A Social-Cognitive Perspective on Blood Donation Fear, Perceived Rewards, Self-Efficacy,

and Intention to Return Among Blood Donor College Students in Angeles City, Pampanga

Research Tool

A: General Information

Name (Optional) --------------------------

Are you between the ages of? If you are 18–30
under 18 or older than 59 years of age, 31–40
kindly indicate your age. 41–50
51–59 years old
Others: _____
Sex Male
Female
Birthdate -------------------------
Where do you live? ◻ City
◻ Rural
What is your undergraduate year/level? ◻ Year 1
◻ Year 2
◻ Year 3
◻ Year 4
◻ Year 5

What is your marital status? ◻ Single

◻ Married
◻ Divorced
◻ Widowed
Donor History First-time donor Repeated Donor

Section B. Survey Questionnaire

 
Instruction: Carefully read and analyze the statements. Rate your level of agreement on each
statement using the four-point rating scales from 4- Strongly Agree as the highest to 1- Strongly
Disagree as the lowest. Please SELECT your response according to your level of agreement in
the statements. PLEASE ANSWER THE QUESTIONNAIRE TRUTHFULLY AND LEGIBLY.
The rating is shown as follows:

4= Strongly Agree    3= Agree    2= Disagree   1= Strongly Disagree

 
Blood Donation Intention to Return Strongly Agree Disagre Strongly
  Agree e Disagree

1. “I will try to donate blood within the next 4 3 2 1

three months”
 

2. “I intend to donate my blood within the 4 3 2 1

next year”
 

3. ” I will participate anytime there is a blood 4 3 2 1

drive in our area”
 

4.  ” I will donate blood if I read a post where 4 3 2 1

someone of my blood type is in need of
blood”

5. “I will actively participate when I 4 3 2 1

see/receive posters/flyers about blood
donation”

6. “I will try to be always healthy in order for 4 3 2 1

me to donate blood especially in emergency
occasions”

7. “I will strictly follow the necessary 4 3 2 1

requirements in donating blood in order to
be eligible for it”

Blood Donor Students' Perceptions on Fear Strongly Agre Disagree Strongly

in Blood Donation Agree e Disagree
1. “I have fear of needles” 4 3 2 1
 

2. “I might contract a disease when I donate” 4 3 2 1

 

3. “Blood donation leads to anemia” 4 3 2 1

 

4. “I lack trust in aseptic measures practiced 4 3 2 1

at the blood donation centers”

5. ” I worry that the person who will be 4 3 2 1

assigned to me is not very skilled”

6.  “I worry that the bleeding wouldn’t stop 4 3 2 1

right away” 

7.  “I worry that hospitals and health facilities 4 3 2 1

now aren’t safe because of the Covid - 19
pandemic”
 8.  “I worry that I will not get well after 4 3 2 1
donating blood”

 
 
 
Blood Donor Students’ Perceived Rewards Strongly Agre Disagree Strongly
in Blood Donation Agree e Disagree

1. “Blood donation makes people feel 4 3 2 1

healthy”
 

2. “Blood donation is good for making new 4 3 2 1

friends”
 

3. “Blood donation makes us help other 4 3 2 1

people in need of blood”
 

4.  “Blood donation helps in lowering the 4 3 2 1

risk of having mental health illnesses”

5. ” I can be hero for donating my blood” 4 3 2 1

 6. “Blood donation can increase a person’s 4 3 2 1
longevity”

7.  ” Knowing that I helped someone makes 4 3 2 1

me happy and content” 

8. “Blood donation is a small way on giving 4 3 2 1

back to the community”

 
Blood Donor Students’ Self-Efficacy in Blood Strongly Agree Disagree Strongly
Donation Agree Disagree

1. “I can make it soon if I want to donate my 4 3 2 1

blood”
 

2. “I would be capable of donating blood 4 3 2 1

during the next 12 months, even if I were
afraid of needles”
 

3. “Blood donation has health benefits” 4 3 2 1

4.  “I will be mindful of the necessary 4 3 2 1

requirements to be an eligible donor”

5.  “Blood donation save lives” 4 3 2 1

6.  “Supply of blood is always in demand” 4 3 2 1

7.  “Donating blood will improve my overall 4 3 2 1

well-being”

8.  “Donating my blood will be a big help in 4 3 2 1

the health industry”