Determinants of blood donation among Chinese university students: A structural equation modeling study based on an...

Recruiting young blood donors remains challenging. This study proposed and tested an Extended Theory of Planned Behavior (ETPB) model incorporating knowledge and donation-related anxiety to understand the psychosocial correlates of blood donation among Chinese university students.

A survey was conducted among 1786 students from 10 universities in Xi'an, China, with participants originating from 25 provinces. Measures included socio-demographics, donation knowledge, lifetime donation history, and ETPB constructs (Attitude, Subjective Norm, Perceived Behavioral Control, Behavioral Intention, and Blood Donation-Related Anxiety, reverse-scored). Structural equation modeling (SEM) and multi-group analysis (medical vs. non-medical majors) were employed.

The donation rate was 23.18%. The ETPB model showed excellent fit. A higher-order "TPB Core Factors" was most strongly associated with intention (β = 0.863, p < 0.001). Lower anxiety was associated with both higher intention (β = 0.166) and lifetime donation history (β = 0.157, both p < 0.001). Knowledge showed indirect associations through TPB core factors (β = 0.265, 95%CI 0.201-0.336) and blood donation-related anxiety (β = 0.036, 95%CI 0.015-0.062). The knowledge to TPB core factors path was stronger for medical students (Δβ = 0.100).

This study provides empirical support for an ETPB framework, confirming the strong association of core TPB beliefs with intention and highlighting the independent association of anxiety with donation outcomes. Interventions should move beyond information dissemination to strategies that build positive beliefs, alleviate fears, and are tailored to audience characteristics such as academic background.