Bridging the attitude–behaviour gap in blood donation: A large‐scale knowledge–attitudes–practices study among university students in China

BACKGROUND AND OBJECTIVES: University students are a vital yet underutilized donor population, constrained by a knowledge-attitude-practice (KAP) gap. We sought to assess the KAP status and identify modifiable determinants of blood donation among university students in a major Chinese city to inform targeted recruitment strategies. MATERIALS AND METHODS: A cross-sectional online survey was conducted from September to November 2023, involving students from all 17 universities in Wuxi, China. The questionnaire covered socio-demographic data, blood donation knowledge, attitudes and influencing factors. Data were analysed using descriptive statistics, chi-square tests and multivariable logistic regression. RESULTS: Among 8537 valid respondents, 917 (10.7%) reported a history of blood donation. Attitudes were generally positive, but knowledge gaps were evident, particularly regarding operational details. Despite this positive outlook, a pronounced attitude-behaviour gap was observed: 59.8% expressed willingness to donate, yet only 10.7% had actually done so. Multivariable analysis identified political/league membership, student leadership roles and club participation as significant positive predictors of donation behaviour. Notably, while experiential factors (sense of glory/honour, donation environment, staff competence) were significant predictors, perceived physical eligibility was not, implying that for non-donors, this commonly cited barrier may be overridden by positive experiential factors. CONCLUSION: A significant gap between willingness to donate (59.8%) and reported donation behaviour (10.7%) exists among students, shaped by distinct factors for donors and non-donors. Bridging this gap requires a strategic shift from general awareness campaigns to tailored, experiential interventions that address specific cognitive and experiential barriers and reinforce positive donor experiences.