Our study was carried out according to the ethics guidelines of the Moroccan law concerning the protection of human subjects participating in biomedical research [10] . The authorization to carry out the study was obtained from the Ministry of Health of Morocco as well as from the Head of each participating health center. Before participation in the study, the investigator explained the purpose of the study and informed health professionals that participation in the study was voluntary and that all data will be anonymous and confidential. Verbal consent was obtained before respondents completed the anonymous questionnaires.

This is a cross-sectional study conducted between November 2015 and July 2016 among health professionals working at different public and private health centers in Oujda, which is the main city in Eastern Morocco. This study was carried out in the following health centers: Mohammed VI University Hospital, Al-Farabi Regional Hospital, Boussif Diagnostic Center, eight other public health centers and three private clinics. Health professionals enrolled in this study were physicians and paramedical staffs (nurses and lab technicians).

The survey questionnaire was developed based on several studies [3] [11] [12] [13] . The self-administered anonymous questionnaire was composed of three sections. The first section was about the socio-demographic data of each participant (age, gender, occupation, specialty, etc.). The second section focused on participants’ knowledge of biobanks. For participants who have never heard of biobanks, a paragraph explaining the concept of biobanks was included at the end of this second section. The third section was about whether the participants were willing to donate their own biological samples to biobanks, and their willingness to recruit their patients to biobanks (see appendix).

A pilot survey was conducted with a small sample of participants (n = 20), to ensure content validity, effectiveness and reliability of the questionnaire. Then, the questionnaires were distributed in the different participating centers by the investigator who explained the purpose of the study and informed health professionals that participation in the study was voluntary and that all data will be anonymous and confidential. Moreover, verbal consent was obtained before respondents completed the anonymous questionnaires. The questionnaires were then collected from participating centers few days later by the investigator.

All data were coded and analyzed with the SPSS software version 21.0. Descriptive analyses were used to describe the knowledge and attitude of participants toward biobanks according to age, sex and occupation. Univariate logistic regression was carried out to examine the association between socio-demographic factors and other factors related to biobanks such as knowledge, attitude, willingness to donate biospecimens and recruit patient to biobanks. Only variables identified as significant in univariate analyses were included in multivariate analyses. The results have been considered as significant when p < 0.05.

A total of 600 health professionals completed and returned the questionnaire. The socio-demographic characteristics of the surveyed population are shown in Table 1. Among the participants, 60.8% were female and 39.2% were male, with a female to male ratio of 1.55. The mean age was 34.94 ± 12.27 years (range 19 - 65) with 42.2% belong into the class of age 25 - 34 years. Two-thirds of the participants were paramedical staffs (61.4%) and 38.6% were physicians. The majority of participants were from the public sector (94.3%), while only 5.7% of participants were from the private sector.

N: number of participants; *: number of participants with known information; SD: standard deviation.

Table 2 shows the analysis of the knowledge of biobanks among health professionals. We found that more than a third of health professionals (37.5%) had knowledge of biobanks. Almost two-thirds (62.5%) of the participants had never heard of biobanks. Among the participants who had knowledge of biobanks, 30.2% had their information of the concept of biobanks by scientific events, 24.9% through reading, 18.2% from Medias, and 5.8% by combination of several sources (scientific events, reading, media, etc.).

The association analysis of participants’ knowledge about biobanks with sociodemographic factors is shown in Table 3. Participants aged between 25 and 34 years had more knowledge of biobanks in comparison with participants belonging to other age groups (OR = 1.85, p = 0.012). The knowledge of biobanks was significantly associated with the profession. Indeed, among the participants, physicians had more knowledge of biobanks (OR = 2.68, p = 0.000). In addition, our data showed that health professionals working at the University Hospital had more knowledge of biobanks compared to those working in the other participating health centers (p < 0.001). Respondent’s gender and sector were not significantly associated with biobank knowledge (p > 0.05).

N: number of participants.

OR: Odds ratio; AOR: Adjusted Odds Ratio; CI: confidence interval; ^a: Reference category for each variable, UH: University Hospital; RH: Regional Hospital; DC: Diagnostic Center; HC: health centers.

When assessing all sociodemographic characteristics in a multiple regression analysis, only variables related to professions and health centers (AOR = 2.50, p < 0.001 and p = 0.018 respectively) were significantly associated with the knowledge of biobanks (Table 3).

In a question about their willingness to donate their own biospecimens associated to their personal and clinical data to biobanks, the majority of health professionals (82.9%) showed positive attitudes (Table 4). Most participants (82.8%), agreed to explain to patients the role of biobanks for the development of biomedical research, and to convince them to participate in biobanks (Table 4).

Our study demonstrates that biobanks are poorly known among health professionals. This result was expected because the concept of biobank is quite new in Morocco and therefore still poorly known. Many studies carried out in other countries, have also shown that biobanks remained very poorly known among health personnel. For example, an Australian study revealed that the majority of health professionals had no knowledge of biobanks [9] . The lack of knowledge about biobanking was also observed among health students in Saudi Arabia [14] . Regarding the association between the knowledge of biobanks and socio-demographic factors, our study demonstrated that participants aged between 25 and 34 years, physicians, and health professionals working at the University

Hospital had more knowledge of biobanks. Together, our data highlight the necessity to establish awareness about biobanking among health professionals in Eastern Morocco. This can be achieved by implementing an appropriate education and training program on biobanking for health professionals.

Despite that biobanks are poorly known among health professionals, most participants were willing to donate their own biospecimens associated to their personal and clinical data to biobanks. We found that factors such as gender or age were not significantly associated with the health professionals’ willingness to donate biospecimens to biobanks. However, profession was significantly associated with the willingness to donate to biobanks. In fact, physicians were more willing to donate biospecimens to biobanks than paramedical personnel. An Italian study among university students, demonstrated that women were more willing to donate their biological samples to biobanks than men, and medical students or professional nursing were more willing to do so than law students [15] . Another study conducted among senior health students in Saudi Arabia, showed that the majority (89%) of the participants were willing to donate biospecimens to biobanks for biomedical research purposes [14] .

Most of health professionals were willing to explain to patients the role of biobanks in biomedical research, in order to convince them to participate in biobanks. This positive attitude was observed in several previous studies [9] [16] . An Australian study has explored the opinion of health professionals on biobanks of cancer, has shown that the majority of participants are very favorable to biobanks [9] [17] [18] . A positive attitude towards the creation of a biobank of DNA has also been observed in a study in the United States and Scotland, where 83% of health professionals were in favor of creating a DNA biobank [11] .

Despite the important finding of this study, there were some limitations. For example, some items of the questionnaire may not be well understood, especially since the majority of health professionals were not aware of biobanks. The other limitation is that the study assessed only a hypothetical willingness to support biobanking, and that an assessement of an actuel participation in a biobank could provide a different, probably lower rate.