Exploring barriers and facilitators to blood donation in secondary schools in Malawi.

Background and objective: Despite the Malawi Blood Transfusion Service (MBTS) increasing the amount of blood collected since its inception in 2004, Malawi remains with a 27% deficit in required blood supplies nationally. We sought to understand the facilitators and barriers to blood donation among secondary school students in Malawi.

Methods: We utilised a qualitative exploratory design, with a sample of 135 participants purposefully selected from 16 secondary schools across Malawi. Data collection methods included in-depth interviews with 20 participants (inclusive of first-time and repeat donors, lapsed and non-donors), 20 key informant interviews (including community leaders, policy-level stakeholders and MBTS staff), and 16 focus group discussions involving 95 participants (community stakeholders and all donor categories). We used the consolidated framework for implementation research (CFIR) to assess barriers and facilitators of blood donation, focusing only on four CFIR domains: internal and external factors; the implementation process and individual characteristics influencing blood donation.

Results: Blood donation among students are facilitated by altruism, incentives including milestone awards, knowledge, motivation, transport, peer pressure and individual health status. Common barriers cited included: negative experiences with the blood donation process, fear, unsupported environment, poor incentives, privacy issues and the donation activities starting late than scheduled.

Conclusion: While there have been efforts to motivate students to donate blood, significant barriers to blood donation still exist. Intensifying education and awareness campaigns may help dispel misconceptions and fears surrounding donation experiences and blood usage. Also, continuing with the provision of appropriate incentives including milestone awards may also encourage students.