

36

12.0

Total

300

100.0

12.0 46.3

41.7

science

arts

commerece

Fig- 4.3:- Distribution of undergraduate students according to Subject. It is evident from the Table No: 4.3, that majority(53.7%) of under graduate students were studying non science subjects.

4.2.4 YEAR OF STUDY Table 4.4: - Distribution of undergraduate students according to year of study. Year of Study I year II year III year Total

Number

Percentage

100

33.3

100

33.3

100

33.3

300

100.0

33.3

33.3

33.3

1st Year

2nd Year

3rd Year

Fig- 4.4:- Distribution of undergraduate students according to year of study. The table and figure shows that the subjects represent equally from all the three years (33.3%)

4.2.5 COLLEGE OF STUDY Table 4.5: - Distribution of undergraduate students according to college of study. College of study

Number

Percentage

Mar Ivanios College Sree Narayana College St. Xavier’s College

100

33.33

100

33.33

100

33.33

Total

300

100

33.3

33.3

33.3

mar ivanios college

St Xaviours college

SN college

Fig-4.5:- Distribution of undergraduate students according to college of study. It is clear from the table and figure that the sample representations from all the three colleges were equal (33.3%).

4.2.6 RESIDENCE Table 4.6: - Distribution of undergraduate students according to residence.

Residence

Number

Percentage

Rural

194

64.7

Urban

106

35.3

Total

300

100.0

35.3

64.7

Rural

Urban

Fig - 4.6:- Distribution of undergraduate students according to residence. The data from Table and Figure 4.6 clearly depicts that majority of students 64.7 percent were living in rural area and 35.3 percent in urban area.

4.2.7 TYPE OF FAMILY Table 4.7: - Distribution of undergraduate students according to type of family

Type of Family

Number

Percentage

Nuclear

256

85.3

Joint

14

4.7

Extended

30

10

Total

300

100

10.0 4.7

85.3

Nuclear

Joint

Extended

Fig – 4.7:- Distribution of undergraduate students according to type of family Majority of students in the study group were living in nuclear families (85.3%) while only 10 and 4.7 percent hail from extended and joint families respectively.

4.2.8 RELIGION Table 4.8: - Distribution of undergraduate students according to religion Religion Hindu Christian Muslim Total

Number

Percentage

196

65.3

68

22.7

36

12.0

300

100.0

12.0

65.3

22.7

Hindu

Christian

Muslim

Fig – 4.8:- Distribution of undergraduate students according to Religion Data from the table and figure depicts that majority of the undergraduate students (65.3%) studied were Hindus, 22.7 percent Christians and Muslims constituted only 12 percent.

4.2.9 FAMILY INCOME Table 4.9: - Distribution of undergraduate students according to monthly family income Monthly Family Income < 1500

Number

Percentage

77

25.7

1500-3000

65

21.7

3001-5000

53

17.7

> 5001

105

35.0

Total

300

100.0

25.7

35.0

21.7

17.7

5000

Fig – 4.9:- Distribution of undergraduate students according to monthly family income It is evident from the above table and figure that 35 percent of the students had monthly family income more than 5000. 25.7% of the study subjects had income less than 1500 and 21.7 percent and 17.7 percent belonged to the income group 1500-3000 and 3001-5000 respectively.

4.2.10 BLOOD GROUP Table: 4.10 Distribution of undergraduate students according to blood group Blood Group A + ve A -ve B +ve B -ve AB +ve AB -ve O +ve O -ve Don’t Know Total 40.0 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0

A+

Fig: – 4.10

Number

Percentage

57 9 47 5 16 1 108 7 50 300

19.0 3.0 15.7 1.7 5.3 .3 36.0 2.3 16.7 100.0

36.0

19.0

16.7

15.7 5.3

3.0 A+

A-

A-

B+

1.7 B+

B-

B-

AB+

2.3

0.3 AB+

AB-

AB-

O+

O+

O-

O-

Don

Don

Distribution of undergraduate students according to blood group

According to the table majority of the students (36%) in the study group were O+ves, followed by 19 percent A+ve, 15.7 percent B+ves and 5.3 percent AB+ve. AB-ve was the rarest group in the study(0.3%) and 16.7 percent of the students didn’t knew their blood group. A-ve, B-ve and O-ve were 3, 1.7, and 2.3 percent respectively.

4.2.11 MEMBERSHIP IN VOLUNTARY ORGANIZATIONS. Table 4.11: -Distribution of Undergraduate students according to membership in voluntary organizations. Voluntary Organization NSS NCC Both NSS & NCC Red Ribbon Clubs Club 25 Others No Membership Total

Frequency

Percentage

63 14 5 0 0 1 217 300

21 4.66 1.66 0 0 .33 72.33 100

80 60 40 20

0

Fig 4.11:- Distribution of Undergraduate students according to membership in voluntary organizations. As per the Table and Figure 4.11, nearly 3/4th (72.33%) of the students did not have any membership in any voluntary organizations. Only 21percent of the students had membership in NSS and a few (4.66%) were members in the NCC.

80

70

60

50

40

30

20

10

0 Knowledge regarding blood

Knowledge regarding blood groups

Knowledge regarding blood donation

Good (60-80%)

Knowledge regarding donated blood

Average(40-60%)

Knowledge regarding blood safety

Overall Knowledge regarding blood donation

Poor (