Fear of donation-related stimuli is reported across different levels of donation experience

A virtual reality paradigm simulating blood donation serves as a platform to test interventions to promote donation

Effective interventions that support blood donor retention are needed. Yet, integrating an intervention into the time-pressed and operationally sensitive context of a blood donation center requires justification for disruptions to an optimized process. This research provides evidence that virtual reality (VR) paradigms can serve as a research environment in which interventions can be tested prior to being delivered in blood donation centers. Study 1 (N = 48) demonstrated that 360°-video VR blood donation environments elicit a similar profile of emotional experience to a live donor center. Presence and immersion were high, and cybersickness symptoms low. Study 2 (N = 134) was an experiment deploying the 360°-video VR environments to test the impact of an intervention on emotional experience and intentions to donate. Participants in the intervention condition who engaged in a suite of tasks drawn from the process model of emotion regulation (including attentional deployment, positive reappraisal, and response modulation) reported more positive emotion than participants in a control condition, which in turn increased intentions to donate blood. By showing the promise for benefitting donor experience via a relatively low-cost and low-resource methodology, this research supports the use of VR paradigms to trial interventions prior to deployment in operationally-context field settings.

The use of mixed reality technology within the donor collection experience

BACKGROUND

Mixed reality (MR), a form of virtual reality (VR), provides an immersive and interactive experience for the user. Given VR's benefits in patients undergoing needle insertion procedures, MR's usability, impact on anxiety, and safety were evaluated in the blood donation setting.

STUDY DESIGN AND METHODS

Whole blood donors ≥18 years old (yo) were enrolled at two blood centers and provided a MR headset with independently developed software to wear during blood donation. Pre- and post-donation questionnaires were conducted, and reaction data were reviewed. A post-study questionnaire was also completed by staff who assisted donors with MR. Descriptive statistics, bivariate analyses, and multinomial logistic regression were performed, and p values determined statistical significance between variables.

RESULTS

A total of 282 donors completed the study. 84% wanted to try MR because it seemed fun/different/cool/interesting, and most staff (69%) and donors (68%) found MR easy to use. Baseline subjective anxiety, reported by 50.3% (more often in females, first-time donors, and donors <20 yo), was reduced by MR in 68.4% of donors, and there was a 3.6 times higher odds of anxiety reduction with MR. 54% of donors with baseline anxiety would use MR again with the highest future interest in young donors. Donor reactions while using MR were mild and included pre-faint reactions and hematomas.

CONCLUSION

This study demonstrates the potential of MR in reducing donor anxiety, its feasibility during blood donation, and its safety in blood donors. MR is an innovative technology that holds promise to increase donor engagement, satisfaction, and retention.

Pain associated with intravascular instrumentation reduces orthostatic tolerance and predisposes to vasovagal reactions in healthy young adults without needle phobia: a randomised controlled study

PURPOSE

Vasovagal syncope (VVS), or fainting, is frequently triggered by pain, fear, or emotional distress, especially with blood-injection-injury stimuli. We aimed to examine the impact of intravenous (IV) instrumentation on orthostatic tolerance (OT; fainting susceptibility) in healthy young adults. We hypothesized that pain associated with IV procedures would reduce OT.

METHODS

In this randomised, double-blind, placebo-controlled, cross-over study, participants (N = 23; 14 women; age 24.2 ± 4.4 years) underwent head-up tilt with combined lower body negative pressure to presyncope on three separate days: (1) IV cannulation with local anaesthetic cream (EMLA) (IV + EMLA); (2) IV cannulation with placebo cream (IV + Placebo); (3) sham IV cannulation with local anaesthetic cream (Sham + EMLA). Participants rated pain associated with IV procedures on a 1-5 scale. Cardiovascular (finger plethysmography and electrocardiogram; Finometer Pro), and forearm vascular resistance (FVR; brachial Doppler) responses were recorded continuously and non-invasively.

RESULTS

Compared to Sham + EMLA (27.8 ± 2.4 min), OT was reduced in IV + Placebo (23.0 ± 2.8 min; p = 0.026), but not in IV + EMLA (26.2 ± 2.2 min; p = 0.185). Pain was increased in IV + Placebo (2.8 ± 0.2) compared to IV + EMLA (2.0 ± 2.2; p = 0.002) and Sham + EMLA (1.1 ± 0.1; p < 0.001). Orthostatic heart rate responses were lower in IV + Placebo (84.4 ± 3.1 bpm) than IV + EMLA (87.3 ± 3.1 bpm; p = 0.007) and Sham + EMLA (87.7 ± 3.1 bpm; p = 0.001). Maximal FVR responses were reduced in IV + Placebo (+ 140.7 ± 19.0%) compared to IV + EMLA (+ 221.2 ± 25.9%; p < 0.001) and Sham + EMLA (+ 190.6 ± 17.0%; p = 0.017).

CONCLUSIONS

Pain plays a key role in predisposing to VVS following venipuncture, and our data suggest this effect is mediated through reduced capacity to achieve maximal sympathetic activation during orthostatic stress. Topical anaesthetics, such as EMLA, may reduce the frequency and severity of VVS during procedures requiring needles and intravascular instrumentation.

Fear is associated with attrition of first-time whole blood donors: A longitudinal examination of donor confidence and attitude as potential mediators

BACKGROUND

Elevated fear and anxiety regarding donation-related stimuli (e.g., needles, pain, blood, fainting) has been associated with reduced blood donor recruitment and retention. The present longitudinal study tests the notion that this inverse relationship may be accounted for by lower donation confidence and more negative donation attitudes among fearful first-time donors.

STUDY DESIGN AND METHODS

In a sample of 1479 first-time whole blood donors [67.9% female; mean age = 19.3 (standard deviation (SD) = 2.5) years], path analyses were conducted to examine relationships among donor ratings of fear of blood draw and donation anxiety obtained approximately 1 week after donation, donation confidence and attitudes assessed approximately 6 weeks later, and donation attempts over the 14 months following the original donation.

RESULTS

Path analyses indicated that both fear of blood draws and donation anxiety were associated with fewer attempted donations, and that these effects were indirectly mediated by a combination of lower donor confidence and more negative donation attitudes.

CONCLUSION

Because retention of new blood donors is essential to maintain a healthy blood supply, the results of the present study suggest that first-time donors should be assessed for fear and anxiety so that appropriate strategies can be provided to address their concerns, bolster their confidence and attitudes, and ultimately promote their long-term retention.

Improving the donation experience and reducing venipuncture pain by addressing fears among whole-blood and plasma donors

BACKGROUND

Fear of blood donation is implicated in vasovagal reactions, donor recruitment, and retention. This study examined the extent to which fear among donors is associated with various donor outcomes in an Australian sample, and whether fear can be addressed on-site to reduce adverse reactions and improve the donation experience.

STUDY DESIGN AND METHODS

Six hundred and sixty-four donors (age M = 33.4, SD = 12.7; 55% female) participated in a two-center, pragmatic, parallel group, individually randomized controlled trial. Following donor registration and consent, whole-blood (n = 539) and plasma (n = 125) donors were assigned to one of four Conditions: control; fear assessment; fear assessment + brochure; fear assessment + brochure + tailored conversation focused on any self-reported fear and coping strategies. Post-donation questionnaires assessed the donors' experience including positive support, donor self-efficacy, anxiety, fear, venipuncture pain, and vasovagal reactions.

RESULTS

Fear among donors predicted higher venipuncture pain, post-donation anxiety, and vasovagal reactions and remained significant after controlling for other established predictors (i.e., total estimated blood volume, age, sex, and donation experience). Mediational analyses showed that exposure to brochures (with or without the tailored conversation) was associated with less pain, with this effect mediated by donor perceptions of more positive support. Venipuncture pain was also associated with vasovagal reactions, reduced likelihood of return within 6 months, and less satisfaction with the donation experience.

CONCLUSION

The current results underline the importance of interventions to address fear among both whole-blood and plasma donors to secure the safety and well-being of donors and the blood supply.

Donation related fears predict vasovagal reactions and donor attrition among high school donors

BACKGROUND

This longitudinal study of high school whole blood donors examined relationships among donation-related fears assessed prior to donation, vasovagal reactions to donation, and the proportion of donors who attempted another donation over the subsequent 60 weeks.

STUDY DESIGN AND METHODS

Data regarding vasovagal reactions and attempted donation were obtained from donor records of 530 female and 342 male high school donors who answered questions about five types of fear (ie, of blood draw, needles, seeing blood, feeling pain, or fainting) prior to their index donation.

RESULTS

Each type of fear was associated with an increased risk of vasovagal reactions (all P < .001) and a smaller percentage of attempted donations was seen among those who reported at least one type of fear (53%) as compared to those who did not report any fear (62.1%); P = .022; β = -0.374, OR = 0.69; 95% CI, 0.50-0.94. Path analyses of the relationships among fear, vasovagal reaction, and attempted donation revealed significant indirect effects for each type of fear. Specifically, donors who reported fear were at increased odds of experiencing a vasovagal reaction, which, in turn, was associated with decreased odds of attempting a repeat donation.

CONCLUSION

Donation-related fears are associated with reduced donor return rates, and this effect is mediated through an increased risk for vasovagal reactions. For both practical and ethical reasons, blood collectors are encouraged to identify and intervene with fearful donors to reduce the likelihood of negative donation-related symptoms and enhance donor retention.

Joint effects of risk factors on adverse events associated with adult blood donations

The process for blood donation is considered safe, but some adverse events have been reported. Risk factors for adverse events were assessed in this study.A retrospective case-control study was conducted to investigate the risk factors for adverse events after blood donation between 2010 and 2013. Variables such as gender, age, body mass index (BMI), donation status, donation volume, donation site, pre-donation systolic blood pressure (SBP), and pre-donation diastolic blood pressure were compared between donors with and without adverse events. Multiple logistic regression analysis was performed to assess the joint effects of age, gender, and donation status on adverse events.The incidence of adverse events among adult blood donations was 1287/1,253,678 (0.1%). On multivariate logistic regression analysis, blood donors aged <35 years (odds ratio [OR], 2.99, 95% confidence interval [CI], 2.57-3.48), of female gender (OR, 3.30, 95% CI, 2.62-4.15), and with first-time donor status (OR, 6.40, 95% CI, 5.17-7.93), donation of 500 mL (OR, 2.22, 95% CI, 1.83-2.69), predonation SBP <124 mm Hg (OR, 1.25, 95% CI,1.05-1.48) and BMI <24 kg/m (OR, 1.67, 95% CI, 1.42-1.96) were associated with increased likelihood of adverse event. Further analysis with joint effects method revealed that first-time female donors aged <35 years are associated with the highest odds of adverse events when compared with repeat male donors aged ≧35 years (OR, 100.57, 95% CI, 48.45-208.75).The findings of our study should prove useful in identifying donors at risk and planning appropriate strategies for the prevention of adverse effects.

Estimating the risk of blood donation fainting for self versus others: the moderating effect of fear

BACKGROUND

People overestimate the likelihood that blood donors will experience faint and prefaint reactions, particularly if they are themselves fearful of having blood drawn. This study investigated the influence of making a risk assessment for oneself versus others, and examined whether providing information about the low base rates of reactions affected donation attitude, anxiety, and intention.

STUDY DESIGN AND METHODS

An anonymous online survey was completed by 3702 individuals (53.9% female; mean age, 36.9 years; standard deviation, 12.1 years; range, 18-84) that included questions about fear of having blood drawn and estimation of the risk of donation-related faint and prefaint symptoms for themselves and others. A random one-half of the respondents received accurate information about the proportion of whole blood donors who experience such reactions before all participants completed questions concerning their donation attitude, anxiety, and intention.

RESULTS

Estimates of both faint and prefaint reactions revealed a pattern of lower perceived risk for self versus others among individuals with low fear, and higher perceived risk for self versus others among those with high fear. Provision of accurate information about risk of reactions was associated with more positive donation attitudes (F[1, 3692] = 8.182, p = 0.004) and intentions (F[1, 3692] = 10.137, p = 0.001) but did not significantly affect anxiety.

CONCLUSION

Donation-related fear is associated with inflated expectancies of adverse events, especially regarding oneself. Such fear may be particularly important to address, as it has both a direct and indirect negative effect on donor retention.

Caregivers and community perceptions of blood transfusion for children with severe anaemia in Uganda

OBJECTIVE

To describe local perceptions of blood transfusion for children with severe anaemia in Uganda.

BACKGROUND

Blood transfusion is a common emergency treatment for children with severe anaemia and saves millions of lives of African children. However, the perceptions of transfusion recipients have not been well studied. A better understanding of the perceived risk may improve transfusion care.

METHODS

A qualitative study based on 16 in-depth interviews of caregivers of transfused children, and six focus group discussions with community members was conducted in three regions of Uganda between October and November 2017.

RESULTS

Caregivers of children and community members held blood transfusion in high regard and valued it as life-saving. However, there were widespread perceived transfusion risks, including: Human immunodeficiency virus (HIV) transmission, too rapid blood infusion and blood incompatibility. Other concerns were: fatality, changes in behaviour, donor blood being 'too strong' and use of animal blood. In contrast, recent transfusion, older age, knowledge of HIV screening of blood for transfusion, faith in God and having a critically ill child were associated with less fear about transfusion. Respondents also emphasised challenges to transfusion services access including distance to hospitals, scarcity of blood and health workers' attitudes.

CONCLUSION

Perceptions of the community and caregivers of transfused children in Uganda about blood transfusion were complex: transfusion is considered life-saving but there were strong perceived transfusion risks of HIV transmission and blood incompatibility. Addressing community perceptions and facilitating access to blood transfusion represent important strategies to improve paediatric transfusion care.