Religiosity, anxiety, and discussions about organ donation: understanding a complex system of associations

Use of default option nudge and individual differences in everyday life decisions

People often make inefficient decisions for themselves and the community (e.g. they underuse medical screenings or vaccines and they do not vote) also because of their individual characteristics, such as their level of avoidance or anxiety. In recent years, governments have successfully applied strategies, called "nudges", to help people maximizing their decisions in several fields; however, the role of individual characteristics has been poorly explored. The present study investigated whether one kind of nudge, the default option (automatic enrolment in a specific plan), can modulate the influence of such individual differences, promoting favourable decisions in different field, such as the medical and civic ones. One hundred and eighty-three participants completed the Trait Anxiety Inventory, the General Decision-Making Styles Inventory and scenarios about health and civic decisions. Participants have hypothetically been enrolled by default or not enrolled in specific plans and had to decide whether adhere or not to the plan proposed. Result showed that the default option drives anxious and avoidant individuals, who usually refuse to make a choice due to their overestimation of negative events' occurrence, to undergo medical screenings and vaccine and to vote more. Nudge confirmed its effectiveness in favouring better decisions among people according to their individual differences.

Moderating Role of Religiosity and the Determinants to Attitude, Willingness to Donate and Willingness to Communicate Posthumous Organ Donation Decisions among University Students in Pakistan

Organ transplantation is considered an alternative treatment to save lives or to improve the quality of life and is a successful method for the treatment of patients with end-stage organ diseases. The main objective of the current study was to explore the determinants of the attitudes and willingness to communicate the posthumous organ donation decisions to the families. Questionnaires were used to test the hypothesized relationships. The results confirmed altruism, knowledge, empathy, and self-identity as the antecedents to attitude. We also found perceived behavioral control, moral norms, and attitude as significant antecedents to the willingness to donate organs after death. The results of the study also indicated that those who were willing to sign the donor card were also willing to communicate their decision to their families. Religiosity moderated the relationship between willingness to donate and signing the donor card, and it strengthened the relationship. The findings of this study would provide insight into the factors which can influence posthumous organ donation among university students in Pakistan.

Extending the purview of risk perception attitude (RPA) framework to understand health insurance-related information seeking as a long-term self-protective behavior

Objective: The purpose of this study is to examine the roles of risk perceptions and efficacy beliefs play in predicting emerging adults' health insurance information seeking behavior based on the risk perception attitude (RPA) framework. In addition, the current study tests a role of worry to elucidate an underlying mechanism of their health insurance information seeking behavior. Participants: A total of 694 participants was recruited from a large public university in Southwest, USA. Methods: Participants completed an online survey questionnaire. Results: Efficacy beliefs influenced health insurance-related information seeking behavior. An intriguing finding is that there were significant differences in worry across the attitudinal groups posited in the RPA framework, which is consistent with findings in prior literature. Conclusions: Information about health insurance helps individuals make good decisions for their health in a long-term perspective, which is the primary interest of the RPA framework and the current study. The findings would provide resources for designing effective communication materials to help human beings improve their well-being and prepare for their well-ending. This communication effort would contribute to ensuring public health safety, reducing health disparities, and enhancing a society's well-being.

A Systematic Literature Review and Research Agenda for Organ Donation Decision Communication

Background:

This study systematically located and appraised peer-reviewed evidence for the efficacy of strategies to increase organ donation decision communication among adults including an assessment of study quality to guide future research in this field. There is little room to move in strengthening unanimously positive public attitudes toward organ donation. Consequently, researchers have called for a focus on organ donation decision communication to understand modifiable factors to increase organ donation rates.

Methods:

Multiple databases were searched during September 2015, and 44 studies were selected for inclusion. Data concerning participants, design, and outcomes were extracted. Studies were rated for quality and levels of evidence.

Findings:

Although not amenable to meta-analysis, the literature indicates that approximately 50% of adults who are willing to become an organ donor have discussed this decision with family. The majority of research was conducted in a Western context with an overrepresentation of students. Strategies to increase communication include education, motivation, input from lived experience, efforts to address salient audience beliefs, and scheduled reminders or prompts. Intentions and willingness to discuss organ donation were consistently positively related to discussion behavior; however, formative research and experimental studies testing theoretically driven interventions were scarce.

Conclusions:

There is mixed evidence for the role of demographic and attitudinal characteristics in the success of organ donation communication interventions. Additional theoretically based research is recommended to establish boundary conditions and validate strategies to increase organ donation decision communication among adults.

Understanding African American's religious beliefs and organ donation intentions

African Americans are overrepresented on the organ transplant waiting list and underrepresented among organ and tissue donors. One of the most highly noted reasons for lack of donation is the perception that donation is contrary to religious beliefs. The purpose of this cross-sectional study is to explore the complexities of religion (beliefs, religiosity, and religious involvement) and its association with willingness to donate and the written expression of donation intentions. Findings from a sample of 505 African American participants suggest that religion is a multidimensional construct and results differ depending on how the construct is measured and operationalized.

Development and validation of the Communicating with Family about Brain Death Scale

This study reports development of a scale assessing communication with family about brain-dead organ donation. Two cross-sectional studies demonstrated scale validity. Tests of internal, external, and predictive validity were conducted using confirmatory factor analysis. In both studies, the same 6 items were shown to be unidimensional with acceptable reliability. Parallelism was shown between the Brain Death Scale and a measure of communication with family. Predictive validity was exhibited between participants' donor status and the Brain Death Scale. The scale was associated with knowledge about brain death confirming misconceptions about brain-dead organ donation.

The fear associated with blood and organ donation: an explication of fright and anxiety

CONTEXT

Fear inhibits potential donors' willingness to engage in behaviors. Theoretically, fright and anxiety are differentially associated with blood and organ donation, respectively. Fright is the experience of an immediate harm, whereas anxiety is a fear of the unknown.

OBJECTIVE

To compare the fear-related concepts of fright and anxiety in relation to blood donation and signing an organ donor card.

DESIGN

Scales were created to separate the 2 fear types that were consistent in theme and addressed the same dependent variables fright and anxiety.

SETTING AND PARTICIPANTS

Participants were 509 college students at a large midwestern university.

RESULTS

Survey responses from 509 participants supported the theoretical explication of the 2 fear types. Multisample analyses and multimeasurement models using confirmatory factor analysis supported that fright and anxiety were differentially associated with the contexts of blood and organ donation.

CONCLUSIONS

The results supported the theoretical proposal that fright and anxiety are differentially related. The ability to measure such emotions will help future researchers create models that are more accurate for predicting potential donors and create messages to assuage fears. A greater understanding of fear will lead to more effective messages.

Mass media campaigns and organ donation: managing conflicting messages and interests

Mass media campaigns are widely and successfully used to change health decisions and behaviors for better or for worse in society. In the United States, media campaigns have been launched at local offices of the states' department of motor vehicles to promote citizens' willingness to organ donation and donor registration. We analyze interventional studies of multimedia communication campaigns to encourage organ-donor registration at local offices of states' department of motor vehicles. The media campaigns include the use of multifaceted communication tools and provide training to desk clerks in the use of scripted messages for the purpose of optimizing enrollment in organ-donor registries. Scripted messages are communicated to customers through mass audiovisual entertainment media, print materials and interpersonal interaction at the offices of departments of motor vehicles. These campaigns give rise to three serious concerns: (1) bias in communicating information with scripted messages without verification of the scientific accuracy of information, (2) the provision of misinformation to future donors that may result in them suffering unintended consequences from consenting to medical procedures before death (e.g, organ preservation and suitability for transplantation), and (3) the unmanaged conflict of interests for organizations charged with implementing these campaigns, (i.e, dual advocacy for transplant recipients and donors). We conclude the following: (1) media campaigns about healthcare should communicate accurate information to the general public and disclose factual materials with the least amount of bias; (2) conflicting interests in media campaigns should be managed with full public transparency; (3) media campaigns should disclose the practical implications of procurement as well as acknowledge the medical, legal, and religious controversies of determining death in organ donation; (4) organ-donor registration must satisfy the criteria of informed consent; (5) media campaigns should serve as a means of public education about organ donation and should not be a form of propaganda.

The role of anticipated guilt in intentions to register as organ donors and to discuss organ donation with family

This project extends previous cognition-based organ donation research by addressing the role of anticipated guilt in individuals' intentions to register as donors and to discuss organ donation with family under the theoretical framework of the integrative model of behavioral prediction. Structural equation modeling analysis revealed that after controlling for the influence of attitudes, norms, and self-efficacy, anticipated guilt positively predicted intentions and was a stronger predictor of intentions in the donor registration model than in the family discussion model. Anticipated guilt was in turn predicted by empathic concern and norms in the donor registration model and by empathic concern, attitudes, and norms in the family discussion model. Both theoretical and practical implications are discussed.

Choosing to be a designated organ donor on their first driver's license: actions, opinions, intentions, and barriers of Asian American and Pacific Islander adolescents in Hawaii

CONTEXT

The factors associated with Asian American and Pacific Islander adolescents' decision to be a designated organ donor on their first driver's license are largely unknown.

OBJECTIVE

To assess knowledge and attitudes about organ donation and sociocultural factors associated with designated organ donor status in Asian American and Pacific Islander youth in Hawaii.

DESIGN AND SETTING

Written surveys and focus groups were conducted at high schools and churches.

PARTICIPANTS

Two hundred eight Asian American and Pacific Islander teens, mean age 16 (SD, 2) years, 52.6% females, and 53.4% Catholic.

MAIN OUTCOME MEASURES

Donor status on driver's license, awareness, attitudes, intentions, and barriers to becoming a designated organ donor.

RESULTS

Eighteen percent of teens with a driver's license are designated organ donors. Twenty-one percent have talked to their parents about becoming a designated donor on their license. Of those without a license, 27.7% intended to become a designated donor. Sex, grade level, and immigrant status were not associated with designated organ donor status; however, Catholics were significantly less likely to be donors. Key barriers to being a designated donor included a lack of knowledge or misperceptions due to urban myths about organ donation, parents completing "organ donor" question on driver's license application, and not wanting to have their body "cut up."

CONCLUSIONS

Future organ donor campaigns should educate ethnic minority adolescents about the importance of becoming a designated organ donor on their first driver's license and counter urban myths about deceased organ donation. Guidelines for how to initiate family discussions about organ donation should be sensitive to cultural and religious beliefs.

Choosing to Be a Designated Organ Donor on Their First Driver's License: Actions, Opinions, Intentions, and Barriers of Asian American and Pacific Islander Adolescents in Hawaii

Context

The factors associated with Asian American and Pacific Islander adolescents' decision to be a designated organ donor on their first driver's license are largely unknown.

Objective

To assess knowledge and attitudes about organ donation and socio-cultural factors associated with designated organ donor status in Asian American and Pacific Islander youth in Hawaii.

Design and Setting

Written surveys and focus groups were conducted at high schools and churches.

Participants

Two hundred eight Asian American and Pacific Islander teens, mean age 16 (SD, 2) years, 52.6% females, and 53.4% Catholic.

Main Outcome Measures

Donor status on driver's license, awareness, attitudes, intentions, and barriers to becoming a designated organ donor.

Results

Eighteen percent of teens with a driver's license are designated organ donors. Twenty-one percent have talked to their parents about becoming a designated donor on their license. Of those without a license, 27.7% intended to become a designated donor. Sex, grade level, and immigrant status were not associated with designated organ donor status; however, Catholics were significantly less likely to be donors. Key barriers to being a designated donor included a lack of knowledge or misperceptions due to urban myths about organ donation, parents completing “organ donor” question on driver's license application, and not wanting to have their body “cut up.”

Conclusions

Future organ donor campaigns should educate ethnic minority adolescents about the importance of becoming a designated organ donor on their first driver's license and counter urban myths about deceased organ donation. Guidelines for how to initiate family discussions about organ donation should be sensitive to cultural and religious beliefs.

Mapping the processes and patterns of family organ donation discussions: conversational styles and strategies in live discourse

People in the United States report positive attitudes toward organ donation (OD); however there is a disjoint between pro-donation attitudes and declared-donor status. OD campaigns promote family discussions to increase donor status and compliance with OD wishes. Unfortunately, the discourse processes involved in family OD discussions have not been systematically studied. This investigation explores how families enact the recommendation to have a family OD discussion by mapping patterns, processes, and implications of 21 undirected family discussions. Analyses revealed 3 discussion styles: cooperative, collaborative, and challenging. Discussions were marked by a general pro-OD norm, a focus on individual rights and family loyalty, and 2 specific communication strategies used to explore individual boundaries, hypothetical ethical scenarios and hypothetical family scenarios. Finally, this investigation offers insight into the processes of OD discussions such as topic initiation, topic shifting, and establishing consensus. This research serves as a significant step toward enhancing competent discussions about OD.