Exploring the dynamics of the theory of planned behavior in the context of blood donation: does donation experience make a difference?

The social contagion of prosocial behaviour: How neighbourhood blood donations influence individual donation behaviour

Life-saving transfusions and numerous other medical treatments are enabled by a minority of people that donate blood. But why do some people repeatedly engage in such prosocial behaviour, especially when it is costly to themselves? This study examines to what extent social contagion within neighbourhoods - changing behaviour in response to the behaviour of others - affects repeated blood donation behaviour. We draw on longitudinal survey and register data from a representative sample of blood donors in the Netherlands from 2007 to 2014 (N = 15,090). Using a panel data model and an instrumental variable approach, we find that donors are positively affected by donations made by other donors living in their neighbourhood. This effect does not seem to be mediated by normative or informational social influence. Exploratory analysis further attributes this finding to social contagion within donor couples. Our study contributes to the literature on repeated blood donation behaviour, and can inform retention strategies of blood banks.

A systematic literature review of voluntary behaviour change approaches in single use plastic reduction

Plastic waste is a leading contributor to climate change due to its build up in landfill and oceans, releasing harmful greenhouse gases and causing harm to ecosystems. The past decade has seen a rise in the number of policies and legislative regulations surrounding the use of single-use plastics (SUP). Such measures are needed and have shown effectiveness in the reduction of SUP's. However, it is becoming apparent that voluntary behaviour change efforts, which preserve autonomous decision making are also needed to further reduce demand for SUP. This mixed-methods systematic review had three aims, 1) synthesise existing voluntary behavioural change interventions and approaches aimed at reducing SUP consumption, 2) assess the level of autonomy preserved in interventions, and 3) assess the extent of theory use in voluntary SUP reduction interventions. A systematic search was executed across six electronic databases. Eligible studies were peer-reviewed literature published in English between 2000 and 2022 reporting on voluntary behaviour change programs aimed at reducing the consumption of SUPs. Quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Overall, 30 articles were included. Due to the heterogenic nature of outcome data in included studies, meta-analytic analysis was not possible. However, data were extracted and narratively synthesised. Communication and informational campaigns were the most common intervention approach with most interventions taking place in community or commercial settings. There was limited theory use among included studies (27% used theory). A framework was created using the criteria outlined by Geiger et al. (2021) to evaluate level of autonomy preserved in included interventions. Overall, level of autonomy preserved in included interventions was low. This review highlights the urgent need for more research into voluntary SUP reduction strategies, increased integration of theory in intervention development, and higher levels of autonomy preservation in SUP reduction interventions.

Did you donate? Talking about donations predicts compliance with solicitations for donations

Many forms of prosocial behaviour are highly institutionalized. They are facilitated by organizations that broker between donors and recipients. A highly effective tool that organizations use to elicit prosocial behaviour are solicitations for donations (e.g., of blood, time, or money). Using register and survey data on blood donations in the Netherlands, we examine to what extent compliance with these solicitations is predicted by being recruited via word of mouth (WOM) and talking about donations. Our model predicts that donors that are one unit higher on our measure of talking about donations (range = 1-4) have a 2.9 percentage points higher compliance with solicitations for donations. In addition, this association is stronger for novice donors. Our study demonstrates the social embedding of the donors' decision-making processes about compliance. For practice, our results imply that organizations may increase their contributors' communication about donations to increase the effectiveness of their solicitations.

The Effect of Functional Motivation on Future Intention to Donate Blood: Moderating Role of the Blood Donor's Stage

The low retention rate and lack of long-term blood donors are still worldwide problems, and the fostering and retaining of more blood donors has posed an urgent problem that requires a solution. The purpose of this study was to explore the role of functional motivation and blood donor stage in the future intention to donate blood. Three sites in China provided 252 blood donors who filled out a questionnaire including the volunteer function inventory, their future intention to donate blood, number of blood donations and demographic information. Based on a functional motivation approach, we investigated the motivations that influence unpaid blood donors' future intention through qualitative interview methods. The results showed that blood donor stage moderated the relationship between values motivation and future intention to donate blood. More specifically, the predictive effect of values motivation on future intention decreased gradually from new donors to regular donors. Our study found that the effect of various motivations on blood donors' intention was conditional; this effect changed with the development of blood donor behavioral stages. The results are significant in practice for establishing effective intervene strategies in maintaining blood donors.

Stated versus revealed preferences: An approach to reduce bias

Stated preference (SP) survey responses may not predict actual behavior, leading to hypothetical bias. We developed an approach that harnesses large-scale routine data to help SP surveys provide more accurate estimates of revealed preferences (RPs), within a study which elicited preferences for alternative changes to the blood service in England. The SP survey responses were used to predict the mean number of annual whole blood donations. Ex ante, the iterative survey design estimated hypothetical bias by contrasting pilot SP survey responses (N = 1254), with individually linked data on RPs, to inform the main SP survey design (N = 25,187). Ex post, the analysis recognized mediation of the relationship between SP and RP when blood donation is deferred. The pilot survey reported that donors' intended donation frequency of 3.2 (men) and 2.6 (women) times per year, exceeded their actual frequency by 41% and 30% respectively. Choice scenario attributes for the main SP survey were then modified, and over-prediction subsequently decreased to 34% for men and 16% for women. The mediating effect of deferrals explained 29% (men) and 86% (women) of the residual discrepancy between SP and RP. Future studies can use this approach to reduce hypothetical bias, and provide more accurate predictions for decision-making.

Using Digital Platforms to Promote Blood Donation: Motivational and Preliminary Evidence from Latin America and Spain

The lack of blood donors is a global problem that prevents the demand for blood prompted by an ageing population and increased life expectancy from being met. The aim of this study was to conduct an initial exploration of the reasons for using digital platforms in blood donation. Using a Theory of Planned Behaviour (TPB) framework, microdata for 389 participants from Latin American countries and Spain, and Partial Least Square-Structural Equation Modelling (PLS-SEM), the study obtained three main prediction paths. The first two started from feelings of trust in the digital community and a positive mood state associated with a modern lifestyle, and they were linked to attitudes and behavioural control in the explanation of the intention to donate and actual blood donation. The third path started from modern lifestyles, and was linked to the subjective norm in the prediction of intention and actual donation. These paths represent one of the very first attempts to predict intentions of donation and collaborative donation by taking a PLS-SEM approach. By determining the paths underpinning collaborative blood donors' motives, the results of this study provide strong support for the usefulness of the TPB model within the context of digital platform use and blood donation.

"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.

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.

Current approaches to increase blood donations in resource-limited countries

BACKGROUND

Low- and middle-income countries (LMIC) suffer from chronic or seasonal blood shortage. The first review was published in 2007.

METHODS

The review of literature since 2005 presented here uncovered a fairly large number of articles justifying the grouping of blood donation issues into five geographical areas sharing common background. These are Sub-Saharan Africa (SSA), Muslim countries, India, China/South East Asia and Latin America/Caribbean islands (LA&C).

RESULTS

SSA countries start collecting at 16-18 years of age in schools where female donors can be reached better than in other settings. Community-oriented culture favours family donors who need, similar to volunteer non-remunerated donors (VNRD), to be actively induced to repeat donation. Muslim countries share the contradiction of religion encouraging blood donation but restrain women from donating. The active involvement of religious leaders and the progressive easing of female participation are the keys to increasing blood donation. In India, 'social duty' is a major inducement to blood donation but also benefits and rewards. Ways of involving female donors by reducing the donation age to 16 years and providing donor education in schools need to be considered. In China and East Asia, the option of small-volume donation impairs blood collection without being justified by scientific evidence but is a concession to culture. Reducing the donation age would also help the supply. In LA&C, the concept of 'social capital' was developed as a complement or alternative to the theory of planned behaviour.

CONCLUSIONS

Strategies to improve blood donation and repeat donation should be innovative and adapted to local or regional culture and environment.

Integrating self-determination theory and the theory of planned behaviour to predict intention to donate blood

OBJECTIVES

The aim of this research was to test a model integrating self-determination theory (SDT) and the theory of planned behaviour (TPB) to predict intention to donate blood.

BACKGROUND

Social science research suggests that motivational orientations outlined by SDT can be usefully integrated with constructs from the TPB to collectively predict intention and behaviour. Such analysis has not yet been undertaken in the context of blood donation.

METHODS

A total of 458 currently eligible donors completed measures of blood donor motivations, attitudes, subjective norms, perceived behavioural control (PBC) and intention. Path analyses modelled the direct and indirect effects (via TPB constructs) of motivational orientations on intention.

RESULTS

SDT motivational orientations explained an additional 14% of the variance in blood donation intention, compared to a TPB-only model. Amotivation had a negative direct effect on intention; external regulation had no overall effect on intention; introjected regulation had positive direct and indirect effects on intention; and autonomous motivation predicted intention both directly as well as via attitudes, subjective norms and PBC.

CONCLUSION

This research provides the first evidence that integrating SDT and the TPB is a useful approach in donor research, particularly for specifying plausible pathways through which motivational orientations impact intention to donate blood.

Psychosocial characteristics of blood donors influence their voluntary nonmedical lapse

BACKGROUND

Approximately 10% of Dutch donors lapse yearly. Common reasons are nonvoluntary medical issues (e.g., low hemoglobin), reaching the upper age limit, and voluntary (e.g., own request, nonresponse). Little is known about predictors of voluntary noncompliance (lapses). Psychosocial characteristics have been linked to various health behaviors, including voluntary noncompliance. Hence, we investigated whether psychosocial characteristics, measured before the first donation, similarly predict subsequent voluntary nonmedical lapse.

STUDY DESIGN AND METHODS

New donors (n = 4861) randomly received a blood donation survey between July 2008 and March 2009, before their first appointment at the blood bank. Voluntary lapses included personal reasons, nonresponse to invitations, donor who could not be reached, and no show. Univariate and multivariate Cox regression models of lapse on psychosocial characteristics and confounders (e.g., demographics) were estimated.

RESULTS

Of 2964 donors who took the questionnaire, more than one-third (36.5%) had voluntarily lapsed due to nonmedical reasons by 2016. Univariate regression showed that lapse negatively associated with norms, attitudes, and intentions toward blood donation; self-efficacy; and more donation experience. Lapse positively associated with anxiety. Multivariate Cox models showed that lapse was primarily driven by anxiety and need for information.

CONCLUSION

Certain psychosocial characteristics increase risks of voluntary lapse. Especially donors with higher donation anxiety had increased lapsing risks. They might benefit from extra attention during donation. Donors with more information need or wish about procedure and patients were less likely to lapse, indicating that binding with the blood bank might prevent lapse. Generally, this study showed that donor lapse and donor return are determined by different psychosocial factors not just the reverse of each other.

Blood donor show behaviour after an invitation to donate: The influence of collection site factors

BACKGROUND AND OBJECTIVES

Show behaviour after invitation to donate varies considerably across donors. More insight into this variation is important for blood banks in achieving stable stocks. This study examined individual factors determining intended show behaviour. Most importantly, however, this study is the first study to account for variation in donor behaviour across different collection sites.

MATERIALS AND METHODS

We applied a multilevel approach to data from Donor InSight, including 11 889 donors from 257 fixed and mobile collection sites in the Netherlands. The aim of the multilevel models was to account for variance at two levels, that is donors and collection sites. We estimated the likelihood of showing after invitation based on individual predictors, including demographics, donation history and attitude. At the collection site level, we included satisfaction with the blood bank aggregated from individual responses by donors who donate at this site, opening hours and collection site type, that is fixed/mobile.

RESULTS

Most importantly, show behaviour varied considerably across collection sites and depended on characteristics of these sites. Moreover, women, older and more experienced donors had higher odds of showing after invitation than men, younger and less experienced donors. Donors higher on warm glow, self-efficacy and donor identity more likely showed after an invitation. Higher aggregate satisfaction and donating at fixed collection sites increased the odds of show.

CONCLUSION

In addition to individual factors, collection site characteristics are important in explaining variation in donor show behaviour, thus presenting clues for blood bank policies and interventions to improve donor show.

Organ Donation Registration and Decision-Making Among Current Blood Donors in the Netherlands

INTRODUCTION

In the Netherlands, there is a constant shortage in donor organs, resulting in long waiting lists. The decision to register as organ donor is associated with several demographic, cultural, and personal factors. Previous research on attitudes and motivations toward blood and organ donations provided similar results.

RESEARCH QUESTION

The current study investigated demographic, cultural, and personal determinants of organ donation registration among current Dutch blood donors.

DESIGN

We used data from Donor InSight (2012; N = 20 063), a cohort study among Dutch blood donors, to test whether age, gender, religious and political preferences, donor attitude, and altruism predicted organ donor registration among current blood donors.

RESULTS

Organ donors were more often represented in the blood donor population compared to the general Dutch population. Women showed a higher propensity to be registered as organ donor. Higher education as well as higher prosocial value orientation, prosocial behavior, that is, doing volunteer work, and awareness of need significantly associated with being registered as organ donor. Religious denomination negatively predicted organ donation registration across all faiths.

DISCUSSION

Results are discussed in light of cultural context, and possible implications for improving information provision and recruitment are mentioned.

A motivational interview promotes retention of blood donors with high internal motivation

BACKGROUND

Based on the hypothesis that self-determined motivation is associated with an increased likelihood of future behavior, the present study examined the ability of a motivational interview to promote internal motivation for giving blood and future donation attempts.

STUDY DESIGN AND METHODS

A sample of 484 recent whole-blood and double red blood cell donors (62.4% female; age = 30.2 ± 11.8 years) were randomly assigned to either a telephone-delivered motivational interview or a control call approximately 6 weeks after donating. Several weeks before the call and again 1 week after the call, participants completed the Blood Donor Identity Survey, a multidimensional measure of donor motivation, to derive indices of amotivation, external motivation, and internal motivation to give blood. Repeat donation attempts were tracked using blood center records.

RESULTS

Relative to controls, participants in the motivational interview group showed a shift toward more self-determined motivation, as indicated by significant decreases in amotivation (p = 0.01) and significant increases in external (p = 0.009) and internal (p = 0.002) motivation. Furthermore, those with initially high levels of autonomous motivation were more likely to make a donation attempt in the subsequent year if they completed the motivational interview (71.1%) versus the control call (55.1%).

CONCLUSION

Motivational interviewing is a potentially useful strategy to enhance retention of existing blood donors, particularly among those who express a greater sense of internal motivation for giving.

Negative experiences and pre-donation blood pressure: the role of attitude and anxiety

BACKGROUND/OBJECTIVES

Negative experiences (NEs) have been shown to result in an increased stress response, as indicated by blood pressure, at the subsequent donation. This response might be influenced by how the donor rates the donation in terms of importance and pleasantness [affective attitude (AA)/cognitive attitude (CA)] or by anxiety about donating blood. We investigated the effect of AA/CA/anxiety on the impact of NEs on pre-donation blood pressure (pd-BP) in the subsequent donation.

MATERIALS/METHODS

pd-BP at visit 3 was compared between donors with and without a history of NEs during or after their first two visits (visit 1: medical check, visit 2: first donation). The effect of AA/CA/anxiety (measured 1 month prior to visit 1 on a 7-point scale) on visit 3 pd-BP was explored using linear regression and interaction analyses. Analyses were stratified for gender, age and pd-BP at visit 1, which were taken into account as confounders.

RESULTS

In 1106 first-time blood donors (70% female), 632 donors (57% of total) indicated an NE at their first donation. Mean scores for AA/CA/anxiety were 5·2/6·5/2·2 (men without NE), 4·8/6·3/3·0 (men with NE), 5·2/6·6/2·6 (women without NE) and 4·8/6·6/3·2 (women with NE). No significant associations were found for NE and pd-BP at visit 3 after adjusting for confounding. Of 48 interaction effects, four were significant, but effects were small and inconsistent.

CONCLUSION

In donors who had had negative experiences during their first donation, anxiety and attitude to donation did not influence their pre-donation blood pressure at their subsequent visit.

[Commitment in plasmapheresis donation: A study of determinants among regular donors in plasmapheresis]

The purpose of this study, based on the Theory of planned behavior, is to identify and ultimately better understand what determines the fidelity and the regularity of donors committed in plasmapheresis donation. This qualitative study is a primary stage to establish a classification of donors in a French socio-cultural context. For this reason, we have carried out a survey among 16 regular plasmapheresis donors, by way of semi-structured individual interviews at the Établissement français du sang - Brittany. The level of commitment of these regular donors is considered as a level of appropriation. If subjective norms have initially influenced their decision to donate blood, no specific motivation has been highlighted for them to donate plasma except a generally favourable attitude towards the voluntary donation process. The perception of control over their environment is a variable which played a decisive role in the donor's intention to give, with little cost associated to plasmapheresis donation and recourse to internal causal explanations. A better comprehension of the plasmapheresis donors' determinants should lead us to a more efficient awareness of new potential donors, thereby enhancing recruitment and retention. Due to the increasing need for plasma-derived products, this study's ultimate issue is closely correlated both with ethical and socio-economic aspects. Following which, after analysing the results, a certain number of recommendations will be made.

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.

[Ethical issues in transfusion medicine]

Ethics is on the cross road of off values that are present along the ways of transfusion medicine. This is an important tool to afford opinions as well as debates that always emerge when discussing transfusion medicine. The wording is particularly important; this was one among several others that characterized the soul of Jean-Jacques Lefrère when he opened the doors of the ethical issues of transfusion medicine.

Improving first-time donor attendance rates through the use of enhanced donor preparation materials

BACKGROUND

Many nondonors are positive about blood donation and this motivates booking an appointment to donate. However, as their appointment approaches barriers to donating-such as anxiety-may become salient and deter attendance. Building on research of France and colleagues demonstrating the positive effect of enhanced preparation materials on donor recruitment, this study sought to determine whether these materials could effectively boost first donation appointment attendance.

STUDY DESIGN AND METHODS

A field study comprising a 3 (brochure: none, e-mail, hard copy) × 2 (national call center [NCC] contact: none, call) between-subjects design was conducted with 3646 nondonors who had scheduled their first appointment. Participants in the brochure conditions received either a hard copy or an e-mailed link to electronic materials modeled on the donor preparation research of France and colleagues. Participants in the NCC call condition also received a call scripted in line with these preparation materials. The key outcome was new donor attendance rate.

RESULTS

Although first-appointment attendance rates were high in the control (no additional contact) condition at 85.07% of those not canceling in advance, dual exposure to the preparation materials through a NCC call and an electronic brochure boosted attendance. The relative risk of attending in the NCC call and electronic brochure condition was 1.0836 (95% confidence interval, 1.0352-1.1343; p = 0.0006), with attendance 8.36% higher than in the control. This gain in attendance came at a relative increase in recruitment costs of 2%.

CONCLUSION

The use of tailored communication to address new donors' concerns and prepare them for donating bolsters attendance rates.

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.

Blood donation knowledge and attitudes among undergraduate health science students: A cross-sectional study

Awareness towards blood donation can be empowered by health professionals' role-modelling. We aimed to assess knowledge and attitudes among Greek undergraduate medical laboratory students. A questionnaire was distributed to 330 students (response rate: 88.7%). Overall, 24% had donated blood at least once, with males 4.62 times more likely to be donors. Voluntary, non-remunerated blood donors were more likely to be repeaters. A quarter of all students were inclined to offer blood for monetary reward, with men more prone to accept payment. There is a need to campaign health science students during formal education through need-based as well as altruistic 'smart' messages.

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.

The heritability of blood donation: a population-based nationwide twin study

BACKGROUND

Voluntary blood donation is believed to be mostly motivated by altruism. Because studies have suggested that altruistic personality is determined by both genetic and environmental factors, we speculated that willingness to donate blood could also be governed by constitutional factors. This hypothesis was tested in a study among Danish twins.

STUDY DESIGN AND METHODS

The nationwide Danish Twin Register, which is virtually complete for all twins born since 1968, was linked with Danish portion of the Scandinavian Donation and Transfusion (SCANDAT) Database, which includes information on all active Danish blood donors from 2002 to 2012, to establish blood donor status for Danish twins, who at age 17 years became eligible for donation in 2002 or later. Casewise concordance in monozygotic (MZ) and dizygotic (DZ) twins were presented and heritability was estimated in Mx by variance component analysis in a liability threshold model.

RESULTS

A total of 274 MZ and 484 same-sex DZ twins age 17 to 27 years were identified as donors in SCANDAT. There was no difference between MZ and DZ twins with regard to age at first donation or number of donations. Casewise concordance rates were 0.61 (95% confidence interval [CI], 0.56-0.67) and 0.41 (95% CI, 0.36-0.47) in MZ and DZ twin pairs, respectively. Heritability analysis using the ACE model found that additive genetic and shared environmental effects accounted for 0.53 (95% CI, 0.33-0.73) and 0.28 (95% CI, 0.10-0.45) of the variance in the motivation to donate blood, respectively.

CONCLUSION

Becoming a volunteer blood donor is determined by both genetic and environmental factors shared within families.

Donor cycle and donor segmentation: new tools for improving blood donor management

BACKGROUND AND OBJECTIVES

An adequate donor population is of key importance for the entire blood transfusion chain. For good donor management, a detailed overview of the donor database is therefore imperative. This study offers a new description of the donor cycle related to the donor management process. It also presents the outcomes of a European Project, Donor Management IN Europe (DOMAINE), regarding the segmentation of the donor population into donor types.

MATERIALS AND METHODS

Blood establishments (BEs) from 18 European countries, the Thalassaemia International Federation and a representative from the South-Eastern Europe Health Network joined forces in DOMAINE. A questionnaire assessed blood donor management practices and the composition of the donor population using the newly proposed DOMAINE donor segmentation. 48 BEs in 34 European countries were invited to participate.

RESULTS

The response rate was high (88%). However, only 14 BEs could deliver data on the composition of their donor population. The data showed large variations and major imbalances in the donor population. In 79% of the countries, inactive donors formed the dominant donor type. Only in 21%, regular donors were the largest subgroup, and in 29%, the proportion of first-time donors was higher than the proportion of regular donors.

CONCLUSION

Good donor management depends on a thorough insight into the flow of donors through their donor career. Segmentation of the donor database is an essential tool to understand the influx and efflux of donors. The DOMAINE donor segmentation helps BEs in understanding their donor database and to adapt their donor recruitment and retention practices accordingly. Ways to use this new tool are proposed.

Donor anxiety, needle pain, and syncopal reactions combine to determine retention: a path analysis of two-year donor return data

BACKGROUND

Efforts to expand the donor pool by recruiting younger donors have resulted in higher numbers of initial donations, but retention of young donors continues to be challenging.

STUDY DESIGN AND METHODS

Path analysis was used to examine the simultaneous relationships among syncopal reactions, donation anxiety, needle pain, donor satisfaction, and donation intention in predicting repeat donation. Participants included 421 first- and second-time donors recruited for a study comparing the effects of predonation water loading with and without the use of applied muscle tension during donation (52% female, 60.8% first-time donor, mean age 20.3 years). For this longitudinal follow-up study, donor database records were accessed 2 years after the index donation to assess repeat donation.

RESULTS

Results of a series of path analyses demonstrated the influential role of donor anxiety in shaping donor retention (final model χ(2) = 35.75, root mean square error of approximation 0.03, comparative fit index 0.98, weighted root mean square residual 0.74). First, anxiety exerted a direct negative influence on donation intention, the proximal and sole direct predictor of repeat donation. Second, anxiety increased the likelihood of donor-reported needle pain, adversely affecting donation satisfaction and, subsequently, donation intention. Finally, anxiety was associated with donor ratings of syncopal reactions through its impact on needle pain, which also contributed to decreased donation intention.

CONCLUSION

These results provide novel evidence that donation anxiety plays a central role in shaping future donation behavior. Individual differences in anxiety must be considered when developing and testing strategies to enhance blood donor retention.

Predicting the retention of first-time donors using an extended Theory of Planned Behavior

BACKGROUND

Donor retention is vital to blood collection agencies. Past research has highlighted the importance of early career behavior for long-term donor retention, yet research investigating the determinants of early donor behavior is scarce. Using an extended Theory of Planned Behavior (TPB), this study sought to identify the predictors of first-time blood donors' early career retention.

STUDY DESIGN AND METHODS

First-time donors (n=256) completed three surveys on blood donation. The standard TPB predictors and self-identity as a donor were assessed 3 weeks (Time 1) and at 4 months (Time 2) after an initial donation. Path analyses examined the utility of the extended TPB to predict redonation at 4 and 8 months after initial donation.

RESULTS

The extended TPB provided a good fit to the data. Post-Time 1 and 2 behavior was consistently predicted by intention to redonate. Further, intention was predicted by attitudes, perceived control, and self-identity (Times 1 and 2). Donors' intentions to redonate at Time 1 were the strongest predictor of intention to donate at Time 2, while donors' behavior at Time 1 strengthened self-identity as a blood donor at Time 2.

CONCLUSION

An extended TPB framework proved efficacious in revealing the determinants of first-time donor retention in an initial 8-month period. The results suggest that collection agencies should intervene to bolster donors' attitudes, perceived control, and identity as a donor during this crucial post-first donation period.

Right here, right now: the impact of the blood donation context on anxiety, attitudes, subjective norms, self-efficacy, and intention to donate blood

BACKGROUND

While research has established the role of anticipated emotions in augmented Theory of Planned Behavior (TPB) models of donor behavior, research has yet to consider the impact of immediate emotions that may be triggered by the blood donor context on respondents' intentions to donate blood. This study explored the impact of blood donor paraphernalia on respondents' positivity toward blood donation and on the interrelationships typically observed in TPB blood donation studies.

STUDY DESIGN AND METHODS

Seventy-six participants were randomly allocated to complete TPB questionnaires assessing attitudes, subjective norm, and self-efficacy along with intention to donate blood in either an affectively "hot" (blood donation paraphernalia) or a cold (control) condition. Anxiety about donating blood was also assessed.

RESULTS

Respondents in the affectively hot condition reported significantly greater anxiety about donating blood along with less positive attitudes, weaker subjective norms, lower self-efficacy, and lower intention to donate than respondents in the cold control condition. In support of extant TPB research, correlational analyses indicated that the relationships between attitudes, self-efficacy, and intention were not impacted upon by condition.

CONCLUSION

Blood donation paraphernalia induces anxiety in donors and results in diminished positivity toward donating. An awareness of what donors experience as a function of the context of blood donation may allow blood services to effectively intervene to bolster donors' positivity toward blood donation at the point where donation can take place.