Increasing first‐time blood donation of newly registered donors using implementation intentions and explicit commitment techniques

Paths to improve voluntary blood donation in mixed public/private blood donation systems such as in Lebanon?

BACKGROUND

The World Health Organization advocates for the achievement of 100% voluntary non-remunerated blood donation (VNRD) globally by the year 2020. However, until today, little was known in Lebanon regarding its actual rate or influencing factors, particularly donor motivations and behaviors. Therefore, the aim of this study was to assess the knowledge, attitudes, and practices of blood donors in Lebanon. The ultimate goals were to retain first-time donors, encourage them to become regular ones, and facilitate the transition from replacement donation to VNRD.

MATERIALS AND METHODS

A multi-centric cross-sectional study was carried across the five governorates in Lebanon. A self-administered and structured questionnaire was used in this survey. Results were presented in terms of odds ratios, with statistical significance defined at a P value of 0.05 and a 95% confidence interval. Additionally, a benchmarking analysis of the situation of blood donation in Lebanon was also conducted, identifying several areas for improvement.

RESULTS

A total of 620 blood donors participated in this study, with 21.3% being first-time donors and 78.7% repeat donors. While the latter were primarily motivated by self-esteem, solidarity or returning a favor (89%, 77.9% and 78.1%), the main obstacle for becoming regular donors was a lack of initiative (34.6%). Female donors (9.9% of the total) exhibited better knowledge (OR = 2.20, p = 0.011) and were more inclined to donate voluntarily (OR = 1.52, p = 0.048). Conversely, male donors were more likely to be repeat donors, often through replacement donation (OR = 2.95, p = 0.001).

CONCLUSION

There is a significant disparity between the low rate of voluntary donation in Lebanon (22.2%) and the relatively high proportion of donors with adequate knowledge of the donation process (60.5%). Therefore, urgent action by public authorities, based on the evidence based strategies outlined in this article, is crucial to enhancing the voluntary donation rate in Lebanon.

Specificity, frequency, and intent: Multiple characteristics of adolescents' suicide plan correlate with their history of suicidal behavior

BACKGROUND

Suicide plans (SP) can be a common precipitant to suicidal behavior (SB) during adolescence, and SPs can vary in how specific they are, how frequently they are thought about, and how strongly they are intended to be enacted. To date, we have limited understanding of how discrete SP characteristics (i.e., specificity, frequency, and intent to act) present among adolescents, and whether they relate to SB. In the current study, we investigated SP characteristics and their association with SB history among adolescents who had previously considered suicide.

METHODS

Participants were 142 community-based adolescents (14-19 years; M = 17.6, SD = 1.4) who reported a history of suicidal ideation. Adolescents provided responses pertaining to their SP history, SP characteristics, and SB history, via the Self-Injurious Thoughts and Behaviors Interview-Revised (SITBI-R).

RESULTS

Greater specificity, frequency, and intent were each associated with modestly increased odds of reporting an SB history. The associations between plan specificity and SB history, as well as between frequency of thinking about one's SP and SB history, were mediated by adolescents' intent to act on their SP.

CONCLUSIONS

It may not only be whether, but how, adolescents plan for suicide that relates to their tendency to engage in SB.

Blood donor recruitment in Guangzhou, China, during the 2019 novel coronavirus (COVID-19) epidemic

Background

The coronavirus disease 2019 (COVID‐19) epidemic affected blood collection in Guangzhou, China.

Study Design and Methods

This paper includes three studies. The observational study reported the trends of blood collection during the epidemic in Guangzhou, China. The cross‐sectional survey investigated factors influencing blood donation during the COVID‐19 epidemic, and a self‐administered questionnaire was given to 1584 street whole blood donors (SWBDs) who donated during the epidemic. The randomized controlled trial involved 19 491 SWBDs who donated in 2019 but did not donate during the epidemic. Trial participants were randomly assigned to two intervention groups: Group 1 completed Questionnaire 1, which contained precautionary measures in response to COVID‐19 and other messages about blood donation during the epidemic; Group 2 completed Questionnaire 2, which did not include this information. A control group did not receive any questionnaire.

Results

As measures were implemented, the number of blood donors increased accordingly. Both first‐time and repeat SWBDs perceived the same level of blood need and donated blood because it would save lives. SWBDs who completed Questionnaire 1 expressed a greater intention to donate during the epidemic. Enabling blood donors to perceive a higher level of blood need and a lower level of COVID‐19 infection risk related to blood donation mobilized experienced SWBDs to donate within 3 weeks. Intention‐to‐treat analyses and average‐treatment‐effect‐on‐the‐treated estimations confirmed that Questionnaire 1 could motivate SWBDs to actually donate blood.

Conclusion

Various measures could ease blood shortage during the COVID‐19 epidemic. Administration of Questionnaire 1 could increase blood donations during the epidemic.

Effective methods for reactivating inactive blood donors: a stratified randomised controlled study

BACKGROUND

Recruiting of sufficient numbers of donors of blood products is vital worldwide. In this study we assessed the efficacy and cost-effectiveness of telephone calls and SMS reminders for re-recruitment of inactive blood donors.

METHODS

This single-centre, non-blinded, parallel randomised controlled trial in Guangzhou, China included 11,880 inactive blood donors whose last donation was between January 1 and June 30, 2014. The donors were randomly assigned to one of two intervention groups (telephone call or short message service [SMS] communications) or to a control group without intervention. SMS messages with altruistic appeal were adopted in the SMS group; in addition to altruistic appeal, reasons for deferral of blood donation were also asked in the telephone group. All participants were followed up for 1 year. The primary outcome was re-donation rate, and rates in different groups were compared by intention-to-treat (ITT) analysis and estimation of the average treatment effect on the treated (ATT). Secondary outcomes were the self-reported deterrents. Other outcomes included the re-donation interval, and the incremental cost-effectiveness ratio (ICER) of telephone calls and SMS reminders on re-recruitment.

RESULTS

ITT analysis revealed no significant differences in the re-donation rate among the three groups. ATT estimations indicated that among compliers, telephone calls significantly increased re-donation compared to both SMS reminders and no intervention. Donor return behaviour was positively associated with receiving reminders successfully, being male, older age, and previous donation history. The SMS reminder prompted donors to return sooner than no reminder within 6 months, and according to ICER calculations, SMS reminders were more cost-effective than telephone calls. Donors reported time constraints as the most main causes of self-deferral in the telephone group, and altruistic appeal had a positive effect on these donors.

CONCLUSIONS

Interventions to reactivate inactive blood donors can be effective, with telephone calls prompting more donors to return but at a greater cost than SMS messages. SMS reminder with altruistic appeal can urge donors to re-donate sooner within 6 months than no reminder.

TRIAL REGISTRATION

NCT03366441 (Reactivation of Inactive Blood Donors). Retrospectively registered 4 December 2017.

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.

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.

The association between interval from acceptance to first-time donation, missed first appointment and future donation behaviour

BACKGROUND AND OBJECTIVES

We examined the association of the interval between the date an individual is accepted for blood donation and the date of first donation (IFD-interval, index-to-first-time donation interval) and missed first appointment with future donation behaviour among new donors. These two variables have not been analysed in previous studies of donation behaviour among new donors.

METHODS

Categories were generated for age (18-29 vs 30-65 years), missed-appointment status (no-show vs same-day cancellation) and the IFD-interval [short (≤median time) vs long (>median time)]. Accepted donors (n = 807) were followed for 19 months. Outcome measures were first-appointment attendance rates, return rates among first-time donors and the proportion of experienced donors, defined as those who gave ≥5 donations.

RESULTS

In logistic regression analyses, high no-show rates were significantly associated with decreased likelihood of first-time donation. Long IFD-intervals were significantly associated with decreased likelihood of returning for a second donation among first-time donors. Experienced donors, compared to novice donors, were more likely to be male than female, older than younger and with shorter vs longer IFD-intervals.

CONCLUSIONS

No-show and long IFD-intervals may be behavioural markers of low levels of motivation for making the first donation and for returning for a second donation, respectively.

[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.

The watching-eyes phenomenon and blood donation: Does exposure to pictures of eyes increase blood donation by young adults?

This study examined the effectiveness of exposure to a "watching-eyes image" in increasing blood donation rates among young people, a segment of the population that is particularly underrepresented among blood donors. Participants were 454 first-year university students, each of who was given a blood-donation flyer at the beginning of a lecture. Participants were randomly assigned to one of two conditions depending on whether the flyer they received bore a picture of eyes (experimental condition) or a neutral picture (control condition). We recorded the numbers of participants who promised to give blood and who actually gave blood during the blood drive. Results show that the number of people who gave blood was significantly higher in the experimental condition than in the control condition. These findings provide the first evidence of the effectiveness of the watching-eyes strategy in encouraging young people to give blood. We discuss the processes underlying the "watching-eyes effect" with respect to blood donation.

How to encourage non-donors to be more willing to donate blood? Testing of binding communication based interventions

OBJECTIVES

Our study aims to test the effectiveness of binding communication based interventions (vs classical persuasive communication based ones) inciting non-donors to act in favour of blood donation.

BACKGROUND

The implementation of effective communication interventions represents a major public health issue. Nevertheless, persuasive media campaigns appear to have little effect on behaviours. Even though non-donors hold a positive attitude towards blood donation, they are not inclined to donate. As an alternative to producing behavioural changes, many recent studies have shown the superiority of binding communication over persuasive communication.

METHODS

All participants, non-donors, were randomly assigned to one of four experimental conditions of a 2 (type of communication: persuasive vs binding) × 2 (source credibility: low vs high) factorial design. Then, they were asked to report their intention to donate blood, and their intention to distribute leaflets regarding blood donation.

RESULTS

Binding communication is a more effective strategy for increasing intention towards blood donation compared with persuasive communication, especially when combined with high credibility source.

DISCUSSION

Accordingly this study calls for more consideration of knowledge of social psychology to design effective communication interventions and increase the number of donations.

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.

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.