Factors explaining the intention to give blood among the general population

Applying the theory of planned behavior for prediction of oocyte donation intention among Iranian women

BACKGROUND

Oocyte donation is a complex and multifaceted behavior in women. Due to the acute deficiency of donated oocytes, it is necessary to identify the factors affecting the desire to donate. Planned behavior theory is a suitable model for explaining and predicting behavior in many behavioral domains. The aim of this study was to predict oocyte donation intention using the theory of planned behavior.

METHODS

This cross-sectional study was performed on 556 women who were covered by the comprehensive health service centers in Gonabad and Neyshabour cities in 2020. Sampling was performed by the two-step method in Gonabad city and by the convenience sampling method in Neyshabour city. Data were collected online using researcher-made questionnaires included oocyte donation awareness questionnaire and oocyte donation intention questionnaire (based on the TPB constructs). The validity of the questionnaires was confirmed by face and content validity and its reliability was confirmed by Cronbach's alpha coefficient. Data were analyzed in SPSS software (version 16) using hierarchical linear regression. The statistical significance was considered as P < 0.05.

RESULTS

The results showed that there was a significant positive correlation between the oocyte donation intention with all constructs of planned behavioral theory (P < 0.050). Planned behavior theory constructs explained 47% of the variance of oocyte donation intention. In addition, constructs of perceived power (β = 0.461), control beliefs (β = 0.154) and normative beliefs (β = 0.125) were the strongest predictors of oocyte donation intention, respectively.

CONCLUSION

Planning and implementing educational courses according to the constructs of the theory of planned behavior can be a great step toward the elimination of oocyte deficiency and infertility problems. Also performing of intervention or training strategies in the field of oocyte donation requires the enhancement of social norms and perceived behavioral control in the population under study.

Better safe than sorry: the role of anticipated regret and organizational ethical climate in predicting workplace safety behavior

Purpose

Based on the theory of reasoned action, this study aims to illustrate how employees’ safety behavior can be enhanced in the workplace by specifically examining how anticipated regret leads to workplace safety behavior and the contextual factor of organizational ethical climate.

Design/methodology/approach

The authors adopted a quantitative approach and designed their survey from validated scales in prior studies. Data were obtained from two different sources, including 149 employees and 31 immediate supervisors. Hierarchical linear modeling techniques were applied to test the hypotheses.

Findings

The results showed that anticipated regret was significantly related to safety compliance and safety participation; egoistic ethical climate was negatively correlated with safety compliance and safety participation, while benevolent ethical climate was only positively correlated with safety participation. For cross-level moderating effects, both benevolent and principle ethical climate moderate the relationship between anticipated regret and safety participation, whereas all three ethical climates did not moderate the relationship between anticipated regret and safety compliance.

Research limitations/implications

It contributes to current literature by identifying critical determinants of employees’ safety behavior, which would enable practitioners to manage safety in the workplace and foster a safe working environment. Specifically, fostering benevolent ethical climate can better promote employees’ perceptions of the importance of discretionary safety behavior.

Originality/value

This study suggests that organizational practitioners could use the salience of anticipated regret to promote the safety behavioral intentions of employees in the workplace. Further, the authors examined a multilevel framework, which elaborates individual- and organizational-level antecedents of employee safety behavior as well as the impact of cross-level interactions on employee safety behavior.

The use of the Decision Regret Scale in non-clinical contexts

The Decision Regret Scale (DRS) was assessed for its psychometric qualities in measuring decision regret in ordinary life scenarios. Although the scale has typically been used with patients and in the context of medical decision-making in earlier studies, this contribution shows that the instrument may have a variety of uses, retaining excellent metric properties even in non-medical contexts. The tool showed good fits with both the CFA and the gender Measurement Invariance. A non-probabilistic selection of 2,534 Italian university students was conducted. The internal consistency measures were found to be completely appropriate. Correlations with the General Decision-Making Style (GDMS) and Scale of Regulatory Modes were used to check for convergent validity (SRM). Convergence analysis showed that participants with higher regret scores were those who favored a rational decision-making style, while lower regret scores correlated with avoidant and spontaneous styles. With regard to the regulatory modes, the relationship between regret and locomotion was positive. Overall, the directions of association point to an interesting predictive measure of a person's decision-making and self-regulatory orientation through the evaluation of regret using the DRS. The excellent psychometric properties found foreshadow a reliable use in various contexts where knowledge of post-decisional attitude becomes important: school, university, professional orientation, marketing studies, relationship choices, as well as for use in research.

Does a Low-Cost Act of Support Produce Slacktivism or Commitment? Prosocial and Impression-Management Motives as Moderators

Increase or decrease in subsequent action following a low-cost act of support for a cause can be predicted from both commitment theory and the slacktivism effect. In this paper, we report on three studies that tested type of motivation (prosocial vs. impression management) as a moderator of the effect of an initial act of support [wearing a badge (S1) and writing a slogan (S2 and 3)] has on support for blood donation. Small-scale meta-analysis performed on data from the three studies shows that activating prosocial motivation generally leads to greater support for the cause after an initial act of support compared to the control condition, while the effect from impression-management motivation can either be negative or null.

Awareness, Motivation, and Fear towards Canine Blood Donation-A Survey of Dog Owners in Lithuania

Simple Summary

Canine blood transfusions and blood donations are integral to veterinary medicine. Currently, the supply of canine blood products is not meeting the demand, and veterinarians find it difficult to recruit blood donors, especially when animal welfare is a priority. The general aim of our study was to determine how to improve the effectiveness of canine blood donor recruitment. To do this, we conducted a survey to identify the level of dog owners’ awareness about canine blood donation and to help us understand what would motivate people to become a part of the donation process as well as what people are afraid of. The results of our study suggest that donor recruitment could be increased by dispelling the myths about possible complications and by improving communication between veterinary doctors and dog owners, as the awareness of canine blood donation is poor. In conclusion, recruitment strategies should focus on the management of fear regarding canine blood donation, as well as animal welfare and the education of clients, as motivational strategies come second.

Abstract

The recruitment of canine blood donors remains a challenge, especially in countries where blood donation and veterinary medicine are still emerging medical fields. There are few previous studies that have discussed canine blood donation strategies, and the subject of fear and its influencing factors have not been investigated. The main purpose of our study was to investigate dog owners’ awareness, motivation, and fear regarding canine blood donation in order to improve donor recruitment strategies. We created a six-page questionnaire and submitted it to dog owners (n = 207) in person. Two-thirds of the respondents (65.7%) were not aware that canine blood donation exists in Lithuania. We did not find any factors that would significantly affect the motivation of respondents toward donation. We found an association between the fear of the owner and the health status of the owned dog (p = 0.008), as well as if their animal had needed urgent care in the past (p = 0.031). The fact that some participants were blood donors themselves did not affect their motivation, but they were 19.76% less afraid of canine blood donation (p = 0.001), as were respondents who were aware of canine blood donation (p = 0.004). In conclusion, the recruitment strategy should focus on the management of fear toward canine blood donation and the education of clients, and donor welfare must remain a priority.

Help Is in Your Blood-Incentive to "Double Altruism" Resolves the Plasma Donation Paradox

Blood donation is considered as one of the purest forms of altruism. Plasma donation, in contrast, despite being a similar process, is mostly a paid activity in which donors are compensated for their contribution to the production of therapeutic preparations. This creates a so-called "plasma paradox:" If remuneration is promised for a socially useful effort, volunteers with altruistic motives might be deterred. At the same time, regular plasma donors who pursue the monetary benefits of donation might drop out if remuneration stops. The same controversy can be caught in the messages of most plasma donation companies as well: They promise a monetary reward (MR), and at the same time, highlight the altruistic component of donation. In this study, we tested the assumption that emphasizing the social significance enhances the willingness to donate blood plasma more effectively than either MR or the combination of these two incentives. This had to be rejected since there was no significant difference between the three scenarios. Furthermore, we also hypothesized that individuals might be more motivated to donate plasma if there is a possibility of offering an MR toward other socially beneficial aims. We found an increased willingness to donate in scenarios enabling "double altruism", that is, when donating plasma for therapeutic use and transferring their remuneration to nongovernmental organizations, is an option. We propose relying on double altruism to resolve the plasma paradox, and suggest that it could serve as a starting point for the development of more optimized means for donor recruitment.

Motivators, barriers and communication channels for blood donation in relation to students at a university in Spain

BACKGROUND

Targeting young people to donate blood is a particularly promising option. The aim of this work was to know the motivators, barriers and preferred communication channels for blood donation among university students, and to determine the factors that explain why donors give blood.

MATERIALS AND METHODS

A questionnaire was distributed to 420 students (response rate: 88.3 %) attending the University of Huelva (Spain). Data were gathered on sociodemographic variables, blood donation history, motivators and barriers to donation, and communication channels. Non-parametric contrasts were used to determine possible differences in the sociodemographic characteristics or donation history, and logistic regression to determine the factors associated to donation.

RESULTS

67.38 % of the students surveyed were non-donors, 12.94 % were first-time donors, 11.05 % were infrequent donors and 8.63 % were frequent donors. "Solidarity" was the main motivator for donating blood (40 %). "Lack of information on where and how to give blood" was the main barrier for non-donors (26.4 %), with "medical reasons" cited by first-time donors (22.2 %). 93.8 % of donors wished to be notified about their next donation appointment. The majority of those surveyed preferred e-mail to receive alerts and information on donation campaigns. The factors that explained blood donation were over 26 years of age and place of residence.

CONCLUSION

The study identified differences in the motivators, barriers and choice of communication channel among the university students in terms of blood donation, and the factors that explain blood donation. This knowledge is a useful source of information when designing blood donation campaigns that target young people.

Multivariate pattern analysis of electroencephalography data reveals information predictive of charitable giving

Charitable donations are an altruistic behavior whereby individuals donate money or other resources to benefit others while the recipient is normally absent from the context. Several psychological factors have been shown to influence charitable donations, including a cost-benefit analysis, the motivation to engage in altruistic behavior, and the perceived psychological benefits of donation. Recent work has identified the ventral medial prefrontal cortex (MPFC) for assigning value to options in social decision making tasks, with other regions involved in empathy and emotion contributing input to the value computation (e.g. Hare et al., 2010; Hutcherson et al., 2015; Tusche et al., 2016). Most impressively, multivariate pattern analysis (MVPA) has been applied to fMRI data to predict donation behavior on a trial-by-trial basis from ventral MPFC activity (Hare et al., 2010) while identifying the contribution of emotional processing in other regions to the value computation (e.g. Tusche et al., 2016). MVPA of EEG data may be able to provide further insight into the timing and scalp topography of neural activity related to both value computation and emotional effects on donation behavior. We examined the effect of incidental emotional states and the perceived urgency of the charitable cause on donation behavior using support vector regression on EEG data to predict donation amount on a trial by trial basis. We used positive, negative, and neutral pictures to induce incidental emotional states in participants before they made donation decisions concerning two types of charities. One category of charity was oriented toward saving people from current suffering, and the other was to prevent future suffering. Behaviorally, subjects donated more money in a negative emotional state relative to other emotional states, and more money to alleviate current over future suffering. The data-driven multivariate pattern analysis revealed that the electrophysiological activity elicited by both emotion-priming pictures and charity cues could predict the variation in donation magnitude on a trial-by-trial basis.

Determinants of the intention to participate in a programme of plasma donation for fractionation among men who have sex with men

Background and objectives

Several approaches are currently under study to contribute to efforts to allow men who have sex with men (MSM) to donate blood. One of these approaches involves implementing a programme of plasma donation for fractionation, with a quarantine period. The goal of this article is to identify the determinants of intention to participate in the plasma donation programme among MSM in Montreal, Canada.

Materials and methods

Based on the theory of planned behaviour, a questionnaire was developed to measure MSM’s intention to donate plasma and identify influencing factors. A multiple linear regression analysis was conducted to identify the determinants of intention to donate plasma.

Results

Respondents’ (N = 933) intention to donate plasma in the next six months was moderate. The multiple linear regression model explained 55% (P < 0·001) of the variation of intention. Intention was predicted by attitudes (β = 0·34, P < 0·001), perceived behavioural control (β = 0·28, P < 0·001), aged under 35 years (β = 0·26, P < 0·001), history of blood donation (β = 0·24, P < 0·001), subjective norm (β = 0·21, P < 0·001), income above $40,000 (β = 0·20, P < 0·001), moral norm (β = 0·18, P < 0·001) and higher level of involvement in various issues LGBTQ+ communities are fighting for (β = 0·09, P < 0·001).

Conclusion

Our analyses show that intention to donate plasma within the proposed programme is associated with personal, social and structural factors, but more strongly predicted by factors related to the theory of planned behaviour. Our results also highlight the importance of involving MSM; community acceptability of the plasma donation programme would probably be higher if MSM felt respected and party to the decisions.

"Blood for Blood"? Personal Motives and Deterrents for Blood Donation in the German Population

It is crucial to provide updated knowledge about blood (non-)donors, as it is necessary to design targeted interventions with the aim of retaining blood donors and thus contributing to a functioning health system. This study investigates the prevalence and socio-demographic patterning of lifetime blood donation, assessing blood donation intention within the next 12 months and exploring personal motives and deterrents of blood donation qualitatively in the German population. A face-to-face cross-sectional survey with 2531 respondents was conducted, representative of the German population in terms of age, gender, and residency. Closed as well as open questions were asked. Qualitative content analysis was used for coding the qualitative material. Basic descriptive statistics were conducted to address our research questions. More than one-third of the participants reported that they have donated blood at least once in their lifetime. Motives and deterrents were assigned to 10 domains with 50 main categories and 65 sub-categories. The most frequently stated motives for blood donation were "altruism", "social responsibility", and "charity", whereas the most frequently stated deterrents were "health status", "age", and "lack of time". This study provides information to tailor recruitment and reactivation strategies to address donors at different career steps-from non-donor to loyal donor.

Promoting the propensity for blood donation through the understanding of its determinants

BACKGROUND

The paper aims to understand the main antecedents related to the blood donation propensity related to both donors and non-donors. With our research, we will analyse the two perspectives to identify similarities and differences concentrating on the Italian context. Blood is a vital resource that strongly affects every national healthcare system's efficacy and sustainability and the system's ability to achieve the goal of universal coverage.

METHODS

The purpose of this paper is to understand the main antecedents of citizens' blood donation intention and the propensity to encourage communication about blood donation among both donors and non-donors. The Theory of Planned Behaviour is adopted as a theoretical lens. An empirical investigation was performed in Italy, adopting a mixed methods research design. First, a qualitative analysis was carried out through 30 in-depth interviews. Then, a survey was used to quantitatively investigate the intention to donate among both donors (N = 173) and non-donors (N = 87). A conceptual model was developed and tested through Structural Equation Modelling, developing a multi-group approach.

RESULTS

The present study confirms the relations proposed by the Theory of Planned Behaviour, even though some differences between the two groups are shown. The construct Information and Communication is crucial for donors, non-donors, whereas for non-donor inhibitors is vital. Service quality has an impact on the propensity to recommend and communicate the value of blood donation.

CONCLUSION

This paper reveals the main differences between donor and non-donor perspectives. Fruitful insights for enhancing blood donation awareness are provided.

Barriers and enablers to source plasma donation by gay, bisexual and other men who have sex with men under revised eligibility criteria: protocol for a multiple stakeholder feasibility study

Background

Blood donation policy in Canada for gay, bisexual and other men who have had sex with men (gbMSM) has changed progressively in the last decade from indefinite deferral to 3-month deferral from last male-to-male sex. Driven by safety data and overseen by the national regulator, more inclusive policies continue to redress the disparity in donation for gbMSM. At the same time, the need for source plasma to prepare fractionated blood products is growing worldwide. The collection and processing of source plasma ensures greater safety compared to whole blood donation with respect to transfusion-transmitted infection. This greater safety offers an opportunity to evolve policies for gbMSM from time-based to behaviour-based deferral using revised eligibility criteria. However, changing policies does not in itself necessarily guarantee that gbMSM will donate or that staff in donor clinics are ready to support them to do so. In anticipation of a move to behaviour-based donation screening for gbMSM in Canada, we aim to assess the acceptability of and perceived barriers and enablers to source plasma donation using revised screening criteria for gbMSM among key stakeholders to inform policy implementation strategies.

Methods

This mixed-methods feasibility study will involve gbMSM and donor centre staff to understand modifiable barriers to implementing more inclusive eligibility criteria. Key informant interviews and surveys will be rooted in the Theoretical Domains Framework to identify modifiable factors associated with source plasma donation motives in gbMSM and training needs in donation centre staff. We will use an integrated knowledge translation approach involving a partnership between researchers, the national blood operator and gbMSM, situating knowledge users as key research team members to ensure their perspectives inform all aspects of the research.

Discussion

Our integrated knowledge translation approach will provide a more comprehensive and collaborative understanding of blood operator and gbMSM needs while accelerating the implementation of study findings. Given the historical backdrop of the decades of exclusion of sexually active gbMSM from blood donation, this study has the potential not only to inform a process and policy for gbMSM to donate source plasma, a blood product, but also offers opportunities for new relationships between these knowledge users.

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.

Motivation to Donate, Job Crafting, and Organizational Citizenship Behavior in Blood Collection Volunteers in Non-Profit Organizations

This study assesses the levels of and relationships between the Motivation to donate, Job crafting propensity, and the Organizational citizenship behavior of blood collection volunteers in a non-profit association. An Italian sample of AVIS (the Italian Association of Voluntary Blood donors) blood donors (N = 1215) actively involved in organizing blood collection, were asked to complete the Italian version of the Volunteer Function Index, the Job crafting scale, and the Organizational citizenship behavior scale. The tools were verified by Confirmatory factor analysis and their relationships were explored using Structural equation modeling for hidden variables. The three constructs have overall high scores. Motivation to donate and Job crafting show a clear correlation, with the latter influencing volunteer Organizational citizenship behavior. The study highlights the need to take into consideration the Motivation to donate, Job crafting and Organizational citizenship behavior of volunteers, particularly in countries such as Italy, where blood collection is almost exclusively carried out thanks to spontaneous, altruistic, and disinterested commitment.

Filling the Organ Donor Pool by Giving Priority

CONTEXT

Many of the alternatives for procuring donor organs are considered either ineffective, unethical, or illegal. One possibility that may not face such challenges is a priority system whereby individuals who register as an organ donor are given priority to receive an organ over those who have not registered. However, providing extrinsic rewards can sometimes paradoxically reduce the target behavior, especially for those who are more altruistically motivated.

METHODS

Two behavioral experiments were employed and data were analyzed using regressions as well as examining open-ended responses.

FINDINGS

The results suggest that giving priority to receive an organ to those who register to donate postmortem could increase overall registration rates. Further, the effect of providing priority appears to work by inducing anticipated regret, which can be used to overcome common obstacles to registration. Finally, it was found that a priority system is most effective in increasing donor rates for those individuals who are less altruistically motivated and does not reduce registration rates for those who are more altruistically motivated.

CONCLUSIONS

Given the unabated shortage of transplant organs, the finding that a priority system could increase the willingness to register as a donor without crowding out altruistically motivated individuals is highly encouraging.

Knowing the Blood Nondonor to Activate Behaviour

This work is aimed at further developing the study of blood nondonor behaviour through a joint analysis of sociodemographic characteristics, psychological and physical barriers, impure altruism and anticipated emotions, as predictors of intention to donate. To that end, a step-by-step hierarchical regression analysis was applied on a sample of 2383 Spanish nondonors. The study’s results confirm the influence of traditional variables (sociodemographic characteristics, psychological and physical barriers and impure altruism), as well as the power of anticipated emotions, both positive and negative, of donation action and inaction as variables explaining the intention to donate. Another important contribution has been to develop the moderating role of psychological and physical barriers, in addition to impure altruism, on cause–effect relationships between anticipated emotions and intention to donate. A number of practical implications can be derived from this study for transfusion centres responsible for donation promotion.

Recruitment strategies: non-donor segmentation based on intrinsic and extrinsic stimuli

BACKGROUND AND OBJECTIVES

Non-donor behaviour can be influenced by many variables, both intrinsic and extrinsic, which differ among individuals. The aim of this study was therefore to segment Spanish non-donors based on criteria such as barriers and motivations, which influence the decision to donate for the first time, with the aim of improving the efficiency and effectiveness of recruitment actions.

MATERIALS AND METHODS

A total of 2383 non-donors residing in Spain evaluated 21 barriers and 25 motivations through an online self-administered survey distributed by blood transfusion centres, which are responsible for donations in Spain, and several Spanish universities. After validating these scales and determining the underlying categories in each of them, latent class/profile analysis was performed to segment non-donors.

RESULTS

Spanish non-donors were divided into six clusters. According to their barriers and motivations, the following labels were assigned: (1) 'Impure altruists', (2) 'I want to, but make it easy for me', (3) 'Free-riders', (4) 'Reciprocal altruists', (5) 'I can't because I'm scared' and (6) 'I want to, but I can't'. Specific marketing actions were proposed for each cluster based on their characteristics, prioritizing them depending on their attractiveness.

CONCLUSION

The scales which were designed to evaluate barriers and motivations make a solid contribution to the existing literature due to their holistic, integrative nature. The existence of differentiated clusters and the lack of resources of blood transfusion centres make it clear that there is a need to define and implement targeted marketing strategies.

Beyond Description: The Predictive Role of Affect, Memory, and Context in the Decision to Donate or Not Donate Blood

Background

Research on the recruitment and retention of blood donors has typically drawn on a homogeneous set of descriptive theories, viewing the decision to become and remain a donor as the outcome of affectively cold, planned, and rational decision-making by the individual. While this approach provides insight into how our donors think about blood donation, it is limited and has not translated into a suite of effective interventions. In this review, we set out to explore how a broader consideration of the influences on donor decision-making, in terms of affect, memory, and the context in which donation takes place, may yield benefit in the way we approach donor recruitment and retention.

Summary

Drawing on emerging research, we argue for the importance of considering the implications of both the positive and the negative emotions that donors experience and we argue for the importance of directly targeting affect in interventions to recruit nondonors. Next, we focus on the reconstructed nature of memory and the factors that influence what we remember about an event. We discuss how these processes may impact the retention of donors and the potential to intervene to enhance donors' recollections of their experiences. Finally, we discuss how our focus on the individual has led us to neglect the influence of the context in which donation takes place on donor behavior. We argue that the amassing of comprehensive large data sets detailing both the characteristics of the individuals and the context of their giving will ultimately allow for the more effective deployment of resources to improve recruitment and retention.

Key Messages

In suggesting these directions for future research, our want is to move beyond the ways in which we have traditionally described blood donation behavior with the aim of improving our theorizing about donors while improving the translational value of our research.

Segmenting Active Blood Donors According to Their Barriers to Develop Retention Programs

Given the lack of a consensus on a catalogue of donation barriers, this study proposes a holistic scale of barriers which was used to segment Spanish active blood donors to define specific retention and loyalty strategies. A sample of 26 626 active donors from 14 of the 17 Spanish blood transfusion centers assessed a total of 25 barriers through an online survey. This scale was validated and 4 barrier categories were defined: Informative, Intrinsic, Time-space and Procedural. Segmentation was performed through k-means clustering. Four active donor clusters were created: (1) "Very Inhibited" (13.2%), who experienced a high number of barriers in all categories; (2) "Uninhibited" (46.9%), which was the largest cluster with fewer barriers; (3) "Apprehensive" (16.9%), whose most prevalent barriers were Informative and Intrinsic in nature; and (4) "Busy" (23.0%), who experienced mainly Time-space and Informative barriers. Afterward, depending on the size of the cluster, the presence of barriers, and the greater ease or difficulty to act on them, the attractiveness of each cluster was established to propose specific marketing actions.

Validity and Reliability of the Decision Regret Scale in Cancer Patients Receiving Adjuvant Chemotherapy

OBJECTIVES

Decisional regret is an indicator of satisfaction with the treatment decision and can help to identify those patients who need more support and evaluate the efficacy of decision support interventions. The objectives of this study are, 1) to evaluate the psychometric properties of the Decision Regret Scale and 2) to analyze the moderating effect of psychological distress on functional status and regret in patients with cancer following adjuvancy.

METHODS

A prospective, multicenter cohort of 403 patients who completed the Decision Regret Scale (DRS), Health-Related Quality of Life (EORTC QLQ-C30), and Brief Symptom Inventory (BSI). The evaluation was conducted six months after receiving adjuvant treatment in patients with resected cancer.

RESULTS

After treatment, most participants (51.9%) experienced no decision regret; 33.7% felt mild regret, and 14.4% exhibited high levels of regret. The Spanish version of the DRS demonstrated satisfactory properties: it had a strong, clear unidimensional factorial structure with substantial loadings. Decisional regret was related with lower scores on functional, symptom, and quality of life scales, and higher levels of psychological distress (all P = 0.001). Psychological distress was found to have a moderating effect on the relationship between functional state and decision regret.

CONCLUSIONS

The Spanish version of the DRS is a reliable, valid tool to evaluate regret and post-decisional quality in clinical practice and further highlights the potential clinical implications of psychological distress for the relation between physical status and regret.

Applying self-determination theory to the blood donation context: The blood donor competence, autonomy, and relatedness enhancement (Blood Donor CARE) trial

The Blood Donor Competency, Autonomy, and Relatedness Enhancement (Blood Donor CARE) project was designed as a practical application of self-determination theory to encourage retention of first-time donors. Self-determination theory proposes that people are more likely to persist with behaviors that are internally-motivated, and that externally-motivated behavior can evolve and become internalized given the appropriate socio-environmental conditions. According to self-determination theory, motivation to engage in blood donation may become increasingly self-determined if the behavior satisfies fundamental human needs for competence (a sense of self-efficacy to achieve specific goals), autonomy (a sense of volitional control over one's behavior), and relatedness (a sense of connection to a larger group). The primary aim of this randomized controlled trial is to examine the effect of competence, autonomy, and/or relatedness interventions on donor retention. Using a full factorial design, first-time donors will be assigned to a control condition or one of seven intervention conditions. Donation competence, autonomy, and relatedness, along with additional constructs associated with return donation, will be assessed before and after the intervention using online surveys, and donation attempts will be tracked for one-year using blood center donor databases. We hypothesize that, compared to the control condition, the interventions will increase the likelihood of a subsequent donation attempt. We will also examine intervention-specific increases in competence, autonomy, and relatedness as potential mediators of enhanced donor retention. By promoting first-time donor competence, autonomy, and relatedness our goal is to enhance internal motivation for giving and in so doing increase the likelihood of future donation.

Too Many Blood Donors - Response Bias in the Swiss Health Survey 2012

BACKGROUND

Data on blood donor status obtained from general surveys and health interview surveys have been widely used. However, the integrity of data on self-reported blood donor status from surveys may be threatened by sampling and non-sampling error. Our study aimed to compare self-reported blood donors (including one-time as well as regular donors) from the Swiss Health Survey 2012 (SHS) with register-based blood donors recorded by blood establishments and evaluate the direction and magnitude of bias in the SHS.

METHODS

We compared population-weighted SHS point estimates of the number of blood donors with their corresponding 95% confidence intervals to the respective figures from blood donor registries (birth cohorts 1978-1993) and estimates of donors based on period donor tables derived from blood donor registries (birth cohorts 1920-1993).

RESULTS

In the birth cohorts 1978-1993, the SHS-predicted number of donors was 1.8 times higher than the respective number of donors based on registry data. Adjusting for foreign and naturalized Swiss nationals that immigrated after their 18th birthday, the SHS overall predicted number of donors was 1.6 times higher. Similarly, SHS estimates for the 1920-1993 birth cohorts were 2.4 and 2.1 times higher as compared to register-based estimates. Generally, the differences between SHS and register-based donors were more pronounced in men than in women.

CONCLUSION

Self-reported blood donor status in the SHS is biased. Estimates of blood donors are substantially higher than respective estimates based on blood donor registries.

How Can We Improve Retention of the First-Time Donor? A Systematic Review of the Current Evidence

Blood products are critical to health systems and donations by voluntary nonremunerated donors are recommended. Worldwide, however, only around 5% of those eligible to donate do so and around half of those never return to donate again. This review focuses on what deters first-time donors, what predicts their retention, and what interventions may promote retention of this group. A comprehensive search of relevant databases identified 9 studies investigating motives and deterrents of first-time donors, 14 studies investigating predictors for first-time donors (13 whole blood [WB] and 2 plasmapheresis), and 15 studies (in 14 published articles) detailing interventions conducted on first-time donors. Drawing on an established blood donation taxonomy, studies were classified by 2 independent raters. Interventions were also classified into traditional, behavioral, or social science interventions. With only 2 eligible studies among first-time plasmapheresis donors, analyses focused on WB donors. First-time WB donors reported benevolent and collectivistic motivations, as well as personal benefits to commence WB donation. Self-reported deterrents have typically not been examined. Intention predicted first-time donor retention with intention determined by attitudes and a sense of (perceived behavioral) control. However, anxiety, adverse events, and deferrals all deterred retention. Traditional interventions, such as reminders and incentives, are widespread yet had only a small effect on return of first-time donors. Although behavioral science interventions such as fluid loading are effective, the strongest effect for the return of first-time donors was found when individual psychological support was provided. The purpose of this analysis was to identify the factors associated with the commencement and continuation of first WB donations. The current review revealed that self-reported motivators are typically not effective, and most successful predictive factors identified have not been translated into interventions. Future work would do well to identify, manage, and meet donors' expectations along with developing more individualized donation experiences. Blood donor research should delineate donor career stages; addressing first-time donor retention will support stable panels for blood collection agencies.

A brief motivational interview with action and coping planning components enhances motivational autonomy among volunteer blood donors

BACKGROUND

In contrast to standard donor retention strategies (e.g., mailings, phone calls, text messages), we developed a brief telephone interview, based on motivational interviewing principles, that encourages blood donors to reflect upon their unique motivators and barriers for giving. This study examined the effect of this motivational interview, combined with action and coping plan components, on blood donor motivations.

STUDY DESIGN AND METHODS

The design was to randomly assign blood donors to receive either a telephone-delivered motivational interview with action and coping plan components or a control call approximately 6 weeks after their most recent donation. Participants completed a series of surveys related to donation motivation approximately 3 weeks before telephone contact (precall baseline) and then repeated these surveys approximately 1 week after telephone contact (postcall).

RESULTS

The sample was 63% female, included a majority (52.6%) of first-time blood donors, and had a mean age of 30.0 years (SD, 11.7 years). A series of analyses of variance revealed that, relative to controls (n = 244), donors in the motivational interview group (n = 254) had significantly larger increases in motivational autonomy (p = 0.001), affective attitude (p = 0.004), self-efficacy (p = 0.03), anticipated regret (p = 0.001), and intention (p = < 0.001), as well as larger decreases in donation anxiety (p = 0.01), from precall baseline to postcall assessment.

CONCLUSION

This study supports motivational interviewing with action and coping planning as a novel strategy to promote key contributors to donor motivation.

Differences in social representation of blood donation between donors and non-donors: an empirical study

BACKGROUND

Both donors and non-donors have a positive image of blood donation, so donors and non-donors do not differ regarding their views on donation but do differ in converting their opinion into an active deed of donation. Several studies have identified altruism and empathy as the main factors underlying blood donation. However, a mixture of various motivational factors mould the complex behaviour of donation. This paper presents an exploratory study on differences of social representations of blood donation between blood donors and non-donors, in order to understand the reasons that bring someone to take the decision to become a blood donor.

MATERIALS AND METHODS

Participants filled in the Adapted Self-Report Altruism Scale, Toronto Empathy Questionnaire and answered a test of verbal association. Descriptive and correlation analyses were carried out on quantitative data, while a prototypic analysis was used for qualitative data.

RESULTS

The study was carried out on a convenience sample of 786 individuals, 583 donors (mean age: 35.40 years, SD: 13.01 years; 39.3% female) and 203 non-donors (mean age: 35.10 years, SD: 13.30 years; 67.5% female). Social representations of donors seem to be more complex and articulated than those of non-donors. The terms that appear to be central were more specific in donors (life, needle, blood, help, altruism were the words most associated by non-donors; life, aid, altruism, solidarity, health, love, gift, generosity, voluntary, control, needed, useful, needle were the words most associated by donors). Furthermore, non-donors associated a larger number of terms referring to negative aspects of blood donation.

DISCUSSION

Aspects related to training and the accuracy of any information on blood donation seem to be important in the decision to become a donor and stabilise the behaviour of donation over time, thus ensuring the highest levels of quality and safety in blood establishments.

Blood donation: comparing individual characteristics, attitudes, and feelings of donors and nondonors

The shortage of blood donors and increased demand for blood is an important health issue. Finding ways to increase donor recruitment and retention is a priority and, thus, an important area for research. This article aims to better understand donors and nondonors on the basis of their social responsibility, susceptibility to interpersonal influence, involvement in and attitude towards the blood donation issue, and their aroused feelings. The data from 345 completed surveys were collected via a web-based, self-administered method. Mean differences were examined and the conceptual model was tested via structural equation modeling. The findings provide important clarification of donation and nondonation behavior.

Motivating first-time, group O blood donors to return: Rationale and design of a randomized controlled trial of a post-donation telephone interview

First-time blood donors are essential to the US donor pool, providing nearly a third of all donations. Unfortunately, there are a wide variety of obstacles to repeat donation and new donors are extremely difficult to retain. Because each donor experiences a unique set of deterrents, we developed a post-donation interview based on motivational interview principles in order to flexibly address individual barriers. The primary aim of this randomized clinical trial is to examine retention of first-time, group O blood donors who are randomly assigned to receive either a telephone-delivered interview with motivational and action planning components or a standard-of-care control call approximately six weeks after their donation. Measures of donation attitude, perceived behavioral control, intention, and motivational autonomy will be measured before and after the telephone contact using online surveys, and donation attempts will be tracked for one year using blood center donor databases. We hypothesize that, compared to controls, donors who receive the telephone interview will be more likely to make a donation attempt over the following year. In addition, we will examine possible mechanisms of action of the interview using key predictors of donation behavior as described by Self Determination Theory (i.e., motivational autonomy) and the Theory of Planned Behavior (i.e., attitude, perceived behavioral control, and intention). Results of this intervention may help to support a novel strategy to enhance retention of selected blood donors in an effort to better meet the nation's blood supply needs.

Reconstructing Aboriginal Identity and the Meaning of the Body in Blood Donation Decisions

Ethno-cultural disparities in blood and tissue donation patterns have been described as an emergent challenge in the context of the transfusion medicine literature (Boulware et al. in Med Care 40(2):85-95, 2002; Molzahn et al. in Nephrol Nurs J 30(1):17-26, 2003, Can J Nurs Res 36(4):110-128, 2004). In the North American context, much has been written about blood and tissue donation patterns among different religious and cultural groups within the United States. However, there are few available statistics or descriptive research that discusses blood donation decisions among Aboriginal Canadians. In 2001, Aboriginal Canadians represented approximately 4.1% of the total Canadian population, or 1.1 million persons (Birn et al., in Textbook of international health: global health in a dynamic world. Oxford University Press, New York, NY, 2009). Comparatively, Canada Blood Services reports that Aboriginal Canadians represent only 0.9% of registered donors (Canadian Blood Services 2011a). These low donation patterns suggest that blood donation choice among Aboriginal Canadians requires better understanding. This paper discusses several factors that may influence Aboriginal health choices, specifically those associated with blood donation decision-making. Several influential factors will be discussed, including: the meaning of the body and its parts in relationship to the interconnectedness of all things (religio-cultural), the reflexivity of choice and control (political), and relationships with others (social).

Antecedents of philanthropic behavior of health care volunteers

Purpose

– This paper aims to propose a conceptual model of philanthropic behavior of volunteers in the health care sector.

Design/methodology/approach

– This study is based on an extensive review of past research on philanthropic behavior. To conduct the literature review, keywords such as philanthropy, philanthropic behavior, giving, donating, competencies, volunteering and social network in health care were identified.

Findings

– From the literature reviewed, three groups of antecedents of philanthropic behavior among health care volunteers (HCVs) were identified, viz., individual factors, social factors and organizational factors. This paper proposes social network as a mediating variable in linking the three groups of antecedents with philanthropic behavior. The paper offers a number of propositions which explain the proposed model of philanthropic behavior of HCVs.

Practical implications

– Further research is suggested to test and validate the framework to provide empirical evidence. Upon model validation, the paper could offer practical interventions for human resource development (HRD) managers to assist philanthropic-based organization toward developing and managing philanthropic behavior of HCVs. The paper highlights the importance of social network to promote individuals to engage in philanthropic actions.

Originality/value

– The paper yields a new approach in theorizing philanthropic behavior among HCVs by integrating the theory of planned behavior, social identity approach and organizational support theory. The proposed social network as a mediator could provide new insights to the HRD practitioners on developing philanthropic behavior among HCVs subject to model validation. The research contributes to literature in philanthropy, HRD and community development.

Factors associated with intention to donate blood: sociodemographic and past experience variables

Background and Objectives. This study was conducted to assess the level of intention of the general public towards blood donation and the factors associated with it. Methods. A descriptive cross-sectional study was conducted in South-East Botswana amongst participants aged 21–65 years. An interviewer-administered questionnaire was completed for 384 participants. Results. Of the 384 participants, 104 (27.1%) reported that they had donated blood in the past and 269 (70.1%) stated that they were willing to donate blood in the future. Thirteen out of the 104 past donors (12.5%) reported that they had donated blood in the 12 months preceding the survey and only 10 (9.6%) participants reported that they have been regular donors. In the backward logistic regression analysis, the variables that remained significant predictors of the intention to donate blood were secondary education (adjusted odds ratio (AOR) (95% confidence interval (CI)): 2.92 (1.48, 5.77)), tertiary education (AOR (95% CI): 3.83 (1.52, 9.62)), and knowing a family member who had ever donated blood (AOR (95% CI): 2.84 (1.58, 5.12)). Conclusion. Being informed about blood transfusion and its life-saving benefits through either the education system or the experience made people more likely to intend to donate blood. Evidence-based interventions to retain blood donors as regular donors are recommended.

Recruiting underserved mothers to medical research: findings from North Carolina

Representative samples are required for ethical, valid, and useful health research. Yet, recruiting participants, especially from historically underserved communities, can be challenging. This paper presents findings from in-depth interviews with 40 mothers about factors that might influence their willingness to participate or allow their children to participate in medical research. Saliency analysis organizes the findings. Frequent and important salient themes about research participation included concerns that it might cause participants harm, hope that participants might gain a health benefit, and recognition that time and transportation resources could limit participation. Ultimately, we propose that a theoretical model, such as the Theory of Planned Behavior (TPB), will facilitate more systematic evaluation of effective methods for recruitment and retention of participants in medical research. Future research should explore the utility of such a model for development of effective recruitment and retention strategies.

Public awareness of blood donation in Central Saudi Arabia

INTRODUCTION

In Saudi Arabia, voluntary donors are the only source of blood donation. The aim of this study was to assess the level of public knowledge and attitude toward blood donation in Saudi Arabia.

METHODS

Using a previously validated questionnaire that comprises 38 questions to assess the levels of knowledge, attitudes, and motivations towards blood donation, 469 Saudi adults who attended different shopping malls in Riyadh, Saudi Arabia were surveyed. Multiple regression analyses were used to identify the significant predictors of blood donation, with the significance set at P<0.05.

RESULTS

Approximately half of all subjects (53.3%) reported that they had previously donated blood, 39% of whom had donated more than once. The knowledge percentage mean score was 58.07%, denoting a poor level of knowledge, with only 11.9% reporting a good level of knowledge. The attitude percentage mean score towards donation was 75.45%, reflecting a neutral attitude towards donating blood, with 31.6% reporting a positive attitude. Donation was significantly more prevalent among males than females (66% versus 13.3%; P<0.001). After adjustment for confounders, a higher knowledge score (t=2.59; P=0.01), a higher attitude score (t=3.26; P=0.001), and male sex (t=10.45; P<0.001) were significant predictors of blood donation. An inability to reach the blood donation centers and a fear of anemia were the main reasons for females not donating blood (49.9% and 35.7%, respectively), whereas a lack of time was the main reason for males (59.5%).

CONCLUSION

Prevalence of blood donation was less than satisfactory among the Saudi public, probably due to misconceptions, poor knowledge, and unfavorable attitude to donation. Educational programs are necessary to increase the level of knowledge and improve the attitude of the Saudi public toward blood donation. Providing mobile blood collection units nearer to individuals' places of work to reduce their time costs of donating is a necessity.

Giving blood and enrolling on the stem cell donor registry: ranking of obstacles and motives in Switzerland

BACKGROUND

To obtain a better understanding of factors affecting blood and blood stem cell donation behavior in Switzerland, a series of studies has been performed. In the recent study of this series, which is described here, motivators and barriers in the field of blood and blood stem cell donation were identified.

METHODS

Web-based survey data from a non-random sample of the Swiss population 2012/2013 (n = 3,153) were used to describe and compare the ranking of motives and obstacles to donate blood and to enroll on the Swiss blood stem cell registry. Wilcoxon rank-sum test and Spearman's rank correlations were used to assess differences and associations between ranks and groups.

RESULTS

The prospect of saving lives and solidarity were the top two motives to donate blood or to enroll on the blood stem cell registry. The top two obstacles to enroll on the blood stem cell registry were lack of general information on blood stem cell donation and on its risks, whereas the top two obstacles to donate blood were the lack of information where and when to donate and deferral of or exclusion from blood donation.

CONCLUSION

Classical altruistic motives are top drivers for giving blood as well as registering for blood stem cell donation. Recruitment campaigns should focus on these motivators. Similarities in motivational factors as well as in obstacles regarding blood and blood stem cell donation can be found.

Donating blood and organs: using an extended theory of planned behavior perspective to identify similarities and differences in individual motivations to donate

Due to the critical shortage and continued need of blood and organ donations (ODs), research exploring similarities and differences in the motivational determinants of these behaviors is needed. In a sample of 258 university students, we used a cross-sectional design to test the utility of an extended theory of planned behavior (TPB) including moral norm, self-identity and in-group altruism (family/close friends and ethnic group), to predict people's blood and OD intentions. Overall, the extended TPB explained 77.0% and 74.6% of variance in blood and OD intentions, respectively. In regression analyses, common contributors to intentions across donation contexts were attitude, self-efficacy and self-identity. Normative influences varied with subjective norm as a significant predictor related to OD intentions but not blood donation intentions at the final step of regression analyses. Moral norm did not contribute significantly to blood or OD intentions. In-group altruism (family/close friends) was significantly related to OD intentions only in regressions. Future donation strategies should increase confidence to donate, foster a perception of self as the type of person who donates blood and/or organs, and address preferences to donate organs to in-group members only.

A systematic review and meta-analysis of antecedents of blood donation behavior and intentions

This meta-analysis sought to identify the strongest antecedents of blood donation behavior and intentions. It synthesized the results of 24 predictive correlational studies of donation behavior and 37 studies of donation intentions. The antecedents were grouped into six research programs: (1) the Theory of Planned Behavior (TPB) and its extensions, (2) prosocial motivation, (3) affective expectations, (4) donor site experience, (5) past donation behavior, and (6) donor demographics. Antecedent categories were cross-validated by multiple coders, and combined effect sizes were analyzed using a random-effects model. For donation behavior, medium positive associations were found with five of the constructs from the extended TPB: intentions to donate, perceived behavioral control, attitude toward donation, self-efficacy and donor role identity. Other antecedents displaying a positive association with donation behavior included anticipated regret for not donating, number of past donations and donor age. Donor experiences at the collection site in the form of temporary deferral or adverse reactions had a medium negative association with behavior. For donation intentions, strong positive associations were observed for perceived behavioral control, attitude, self-efficacy, role identity and anticipated regret. Medium positive associations were observed for personal moral norm, subjective norm, satisfaction, and service quality. All other potential antecedents had weak or non-significant associations with behavior and intentions. Several of these associations were moderated by between-study differences, including donor experience, the period of data collection in which donation behavior was observed, and the use of a nominal (yes/no return) versus a ratio measure of donation behavior. Collectively, the results underscore the importance of enhancing donors' attitudes towards donation and building their perceived behavioral control and self-efficacy to donate. Further, minimizing the risk of adverse reactions and enacting re-recruitment policies for temporarily deferred donors will help protect future donation behavior. Implications of these findings for blood collection agencies and researchers are discussed.

Volunteer bias in recruitment, retention, and blood sample donation in a randomised controlled trial involving mothers and their children at six months and two years: a longitudinal analysis

BACKGROUND

The vulnerability of clinical trials to volunteer bias is under-reported. Volunteer bias is systematic error due to differences between those who choose to participate in studies and those who do not.

METHODS AND RESULTS

This paper extends the applications of the concept of volunteer bias by using data from a trial of probiotic supplementation for childhood atopy in healthy dyads to explore 1) differences between a) trial participants and aggregated data from publicly available databases b) participants and non-participants as the trial progressed 2) impact on trial findings of weighting data according to deprivation (Townsend) fifths in the sample and target populations. 1) a) Recruits (n = 454) were less deprived than the target population, matched for area of residence and delivery dates (n = 6,893) (mean [SD] deprivation scores 0.09[4.21] and 0.79[4.08], t = 3.44, df = 511, p<0.001). b) i) As the trial progressed, representation of the most deprived decreased. These participants and smokers were less likely to be retained at 6 months (n = 430[95%]) (OR 0.29,0.13-0.67 and 0.20,0.09-0.46), and 2 years (n = 380[84%]) (aOR 0.68,0.50-0.93 and 0.55,0.28-1.09), and consent to infant blood sample donation (n = 220[48%]) (aOR 0.72,0.57-0.92 and 0.43,0.22-0.83). ii) Mothers interested in probiotics or research or reporting infants' adverse events or rashes were more likely to attend research clinics and consent to skin-prick testing. Mothers participating to help children were more likely to consent to infant blood sample donation. 2) In one trial outcome, atopic eczema, the intervention had a positive effect only in the over-represented, least deprived group. Here, data weighting attenuated risk reduction from 6.9%(0.9-13.1%) to 4.6%(-1.4-+10.5%), and OR from 0.40(0.18-0.91) to 0.56(0.26-1.21). Other findings were unchanged.

CONCLUSIONS

Potential for volunteer bias intensified during the trial, due to non-participation of the most deprived and smokers. However, these were not the only predictors of non-participation. Data weighting quantified volunteer bias and modified one important trial outcome.

TRIAL REGISTRATION

This randomised, double blind, parallel group, placebo controlled trial is registered with the International Standard Randomised Controlled Trials Register, Number (ISRCTN) 26287422. Registered title: Probiotics in the prevention of atopy in infants and children.

Incidence of Red Cell Alloantibody among the Transfusion Recipients of Universiti Kebangsaan Malaysia Medical Centre

Red blood cell alloimmunization is a common complication among the transfusion recipients. In Malaysia, multiple ethnicity causes genetic heterogeneity among the population which in turn can cause a wide variation of antibody. The objective of this study was to analyse the red cell alloantibody detected during the pre-transfusion testing. This was a cross-sectional study done in the blood bank of Universiti Kebangsaan Malaysia Medical Centre during the period of January-December 2010. The data was retrieved from the hospital laboratory information system. A total of 24,263 patients' blood samples were subjected for pre-transfusion testing. Antibody screening was done using an indirect antiglobulin test method. The positive samples were further identified for antibody specificity. Antibody screening tests were positive in 184 patients out of 24,263 samples with the incidence of 0.76 %. Autoantibodies and alloantibodies were detected in 39/184 (21.2 %) and 140/184 (76.1 %) of the patients respectively. In five patients (2.7 %) the antibody specificity remained undetermined. Total 161 alloantibodies were identified. The suspected Anti-Mia alloantibody was observed most frequently (49/161, 30.4 %) followed by anti-E (30/161, 18.6 %) and anti-D (22/161, 13.7 %). Anti-E and anti-c were the most common combination of multiple alloantibodies. In view of the high incidence of suspected Anti-Mia antibodies, more efforts are needed to look into the techniques for confirmation of the Anti-Mia antibodies. Besides that, we suggested that all multiply transfused patients should be phenotyped for the Rh system and to supply Rh phenotype specific blood in order to limit alloimmunization.