Predicting blood donation maintenance: the importance of planning future donations.

BACKGROUND: Interventions to retain blood donors need to target the most influential and changeable factors. This study tested antecedents of three successive donation decisions. STUDY DESIGN AND METHODS: Participants were donors who had donated for the first time 1 year previous (n = 1018). Intention to continue donating, vasovagal reactions, deferral, anxiety, and planning failure were measured. Analyses distinguished between 1) those who registered for donation after questionnaire completion, versus those who did not; 2) those who did or did not register for donation a second time after questionnaire completion; and 3) those who did or did not register for donation a third time after questionnaire completion. RESULTS: Three logistic regression analyses showed that the first donation decision was influenced by intention (odds ratio [OR], 1.70; 95% confidence interval [CI], 1.30-2.21), number of donations made in the first year (OR, 2.35; 95% CI, 1.81-3.06), vasovagal reactions (OR, 0.92; 95% CI, 0.87-0.97), and planning failure (OR, 0.81; 95% CI, 0.70-0.95). The second donation decision was influenced by intention (OR, 1.44; 95% CI, 1.06-1.95) and planning failure (OR, 0.67; 95% CI, 0.57-0.78), while the third decision was influenced only by planning failure (OR, 0.85; 95% CI, 0.73-1.00). CONCLUSION: This indicates that for new donors, retention efforts should focus on the promotion of a positive intention and decreasing vasovagal reactions. However, decreasing planning failure could be an even better investment since planning seems to determine long-term retention.

Return behavior of occasional and multigallon blood donors: the role of theory of planned behavior, self-identity, and organizational variables.

BACKGROUND: For blood establishments it is important that blood donors return for a donation. Past research has stressed the importance of theory of planned behavior (TPB) on return behavior, but self-identity (SI) and organizational variables (OVs) might play a role as well. This study added SI and OVs to the TPB to identify the determinants for return behavior. STUDY DESIGN AND METHODS: Whole blood donors (n = 2005) completed a questionnaire assessing TPB, SI, and OVs. OVs contained "perceived satisfaction with the blood bank" and "feeling pressure from the blood bank to donate blood." Return behavior over the past 2 years was dichotomized as low return (0%-50%) versus high return (51%-100%). Logistic regression analyses assessed the effects of TPB, SI, and OVs on high return, separately for occasional donors (two to 10 lifetime donations) and multigallon donors (>10 lifetime donations). RESULTS: Results showed that, for all donors, affective attitude was positively associated with return behavior, whereas pressure to donate blood was negatively associated with return behavior. The point estimates of self-efficacy, SI, and perceived satisfaction are high for multigallon donors, but do not reach significance. CONCLUSION: For all donors, positive feelings about donating blood stimulate return behavior, while experiencing a pressure to donate blood emanating from the blood bank was not beneficial. Results suggest that multigallon donors are more stimulated to return when they score higher on self-efficacy, SI, and perceived satisfaction. Interventions aiming at donor retention need to be carefully formulated to avoid negative effects of feeling pressure to donate blood.

Motivational differences between whole blood and plasma donors already exist before their first donation experience.

BACKGROUND: The demand for plasma products has increased rapidly. It is therefore important to understand donating behavior by plasma donors. This study investigates whether motivational differences between whole blood and plasma donors already exist at the beginning of a donor career. STUDY DESIGN AND METHODS: New donors (n = 4861) were invited to fill out a questionnaire before their first donation (response, 61%). The questionnaire assessed variables from the Theory of Planned Behavior (intention, self-efficacy, attitude, and norms), conscientiousness, and donation anxiety. Three years later it was determined who became whole blood or plasma donor. Multivariable linear regression analyses for intention were fitted separately for whole blood and plasma donors. A logistic regression analysis was executed to estimate the effect of intention at the beginning of a donor career on becoming a plasma donor. RESULTS: Plasma donors had a higher intention, self-efficacy, attitude, and conscientiousness and a lower anxiety than whole blood donors. In plasma and whole blood donors, both self-efficacy and cognitive attitude were positively related to intention but with different strength (plasma, ß = 0.47 and ß = 0.30; whole blood, ß = 0.57 and ß = 0.17). Having a high level of intention increased the odds of becoming a plasma donor (odds ratio, 1.33; 95% confidence interval, 1.12-1.59). CONCLUSION: Motivational differences already exist between future whole blood and plasma donors before their first donation. Although a feeling of self-efficacy is necessary for all new donors, more favorable cognitions are important for future plasma donors. Recruitment strategies for plasma donors should focus on attracting the more self-confident donors by highlighting the usefulness of plasma donation.

The influence of adverse reactions, subjective distress, and anxiety on retention of first-time blood donors.

BACKGROUND: This study investigated the effects of adverse events (i.e., needle reactions, fatigue, and vasovagal reactions) and feelings of distress and anxiety on retention of first-time blood donors. All effects were explored separately for men and women. STUDY DESIGN AND METHODS: First-time blood donors (n = 2438) received a questionnaire, asking them about their experience of adverse events, subjective distress, and anxiety at their first donation. Provision of a second donation was checked approximately 18 months later. After exclusion of nonresponders and donors who did not experience an adverse event, 1278 first-time donors were included in the logistic regression analyses. RESULTS: Nine percent of donors who experienced an adverse event at their first donation did not return for a second donation. Vasovagal reactions decreased retention in both males and females (men-odds ratio [OR], 0.45; 95% CI, 0.23-0.89; women-OR, 0.71; 95% CI, 0.51-0.98). Fatigue decreased retention in males only (OR, 0.62; 95% CI, 0.42-0.91), and subjective distress decreased retention in females only (OR, 0.77; 95% CI, 0.65-0.92). CONCLUSION: In addition to decreasing vasovagal reactions, retention interventions could productively target coping with fatigue and reducing subjective distress after adverse reactions.

Does questionnaire distribution promote blood donation? An investigation of question-behavior effects.

PURPOSE: The purpose of this study is to assess the effectiveness of survey administration as a population-level intervention to increase blood donation. METHODS: Study 1 was a randomized controlled trial of new donors comparing 3,518 who received a questionnaire and 3,490 who did not. Study 2 compared matched, randomly selected samples of active donors; 5,789 received a questionnaire, while 6,000 did not. In both studies, the dependent measure was the proportion of donors who attended a blood donation center to give blood within 6 months of survey posting. Study 3 compared data across five similar trials. RESULTS: No difference in volunteering to give blood was observed between those who did and did not receive a questionnaire among either new or active donors, confirming the findings of two other Canadian trials. CONCLUSIONS: Despite earlier optimistic findings, there is little evidence to suggest that survey administration per se will be effective in increasing blood supplies. Implications for behavior change mechanisms are discussed.

Exploring the pattern of blood donor beliefs in first-time, novice, and experienced donors: differentiating reluctant altruism, pure altruism, impure altruism, and warm glow.

BACKGROUND: Using constructs from the Theory of Planned Behavior and theories of altruism, this article explores how multiple motivations and beliefs for blood donation are clustered and change across the donor career. In so doing important distinctions, for blood donation, between impure altruism, pure altruism, and warm glow are explored. STUDY DESIGN AND METHODS: Measures of intentions, cognitive and affective attitudes, role merger, pure altruism, trust, self-efficacy, subjective and moral norms, and habit formation were assessed in a sample of 12,580 whole blood donors. Analyses showed that a distinction between first-time, novice (one to four donations), and experienced donors (five or more donations) is justified. Principal components analysis and confirmatory factor analytic Multiple-Indicator Multiple-Causal models were used to compare models across these groups. RESULTS: A cognition-behavior (CB) factor, including intentions, was common to all groups. First-time and novice donors were marked by a newly identified motivational factor: "reluctant altruism" (i.e., the motivation to donate because of a lack of trust in others). First-time donors exhibited an impure altruism factor whereas for experienced donors warm glow and pure altruism factors were observed. For first-time donors impure altruism and reluctant altruism were both associated with the CB factor in females and impure altruism only in males. For both sexes reluctant altruism was associated of the CB factor in novice donors and warm glow and pure altruism for experienced donors. CONCLUSIONS: New avenues for intervention are suggested by the emergence of reluctant altruism for novice donors and warm glow for experienced donors. The importance of distinguishing aspects of altruism is highlighted.

Adverse reactions, psychological factors, and their effect on donor retention in men and women.

BACKGROUND: This study investigates the effect of a vasovagal reaction (VVR) or needle reaction (NR) on the risk of stopping as a blood donor, taking into account variables from the Theory of Planned Behavior (TPB). Is stopping risk solely related to the adverse reaction itself, or do the TPB variables play a role as well? Emphasis is placed on possible sex differences. STUDY DESIGN AND METHODS: TPB variables were assessed within 12,051 whole blood donors. Also, donors reported the occurrence of adverse reactions during or after their last donation. Blood bank records were used to determine whether donors stopped donating within the next 2 years. Logistic regression analyses were performed to estimate the effect of self-reported adverse reactions on stopping risk, adjusting for the TPB variables. Analyses were performed separately for both sexes. RESULTS: Men have a lower odds of reporting a NR or a VVR than women (odds ratio [OR] 0.34, 95% confidence interval [CI], 0.28-0.43; and OR 0.26, 95% CI 0.19-0.36, for NR and VVR, respectively). For both sexes, only a VVR was associated with stopping risk, which is higher in men (men, OR 3.95, 95% CI 2.19-7.11; women, OR 1.78, 95% CI 1.35-2.35). After adjusting for the TPB variables both ORs declined (men, OR 3.38, 95% CI 1.86-6.15; women, OR 1.58, 95% CI 1.17-2.14). Also, self-efficacy and affective attitude are negatively associated with adverse reactions. CONCLUSION: Female donors report more VVRs than male donors, but male donors have a higher stopping risk after a VVR than female donors. Coping differences and possible reporting tendencies might play a role. For donor retention purposes, prevention and coping techniques should take sex differences into account.

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 (ß=0.605, p<0.001), with affective attitude (ß=0.239, p<0.05) and self-efficacy (ß=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 (ß=0.601, p<0.001), with affective attitude (ß=0.345, p<0.001) and moral norm (ß=-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.

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 (ß = 0.64, p < 0.001). Cognitive attitude (ß = 0.1, p < 0.001) and moral norm (ß = 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.

Healthy donor effect: its magnitude in health research among blood donors.

BACKGROUND: The healthy donor effect has been mentioned as a methodologic problem in blood donor health research. The aim of this study was to investigate different elements of the healthy donor effect. STUDY DESIGN AND METHODS: First, recent donors (<4 years registered as a donor) were compared with the general population. Second, active and lapsed donors were compared. Third, short-career donors (<14 donations) were compared with long-career donors (>37 donations). Various health and lifestyle indicators were used as outcome measures. RESULTS: Compared to the general population, recent donors had a better self-rated health (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.27-1.61), visited the general practitioner (GP) less often (OR, 0.66; 95% CI, 0.60-0.72), and were less often treated by a specialist (OR, 0.83; 95% CI, 0.75-0.93). Recent donors also exhibited a healthier lifestyle compared to the general population. When examining active versus lapsed donors, similar results were found in favor of active donors. With respect to donation career, long-career donors were healthier than short-career donors, but effects were less strong; the ORs were 1.33 (95% CI, 1.15-1.54) for self-rated health, 0.85 (95% CI, 0.76-0.94) for GP visit, and 0.83 (95% CI, 0.68-1.00) for specialist treatment. When comparing long- and short-career donors on lifestyle indicators, there were barely any significant differences. CONCLUSIONS: The findings strongly point to the presence of a healthy donor effect when comparing donors with the general population and active versus lapsed donors. The healthy donor effect was less pronounced within active donors, when comparing long- and short-career donors. Therefore, health research should primarily be carried out within active donors.

Cardiovascular and demographic characteristics in whole blood and plasma donors: results from the Donor InSight study.

BACKGROUND: Within blood establishments little comparative information is available about donors versus the general population. In this study, a description of the donor pool was made in terms of demographic factors and cardiovascular risk factors. The general Dutch population was used as a reference group. STUDY DESIGN AND METHODS: The Donor InSight study provided information on donors. Extensive information has been gathered by a self-administered questionnaire addressing various topics, like demographics, lifestyle, and health. Aggregated donor responses were compared with general population summary data. RESULTS: The study population consisted of 15,076 donors. The median age was 46.3 years and 47.3% were men. Donors were more likely to be highly educated (34.6%), married (71.7%), and of Dutch origin (97.4%), when compared to the general population. Donors were less often smokers (donors, 17.1%; general population, 31.8%), more often moderate drinkers (donors, 82.8%; general population, 74.7%), and physically more active (donors, 2.0 hr/week; general population, 1.0 hr/week). Male donors were more often moderately overweight (47.7%) than men from the general population (39.9%). In donors, 0.9% reported to have Type 2 diabetes versus 1.9% in the general population. In donors, 3.4% reported high cholesterol versus 4.6% in the general population. CONCLUSION: The study provided important knowledge about demographic distributions and cardiovascular risk factors within donors. A proper understanding of demographic characteristics of donors will help us to focus recruitment and retention strategies. The reported beneficial cardiovascular profile suggests a need for further research on the role of blood donation in cardiovascular risk reduction.

Blood donors' physical characteristics are associated with pre- and post-donation symptoms - Donor InSight.

BACKGROUND: Observational data suggest that some donors might benefit from donating while others may be harmed. The aim of this study was to investigate the prevalence and potential, routinely measured, determinants of pre- and post-donation symptoms. MATERIALS AND METHODS: In Donor InSight, questionnaire data from 23,064 whole blood donors (53% female) were linked to routinely measured data on donors' physical characteristics (haemoglobin, blood pressure, body mass index and estimated blood volume) from the Dutch donor database. Absolute and relative associations between donors' physical donor and the presence of pre- and post-donation symptoms were studied using multivariable logistic regression. RESULTS: Pre-donation symptoms (lack of energy, headaches) were reported by 3% of men and 3% of women. Five percent of men and 4% of women reported positive post-donation symptoms (feeling fit, fewer headaches). Negative symptoms (fatigue, dizziness) were more common, occurring in 8% of men and 19% of women. All the studied donors' physical characteristics were positively associated with pre- and positive post-donation symptoms and negatively associated with negative symptoms. Body mass index was most consistently and independently associated with symptoms. DISCUSSION: Donors' physical characteristics, in particular body mass index, were consistently associated with pre- and post-donation symptoms. This indicates that subgroups of donors more and less tolerant to donation might be identifiable using routinely measured data. Further research is warranted to study underlying mechanisms and potential strategies to predict and prevent donor reactions.

Risk factors for complications in donors at first and repeat whole blood donation: a cohort study with assessment of the impact on donor return.

BACKGROUND: First-time donation is among recognised risk factors for vasovagal reactions to blood donation and reactions are known to reduce donor return. We assessed associations between potential risk factors and vasovagal reactions and needle-related complications in first-time whole blood donation in comparison to repeat donation and analysed the impact of complications on donor return. MATERIALS AND METHODS: We performed a cohort study on whole blood donations in The Netherlands from 1/1/2010 to 31/12/2010 using data extracted from the blood service information system. Donation data up to 31/12/2011 were used to ascertain donor return. RESULTS: In 2010 28,786 donors made first whole blood donations and there were 522,958 repeat donations. Vasovagal reactions occurred in 3.9% of first donations by males and 3.5% of first donations by females compared to in 0.2% and 0.6%, respectively, of repeat donations. Associations of vasovagal reactions with other factors including age, body weight, systolic and diastolic blood pressure were similar in first-time and repeat donors. Needle-related complications occurred in 0.2% of male and 0.5% of female first-time donations and in 0.1% and 0.3%, respectively, of repeat donations. Among first-time donors, the return rate within 1 year was 82% following an uncomplicated first donation, but 55% and 61% following vasovagal reactions and needle-related complications, respectively; the corresponding percentages among repeat donors were 86%, 58% and 82%. DISCUSSION: Among first-time donors, females suffered less than males from vasovagal reactions. Other risk factors had similar associations among first-time and repeat donors. Vasovagal reactions and needle-related complications in both first-time and repeat donors are followed by reduced donor return.

Characteristics of donors who do or do not return to give blood and barriers to their return.

BACKGROUND: In the Netherlands about 50% of whole blood donors return to give blood after an invitation to donate. This study aimed to investigate the characteristics of donor return behaviour and to gain insight into the barriers to blood donation reported by the donors themselves. MATERIALS AND METHODS: A total of 4,901 whole blood donors were invited to donate in week 39 of 2009. Barriers mentioned by donors who informed the blood bank for not donating were registered for 1 month. Logistic regression analyses assessed relevant characteristics of return behaviour, such as age and blood type, in men and women separately. RESULTS: Of the invited donors, 55% returned to give a donation, whereas 45% did not return. Male donors were more likely to return when they were older, had a higher previous return rate and had no past deferrals. The same pattern was found among women, but was less strong. The main barriers were: time constraints (35%), preference to postpone donation due to general physical problems although being eligible to donate (29%), and being ineligible to donate due to medical deferral criteria (9%). DISCUSSION: Specific donor characteristics are associated with return behaviour. Not donating due to time constraints could mean that donors do not feel the urgency of donating blood. Interventions targeted to increase commitment among specific donor groups should be tested further.

Hemoglobin level is positively associated with blood pressure in a large cohort of healthy individuals.

It has been hypothesized that an increased hemoglobin level elevates blood pressure. The present study investigated the association between hemoglobin level and systolic blood pressure and diastolic blood pressure in healthy persons. The study population was composed of 101 377 whole blood and plasma donors, who made 691 107 visits to the blood bank. At each visit, hemoglobin level and blood pressure were measured as part of the standard procedure before a blood donation. We used repeated measurement analysis to analyze the data. We used generalized estimating equation models to assess the between-person effect and linear mixed models to assess the within-person effect. All of the analyses were done separately for men and women. In the study population, 50% were men. The mean age in men was 49.3 years (±12.5 years), and in women it was 42.4 years (±13.7 years). Hemoglobin level was positively associated with both systolic and diastolic blood pressures. With respect to the between-person effect, regression coefficients for systolic blood pressure were 1.3 mm Hg per millimole per liter increase in hemoglobin level for men and 1.8 mm Hg per millimole per liter increase in hemoglobin level for women. With respect to the within-person effect, regression coefficients for systolic blood pressure were 0.7 mm Hg and 0.9 mm Hg per millimole per liter increase in hemoglobin level, for men and women, respectively. For diastolic blood pressure, results were comparable. The results show that hemoglobin level is positively associated with both systolic and diastolic blood pressures in healthy individuals. We observed consistent effects between persons but also within persons.

Motivating blood donors to recruit new donors: experimental evaluation of an evidence-based behavior change intervention.

OBJECTIVE: A sustainable, evidence-based intervention to motivate current blood donors to recruit new donors was evaluated using a quasi-experimental, in-service trial at three donation centers. DESIGN: Participating blood donors in three conditions (N = 734), received (1) an evidence-based leaflet designed to enhance recruitment motivation and five postcards facilitating recruitment and donor registration, (2) five postcards alone, or (3) no materials. MAIN OUTCOME MEASURES: Self-reported donor recruitment by donors was measured at 1-week and 6-week follow-up. RESULTS: At 1-week and at 6-week follow-up, donors in both intervention conditions reported talking to more people about donation and asking more people to donate than control participants. Intervention participants also reported persuading more people to register as a donor than control participants. Results indicated that postcards plus leaflet was somewhat more effective than the postcards alone. Donors' intentions to recruit at 1-week follow-up mediated the behavioral effects at 6-week follow-up. CONCLUSION: Motivating and facilitating recruitment of new blood donors through existing donors has the potential to continually replenish the donor population.