A refined method for estimating the size of the potential blood donor pool in Australia

Prevalence of blood donation eligibility in Australia: A population survey

BACKGROUND

Reliable estimates of the population proportion eligible to donate blood are needed by blood collection agencies to model the likely impact of changes in eligibility criteria and inform targeted population-level education, recruitment, and retention strategies. In Australia, the sole estimate was calculated 10+ years ago. With several subsequent changes to the eligibility criteria, an updated estimate is required.

STUDY DESIGN AND METHODS

We conducted a cross-sectional national population survey to estimate eligibility for blood donation. Respondents were aged 18+ and resident in Australia. Results were weighted to obtain a representative sample of the population.

RESULTS

Estimated population prevalence of blood donation eligibility for those aged 18-74 was 57.3% (95% CI 55.3-59.3). The remaining 42.7% (95% CI 40.7-44.7) were either temporarily (25.3%, 95% CI 23.5-27.2) or permanently ineligible (17.4%, 95% CI 16.1-18.9). Of those eligible at the time of the survey, that is, with the UK geographic deferral for variant Creutzfeldt-Jakob disease included, (52.9%, 95% CI 50.8-54.9), 14.2% (95% CI 12.3-16.3) reported donating blood within the previous 2 years. Eligibility was higher among men (62.6%, 95% CI 59.6-65.6) than women (52.8%, 95% CI 50.1-55.6). The most common exclusion factor was iron deficiency/anemia within the last 6 months; 3.8% (95% CI 3.2-4.6) of the sample were ineligible due to this factor alone.

DISCUSSION

We estimate that approximately 10.5 million people (57.3% of 18-74-year-olds) are eligible to donate blood in Australia. Only 14.2% of those eligible at the time of survey reported donating blood within the previous 2 years, indicating a large untapped pool of potentially eligible blood donors.

The vasovagal reaction experience among blood donors: A qualitative study of factors that affect donor return

RATIONALE

Blood collection agencies face ongoing challenges in retaining voluntary donors to meet the demand for blood and blood-related products by healthcare services. A known deterrent to continued blood donation is the experience of a vasovagal reaction (VVR). However, there has been little research into donors' experiences of these reactions and the factors that influence their decision to return, which is essential information to inform strategies to improve donor return.

OBJECTIVE

The aim of this paper was to explore blood donor views and experiences of a VVR, with a particular interest in how the reaction influenced their return behaviour, using the Transactional Model of Stress and Coping.

METHODS

We conducted 34 semi-structured in-depth interviews between February and April 2018 with a sample of Australian donors who had experienced a VVR in the last seven days. Transcripts were analysed using the Framework Method.

RESULTS

The VVR elicited various emotional responses, which appeared to be influenced by social support, being aware of the possibility of experiencing a VVR, or the donation outcome. In turn, the VVR experience affected intentions to return, with those who reported more positive experiences expressing stronger intentions. Further, donors felt more likely to return if they perceived their risk of a recurrent event as low and if they were able to identify appropriate problem and emotion-focused coping strategies.

CONCLUSION

This article provides novel insights into possible ways to encourage blood donor return following a VVR.

The effects of text messaging for promoting the retention of the first-time blood donors, a randomized controlled study (TEXT study)

BACKGROUND

Donor recruiting remains a challenging process to obtain sufficient blood product supply worldwide. This was a randomized controlled trial aimed to evaluate the efficacy of text messaging for promoting the retention of first-time blood donors.

STUDY DESIGN AND METHODS

Participants enrolled were 18 years of age or older who were first-time blood donors and able to understand text messages. Participants were randomized in a 1:1 ratio (text group vs control group). Only participants who were allocated in the "text group" received a text message once their blood product was dispatched from the transfusion service. The content of the text message was "We would like to inform you that your blood has been used for patients on the date (DD/MM/YY)." The primary outcome of the study was the rate of returning at 9 months after the first donation.

RESULTS

In an intention-to-treat analysis, 1270 participants were allocated to the text group and 1270 participants to the control group. The primary outcome occurred in 199 in the text group (22.4 per 100 donor-years) and 152 in the control group (16.9 per 100 donor-years). The incidence rate ratio was 1.31 (95% confidence interval, 1.06-1.63; P = .005). The number needed to treat was 22. The median time to return for blood donation was 112 days (interquartile range [IQR], 98-146) in the text group and 113 days (IQR, 97-144) in the control group.

CONCLUSION

Among first-time blood donors, text messaging after blood product being dispatched is an effective and simple intervention to increase the retention rate for subsequent donations.

Attitudes and willingness to donate blood among gay and bisexual men in Australia

BACKGROUND

Men who have sex with men in Australia are currently ineligible to donate blood (are "deferred") for 12 months since last oral or anal sexual contact with another man. In Australia and overseas, there has been limited research on attitudes and perceptions related to blood donation in this population.

STUDY DESIGN AND METHODS

Questions on blood donation histories and attitudes toward the deferral policy were included in the questionnaire of an online prospective cohort of gay and bisexual men (GBM) living in Australia.

RESULTS

In 2018, 1595 GBM responded to the survey. In this sample, 28.7% reported previously donating blood. Among the remaining men who had never donated blood, 64.5% expressed an interest in doing so. Nearly all men indicated they were not willing to abstain from sex with another man for 12 months in order to donate, and the vast majority believed the rule was unfair, too strict, and homophobic. Three-quarters (77.7%) said that if the policy changed, they would likely donate blood. Age and openness about one's sexuality were independently associated with one's willingness to donate blood in the absence of the deferral.

CONCLUSION

There was a high level of willingness and desire to donate blood among GBM. However, rather than abstaining from sex in order to donate, many men comply with the deferral policy and do not donate. A less conservative deferral policy may increase donations from GBM.

Blood donation amongst people who inject drugs in Australia: research supporting policy change

BACKGROUND AND OBJECTIVES

Until recently, people in Australia with a history of injection drug use (IDU) were deferred indefinitely from donating blood. Knowledge gaps regarding policy non-compliance and the prevalence of blood donation practices amongst people who inject drugs (PWID) precluded changes to this policy. We sought to address these gaps and to estimate the additional risk to Australia's blood supply associated with changing the indefinite deferral policy to 1 or 5 years since last injecting episode.

MATERIALS AND METHODS

Data on blood donation amongst PWID were collected from 1853 interviews across two Australian studies of PWID conducted during 2015/16. Mathematical modelling was used to estimate the additional risk of hepatitis C (HCV)-infected window period collections as a result of changing the deferral policy.

RESULTS

A very few (2-4%) study participants reported ever donating blood after ≥1 IDU episode. Changing the deferral policy from indefinite to 1 or 5 years was estimated to result in an additional 0·00000070 (95%CI: 0·00000033-0·00000165) or 0·00000020 (95%CI: 0·00000008-0·00000041) HCV-positive window period collections per year, respectively.

CONCLUSION

Changing Australia's indefinite deferral period to 1 or 5 years since last injecting episode poses a negligible increase in the risk of HCV-infected window period collections from blood donors with a history of IDU. Our results informed a successful submission to the Australian regulator to change the deferral period from indefinite to 5 years since last injecting episode, a policy which came into effect in September 2018.

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.

Translation strategies, contradiction, and the theory of social representations: Why discussing needles may improve blood donor retention

Retaining blood donors is a cost-effective way of ensuring a safe blood supply, yet despite the plethora of research, only 5.1% of the eligible population in Australia donate blood and 40% of these do not make a second donation. We offer an alternative to traditional approaches by conceptualizing blood donation within social representations theory as socially derived symbolic knowledge with a specific focus on cognitive polyphasia and Guimelli's (1998) normative and functional dimensions. An online survey, completed by 703 residents from NSW Australia, comprised a blood donation word association task, Likert-style questions constructed from previous word association data and contextualized blood donation statements. Individual difference scaling analysis revealed all donor groups (including non-donors) associated blood donation with a few central, albeit contradictory ideas/beliefs. Exploratory factor analysis and confirmatory factor analysis performed on a split data set of the Likert-style items reiterated this finding. Interpreted through Guimelli's dichotomy, all donor groups were aware of these contradictory normative and functional ideas/beliefs but when explicitly asked, it was the functional aspect that differentiated the groups. We argue the key to retaining donors is understanding the interdependence between how blood donation is socially understood at the societal level of discourse and donor behaviour. Translational strategies for recruitment and retention are discussed.

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.

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.