Social Representations of Blood Donation: A Qualitative Study in a Referral Hospital in Perú

ABSTRACT

Background and Aims

Voluntary blood donation rates in Latin America remain critically low, with only 24% of donations in Peru being voluntary in 2023. This qualitative study aimed to explore the social representations of blood donation among relatives of transfusion‐dependent patients in Lima, Peru.

Methods

Seventeen in‐depth interviews were conducted with direct relatives between May 2021 and July 2021, employing a phenomenological approach and thematic analysis to identify the key social, psychological, and cultural factors influencing blood donation behaviors, with particular emphasis on family motivations.

Results

The analysis revealed three key themes: blood donation in the family context, where emotional and moral obligations towards family members led to a preference for family‐based donations; Experiences of blood donors, which highlighted how personal experiences, including fears of adverse reactions and side effects, influenced participants' willingness to donate; and social representations of blood donation, where cultural beliefs and mistrust of the healthcare system shaped participants' attitudes towards blood donation.

Conclusion

The findings emphasize the need for targeted educational interventions and policy reforms to enhance public trust in blood banks, dispel misconceptions, and promote voluntary blood donation, while reducing reliance on family‐based replacement donations.

1. Introduction

Peru has witnessed a steady increase in voluntary blood donations in recent years, with the rate rising from 9.7% in 2018 to 20.8% in 2020, as reported by the Pan American Health Organization (PAHO) [1, 2]. However, the country still lags behind other Andean nations such as Colombia, Ecuador, and Bolivia, where voluntary donation rates are significantly higher—92.7% in Colombia and 75.0% in Ecuador [1, 2]. These disparities underscore the influence of public policies, awareness campaigns, and sociocultural barriers on donation behavior.

Despite improvements in blood donation regulations and distribution systems, access to safe blood remains a challenge in Peru [3, 4]. The country continues to rely heavily on replacement donation, which places undue pressure on families and compromises transfusion safety [3]. Institutions such as the Directorate of Blood Bank and Hemotherapy (DIBAN) under the Ministry of Health (MINSA) and the social health insurance system have launched campaigns to promote altruistic blood donation, aiming for 100% voluntary donors [5, 6]. Nevertheless, by 2023, only 24% of blood donations were voluntary, demonstrating that systemic and cultural barriers persist [7].

A systematic review by Raivola on the sociology of blood donation highlights that sociocultural, organizational, and contextual factors significantly shape an individual's willingness to donate. Blood donation is often perceived either as an altruistic act or a transactional exchange, influenced by social context and trust in institutions. Previous experiences with the healthcare system also impact individuals' motivations and barriers to donation. Blood banks play a crucial role in building public trust and promoting donations through effective organizational strategies. Furthermore, regional disparities in blood donation rates reveal differences in blood supply management and culturally embedded narratives surrounding blood donation [8].

In Latin America, sociocultural factors such as lack of awareness, mistrust, and family influence are critical in shaping attitudes towards blood donation. A national survey in Peru found that 40% of respondents were unaware of basic donation requirements, and 47% mistakenly believed that taking medication would prevent donation [9]. Additionally, perceptions of blood donation vary based on prior experience: a study in a public hospital in Lima found that despite limited initial information, donors' views improved after donating, motivating them to donate again [10]. Similarly, a study among university students showed that while 75.5% believed blood donation was necessary, only 11.2% had donated, highlighting the need for improved education and awareness strategies [11].

PAHO stresses the importance of qualitative research to understand the knowledge, attitudes, and practices surrounding blood donation, as these insights can inform more effective communication strategies to encourage voluntary blood donation [12, 13]. While previous studies have explored general perceptions of blood donation, few have examined the role of family in shaping donation practices [14, 15, 16, 17, 18]. Evidence suggests that family influence and community perceptions are key factors in shaping blood donation behavior. Research in Colombia, Brazil, and Peru has shown that knowledge, trust in the healthcare system, and prior donation experiences significantly impact individuals' willingness to donate [10, 19, 20]. However, no specific studies have analyzed the social representations of relatives of patients requiring transfusions in Peru.

This study aims to explore the social representations of blood donation among relatives of transfusion‐dependent patients in Peru. Understanding these perceptions will aid in developing more effective awareness campaigns and donor recruitment strategies, which are essential for transitioning to a voluntary donation system. The findings will also inform culturally relevant policies that reduce dependence on family replacement donations, enhance trust in blood banks, and promote long‐term voluntary donation.

2. Materials and Methods

A qualitative study employed a phenomenological approach to investigate the social representations of blood donation among relatives of transfusion‐dependent patients. The aim was to explore participants' meanings and interpretations of blood donation and the factors influencing their willingness to engage in it, focusing on lived experiences essential for understanding social representations [21].

2.1. Study Design and Setting

The research was conducted at the Edgardo Rebagliati Martins National Hospital, Lima, Peru, from May 2021 to July 2021. This hospital plays a central role in the blood donation process in Peru, where replacement donations are predominant. In 2023, only 24% of blood donations were voluntary. The setting was chosen due to the hospital's significance in transfusion care and family‐based donations [7].

2.2. Participants and Selection Process

A total of 22 participants were contacted to participate in the study, of whom five withdrew due to incompatibility between the interview schedule and the participants' availability. A total of 17 participants were interviewed, ensuring diversity across age, gender, educational level, and relationship to the patient. This diversity was integral to capturing a wide range of perspectives and experiences related to blood donation. Table 1 presents the demographic characteristics of the participants, providing a comprehensive overview of their backgrounds.

Table 1.

Demographic characteristics of the participants.

Interviewee	Age (Years)	Sex	Educational level	Relationship to the patient	Reason for visiting the blood bank
Interviewee 1	25	M	Higher technical education	Son	Emergency
Interviewee 2	63	F	University education	Cousin	Emergency
Interviewee 3	47	M	Higher technical education	Son	Oncological disease
Interviewee 4	61	F	University education	Daughter	Scheduled surgery
Interviewee 5	24	M	University education	Cousin	Oncological disease
Interviewee 6	38	M	Higher technical education	Nephew	Oncological disease
Interviewee 7	33	M	Higher technical education	Father	Oncological disease
Interviewee 8	55	F	Complete secondary education	Wife	Scheduled surgery
Interviewee 9	46	F	Higher technical education	Niece	Oncological disease
Interviewee 10	56	F	Incomplete secondary education	Niece	Oncological disease
Interviewee 11	38	F	Complete secondary education	Daughter	Chronic illness
Interviewee 12	55	M	Complete secondary education	Brother	Chronic illness
Interviewee 13	45	F	Incomplete secondary education	Daughter	Oncological disease
Interviewee 14	44	F	University education	Daughter	Chronic illness
Interviewee 15	38	F	University education	Brother	Oncological disease
Interviewee 16	56	M	Higher technical education	Sister	Chronic illness
Interviewee 17	21	M	Complete secondary education	Nephew	Scheduled surgery

Participants were relatives of patients with transfusion‐dependent needs who attended the hospital's social assistance area. The inclusion criteria prioritized individuals who had direct involvement in securing blood donations for their loved ones, as they play a pivotal role in the donation process. The inclusion criteria were individuals aged 18 to 65 years, and direct relatives of transfusion‐dependent patients with strong emotional ties (parents, children, siblings, and partners) attending the Edgardo Rebagliati Martins National Hospital.

The exclusion criteria included: individuals in conditions that would prevent them from completing the interview (unconscious state, moderate or severe cognitive impairment, acute mental illness, deaf‐mute); individuals who do not speak Spanish; and those with conditions preventing them from donating blood.

A theoretical sampling approach was employed [22], allowing for the progressive inclusion of participants as data analysis progressed. This approach ensured that a wide range of perspectives was captured as emerging themes informed the selection of new participants. Theoretical saturation was achieved when, after the 15th, 16th, and 17th interviews, no new relevant themes emerged. This process was monitored through the saturation matrix, which demonstrated how key themes emerged early on and were consolidated across subsequent interviews.

2.3. Ethical Considerations

The study was approved by the Institutional Research Ethics Committee of Universidad Peruana Cayetano Heredia (Certificate 034‐02‐20, renewed with Certificate R‐0113‐14‐21) and the Institutional Ethics Committee of the Edgardo Rebagliati Martins National Hospital (Letter N°109‐GRPR‐ESSALUD‐2020). All participants provided written informed consent before the commencement of the interviews, ensuring they fully understood the study's objectives and their right to withdraw at any time without consequence.

To ensure confidentiality and mitigate potential biases arising from the researcher's institutional role, participants were assured that the research was independent of their clinical care and that their participation was voluntary, allowing them to withdraw at any time without consequences, pause, or discontinue the interview in a private and comfortable environment. Participants were assigned alphanumeric codes instead of their real names. Audio recordings and transcripts were securely stored in password‐protected files and were accessible only to the research team. The study also took steps to minimize emotional distress by conducting interviews in a private, comfortable environment. Participants were informed of their right to pause or discontinue the interview at any time.

2.4. Data Collection

In‐depth semi‐structured interviews were conducted using an adaptable interview guide, allowing for the exploration of both predetermined and emerging themes. The interview guide used in this study is available as Supporting Information S1: Appendix A. This guide was designed to explore the social representations of blood donation among family members of transfusion‐dependent patients and was used flexibly to adapt to participants' responses.

Due to the COVID‐19 pandemic, all interviews were conducted in person in a private, well‐ventilated room within the hospital's Blood Bank, following strict biosecurity protocols. Each interview lasted approximately 30–45 min, and all were audio‐recorded with prior consent from the participants to ensure accurate data transcription and analysis.

2.5. Data Analysis

To ensure the reliability of the coding process, an audit trail was maintained, ensuring transparency and traceability throughout the qualitative analysis. The emerging codes were reviewed and discussed in collaboration with the IETSI team, who provided support in coding and interpreting the results. Although Cohen's Kappa was not employed, this approach ensured high consistency in coding and rigorous data analysis. Discrepancies between coders were resolved through consensus, further ensuring the reliability of the findings.

The audio recordings were transcribed verbatim and analyzed using ATLAS.ti software. An open coding approach was initially employed, identifying 50 codes, which were subsequently refined into 34 final codes with corresponding subcodes. These codes were independently reviewed by multiple researchers to ensure inter‐coder reliability, and any discrepancies were resolved through consensus. The coding process was meticulously documented, ensuring transparency and replicability.

A matrix was created using Microsoft Excel to facilitate comparison, summarizing the content of each interview according to the identified categories. The emerging codes were grouped into broader themes, which formed the basis for the thematic analysis. These final themes were defined iteratively, based on both conceptual similarities among codes and their relevance to the research questions.

Theoretical saturation was achieved when no new significant themes emerged from subsequent interviews, confirming the comprehensiveness of the data. The analysis adhered to a phenomenological approach, prioritizing the understanding of participants' lived experiences and the emotional and cultural factors that influenced their willingness to donate blood.

Phenomenology was employed to explore participants' lived experiences with blood donation, facilitating a deep understanding of the personal meanings and emotional connections they attached to the act of donating. This approach enabled the exploration of individuals' subjective experiences, capturing the nuances of their perceptions. Social representations theory provided the interpretive framework to analyze how participants' cultural and social contexts shaped their beliefs, attitudes, and behaviors related to blood donation.

The study adhered to recognized qualitative research guidelines, including COREQ and SRQR standards, ensuring the methodological rigor of the research process and the transparency of its findings.

3. Results

The findings of this study are organized into three key themes, each derived from the phenomenological analysis of the interviews. These themes reflect the social representations, personal experiences, and emotional and cultural factors that influence participants' willingness to donate blood, while also addressing the practical barriers encountered within the familial context of blood donation.

The summary of key findings from each interviewee is presented in Table 2, which outlines the social representations, experiences with blood donation, and their willingness to educate others about blood donation.

Table 2.

Summary of key findings from each interviewee.

Interviewee	Social representations of blood and donation	Experience with blood donations	Willingness to educate the public about blood donation
Interviewee 1	Blood is viewed as an act of love and solidarity.	First‐time donor, fearful of needles, but felt it was a useful experience.	Willing to educate, though only in the family context.
Interviewee 2	Distrust of the public health system, with concerns about blood safety.	Positive experience, open to future donations.	Willing to educate, though lacks opportunities.
Interviewee 3	Blood is regarded as vital and sacred, with donation seen as an act of life.	First donation, motivated by the need of a family member.	Willing to educate but limited by lack of knowledge.
Interviewee 4	Donation is perceived as a personal sacrifice.	Negative experience due to adverse effects, discouraged from donating again.	Distrust of the system, but willing to educate if information improves.
Interviewee 5	Blood is perceived as a vital resource for family members.	First‐time donor, anxiety due to lack of information.	Not comfortable with educating others but acknowledges the importance of spreading awareness.
Interviewee 6	Distrust of the potential sale of blood, with concerns about its use.	First‐time donation, described as traumatic with significant fear.	Willing to educate but feels a need to understand the process more thoroughly.
Interviewee 7	Blood is considered sacred and essential.	Positive donation experience, though confidence is lacking.	Willing to educate but sees lack of information as a barrier.
Interviewee 8	Donation is perceived as a moral obligation.	Occasional donor, prefers family replacement donations.	Educated children on the importance of donation but has limited knowledge.
Interviewee 9	Blood donation is seen as an act of generosity.	Afraid of needles but donated to help a family member.	Willing to educate but lacks trust in the system.
Interviewee 10	Blood is seen as a necessary personal sacrifice.	Rejected due to medical history, leading to discouragement.	Wants to educate but feels the process is not well explained to the community.
Interviewee 11	Blood is viewed as vital, though fears adverse reactions.	Previous donor, stopped due to fear of side effects.	Willing to educate others but needs institutional support.
Interviewee 12	Blood is essential for saving lives.	Positive experience with donation, but fears side effects.	Willing to educate but needs to better understand the safety of the donated blood.
Interviewee 13	Blood is viewed as a resource to save others.	First‐time donation, nervous but felt it was necessary.	Would like to educate but lacks precise knowledge of the process.
Interviewee 14	Distrust of the commercialization of blood.	Concern about adverse effects, no further donations made.	Willing to educate if the system improves, especially regarding safety.
Interviewee 15	Blood is vital but risky.	Donated, but fearful of potential side effects.	Willing to educate but prefers more information before doing so.
Interviewee 16	Blood is seen as a limited and valuable resource.	Donated occasionally, but hesitant due to concerns about effects.	Would like to educate, but has doubts about the safety of blood donation.
Interviewee 17	Blood is regarded as essential for life, though the process is feared.	First‐time donation, afraid of needle,s but did it for a relative.	Willing to educate but needs to see improvements in the system for greater confidence.

4. Blood Donation in the Family Context

4.1. Motivation Driven by Family Need

The most significant motivation for blood donation among participants was the urgent need of a family member. This immediate context marked participants' first exposure to blood donation. As one participant stated: “When I saw my mother in the hospital, I felt I couldn't just sit back. I donated blood for the first time, and I had never considered it before” (Interviewee 5). Most participants indicated they donate blood only when a family member requires it, viewing blood as a personal and limited resource. This emotional and moral connection between the act of donating blood and family obligation emerged as a dominant theme throughout the interviews.

4.2. Emotional and Moral Connection With Family

The emotional ties to family were integral to participants' decision‐making. Even those who had donated blood more than once indicated that their motivation remained focused on family ties, with little consideration for anonymous or altruistic donations. One participant explained: “I prefer to reserve my donations for someone close to me” (Interviewee 9).

4.3. Shift in Perspective Towards Voluntary Donation

Several participants reported a shift in perspective after donating blood in family emergency situations. This change was attributed to a better understanding of the process and the trust generated from the information provided at the blood bank. As one participant reflected: “At first, I only donated for my family, but now I understand the importance of donating for other people. I hope to do it regularly” (Interviewee 4).

This shift highlights the potential for many family replacement donors to become voluntary donors in the future.

4.4. Family as an Educational Platform for Blood Donation

Family also played a significant role in transmitting values related to blood donation. Several participants mentioned educating their children about the importance of blood donation, hoping that they would also donate when they grew up. As one participant noted: “I talk to my children about the importance of donating blood. I hope that when they grow up, they will do it too” (Interviewee 8).

This highlights the intergenerational transmission of values, which could potentially increase future willingness to donate blood.

4.5. Practical Barriers to Donation

Nevertheless, practical barriers impeded these intentions. A few participants highlighted issues such as inflexible work schedules, complex requirements, and logistical challenges. As one participant noted: “I would like to donate more often, but with my work schedule, it's complicated. Weekends would be ideal” (Interviewee 6).

Additionally, some participants expressed distrust in the public healthcare system, raising concerns about the destination of donated blood: “I heard they sell the blood. That's why I prefer to donate only for my relatives” (Interviewee 14).

This cultural distrust represents a significant barrier that limits the willingness to donate voluntarily, thereby favoring family‐based donations instead.

4.6. Experiences of Blood Donors. The First Donation Experience: Emotional and Charged

Participants frequently described their first blood donation as an emotionally charged experience, often driven by a sense of duty or desperation. As one participant shared: “It was the first time I donated, for my mum. I wanted to do it again recently, but they didn't let me” (Interviewee 1).

While this experience sometimes led to a desire to donate again, it was generally approached with caution, influenced by a lack of information or trust in the process.

4.7. Fear and Negative Emotional Impact of Donation

Some participants described their first donation as traumatic, especially when faced with immediate side effects like dizziness and weakness. As Interviewee 6 said: “The first time I donated, it was very difficult. I felt very bad afterwards, I got very dizzy, and I didn't know what was going to happen. It was an experience that scared me, I didn't want to do it again” (Interviewee 6).

This testimony illustrates how a lack of preparation and fear of adverse effects can turn the donation experience into something emotionally negative.

4.8. Lack of Information and Confusion About the Donation Process

Many participants admitted that before being directly affected by the need for a transfusion, they had little or no knowledge about blood donation. As one participant explained: “I had never heard of blood donation or this treatment until then” (Interviewee 2).

These participants often turned to family members or friends for guidance. As one participant mentioned: “I consulted with family and friends. They shared their own experiences and what they had heard from others” (Interviewee 3).

4.9. Barriers to Donation: Fear of Needles and Health Concerns

Fear was another significant theme. Many participants expressed concern about the physical weakness, dizziness, or pain associated with the needle. As one participant commented: “Most people are afraid of needles. And with donation, the needle is thick, which impacts negatively” (Interviewee 9).

Furthermore, some participants were even rejected due to medical history or failure to meet physical criteria, which led to further discouragement. One participant admitted to lying about a tattoo to avoid rejection: “Since my tattoo is hidden, I said I didn't have one because I wanted to donate” (Interviewee 3).

4.10. Confusion Regarding Donation Eligibility

Confusion about the frequency of eligibility was also common, with participants holding varying beliefs about how often one could donate blood. As one participant explained: “Initially they told me three times a year, but then they said every 6 months was better” (Interviewee 1).

Opinions on the effects of donation were mixed, with some fearing weakness or illness, while others believed that donation could be beneficial: “I should donate at least once a year to stay energetic and strong”.

5. Social Representations of Blood Donation

5.1. Blood as an Altruistic Act

Participants exhibited a range of social representations of blood, from symbolic and altruistic to fearful and skeptical. On the positive side, blood was often perceived as vital and sacred, symbolizing solidarity and generosity. As one participant expressed: “Blood is an act of love, giving something of yourself to others” (Interviewee 17).

These representations align with Moscovici's concept of anchoring, where perceptions are integrated into pre‐existing cultural frameworks, reinforcing blood donation as an altruistic and sacred act [23].

5.2. Blood as Dangerous or Contaminated

Conversely, some participants viewed blood as dangerous or contaminated. One participant stated: “Dirty blood can kill the recipient” (Interviewee 3). These negative representations, shaped by community narratives or religious beliefs, affected both the willingness to donate and the perception of receiving blood.

Such distrust constitutes a major barrier to voluntary donation and limits participation in altruistic campaigns.

5.3. Misunderstandings About Eligibility and Process

Participants generally had a basic understanding of the eligibility criteria for blood donation, such as good health, absence of sexually transmitted diseases, and adequate hemoglobin levels. However, misconceptions remained. As one participant explained: “You need adequate hemoglobin levels to avoid fainting. I don't know why this happens, maybe nerves, or you lose too much blood and become weak” (Interviewee 4).

5.4. Comparison With Donation Systems in Other Countries

Overall, social representations were shaped by personal experiences, peer narratives, and broader cultural contexts. Exposure to blood donation systems in other countries also influenced participants' perceptions. One participant remarked: “Here everything is slow and complicated. There, people simply go and donate” (Interviewee 2).

This comparison highlights frustration with inefficiencies in the local blood donation system.

6. Discussion

This study reveals several key social representations of blood donation among family members of transfusion‐dependent patients, highlighting emotional and cultural barriers such as love, sacrifice, and distrust in the healthcare system. These findings align with previous research and provide new insights into the factors influencing individuals' willingness to donate blood within a familial context.

A central finding of this research is that blood donation is primarily viewed as an act of “love” and “sacrifice,” particularly within the family. This is consistent with the study by Arias, which found that the motivation for blood donation is largely shaped by the immediate needs of close family members [10]. In the present study, many participants expressed a willingness to donate only to their closest relatives, indicating a strong emotional and moral connection between the act of donation and family obligation. Similarly, Almeyda and Arana have highlighted that social representations of blood donation are deeply rooted in familial solidarity, which often hinders the transition to altruistic donation outside the family circle [9, 24].

The study also identified significant barriers to donation, including fear of side effects and distrust in the healthcare system. These barriers align with findings from Ponce‐Torres, who emphasized that fear of side effects and lack of trust in the donation process are critical determinants of willingness to donate [25]. Additionally, Gómez‐Cardona underscored that distrust in the healthcare system remains a major obstacle to voluntary blood donation, highlighting the need for greater transparency in the information provided to potential donors [16]. Almeyda identified longstanding myths, such as the belief that blood donation causes weakness, which continue to deter potential donors [9]. This study corroborates these findings, revealing that many family members prefer donating blood only to their relatives due to concerns about the misuse of donated blood, thus reflecting a significant cultural barrier to voluntary donation.

Another critical factor identified in this study is the widespread distrust towards blood banks and the healthcare system in general. This sentiment is well‐documented across Latin America, particularly in countries where replacement donations dominate. Participants expressed a preference for family‐based donations due to the perceived control they have over the use of the blood.

This observation aligns with the work of Charbonneau [15] and Zucoloto [26], who identified cultural perceptions of “blood purity” and fears of its misuse as significant influences on blood donation decisions. In addition, Santisteban [27] and Urbina [28] support the notion that trust in the healthcare system plays a pivotal role in shaping attitudes towards blood donation. According to their studies, fear and misinformation, particularly regarding the safety and handling of donated blood, exacerbate reluctance to participate in voluntary donation campaigns.

Furthermore, Kuperman [29] underscored the importance of addressing regulatory and systemic issues contributing to public distrust in the healthcare system. He argued that inconsistent policies and inadequate regulation not only fuel misconceptions about blood donation but also deter individuals from becoming voluntary donors. These findings resonate with participants in this study, who preferred family‐based donations due to a belief that they had more control over the use of the donated blood.

Many participants reported a lack of knowledge regarding the eligibility criteria for blood donation, further complicating their willingness to donate. Misconceptions about the donation process, such as beliefs about fasting requirements or fears of contamination, were prevalent. These findings are consistent with Flores‐Quispe's research [11], which identified a lack of understanding about basic donation requirements as a major barrier. Likewise, Almeyda [9] noted that misconceptions about the donation process, including the belief that blood donation is harmful, continue to serve as obstacles.

The study also revealed a shift in perspective among some participants after their initial experience with donation. Several participants, initially motivated by the need to help a family member, reported a growing willingness to donate altruistically after better understanding the process and gaining trust in the blood banking system. This shift in perspective underscores the potential for interventions to transform family‐based replacement donors into voluntary donors, particularly through improved education and trust‐building initiatives.

In addition to the barriers mentioned, social representations, attitudes, and beliefs play a key role in participants' willingness to donate blood. Social representations are collective constructions about donation, influenced by cultural context and shared values. On the other hand, attitudes refer to individuals' positive or negative evaluations of the act of donating blood, while beliefs are deep convictions that affect behavior, such as perceptions of safety or the benefits of donation. This theoretical distinction allows for a better understanding of how social representations influence attitudes and beliefs, ultimately affecting willingness to participate in voluntary donation.

Educational campaigns targeting these knowledge gaps and correcting misconceptions about blood donation are crucial for fostering a more informed donor base. This study's findings support the work of Arias [10], who suggested that individuals with prior donation experience are more likely to donate again. Educational efforts should focus on dispelling myths and clarifying the safety and benefits of donation, addressing both the public and family members of transfusion‐dependent patients.

Finally, this study highlights the need for community‐based policies to address the sociocultural barriers to blood donation [9]. Public health interventions must be multifaceted, combining educational initiatives with strategies to enhance transparency and build trust in blood donation systems. Policies should also consider regional variations and cultural differences to ensure that blood donation becomes a sustainable and voluntary practice in the long term [30].

This study provides valuable insights into the factors influencing social representations and willingness to donate blood in Peru. While blood donation is generally viewed positively, significant psychological, cultural, and logistical barriers persist. Interventions should focus on enhancing knowledge, addressing unfounded fears, and building trust in blood collection institutions. Public policies should aim to cultivate a culture of altruistic donation, ensuring the ongoing availability of blood for those in need.

6.1. Limitations

This study's findings are limited by the small sample size (n = 17) and the fact that it was conducted at a single hospital, which restricts the generalizability of the results to the broader Peruvian population or other Latin American contexts. Additionally, the recruitment process, which was carried out exclusively by phone during the COVID‐19 pandemic, may have introduced selection bias, excluding individuals who could not be reached or were unwilling to participate under such conditions. The researcher's role within the hospital also introduces potential bias, particularly in relation to participant responses concerning trust in the healthcare system.

Author Contributions

Lizette Fernandez‐Bolivar: conceptualization, formal analysis, investigation, methodology, resources, validation, visualization, writing – original draft, writing – review and editing. Alfonso Gushiken: investigation, methodology, resources, supervision, validation, writing – review and editing.

Funding

The authors received no specific funding for this work.

Ethics Statement

The research was reviewed and approved by the Institutional Ethics Committee (CIEI) of the Universidad Peruana Cayetano Heredia, through Certificate 034‐02‐20 dated December 9, 2020. Additionally, it was approved for execution by the Institutional Ethics Committee of the Hospital Nacional Edgardo Rebagliati Martins, through Letter No. 109‐GRPR‐ESSALUD‐2020 dated 13th March 2020.

Consent

Informed consent was obtained from all participants prior to conducting the interviews.

Conflicts of Interest

The authors declare no conflicts of interest.

Transparency Statement

The lead author, Lizette Fernandez‐Bolivar, affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

Supporting information

TABLE 1: Demographic Characteristics of the Participants. TABLE 2: Summary of Key Findings from Each Interviewee.

Data Availability Statement

The data that support the findings of this study are openly available in Universidad Peruana Cayetano Heredia at https://repositorio.upch.edu.pe/handle/20.500.12866/16161.