<b>Motivational Factors for Blood Donation, Potential Barriers, and Knowledge About Blood Donation in First-Time and Repeat Blood Donors</b>

Background: Blood transfusion remains a critical component of healthcare globally, with approximately 118.5 million donations annually, but voluntary donation rates vary widely between regions. In Pakistan, cultural, social, and systemic factors influence donation behavior, yet data on determinants of donor motivation, barriers, and knowledge—especially differences between first-time and repeat donors—are limited. Objective: To assess motivational factors, potential barriers, and knowledge about blood donation among first-time and repeat donors in tertiary care hospitals of Peshawar, Pakistan. Methods: A cross-sectional observational study was conducted over three months in 2025 at Lady Reading Hospital, Khyber Teaching Hospital, and Hayatabad Medical Complex. A total of 140 eligible donors aged ≥18 years were recruited using convenience sampling. Data was collected via a structured, validated questionnaire covering sociodemographic variables, motivations, barriers, and knowledge. Descriptive statistics and group-wise comparisons using chi-square tests and odds ratios with 95% confidence intervals were performed in SPSS v24. Results: Repeat donors exhibited significantly higher motivation (e.g., appeals via media: 81.4% vs. 47.1%, OR 4.93, p<0.001) and greater knowledge (e.g., minimum age >18 years: 77.1% vs. 52.9%, OR 2.96, p=0.005) compared to first-time donors. Barriers including fear of dizziness (70.0% vs. 44.3%, OR 2.93, p=0.003) and lack of privacy (80.0% vs. 57.1%, OR 2.98, p=0.005) were more frequently reported by repeat donors. Conclusion: Motivations, perceived barriers, and knowledge differ substantially between first-time and repeat donors. Targeted educational and operational interventions addressing these differences could enhance donor retention and ensure a safer, more sustainable blood supply in Pakistan. Keywords: blood donation; motivation; barriers; knowledge; first-time donors; repeat donors; Pakistan.