Predicting donation among an Irish sample of donors and nondonors: extending the theory of planned behavior

BACKGROUND: Research has indicated the ability of the Theory of Planned Behavior to predict blood donation. This study tested an extended version of the Theory of Planned Behavior (attitude, subjective norm, and perceived behavioral control with the addition of past behavior, moral norm, self-identity, and anticipated regret) in predicting donation intention and behavior among donors and nondonors and if forming implementation intentions improved attendance at a mobile blood donation clinic. STUDY DESIGN AND METHODS: This study used a cross-sectional follow-up design. A questionnaire was distributed to 600 staff and students at the National University of Ireland, Galway, before the arrival of a mobile clinic to Galway city. Half of these participants were invited to make implementation intentions specifying how, where, and when they planned to donate blood. A second questionnaire measuring reported attendance at the clinic was distributed 2 weeks after the first questionnaire. RESULTS: A total of 172 eligible donors returned questionnaires (29% response rate). The extended Theory of Planned Behavior accounted for 51 percent of the variance in intention to donate in the future: anticipated regret, attitude, perceived behavioral control, self-identity, and subjective norm significantly predicted intention. Donors differed from nondonors: they possessed more favorable attitudes toward blood donation, had a greater sense of donor identity, and believed more strongly in a moral obligation to donate blood than nondonors. Those who made implementation intentions were no more likely to donate that those who had not. CONCLUSION: Owing to the different factors influencing the donation decision for donors and nondonors, separate strategies to promote donation should be designed for these subgroups, targeting the elements most pertinent to each group.     

A Web‐based approach to blood donor preparation

BACKGROUND: Written and video approaches to donor education have been shown to enhance donation attitudes and intentions to give blood, particularly when the information provides specific coping suggestions for donation‐related concerns. This study extends this work by comparing Web‐based approaches to donor preparation among donors and nondonors. STUDY DESIGN AND METHODS: Young adults (62% female; mean [±SD] age, 19.3 [±1.5] years; mean [range] number of prior blood donations, 1.1 [0‐26]; 60% nondonors) were randomly assigned to view 1) a study Web site designed to address common blood donor concerns and suggest specific coping strategies (n = 238), 2) a standard blood center Web site (n = 233), or 3) a control Web site where participants viewed videos of their choice (n = 202). Measures of donation attitude, anxiety, confidence, intention, anticipated regret, and moral norm were completed before and after the intervention. RESULTS: Among nondonors, the study Web site produced greater changes in donation attitude, confidence, intention, and anticipated regret relative to both the standard and the control Web sites, but only differed significantly from the control Web site for moral norm and anxiety. Among donors, the study Web site produced greater changes in donation confidence and anticipated regret relative to both the standard and the control Web sites, but only differed significantly from the control Web site for donation attitude, anxiety, intention, and moral norm. CONCLUSION: Web‐based donor preparation materials may provide a cost‐effective way to enhance donation intentions and encourage donation behavior.     

A path analysis of intention to redonate among experienced blood donors: an extension of the theory of planned behavior

BACKGROUND: The need for blood products is constant and unremitting, yet only a small percentage of eligible individuals answer the appeal to donate. Further, most new donors never return to provide a repeat donation. The ongoing need to attract and retain new donors has led to the examination of psychosocial factors that may predict the likelihood of blood donation behavior. By use of regression techniques, prior studies have established that elements of the Theory of Planned Behavior (e.g., attitude, subjective norm, personal moral norm, and perceived control or self-efficacy) can predict intention to donate among nondonors. STUDY DESIGN AND METHODS: Path analysis was used to further examine the utility of the Theory of Planned Behavior in predicting donation intention in a sample of 227 experienced donors who completed an online survey. Experiential measures relating to previous donations, including the experience of vasovagal reactions and overall donor satisfaction, were added to the model. RESULTS: The final model, which provided an excellent fit to the data, characterized 1) three direct pathways from attitude, subjective norm, and self-efficacy to donation intention and 2) four indirect pathways, wherein self-efficacy, personal moral norm, vasovagal reactions, and overall donor satisfaction influence donation intention through attitude. In total, 65 percent of the variance in donation intention and 50 percent of the variance in attitude is accounted for in this model. CONCLUSION: The Theory of Planned Behavior can be used to predict donation intentions among experienced donors. Further, the model's predictive utility is improved by considering the influence of previous donation experiences on donor attitudes.     

Why don’t young people volunteer to give blood? An investigation of the correlates of donation intentions among young nondonors

BACKGROUND: In the past decade, the number of blood donors has steadily declined in the Netherlands, and young adults are underrepresented among registered donors. An understanding of the correlates of donation intentions among nondonors could facilitate targeting psychological prerequisites of donation decisions in recruitment campaigns. STUDY DESIGN AND METHODS. A cross-sectional study with self-administered questionnaires based on an extension of the Theory of Planned Behavior (TPB; a social cognition model to study the determinants of volitional behavior) was conducted to assess potential cognitive determinants of willingness to donate blood in a student sample. A response rate of 50.5 percent yielded a sample of 311. RESULTS: Just over 7 percent of participants were registered blood donors but most (61.7%) had never seriously considered becoming donors. Self-efficacy (confidence in performing the behavior), attitude (the overall evaluation of the behavior), and personal moral norm (the perceived personal responsibility to perform the behavior) regarding blood donation were the most important correlates of the intention to become a blood donor. In total, 43 percent of the variance in the intentions toward blood donation could be explained by a TPB-based model. CONCLUSION: Among students, determinants of the intention to become a blood donor include self-efficacy, attitude, personal moral norm regarding blood donation, and subjective norm (perceived social support). Future research could establish whether campaigns targeting these psychological prerequisites would be more effective than current strategies.     

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.     

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

BACKGROUND: This study investigates the influence of different variables from the theory of planned behavior (TPB) on intention within multiple donation categories, covering the entire range of lifetime number of donations (LND). Does the same set of variables predict intention equally strong throughout the donor career? STUDY DESIGN AND METHODS: Measures of intention, self‐efficacy, cognitive and affective attitude, and subjective and moral norms were assessed within a sample of 11,480 whole blood donors. Donors were categorized into 65 donation classes using their LND; for example, all donors with one donation (n = 483) in the first donation class, all donors with two donations (n = 447) in the second donation class, and so on. For each donation class, separately for men and women, linear multiple regression models for intention were fitted using self‐efficacy, cognitive attitude, affective attitude, subjective norm, and moral norm as predictor variables. RESULTS: During all stages of the donor career, self‐efficacy is the main predictor of intention, with a relatively constant beta (β = 0.64, p < 0.001). Cognitive attitude (β = 0.11, p < 0.001) and moral norm (β = 0.10, p < 0.001) contributed marginally to the prediction. Several sex effects were observed; self‐efficacy is a stronger predictor of intention in women, whereas subjective norm predicts intention in men only. CONCLUSION: Regardless of the number of lifetime donations, the same set of TPB variables, both in composition and in relative strength, predicts intention. A feeling of self‐efficacy remains equally important for all donors. It is worthwhile to study whether directed intervention strategies are necessary to target self‐efficacy within donor groups with different levels of donation experience.     

The role of altruistic behavior, empathetic concern, and social responsibility motivation in blood donation behavior

BACKGROUND: Blood donation can be described as a prosocial behavior, and donors often cite prosocial reasons such as altruism, empathy, or social responsibility for their willingness to donate. Previous studies have not quantitatively evaluated these characteristics in donors or examined how they relate to donation frequency.
STUDY DESIGN AND METHODS: As part of a donor motivation study, 12,064 current and lapsed donors answered questions used to create an altruistic behavior, empathetic concern, and social responsibility motivation score for each donor. Analysis of variance was used to compare mean scores by demographics and donor status and to determine the influence of each variable on the mean number of donations in the past 5 years.
RESULTS: The mean score for each prosocial characteristic appeared high, with lower scores in male and younger donors. Higher altruistic behavior and social responsibility motivation scores were associated with increased past donation frequency, but the effects were minor. Empathetic concern was not associated with prior donation. The largest differences in prior donations were by age and donor status, with older and current donors having given more frequently.
CONCLUSION: Most blood donors appear to have high levels of the primary prosocial characteristics (altruism, empathy, and social responsibility) commonly thought to be the main motivators for donation, but these factors do not appear to be the ones most strongly related to donation frequency. Traditional donor appeals based on these characteristics may need to be supplemented by approaches that address practical concerns like convenience, community safety, or personal benefit.     

Re-donation intentions among experienced blood donors: Does gender make a difference?

Path analysis was used to examine sex differences in motivation for repeat donation among experienced blood donors. Results confirm the importance of constructs from the Theory of Planned Behavior (e.g., donation attitude, subjective norm, personal moral norm, and donation self-efficacy) and of prior donation experience (e.g., vasovagal symptoms, overall satisfaction) as significant predictors of donation intention. Importantly, the findings also indicate that a consideration of sex differences in donor motivations results in a better prediction model and suggests a framework of possible avenues where interventions could be expected to improve donor return rates.     

Enhancing blood donation intentions using multimedia donor education materials

BACKGROUND: Prior research has shown that education materials that directly address prospective donor concerns and provide specific coping suggestions are particularly effective at enhancing donation attitudes and intentions to give blood. This study compared the effect of donor coping materials, provided in written and audiovisual formats, as potential tools to enhance recruitment of prospective blood donors. The role of initial attitudes toward blood donation on responses to these materials was also considered. STUDY DESIGN AND METHODS: Young adults (62% female; mean [SD] age = 19.1 [1.4]; mean [range] prior blood donations = 1.32 [0‐13]) were randomly assigned to 1) read a brochure addressing common blood donor concerns and suggesting specific coping strategies, 2) view a video addressing blood donor concerns and illustrating coping techniques, 3) read the brochure and view the video, or 4) read a control brochure on healthy eating and exercise. Measures of blood donation attitudes, anxiety, confidence, and intentions to give blood were completed before and after the intervention. RESULTS: Relative to the control brochure, all the intervention groups showed larger reductions in anxiety, more positive changes in attitude, and greater increases in donation confidence and intentions. The combination of the brochure and video outperformed either intervention alone in further improving donation attitudes among participants with high initial donation attitudes. CONCLUSION: Blood donation coping materials, presented in either written or audiovisual formats, significantly enhance willingness to donate blood among young adults regardless of their initial attitudes toward blood donation.     

Are lapsed donors willing to resume blood donation,and what determines their motivation to do so?

BACKGROUND: This study investigated the possibility of rerecruiting lapsed blood donors. Reasons for donation cessation, motivation to restart donation, and modifiable components of donation motivation were examined. We distinguished between lapsed donors who had passively withdrawn by merely not responding to donation invitations and donors who had contacted the blood bank to actively withdraw. STUDY DESIGN AND METHODS: A cross‐sectional survey was sent to 400 actively lapsed donors and to 400 passively lapsed donors, measuring intention to restart donation and psychological correlates of restart intention. The data were analyzed using multiple regression analyses. RESULTS: The response rate among actively lapsed donors was higher than among passively lapsed donors (37% vs. 25%). Actively lapsed donors typically ceased donating because of physical reactions, while passively lapsed donors quit because of a busy lifestyle. Nonetheless, 51% of actively lapsed responders and 80% of passively lapsed responders were willing to restart donations. Multiple regression analysis showed that, for passively lapsed donors, cognitive attitude was the strongest correlate of intention to donate in the future (β = 0.605, p < 0.001), with affective attitude (β = 0.239, p < 0.05) and self‐efficacy (β = 0.266, p < 0.001) explaining useful proportions of the variance as well. For actively lapsed donors, cognitive attitude was also the strongest correlate of intention (β = 0.601, p < 0.001), with affective attitude (β = 0.345, p < 0.001) and moral norm (β = ?0.118, p < 0.05) explaining smaller proportions of the variance. CONCLUSION: The majority of lapsed donors indicated a moderate to high intention to restart donations. Interventions focusing on boosting cognitive and affective attitudes and self‐efficacy could further raise such intentions.     

Determinants of repeated blood donation among new and experienced blood donors

BACKGROUND: The maintenance of a safe level of blood supply is provided by a small number of volunteers, and their retention is difficult. The aim of this study was to identify factors predicting repeated blood donation among experienced and new donors. STUDY DESIGN AND METHODS: A random sample of 2,231 donors (2,070 experienced and 161 new) completed a questionnaire assessing psychosocial factors as defined by the most prominent social cognitive theories. Six months later, an objective measure of frequency of registrations to give blood was obtained from the database of the local official agency for blood donation. RESULTS: Logistic regression analysis indicated that for experienced donors, the predictors were intention, perceived control, anticipated regret, moral norm, age, and frequency of blood donation in the past. For new donors, intention and age were the only determinants of behavior. Important differences in the determinants of intention were also noted between experienced and new donors. CONCLUSION: In summary, the results of this study support the idea that distinct promotion strategies should be adopted to increase repeated blood donation among experienced versus new donors.     

An examination of the predictors of blood donors' intentions to donate during two phases of an avian influenza outbreak

BACKGROUND: Data from prior health scares suggest that an avian influenza outbreak will impact on people's intention to donate blood; however, research exploring this is scarce. Using an augmented theory of planned behavior (TPB), incorporating threat perceptions alongside the rational decision‐making components of the TPB, the current study sought to identify predictors of blood donors' intentions to donate during two phases of an avian influenza outbreak. STUDY DESIGN AND METHODS: Blood donors (n = 172) completed an on‐line survey assessing the standard TPB predictors as well as measures of threat perceptions from the health belief model (i.e., perceived susceptibility and severity). Path analyses examined the utility of the augmented TPB to predict donors' intentions to donate during a low‐ and high‐risk phase of an avian influenza outbreak. RESULTS: In both phases, the model provided a good fit to the data explaining 69% (low risk) and 72% (high risk) of the variance in intentions. Attitude, subjective norm, and perceived susceptibility significantly predicted donor intentions in both phases. Within the low‐risk phase, sex was an additional significant predictor of intention, while in the high‐risk phase, perceived behavioral control was significantly related to intentions. CONCLUSIONS: An augmented TPB model can be used to predict donors' intentions to donate blood in a low‐risk and a high‐risk phase of an outbreak of avian influenza. As such, the results provide important insights into donors' decision‐making that can be used by blood agencies to maintain the blood supply in the context of an avian influenza outbreak.     

role of altruistic behavior, empathetic concern, and social responsibility motivation in blood donation behavior.

BACKGROUND: Blood donation can be described as a prosocial behavior, and donors often cite prosocial reasons such as altruism, empathy, or social responsibility for their willingness to donate. Previous studies have not quantitatively evaluated these characteristics in donors or examined how they relate to donation frequency. STUDY DESIGN AND METHODS: As part of a donor motivation study, 12,064 current and lapsed donors answered questions used to create an altruistic behavior, empathetic concern, and social responsibility motivation score for each donor. Analysis of variance was used to compare mean scores by demographics and donor status and to determine the influence of each variable on the mean number of donations in the past 5 years. RESULTS: The mean score for each prosocial characteristic appeared high, with lower scores in male and younger donors. Higher altruistic behavior and social responsibility motivation scores were associated with increased past donation frequency, but the effects were minor. Empathetic concern was not associated with prior donation. The largest differences in prior donations were by age and donor status, with older and current donors having given more frequently. CONCLUSION: Most blood donors appear to have high levels of the primary prosocial characteristics (altruism, empathy, and social responsibility) commonly thought to be the main motivators for donation, but these factors do not appear to be the ones most strongly related to donation frequency. Traditional donor appeals based on these characteristics may need to be supplemented by approaches that address practical concerns like convenience, community safety, or personal benefit.     

Age-related donor return patterns among first-time blood donors in the United States

BACKGROUND: Committed repeat donors are vital to the continued success of blood collections, yet the effect of age of first-time (FT) donation on return behavior is poorly described. Sixteen-year-old donors are increasingly allowed to donate and have the highest rates of adverse events, which negatively impacts return behavior.
STUDY DESIGN AND METHODS: Annual cohorts of allogeneic FT donors from 2005 and 2006 were selected within the American Red Cross system and followed for 25 and 13 months, respectively. Return and total yield rates among different age groups were compared.
RESULTS: A total of 2.3 million FT donors from 2005 and 2006 gave 4.2 million donations during the study. Sixteen- to 19-year old FT donors made up 41% of the FT donor base in 2005 and 16-, 17-, 18-, and 19-year-olds, respectively, had initial return rates of 62, 52, 35, and 28% and yield rates of 2.0, 1.76, 1.51, and 1.41 over 13 months. Multivariate analysis of FT yield rates shows that younger (16 and 17 years) and older (50+ years) donors, males, blood group O donors, and those without any initial adverse reaction are most likely to return. Increasing severity of donor adverse reactions correlated with a reduction in yield and return rates.
CONCLUSION: FT 16-year-old donors had the highest return and yield rates despite the negative impact of increased adverse event rates. Donation at young age is critical to building a cadre of committed repeat donors but donor reactions must be addressed to ensure the donors' well-being and to sustain return behavior.     

The safety of preoperative autologous blood donation in the nonhospital setting

The increasing use of preoperative autologous donation (PAD) of blood has led to more frequent donation in settings outside of hospitals, despite concerns that persons making PADs may face increased risks of postdonation reaction. Analysis was conducted of 5660 PADs made at 25 different blood centers, to determine the risks of PAD in nonhospital settings and to search for predictors of severe reactions. Sixteen percent (886) of the donations studied were by persons who did not meet all usual homologous donor criteria. The most common variances were for cardiovascular disease, including the use of cardiac drugs (416 donors, 41% of those not meeting criteria), history of angina (204, 23%), and history of myocardial infarction (192, 22%). Donation by persons not meeting routine criteria was followed by a higher reaction rate than that by donors without any variance (4.3 vs. 2.7%; p less than 0.0001). An increased likelihood of reaction was associated with donor age less than 17 years, female gender, weight less than 110 pounds, and a history of reaction. Four reactions were graded as severe (transient ischemic attack, 1; angina, 3), and all occurred in donors not meeting all criteria (0.4% of 886 donations). A review of these donors' histories failed to identify distinguishing features from which their severe reactions could have been predicted. This study documents the infrequency of severe reactions after PADs by persons referred to a blood center for donation, even those not meeting routine homologous donor criteria, and quantitates the risk to these donors of a severe reaction.     

Analysis of donor return behavior

BACKGROUND: Efforts to provide a safe, adequate blood supply have been inhibited by persistent shortages attributed to a lack of motivation on the part of the general public and inefficiency in recruiting processes. This study examined whether frequency of donations and/or timing of subsequent donations by first-time donors related to donor demographics. STUDY DESIGN AND METHODS: Characteristics of 879,816 first-time donors making at least one whole-blood donation were analyzed. Cox proportional-hazards regression models evaluated the first 10 return times separately, and a recurrent-event Cox model was applied to simultaneously evaluate the first five returns. RESULTS: The shorter the donation interval between the first two donations, the more likely the donor was to make subsequent donations. The proportion of repeat donors increased with education level. Rate of donation increased with age and education. The recurrent-event Cox regression model showed that Rh-negative donors, older donors, and donors who had completed college had higher donation return rates. CONCLUSION: Time to return for second donation was associated with total number of donations made and with return rate for subsequent returns. Age was the strongest predictor of high donation frequency and early-return rate. Relationships between interdonation interval and the number of future donations may prove useful in understanding return behavior and developing donor recruitment and retention strategies.     

Social support attenuates presyncopal reactions to blood donation

BACKGROUND: The experience of unpleasant blood donation reactions (e.g., dizziness, nausea, and fainting) has been linked to negative attitudes about donation and decreased likelihood of repeat donation. Consequently, interventions to reduce the adverse effects of blood donation are important and likely to increase donor retention. Based on laboratory studies suggesting that social support attenuates both physical and psychological responses to stress, the present study hypothesized that the presence of a supportive person during the donation process may help reduce reactions.
STUDY DESIGN AND METHODS: A final sample of 65 men and women with fewer than three prior donations was randomly assigned to either donate blood as usual or donate with a supportive research assistant. Donors in the support condition were accompanied throughout the donation process by a female research assistant who provided encouragement, made reassuring remarks, and engaged in small talk. Donors in both conditions completed a series of questions to assess anxiety, experience of prefaint reactions, and willingness to provide a future donation.
RESULTS: Compared to standard donation controls, donors in the social support condition reported fewer prefaint reactions (F(1,61) = 9.15, p = 0.004, η²= 0.13) and greater likelihood of donating again within the next year (Z =−1.70, p < 0.05, one-tailed).
CONCLUSION: Relatively novice donors report reduced reactions to blood donation when accompanied by a supportive individual, suggesting that social support may be a simple strategy to enhance the donation experience and possibly increase donor retention.     

Predicting blood donor arrival

BACKGROUND: Keeping waiting time at blood donation short is important for making donation a good experience for the donors and hence to motivate for repeat donations. At the Blood Bank of Oslo, fixed appointments are used, and few donors arrive without appointments. On average, 59 percent of scheduled donors arrive, but day-to-day variations are large. Methods for predicting the number of donors that will arrive on a given day would be valuable in reducing waiting times. STUDY DESIGN AND METHODS: Information about candidate explanatory variables was collected for all appointments made in a 971-day period (179,121 appointments). A logistic regression model for the prediction of blood donor arrival was fitted. RESULTS: Among 18 explanatory variables, the most important were the time from appointment making to appointment date; the contact medium used; the donor age and total number of donations; and the number of no-shows, arrivals, and deferrals during the preceding 2 years. Compared to taking only the average arrival rate into account, prediction intervals were reduced by 43 percent. CONCLUSION: Statistical modeling can provide useful estimates of blood donor arrival, allowing for better planning of donation sessions.