Blood transfusion in Ireland: Perceptions of risk, a question of trust

Parents' understanding and experiences of blood component transfusion in the neonatal intensive care unit: A qualitative study

AIM

Blood component transfusion is a common intervention in the neonatal intensive care unit (NICU). Parents consent on their babies' behalf. This study aimed to explore parents' understandings and experiences of consenting and the subsequent blood transfusion.

METHODS

A "low inference" qualitative descriptive semi-structured interview approach was utilised. Grounded theory was employed. Parents described their memories of babies' transfusions, their responses to the consent process and assessed the written information they were given.

RESULTS

A purposive sample of 17 parents whose babies required blood transfusion in the NICU participated. Parents talked about their initial fears of transfusion, later replaced by confidence in the process and results of transfusion and trust in the healthcare professional team. The main themes elicited by the interviews were parents' expectations and outcomes of transfusion, parents' prior and current opinions of transfusion, parents trust in healthcare professionals and how parents would like to receive information about transfusions in the NICU.

CONCLUSION

Parents in our study trust information from the healthcare professionals caring for their baby and would like more specific information about how blood transfusion will impact their baby, in a variety of means. Parents felt that blood transfusions were beneficial for their babies.

The Quality of Blood Donation Services and Its Association with Blood Donors' Trust and Loyalty at Makkah Blood Donation Centers in Saudi Arabia: A Cross-Sectional Study

The current cross-sectional study was conducted to determine the quality of blood donation services and its association with blood donors' trust and loyalty at Makkah blood donation centers in Saudi Arabia. A total of 373 healthy blood donors aged ≥18 years who visited blood donation centers in Makkah, Saudi Arabia, between 1st and 28th February 2023 were recruited using a census sampling method. A pre-tested and validated Arabic language questionnaire was employed. The study survey included a checklist of sociodemographic variables (seven items), as well as seven-point Likert-scale questions on the quality of blood donation services (21 items), questions to assess the participant's level of trust in blood donation centers (4 items), and questions to evaluate the level of loyalty to blood donations (4 items). SPSS (version 24) was used for data analysis. A total of 373 blood donors were included in this study. Of them, 240 (64.3%) were males and 133 (35.7%) were females. The vast majority of the study participants, 330 (88.5%), had a high educational level. The overall average agreement score for the quality of blood donation services was 71.7%. Furthermore, the overall average item agreement score for trust in blood donation centers and places was 83.0%, while the overall average item agreement score for loyalty to blood donation was 72.1%. Moreover, after adjustment for potential confounding factors, high levels of quality in blood donation services were associated with high levels of trust and loyalty among the blood donors (OR: 1.518, CI 95%: 0.321-0.864 and OR: 2.466, CI 95%: 0.285-0.763, respectively) (p-value < 0.05 for all). The overall quality of, trust in, and loyalty to blood donation services were 71.7%, 83.0%, and 72.1%, respectively. In addition, high levels of quality in blood donation services could improve blood donors' trust and loyalty levels at Makkah blood donation centers in Saudi Arabia.

Understanding ‘risk’ in families living with mixed blood-borne viral infection status: The doing and undoing of ‘difference’

‘Risk’ has long been at the centre of expert and popular perceptions of transmissible and stigmatised blood-borne viral infections, such as HIV and viral hepatitis. There is a substantial body of research on transmission risk among couples with mixed viral infection status (serodiscordance). But we know very little about how families affected by HIV and viral hepatitis engage with understandings of infectiousness and how these shape family relationships in different ways. Guided by cultural theories of risk that build on Mary Douglas’ work, we draw on qualitative interviews to explore the ‘performativity’ of risk in serodiscordant families in Australia. We show how the ‘doing’ of risk could be constitutive of difference, which unsettled the family connection or deepened existing fault lines. Conversely, the ‘undoing’ of risk enabled the preservation of the family bond by rejecting difference and reframing risk as an external threat to the family in the form of stigma. We conclude that risk in the context of serodiscordant families had relational implications far beyond viral transmission and consider what our findings might mean for service provision and health promotion campaigns related to blood-borne viruses.

The application of Signalling Theory to health-related trust problems: The example of herbal clinics in Ghana and Tanzania

In contexts where healthcare regulation is weak and levels of uncertainty high, how do patients decide whom and what to trust? In this paper, we explore the potential for using Signalling Theory (ST, a form of Behavioural Game Theory) to investigate health-related trust problems under conditions of uncertainty, using the empirical example of ‘herbal clinics’ in Ghana and Tanzania. Qualitative, ethnographic fieldwork was conducted over an eight-month period (2015–2016) in eight herbal clinics in Ghana and ten in Tanzania, including semi-structured interviews with herbalists (N = 18) and patients (N = 68), plus detailed ethnographic observations and twenty additional key informant interviews. The data were used to explore four ST-derived predictions, relating to herbalists' strategic communication (‘signalling’) of their trustworthiness to patients, and patients' interpretation of those signals. Signalling Theory is shown to provide a useful analytical framework, allowing us to go beyond the primary trust problem addressed by other researchers – cataloguing observable indicators of trustworthiness – and providing tools for tackling the trickier secondary trust problem, where the trustworthiness of those indicators must be ascertained. Signalling Theory also enables a basis for comparative work between different empirical contexts that share the underlying condition of uncertainty.

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Applies Signalling Theory (ST) to patient-herbalist trust in Ghana & Tanzania.

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Herbalists communicate trustworthiness to patients via observable ‘signals’.

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Patients interpret signal reliability based on perceived costs and pay-offs.

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In conditions of uncertainty, informational mismatches result in misplaced trust.

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ST allows us to go beyond description, enabling prediction and comparative work.

A qualitative study of patient (dis)trust in public and private hospitals: the importance of choice and pragmatic acceptance for trust considerations in South Australia

Background

This paper explores the nature and reasoning for (dis)trust in Australian public and private hospitals. Patient trust increases uptake of, engagement with and optimal outcomes from healthcare services and is therefore central to health practice, policy and planning.

Methods

A qualitative study in South Australia, including 36 in-depth interviews (18 from public and 18 from private hospitals).

Results

‘Private patients’ made active choices about both their hospital and doctor, playing the role of the ‘consumer’, where trust and choice went hand in hand. The reputation of the doctor and hospital were key drivers of trust, under the assumption that a better reputation equates with higher quality care. However, making a choice to trust a doctor led to personal responsibility and the additional requirement for self-trust. ‘Public patients’ described having no choice in their hospital or doctor. They recognised ‘problems’ in the public healthcare system but accepted and even excused these as ‘part of the system’. In order to justify their trust, they argued that doctors in public hospitals tried to do their best in difficult circumstances, thereby deserving of trust. This ‘resigned trust’ may stem from a lack of alternatives for free health care and thus a dependence on the system.

Conclusion

These two contrasting models of trust within the same locality point to the way different configurations of healthcare systems, hospital experiences, insurance coverage and related forms of ‘choice’ combine to shape different formats of trust, as patients act to manage their vulnerability within these contexts.

Tainted blood: Probing safety practices in the Danish blood system

The existing literature on donor screening in transfusion medicine tends to distinguish between social concerns about discrimination and medical concerns about safety. In this article, we argue that the bifurcation into social and medical concerns is problematic. We build our case on a qualitative study of the historical rise and current workings of safety practices in the Danish blood system. Here, we identify a strong focus on contamination in order to avoid ‘tainted blood’, at the expense of working with risks that could be avoided through enhanced blood monitoring practices. Of further significance to this focus are the social dynamics found at the heart of safety practices aimed at avoiding contamination. We argue that such dynamics need more attention, in order to achieve good health outcomes in transfusion medicine. Thus, we conclude that, to ensure continuously safe blood systems, we need to move beyond the bifurcation of the social and medical aspects of blood supply as two separate issues and approach social dynamics as key medical safety questions.

Workers' perception of chemical risks: a focus group study

Workers' perceptions with respect to health and safety at work are rarely taken into account when considering the development of prevention programs. The aim of this study was to explore workers' perceptions of chemical risks at the workplace, in order to investigate the prerequisites for a workplace health program. A qualitative study was conducted involving seven focus groups of 5-10 participants (blue-collar workers) each. All groups were homogeneous in terms of sex, work status, language, and company membership. Results showed that several factors have an important influence on workers' perception of chemical risks. Workers assess risks by means of both sensory and empirical diagnosis and are concerned about the long-term health consequences. They perceive the threat of chemical risks as high. Despite this, they are resigned to accepting the risks. Existing formal sources of information are rarely consulted because they are judged to be difficult to understand and not user friendly. Instead, workers tend to obtain information from informal sources. Communication problems with and lack of trust in prevention advisers and hierarchy are frequently mentioned. Workers feel that their specific knowledge of their working conditions and their proposals for practical, cost-effective solutions to improve health and safety at the workplace are insufficiently taken into account. The use of focus groups yielded a useful insight into workers' perceptions of chemical risks. Our findings suggest that training programs for prevention advisers should include topics such as understanding of workers' perceptions, usefulness of a participatory approach, and communication and education skills.