Blood Donation Knowledge Questionnaire (BDKQ-Brazil): analysis of items and application in primary healthcare users

Zucoloto, Miriane Lucindo; Martinez, Edson Zangiacomi

doi:10.1016/j.htct.2018.03.006

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Hematology, Transfusion and Cell Therapy

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Original Articles • Hematol., Transfus. Cell Ther. 40 (4) • Oct-Dec 2018 • https://doi.org/10.1016/j.htct.2018.03.006 copy

Blood Donation Knowledge Questionnaire (BDKQ-Brazil): analysis of items and application in primary healthcare users

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background:

To present the results of the application of the Blood Donation Knowledge Questionnaire in a large and representative sample of users of primary care services in order to extend the evaluation of the metrics of the items and to assess knowledge about blood donation in association with sociodemographic variables.

Method:

The Blood Donation Knowledge Questionnaire is composed of 24 items based on blood donation requirements of the Brazilian Ministry of Health and on some popular beliefs and concepts of the Brazilian population regarding the blood donation process. Data collection was carried out in 12 healthcare facilities of Ribeirão Preto, São Paulo. The analysis of items was performed using classical test theory with associations being assessed using the multivariate Tobit regression model.

Results:

A total of 1055 individuals participated (79.7% females and a mean age of 40.6 years). Previous blood donation was reported by 246 (23.3%) participants, 669 (63.4%) had never donated, and 140 (13.3%) reported being ineligible to donate blood. This questionnaire is comprised of items considered easy-to-understand, with a facility level of medium to high and generally an adequate capability of discrimination. Higher means of correct answers were detected among females, individuals with more schooling, and subjects who had already donated blood.

Conclusion:

The Blood Donation Knowledge Questionnaire is an instrument that aims to measure some general aspects of knowledge regarding blood donation and can be used in different contexts. There is evidence that knowledge of primary healthcare users regarding blood donation is correlated to sex, educational level, and previous blood donation.

Keywords:
Blood donation; Knowledge; Scales; Primary healthcare users; Blood donor beliefs

	English	Answers^a a The correct answer for each question is highlighted in bold type.	Total
			n	%
1	Do you know your blood type?	No	448	42.5
1	Do you know your blood type?	Yes	607	57.5
2	In order to be able to donate blood, what is the minimum weight that a person needs to have?	40 kg	61	5.8
		50 kg	516	48.9
		60 kg	251	23.8
		I don’t know	227	21.5
3	Is all donated blood tested in order to verify if it has any disease that can be transmitted to others?	No	69	6.5
3		Yes	986	93.5
4	Can under 16-years-old individuals donate blood?	No	854	81.0
		Yes	100	9.5
		I don’t know	100	9.5
5	Can pregnant women donate blood?	No	806	76.4
		Yes	48	4.5
		I don’t know	201	19.1
6	Can a person who has diabetes or high blood pressure donate blood?	No	937	88.8
		Yes	23	2.2
		I don’t know	95	9.0
7	Can a person who has or has had any type of cancer donate blood?	No	895	84.8
		Yes	22	2.1
		I don’t know	138	13.1
8	Can women who are menstruating donate blood?	No	401	38.1
		Yes	330	31.3
		I don’t know	323	30.6
9	Is there a maximum age for blood donation?	No	205	19.4
		Yes	651	61.7
		I don’t know	199	18.9
10	Can women who are breastfeeding donate blood?	No	504	47.8
		Yes	285	27.0
		I don’t know	266	25.2
11	Is the blood from only one donor enough for one person who needs blood?	No	740	70.2
		Yes	204	19.3
		I don’t know	111	10.5
12	When people need to receive blood, do they have to pay?	No	1033	97.9
		Yes	22	2.1
		I don’t know	-	-
13	Does donated blood have to be used within 24 h after donation, otherwise it is not good anymore?	No	745	70.7
		Yes	117	11.1
		I don’t know	191	18.1
14	Can a person acquire a disease by donating blood?	No	749	71.0
		Yes	251	23.8
		I don’t know	55	5.2
15	If the blood donor is male, can he donate every 2 months, and can women donate every 3 months.	No	215	20.4
		Yes	498	47.2
		I don’t know	342	32.4
16	In Brazil, is it allowed by law to pay a person to donate blood?	No	971	92.0
		Yes	23	2.2
		I don’t know	61	5.6
17	When someone donates blood, does the amount of blood in the human body return to what it was before within 24-48 h?	No	58	5.5
		Yes	834	79.1
		I don’t know	163	15.4
18	If a donor has a fever on the day of donation, can he donate blood?	No	828	78.5
		Yes	61	5.8
		I don’t know	166	15.7
19	Does donating blood make you lose or gain weight?	Lose weight	11	1.0
		Gain weight	13	1.2
		Neither	975	92.4
		I don’t know	56	5.3
20	The capacity of a little coffee cup is 50 mL. When a person donates blood, the equivalent to how many coffee cups are taken?	2-4	49	4.6
		5-8	92	8.7
		9-10	202	19.2
		11-20	118	11.2
		I don’t know	594	56.3
21	After a person enters in the donation room to donate blood, how long is the blood donation process?	20 min	372	35.3
		40 m to 1 h	254	24.1
		More than 1 h	28	2.6
		I don’t know	401	38.0
22	In order to donate blood, should the donor be fasting?	No	487	46.2
		Yes	106	10.1
		I don’t know	460	43.7
23	Can smokers donate blood?	No	290	27.5
		Yes	587	55.7
		I don’t know	177	16.8
24	Does donating blood thicken or thin the blood?	Thin	87	8.3
		Thicken	79	7.5
		Neither	745	70.6
		I don’t know	143	13.6

Item	Worst (%)	Best (%)	Discrimination index (%)	Facility index (%)
1	34.08	80.71	46.63^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).	57.54
2	20.6	76.4	55.80^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).	48.91
3	85.77	98.21	12.44	93.46^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).
4	64.79	92.14	27.35	80.95^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).
5	55.43	88.21	32.78^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).	76.4^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).
6	82.77	93.21	10.44	88.82^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).
7	77.15	92.5	15.35	84.83^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).
8	13.48	48.57	35.09^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).	31.28
9	39.33	77.86	38.53^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).	61.71^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).
10	28.46	68.21	39.75^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).	47.77
11	13.11	26.43	13.32	19.34
12	95.88	99.64	3.76	97.90^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).
13	43.45	91.79	48.34^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).	70.62^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).
14	55.81	86.07	30.26^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).	71.00^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).
15	23.6	74.29	50.69^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).	47.2
16	82.77	98.57	15.8	92.04^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).
17	52.81	92.5	39.69^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).	79.05^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).
18	61.42	91.79	30.37^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).	78.48^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).
19	79.4	98.93	19.53	92.42^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).
20	6.74	36.79	30.05^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).	19.15
21	11.99	61.43	49.44^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).	35.26
22	18.35	76.79	58.44^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).	46.16
23	31.46	78.57	47.11^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).	55.64
24	47.19	93.21	46.02^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).	70.62^a a Items with higher discrimination and/or facility index. The best items were those classified as “easy or very easy” in the facility index (cutoff point ≥60), and with a discrimination power classified as moderate to high (cutoff point ≥30).

	Item/subject	Answers^a a The correct answer for each question is highlighted in bold type.	Females		Males		p	Never donated		Unable to donate		Already donated		p
	Item/subject		n	%	n	%	p	n	%	n	%	n	%	p
1	Blood type	No	337	40.1	111	51.9	<0.01	324	48.4	65	46.4	59	24.0	<0.01
1	Blood type	Yes	504	59.9	103	48.1	345	51.6	75	53.6	187	76.0
2	Weight	40 kg	44	5.2	17	7.9	0.04	30	4.5	10	7.1	21	8.5	<0.01
		50 kg	429	51.0	87	10.7	308	46.0	65	46.4	143	58.1
		60 kg	193	23.0	58	27.1	145	21.7	45	32.1	61	24.8
		I don’t know	175	20.8	52	24.3	186	27.8	20	14.3	21	8.5
3	Blood tests	No	55	6.5	14	6.5	0.99	52	7.8	6	4.3	11	4.5	0.10
3	Blood tests	Yes	786	93.5	200	93.5	617	92.2	134	95.7	235	95.5
4	Minimum age for donation	No	684	81.4	170	79.4	0.80	550	82.4	108	77.2	196	79.7	0.07
		Yes	78	9.3	22	10.3	51	7.6	17	12.1	32	13.0
		I don’t know	78	9.3	22	10.3	67	10.0	15	10.7	18	7.3
5	Pregnancy	No	650	77.3	156	72.9	0.13	505	75.5	110	78.6	191	77.6	0.79
		Yes	33	3.9	15	7.0	32	4.8	4	2.9	12	4.9
		I don’t know	158	18.8	43	20.1	132	19.7	26	18.6	43	17.5
6	Diabetes and high blood pressure	No	752	89.4	185	86.4	0.35	594	88.8	123	87.9	220	89.4	0.51
		Yes	16	1.9	7	3.3	15	2.2	1	0.7	7	2.9
		I don’t know	73	8.7	22	10.3	60	9.0	16	11.4	19	7.7
7	Cancer	No	719	85.5	176	82.2	0.45	576	86.1	122	87.2	197	80.1	0.14
		Yes	16	1.9	6	2.8	13	1.9	1	0.7	8	3.2
		I don’t know	106	12.6	32	15.0	80	12.0	17	12.1	41	16.7
8	Menstruation	No	287	34.2	114	53.3	<0.01	253	37.9	52	37.2	96	39.0	0.54
		Yes	291	34.6	39	18.2	210	31.4	38	27.1	82	33.3
		I don’t know	262	31.2	61	28.5	205	30.7	50	35.7	68	27.7
9	Maximum age for donation	No	169	20.1	36	16.8	0.12	138	20.6	20	14.3	47	19.1	<0.01
		Yes	506	60.2	145	67.8	382	57.1	103	73.6	166	67.5
		I don’t know	166	19.7	33	15.4	149	22.3	17	12.1	33	13.4
10	Breast-feeding	No	414	49.2	90	42.1	0.17	299	44.7	74	52.9	131	53.2	0.07
		Yes	222	26.4	63	29.4	189	28.2	31	22.1	65	26.4
		I don’t know	205	24.4	61	28.5	181	27.1	35	25.0	50	20.3
11	Volume demand	No	585	69.6	155	72.4	0.70	464	69.4	94	67.1	182	74.0	0.44
		Yes	165	19.6	39	18.2	133	19.9	27	19.3	44	17.9
		I don’t know	91	10.8	20	9.4	72	10.8	19	13.6	20	8.1
12	Pay for transfusion	No	825	98.1	208	97.2	0.41	654	97.8	138	98.6	241	98.0	0.83
12	Pay for transfusion	Yes	16	1.9	6	2.8	15	2.2	2	1.4	5	2.0
13	Blood durability	No	587	70.0	158	73.8	0.17	459	68.7	99	70.7	187	76.3	0.21
		Yes	101	12.0	16	7.5	81	12.1	13	9.3	23	9.4
		I don’t know	151	18.0	40	18.7	128	19.2	28	20.0	35	14.3
14	Acquire disease in blood donation	No	619	73.6	130	60.8	<0.01	494	73.9	89	63.6	166	67.5	<0.01
		Yes	176	20.9	75	35.0	134	20.0	46	32.9	71	28.9
		I don’t know	46	5.5	9	4.2	41	6.1	5	3.5	9	3.6
15	Period between donations	No	167	19.9	48	22.4	0.09	133	19.9	25	17.8	57	23.2	<0.01
		Yes	388	46.1	110	51.4	278	41.5	74	52.9	146	59.3
		I don’t know	286	34.0	56	26.2	258	38.6	41	29.3	43	17.5
16	Payment for blood donors	No	784	93.2	187	87.4	<0.01	610	91.2	130	92.8	231	93.9	0.15
		Yes	11	1.3	12	5.6	12	1.8	5	3.6	6	2.4
		I don’t know	46	5.5	15	7.0	47	7.0	5	3.6	9	3.7
17	Blood volume replacement	No	39	4.6	19	8.9	0.05	31	4.6	7	5.0	20	8.1	<0.01
		Yes	669	79.6	165	77.1	520	77.7	107	76.4	207	84.2
		I don’t know	133	15.8	30	14.0	118	17.6	26	18.6	19	7.7
18	Fever	No	662	78.7	166	77.6	0.94	521	77.9	111	79.3	196	79.7	0.69
		Yes	48	5.7	13	6.1	38	5.7	6	4.3	17	6.9
		I don’t know	131	15.6	25	16.3	110	16.4	23	16.4	33	13.4
19	Gain or lose weight	Lose weight	7	0.8	4	1.9	0.05	8	1.2	3	2.1	0	-	0.03
		Gain weight	7	0.8	6	2.8	7	1.0	2	1.4	4	1.6
		Neither	784	93.3	191	89.2	608	90.9	131	93.6	236	95.9
		I don’t know	43	5.1	13	6.1	46	6.9	4	2.9	6	2.4
20	Volume of blood donated	2-4	37	4.4	12	5.6	<0.01	34	5.1	3	2.1	12	4.9	<0.01
		5-8	66	7.8	26	12.1	39	5.8	12	8.6	41	16.7
		9-10	152	18.1	50	23.4	84	12.6	26	18.6	92	37.4
		11-20	84	10.0	34	15.9	72	10.8	14	10.0	32	13.0
		I don’t know	502	56.7	92	43.0	440	65.8	85	60.7	69	28.0
21	Time spent during donation	20 min	262	31.1	110	51.4	<0.01	160	23.9	40	28.6	172	69.9	<0.01
		40 m to 1 hour	214	25.5	40	18.7	176	26.3	31	22.1	47	19.1
		More than 1 h	25	3.0	3	1.4	22	3.3	4	2.9	2	0.8
		I don’t know	340	40.4	61	28.5	311	46.5	65	46.4	25	10.2
22	Fasting before donation	No	399	47.5	88	41.3	0.09	265	39.6	65	46.4	157	64.3	<0.01
		Yes	88	10.5	18	8.5	318	47.5	61	43.6	81	33.2
		I don’t know	353	42.0	107	50.2	86	12.9	14	10.0	6	2.5
23	Smokers and blood donation	No	248	29.5	42	19.6	<0.01	223	33.4	35	25.0	32	13.0	<0.01
		Yes	439	52.3	148	69.2	330	49.4	77	55.0	180	73.2
		I don’t know	153	18.2	24	11.2	115	17.2	28	20.0	34	13.8
24	Thicken or thin the blood	Thin	66	7.9	21	9.8	0.72	55	8.2	17	12.1	15	6.1	<0.01
		Thicken	61	7.2	18	8.4	48	7.2	10	7.1	21	8.5
		Neither	599	71.3	146	68.2	451	67.5	101	72.2	193	78.5
		I don’t know	114	13.6	29	13.6	114	17.1	12	8.6	17	6.9

Variable	Categories	n	Correct answers
Variable	Categories	n	Mean	Standard deviation	Minimum-maximum	p-value (a)
Sex	Female	841	15.5	3.2	4-23	<0.01
Sex	Male	214	15.2	3.3	3-22	Ref.
Marital status	Married	648	15.5	3.2	4-23	0.14
	Divorced	107	15.7	2.7	8-22	0.21
	Single	247	15.4	3.3	3-23	0.26
	Widowed	53	14.5	3.1	8-22	Ref.
Socioeconomic class^a a A/B1 (R$ 15,071.00 or USD 4739.00); B2 (R$ 4852.00 or USD 1526.00); C1 (R$ 2705.00 or USD 851.00); C2 (R$1625.00 or USD 511.00); D or E (R$ 728.00 or USD 229.00).	A or B1	65	16.1	3.5	4-22	0.35
	B2	290	16.0	3.1	4-23	0.13
	C1	368	15.5	3.2	3-23	0.28
	C2	235	15.0	3.4	4-22	0.66
	D or E	97	14.3	2.6	7-21	Ref.
Age groups (years)	Under 25	188	14.9	3.3	3-22	0.27
	26-30	132	15.3	3.3	4-21	0.84
	31-40	250	15.9	3.0	8-23	0.26
	41-50	173	15.7	3.2	8-22	0.18
	51-60	164	15.8	3.4	4-23	0.08
	>60	148	15.0	2.9	6-22	Ref.
Educational level^b b Elementary school (preschool to 4th grade); middle school (5th grade to 8th grade); high school (secondary education - 3 years).	Illiterate	130	14.2	3.0	5-22	<0.01
	Elementary school	61	14.3	2.9	6-20	<0.01
	Middle school	221	15.2	3.4	4-23	<0.01
	High school	517	15.7	3.1	3-23	0.02
	Higher education	126	16.8	3.0	9-22	Ref.
Self-perception of health	Good	735	15.6	3.2	3-23	0.07
	Regular	280	15.1	3.3	4-23	0.27
	Poor	40	14.7	3.1	8-20	Ref.
Blood donation practice	Never donated	669	14.9	3.2	3-23	<0.01
	Unable to donate	140	15.5	3.0	8-22	<0.01
	Already donated	246	17.1	2.9	6-23	Ref.

Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH) R. Dr. Diogo de Faria, 775 cj 133, 04037-002, São Paulo / SP - Brasil - São Paulo - SP - Brazil
E-mail: htct@abhh.org.br

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[1] *Corresponding author at: Department of Social Medicine, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP USP), Av. Bandeirantes, 3900, CEP: 14049-900, Monte Alegre, Ribeirão Preto, SP, Brazil. E-mail address: mirianezucoloto@gmail.com (M.L. Zucoloto).