Barriers and motivators of Ghanaian and African-Surinamese migrants to donate blood

The importance of need-altruism and kin-altruism to blood donor behaviour for black and white people

BACKGROUND

Need-altruism (a preference to help people in need) and kin-altruism (a preference to help kin over non-kin) underlie two hypotheses for voluntary blood donation: (i) Need-altruism underlies motivations for volunteer blood donation and (ii) Black people express a stronger preference for kin-altruism, which is a potential barrier to donation. This paper tests these hypotheses and explores how need- and kin-altruism are associated with wider altruistic motivations, barriers, and strategies to encourage donation.

METHODS

We assessed need- and kin-altruism, other mechanisms-of-altruism (e.g., reluctant-altruism), barriers, strategies to encourage donation, donor status, and willingness-to-donate across four groups based on ethnicity (Black; White), nationality (British; Nigerian), and country-of-residence: (i) Black-British people (n = 395), and Black-Nigerian people (ii) in the UK (n = 97) or (iii) across the rest of the world (n = 101), and (v) White-British people in the UK (n = 452). We also sampled a Black-Nigerian Expert group (n = 60).

RESULTS

Need-altruism was higher in donors and associated with willingness-to-donate in non-donors. Levels of kin-altruism did not differ between Black and White people, but need-altruism was lower in Black-British people. Kin-altruism was associated with a preference for incentives, and need-altruism with a preference for recognition (e.g., a thank you) as well as an increased willingness-to-donate for Black non-donors. Need-altruism underlies a blood-donor-cooperative-phenotype.

CONCLUSION

Need-altruism is central to blood donation, in particular recruitment. Lower need-altruism may be a specific barrier for Black-British people. Kin-altruism is important for Black non-donors. The blood donor cooperative phenotype deserves further consideration. Implications for blood services are discussed.

Healthful Practices Among Blood Donors in a Low-Income Setting

Background: Blood donation is sustained by the availability of healthy donors. It does not only require recruiting new healthy donors, but also maintaining existing ones in optimal health. As recruitment of new donors is not guaranteed, it is essential that existing donors are always in good shape. The study therefore assesses the lifestyles and healthy habits of a sample of recurrent blood donors, their demographic characteristics, and motivations for donation. Methods: This was a cross-sectional study involving 127 blood donors between the ages of 17 and 60 years in Korle-bu, Ghana. Participants were sampled by the snowball method and administered pre-tested electronic questionnaires. The data was summarised using the Numbers software by Apple Inc. and then analysed. Results: All were non-smokers and engaged conscientiously in at least one healthy habit of a sort, with 60.3% actively following fitness schedules. There were no lifestyle-related health conditions or substance addictions. Up to 94% of the respondents had attained university education. Motivations for donations revolved mostly around altruism and almost half (46.5%) of the respondents conceded that being blood donors had made them live healthier. Conclusion: Voluntary blood donors in the selected low-income setting were mostly health conscious, and the donor status significantly affected this way of life, only more indirectly than directly. More indirectly because the healthy habits practised were predominantly personal well-being oriented but reinforced by the desire to donate blood in many situations.

Postpartum anemia and its determinant factors among postnatal women in two selected health institutes in Gondar, Northwest Ethiopia: A facility-based, cross-sectional study

Background

Anemia is highly prevalent globally and disproportionately affects postnatal women. It is a significant cause of maternal mortality and morbidity globally.

Objective

The main aim of this study was to determine the extent of postpartum anemia and associated factors among postnatal women in two selected health facilities in Gondar, Northwest Ethiopia.

Methods

A facility-based, cross-sectional study was conducted among 282 postnatal women from March to May 2021. A systematic sampling technique was used to recruit study participants from each institute. Sociodemographic, obstetric, and clinical data were collected through a semi-structured questionnaire. A venous blood sample was collected to determine the red blood cell parameters. A thin blood smear preparation was performed to examine blood morphology. In addition, direct wet mount and formalin-ether sedimentation techniques were used for stool examination to identify intestinal parasites. Data were entered into EpiData and exported to Stata 14 for statistical analysis. Descriptive statistics were presented in text, tables, and figures. A binary logistic regression model was used to identify factors associated with postpartum anemia. A p-value <0.05 was considered statistically significant.

Results

The proportion of postpartum anemia was 47.16%; 95% CI; 41.30-53.03 with moderate, mild, and severe anemia accounting for 45.11, 42.86, and 12.03%, respectively. The majority of the anemia (94%) was of the normocytic normochromic type. It was associated with postpartum hemorrhage (AOR = 2.23; 95% CI: 1.24-4.01), cesarean section (AOR = 4.10; 95% CI: 2.11-7.78), lack of iron and folate supplementation during pregnancy (AOR = 2.12; 95% CI: 1.17-4.02), and low diet diversity level (AOR = 1.83; 95% CI: 1.05-3.18).

Conclusion

The prevalence of anemia was found to be a major public health concern. Iron and folate supplementation during pregnancy, improved management of PPH, an effective cesarean section with post-operative care, and taking a diversified diet will reduce the burden. Therefore, identified factors should be considered to prevent and control postpartum anemia.

Trust and distrust: Identifying recruitment targets for ethnic minority blood donors

Background

We explore the role of trust, distrust, and the prevailing socio‐political context to better understand why people from ethnic minority communities are less likely to be blood donors compared to people from White communities. Recruiting more ethnic minority donors will enhance representativeness, reduce inequality, and help meet the clinical need to increase the proportion of blood with Ro Kell antigen to treat Sickle Cell Disease (SCD).

Study design and methods

A 2 (donor‐status: current donor; non‐donors) by 4 (ethnicity: People from Asian, Black, Mixed and White ethnic backgrounds) quasi‐experiment (N = 981) was conducted to examine perceptions of trust/distrust and their influence on willingness to donate blood, within the socio‐political context of the Windrush scandal and Brexit.

Results

We identified five domains of trust (‘National Health Service [NHS] and staff,’ ‘NHS Blood and Transplant,’ ‘outgroups,’ ‘individuals’ and ‘politics’), and a single domain of conditional distrust domain. Trust across all the domains was lower, and ‘conditional distrust’ higher for ethnic minorities. Trust in ‘individuals’ and ‘NHSBT’ predicted willingness to donate in non‐donors from ethnic minorities and White non‐donors, respectively. Concerns about the Windrush scandal were related to lower political trust. Viewing Brexit as ‘positive for the UK’ was related to lower trust across domains and reduced willingness to donate in White non‐donors through its influence on reduced trust in NHSBT.

Conclusion

Distinct domains of trust and distrust are identified, and targeting ‘trust in others’ through conditional cooperation is recommended as a strategy to increase donor numbers from ethnic minority communities.

Perceptions and Experiences of Migrants in Korea Regarding Blood Donation in Association with Sociodemographic Status

Background

With increasing number of migrants in Korea, there is an increasing need for blood products with rare blood antigens. Accordingly, the role of blood donors among migrants has been acknowledged. We investigated migrants’ experiences and perceptions of blood donation along with their sociodemographic status and identified the effects on self-reported blood donation status.

Methods

A cross-sectional survey using a self-developed, structured questionnaire was conducted on 479 migrants. The questionnaire included items about experiences, knowledge, and perceptions on blood donation and sociodemographic factors of respondents.

Results

Most migrants in this study were from Southeast Asia (54.7%) or China (39.9%). Among them, 28.6% (N=137) had donated blood previously, and 2.7% (N=13) had previously donated blood in Korea. All previous blood donors were volunteers, and the two major deterrents of blood donation for non-donors were the fear of pain and lack of knowledge about blood donation. In multivariable logistic regression analysis, the country of birth (odds ratio [OR]=2.65, P<0.001 [China]; OR=4.85, P=0.001 [countries other than China and Southeast Asian countries]) and employment status (OR=2.80, P=0.034) were independently associated with blood donation.

Conclusions

This is the first Korean study to analyze migrants’ experiences and perceptions of blood donation in relation to their sociodemographic status. Our findings can help establish blood donation policies for migrants, devise campaigns to enhance blood donation awareness, and ultimately create a pool of rare blood resources in a multicultural society.

"Missing minorities" in blood donation: Rethinking blood procurement in Europe as a citizenship regime

Although European blood collection organizations are currently obtaining sufficient and safe blood from the majority population, they report having difficulty recruiting first and second-generation immigrants from non-European countries. Most existing studies on these underrepresented groups, who have been coined the "missing minorities" in blood donation, have adopted an instrumental approach that focuses on the development of targeted recruitment strategies to overcome specific barriers to donation faced by members of these minorities. Although this approach does offer several short-term benefits, our central argument is that it is one-sided in its questioning of the non-participation of ethnic minorities. The literature currently lacks research on how the blood procurement system is failing to include minorities. Drawing on recent social theory, we seek a broader sociological understanding of minority under-representation in blood donor populations by shifting the analytic focus toward a critical examination of the main pillars of the procurement system within the European context. This paper advances a novel analytical framework based on two general propositions. First, we apply the literature on "citizenship regimes" to argue that blood donation is part of one specific institutionalization of citizenship and solidarity. We then reconceptualize the "problem" of missing minorities in European blood donation as an application for social change, suggesting avenues related to blood collection as a way of renegotiating minority-majority relations of solidarity.

Unknown, so also unvalued? Blood donation awareness and attitudes of potential donors of Dutch and African descent

BACKGROUND AND OBJECTIVES

Many Western countries face a shortage of African blood donors, while their specific blood groups are needed to transfuse chronic transfusion patients of similar ethnic background. Blood donation awareness and attitudes greatly impact the decision to become a blood donor, but how they are related and differ across ethnic groups is understudied. This study investigated blood donation awareness and attitudes of individuals of Dutch and African descent in the Netherlands.

MATERIALS AND METHODS

Survey data of 257 African and 152 Dutch non-donors measuring donation awareness (i.e. being familiar with the Dutch blood bank organization and knowing others who donated blood), cognitive (evaluative judgements) and affective (emotional reactions) attitudes were included. t-Tests, chi-square tests, linear and logistic regressions were conducted to study differences and associations between donation awareness and attitudes.

RESULTS

African individuals were less often aware of the Dutch blood bank organization (43%; p < 0·05) or others who donated blood (51%; p < 0·05) than Dutch individuals (55% and 68%, respectively). African individuals had lower cognitive donation attitudes compared with Dutch individuals (p < 0·001), but no differences were found for affective attitudes (p = 0·55). High donation awareness was associated with higher cognitive (p < 0·001) and affective (p < 0·05) donation attitudes among African minorities, but not among Dutch individuals.

CONCLUSION

The lower donation awareness and cognitive attitudes of African minorities should be taken into consideration in donor recruitment. Raising awareness through effective communication strategies might be essential in the donor decision making process of this target group.

Blood donation among individuals of African origin in the Netherlands: how are barriers and motivators associated with intention?

BACKGROUND

Blood donors of African origin are under-represented in high-income Western countries, while their extended blood types closely match chronic transfusion patients with similar ancestral backgrounds. To prevent alloimunisation, it is important to recruit and retain more African blood donors. The aim of this study was to gain insight into blood donation barriers and motivators of individuals of African origin, and to assess how these are associated with the intention to donate blood.

MATERIALS AND METHODS

An online survey sample included 300 participants of sub-Saharan African, Afro-Surinamese and Afro-Caribbean origin living in the Netherlands. They ranked 25 barriers and 19 motivators on the level of impediment and facilitation in blood donation. We compared differences in barriers and motivators between ever- and never-donors and tested associations with the intention to donate blood using univariate and multivariate linear regression analyses, adjusted for gender, age, ethnicity, immigrant generation, educational level, and blood donation history.

RESULTS

Receiving information about the donation procedure was a highly ranked motivator especially among never-donors (50%) and was positively associated with the intention to donate (p<0.05). Non-monetary incentives, convenience factors and awareness were other important motivators. Highly ranked barriers related to fears and not feeling healthy enough to donate, although only "believing donation is scary or stressful" (reported by 8% of the ever-donors and 25% of the never-donors) remained significantly associated with intention to donate in the multivariate model (p<0.05). Recipient preferences, religion and distrust were less often reported and were not associated with donation intention.

DISCUSSION

The highest ranked barriers and motivators were not necessarily the best predictors of donation intention. These findings have valuable implications for future interventions focussing on individuals of African origin.

Ensuring HLA-matched platelet support requires an ethnic diverse donor population

BACKGROUND

Patients refractory for platelet transfusions benefit from human leukocyte antigen (HLA)‐matched platelet transfusions. Differences in ethnic background of patients and donors could hamper the availability of sufficient numbers of HLA‐matched donors for all patients. We evaluated our HLA‐matched donor program and explored the role of ethnic background of patients related to the number of available donors.

METHODS

We performed a cohort study among consecutive patients who received HLA‐matched platelet concentrates in the Netherlands between 1994 and 2017. The number of available matched donors was determined per patient. Haplotypes were constructed from genotypes with computer software (PyPop). Based on haplotypes, HaploStats, an algorithm from the National Marrow Donor Program, was used to assess the most likely ethnic background for patients with 5 or fewer and 30 or more donors.

RESULTS

HLA typing was available for 19,478 donors in September 2017. A total of 1206 patients received 12,350 HLA‐matched transfusions. A median of 83 (interquartile range, 18‐266) donors were available per patient. For 95 (10.3%) patients, 5 or fewer donors were available. These patients were more likely to have an African American background, whereas patients with 30 or more donors were more often from Caucasian origin, compared with Caucasian origin for patients with 30 donors.

CONCLUSION

Adequate transfusion support could be guaranteed for most but not all refractory patients. More non‐Caucasian donors are required to ensure the availability of HLA‐matched donors for all patients in the Netherlands.

Living Donors: Altruism and Feeling Forgotten

OBJECTIVES

Living donors endure several challenges throughout the organ donation process. Physically related effects are further compounded by social and emotional challenges. To date, no previous studies have addressed the motives and impact of organ donations from living donors in Jordan.

MATERIALS AND METHODS

We conducted a qualitative exploratory study to understand the experiences of a random sample of genetically and legally related living donors in Jordan. Participants were identified through the Directorate of the Jordanian Center for Organ Transplantation database. Our sample included Jordanians and non-Jordanians who donated a kidney or liver. Most data were collected by phone interviews with living donors; some donors were personally interviewed. Donors were asked about their experiences during the periods before and after the process of donation, including their feelings, emotions, and motives. Interviews were analyzed using the thematic analysis approach.

RESULTS

In total, 360 participants (337 kidney and 23 liver donors; 290 Jordanians and 70 non-Jordanians) completed the interview. The time from donation to interview ranged from 14 days to 7 years. The period before donation was characterized by fear and confusion. After donation, most donors described a positive emotional state that was marked by selfsatisfaction, pride, and increased support of organ donation. However, many stated that they felt forgotten. Most donors were motivated by social solidarity, and others invoked the role of their religious beliefs as the main motive. Other motives included improving the recipient's life and fear that patients would be abandoned.

CONCLUSIONS

The emotional distress of living donors during the predonation period emphasizes the need for social and psychological support in addition to medical evaluations. Donors who had positive experiences with donation can play a role in advocating for donation. Finally, in Jordan, social solidarity and religious beliefs are the most important factors that motivate donation.

A descriptive phenomenological analysis of the experience of blood donation as a regular donor

Maintaining adequate blood supplies requires the recruitment of a significant number of regular donors. However, research examining the first-hand experience of blood donation from the perspective of regular donors is very limited. This study sought to describe the essential features of this experience from the accounts of 10 regular donors, analysed using Colaizzi's descriptive phenomenological method. Eight essential themes contributed to the fundamental structure of the experience, emphasising issues of blood donor identity, comfortable routine, feeling good helping others and human connectedness and interaction in the donation process. Implications for future research and practice are discussed.