Increasing Organ Donor Registrations in Motor Vehicles Offices Through Health Communication.

Health communication research has played a prominent role in the body of scholarship seeking to meaningfully increase the number of life-saving organs available to waitlisted patients. The current paper builds on earlier work in communication seeking to promote organ donation to individuals in community and organizational settings. The goal of this essay is to review health communication-based interventions seeking to meaningfully increase organ donation registrations in motor vehicles' offices (DMV) transactions in the USA. For convenience, I use the acronym DMV, although it is understood different states use different titles for this office. Before describing the nature and impact of communication interventions and their impact in DMV contexts, I will provide context for the problem and briefly review the role of DMV registrations in relation to demand for organs in the United States.

A positive deviance approach to improve familial authorization for organ donation.

The current study evaluates the Positive Deviance Donation Collaborative, a communication training program designed to identify and disseminate behaviors of requesters with above-average rates of familial authorization to organ donation. The program initiated with a cohort of 99 requesters from 11 OPOs. Requesters' quarterly authorization rates were monitored for 33 months, and their pre-/post-intervention skills in active-empathic listening and self-efficacy to request donation were assessed. Overall, requesters' mean quarterly authorization rate was 53.69% (SD = 4.54). Multilevel models were used to examine change in authorization rates and communication skills, as well as associations between skills and authorization. Low intraclass correlation coefficients for authorization rates established that most variance was due to within-requester variation, rather than OPOs (ρ = 0.0129) or requesters within OPOs (ρ = 0.0221). Models indicated that authorization rates and communication skills failed to improve following intervention and did not identify an association between post-intervention communication skills and authorization. Results provide a framework to discuss programmatic challenges including extensive requester turnover (ie, ~60%), management of data collection across multi-site interventions, and program content.

Breaking Bad News in Veterinary Medicine.

The patient-provider relationship in the context of veterinary medicine represents a unique opportunity for studying how bad news is communicated to pet owners by conducting structured interviews with veterinarians. A sample of 44 veterinarians' responses was recorded and content-analyzed in an effort to identify themes among providers in their clinical experience of breaking bad news (BBN). Two coders revealed several themes in the data that were organized by three overarching areas: (1) breaking bad news in general, (2) euthanasia, and (3) social support. The findings from interviews indicated the COMFORT model (Villagran, Goldsmith, Wittenberg-Lyles, & Baldwin, 2010) in medical education provided a useful framework to organize the communication of BBN in veterinary medicine. Results were discussed in relation to future research in patient-provider communication and COMFORT's potential value for training students in veterinarian education.

A Department of Motor Vehicle-Based Intervention to Promote Organ Donor Registrations in New York State.

CONTEXT: Examination of efficacy of motor vehicle representative educational training and dissemination of promotional materials as a means to promote organ donation enrollments in New York State. OBJECTIVE: To increase the number of New York State residents who consent to donation through the department of motor vehicle transactions during project period. SETTING: County-run motor vehicle offices across New York State. PARTICIPANTS: Customers who present to New York Department of Motor Vehicle offices and the representative who work at designated bureaus. INTERVENTIONS: point-of-decision materials including promotional posters, brochures, website, and the motor vehicle representative training sessions. MAIN OUTCOME MEASURES: Reasons for enrollment decision, knowledge/experience with donation, monthly consent rates, enrollment in state organ, and tissue registry. RESULTS: Customers who elected not to register reported no reason or uncertainty surrounding enrollment. The representatives reported experience with donation, discussion with customers, and need for additional education on organ donation. Enrollment cards were mailed to 799 project staff; counties where offices participated in intervention did not indicate significantly higher monthly enrollments when comparing pre- to postenrollment rates. CONCLUSIONS: Use of point-of-decision materials and enrollment cards proved inexpensive method to register customers with a 3.6% return rate. Customers report low (27%) enrollment rate and reticence to consent to donation. Educational training sessions with representatives did not yield significant enrollment increases when evaluating data at county-level enrollment.

An investigation into mature adults' attitudinal reluctance to register as organ donors.

BACKGROUND: Mature adults (age 50-64) make up a large proportion of organ transplant recipients, and waiting list candidates yet are underrepresented in terms of actual donors. Understanding the reasons why mature adults fail to register as deceased organ donors is critical in achieving the goal of increasing the actionable supply of organs available for transplant. Conceptual models propose certain factors such as bodily integrity, ick (i.e., disgust), jinx (i.e., superstition), medical mistrust, salience, self-efficacy, and stake are associated with organ donation registration attitudes. Moreover, the age myth, or the belief that one's age prevents them from becoming an organ donor, was examined among mature adults between the ages of 50-64. METHOD: An online survey was disseminated to mature adults (N=709). RESULTS: Results indicated jinx, salience, self-efficacy, and stake each predicted organ donation attitudes among mature adults. Moreover, results indicated that age myth accounted for attitudes toward registering as an organ donor among non-registered mature adults after controlling for non-cognitive and vested interest constructs. CONCLUSION: This study demonstrates the age myth is negatively associated with attitudes toward registering as organ donors. The results are discussed with an emphasis on both the theoretical and practical implications of study findings.

Measuring the Effectiveness of Mass-Mediated Health Campaigns Through Meta-Analysis.

A meta-analytic review was undertaken to examine the effects of mass communication campaigns on changes in behavior, knowledge, and self-efficacy in the general public. A review of the academic literature was undertaken and identified 1,638 articles from 1966 through 2012. Using strict inclusion criteria, we included 63 studies for coding and analyses. Results from these efforts indicated that campaigns produced positive effects in behavior change (r = .05, k = 61) and knowledge (r = .10, k = 26) but failed to produce significant increases in self-efficacy (r = .02, k = 14). Several moderators (e.g., health topic, the theory underlying the campaign) were examined in relation to campaign principles that are prescribed to increase campaign effects. The major findings are reviewed, and the implications for future campaign design are discussed.

A Content Analysis of Organ Donation Stories Printed in U.S. Newspapers: Application of Newsworthiness.

The current study applied a theory of newsworthiness to the topic of organ donation. Specifically, content analysis of newspaper stories published in the United States (N = 1,988) was performed to identify whether deviance and significance of a story predicted story prominence, measured as story length and placement in the newspaper. Results indicated support for study hypotheses: Longer stories and front-page stories pertaining to organ donation were more deviant and more significant in content. Analyses also indicated stories more negative in nature were more likely given front-page coverage, represented international events, and were high on deviance and significance. Higher circulating newspapers were more likely to publish stories recounting negative events in organ donation. Results indicated organ donation coverage represents a valid application of newsworthiness theory, and implications of study findings are discussed in relation to the agenda-setting function of news stories.

An examination of three theoretical models to explain the organ donation attitude--registration discrepancy among mature adults.

An inconsistency in the research indicates positive attitudes toward organ donation do not map reliably onto organ donor registrations. Various models have sought to explain this inconsistency and the current analysis formally compared three models: the Bystander Intervention Model (BIM), the Organ Donor Model (ODM), and Vested Interest Theory (VIT). Mature (N = 688) adults between the ages of 50 to 64 years completed surveys related to organ donation. Results revealed that VIT accounted for the most variance in organ donation registrations followed by the BIM and ODM. The discussion emphasizes the importance of employing theories to explain a phenomenon as well as the practical implications of the findings.

Source and Message Framing Considerations for Recruiting Mature Adults as Organ Donors Through Direct Mail Campaigns.

CONTEXT: Mature adults represent an important audience segment for organ donation practitioners. Despite their potential impact as organ donors, compared to other age demographics, their registration rates are much lower. OBJECTIVE: The objective of the current campaign was to determine the most effective source and message strategy to promote organ and tissue donation among mature adults. METHODS: A 2 (states: Illinois and Iowa) by 2 (sources: government agency and organ procurement organization [OPO]) by 3 (taglines: Any age is the right age to share the gift of life, Don't rule yourself out, and Don't rule yourself out: Any age is the right age to share the gift of life) between-subjects design was used to test the effectiveness of direct mailings promoting organ donation to mature adults. RESULTS: Across both Illinois and Iowa, the results revealed that greater organ donation registration rates emerged following exposure to direct mail authored by a state official such as the Illinois Secretary of State or the Iowa Department of Public Health compared to local OPOs. CONCLUSIONS: Overall, the findings speak to the effectiveness of direct mail marketing campaign's ability to register potential organ donors. Moreover, the results reveal that it is more important who sends the message as opposed to what the message states.

Promoting organ donation through challenge campaigns.

CONTEXT: Four challenge campaigns in 2012 and 2013 were undertaken to promote organ donor registrations in New York State. Challenge campaigns relied on community advocates statewide to initiate month-long outreach efforts with top teams earning monetary rewards and public recognition. OBJECTIVE: To significantly increase the number and proportion of New York residents who have consented to donation through the electronic registry. DESIGN: Four month-long campaigns undertaken in fall and spring of 2012 and 2013. SETTING: Statewide recruitment efforts organized by New York Alliance for Donation and the 4 organ procurement organizations in New York State. PARTICIPANTS: Adult residents of New York State. INTERVENTION: Project staff recruited team leaders across New York State and used online and offline resources to recruit teams, educate team leaders, and bolster outreach efforts. MAIN OUTCOME MEASURES: Number of completed registration forms within month-long campaign periods. Also investigated were statistics on website use (eg, page views, new visitors) and interviews with team leaders regarding campaign activities after the campaign. RESULTS: Across 4 campaigns, 107 teams were recruited and 2286 persons registered their consent to donate through the state system. Each team recruited a mean of 21 persons; 40% of teams registered 0 persons.

Numeracy, information seeking, and self-efficacy in managing health: an analysis using the 2007 Health Information National Trends Survey (HINTS).

This study examined the unique effects of numeracy on self-efficacy in managing health and on information-seeking experience, and explored the mediating role of information-seeking experience. The proposed model was tested using a national random-digit-dial sample (n = 4,092) of adults participating in the 2007 Health Information National Trends Survey. Findings from multiple regression analyses revealed that higher numeracy was associated with higher self-efficacy in managing health and better (i.e., more positive) health information-seeking experience, and that better information-seeking experience partially mediated the association between higher numeracy and higher self-efficacy. Findings indicated that communication factors (e.g., information seeking) partially mediated the relationship between cognitive abilities (e.g., numeracy) and self-efficacy. Theoretical implications are discussed, along with practical implications for individuals, health care providers, and public health professionals.

Measurement of the bystander intervention model for bullying and sexual harassment.

Although peer bystanders can exacerbate or prevent bullying and sexual harassment, research has been hindered by the absence of a validated assessment tool to measure the process and sequential steps of the bystander intervention model. A measure was developed based on the five steps of Latané and Darley's (1970) bystander intervention model applied to bullying and sexual harassment. Confirmatory factor analysis with a sample of 562 secondary school students confirmed the five-factor structure of the measure. Structural equation modeling revealed that all the steps were influenced by the previous step in the model, as the theory proposed. In addition, the bystander intervention measure was positively correlated with empathy, attitudes toward bullying and sexual harassment, and awareness of bullying and sexual harassment facts. This measure can be used for future research and to inform intervention efforts related to the process of bystander intervention for bullying and sexual harassment.

Reasons for (not) signing the state registry: surveying Department of Motor Vehicles customers in New York state.

CONTEXT: Prior research examining rationales for enrolling as an organ donor is biased because of its reliance on college student samples and retrospective recall. OBJECTIVE: To characterize New York state residents' registry enrollment decisions in close proximity to a registration opportunity. DESIGN: -Surveys were conducted with customers exiting Department of Motor Vehicle offices. PARTICIPANTS: A total of 1325 customers were surveyed upon exiting 1 of 18 Department of Motor Vehicle offices spanning 9 counties. MAIN OUTCOME MEASURE: Customers making donation-relevant transactions (ie, license renewal/registration) reported whether they had registered as a donor that day, and all other customers reported whether they had registered as a donor in the past. Customers reported reasons to justify their enrollment decision through short interview questions. RESULTS: Among current donation-relevant transactions (n = 299), 27% reported enrolling in the registry. Of remaining customers, 39% reported enrolling in the state registry in the past. For those who elected not to enroll, many failed to communicate a reason for their decision, or reported a lack of opportunity to sign or decisional uncertainty. Among enrollees, reasons for registration included the altruistic benefits of donation, prior registration, personal experience with donation, and rational arguments for donation. CONCLUSION: The value of point-of-decision survey data are discussed in relation to strategic efforts to promote organ donor registration.

Providing social support in a persuasive context: forms of social support reported by organ procurement coordinators.

Eighty-five organ procurement coordinators (OPCs) completed face-to-face interviews designed to elicit the emotional and instrumental social support strategies communicated to potential donor families throughout the request for deceased organ donation. OPCs identified six forms of emotional support and eight forms of instrumental support, with greater reported use of instrumental support strategies. In terms of instrumental support, OPCs most frequently ensured in-hospital comfort (61.2%) or met the nutritional needs of family members (51.8%). With respect to emotional support, OPCs most often expressed sympathy (31.8%) to families and provided support in the form of physical contact (27.1%) with family members. Identifying the forms of social support used by OPCs is a first step toward understanding the strategies that are more (or less) effective in achieving persuasive and support goals.

Clarifications on mass media campaigns promoting organ donation: a response to Rady, McGregor, & Verheijde (2012).

The current paper provides readers some clarifications on the nature and goals of mass media campaigns designed to promote organ donation. These clarifications were necessitated by an earlier essay by Rady et al. (Med Health Care Philos 15:229-241, 2012) who present erroneous claims that media promotion campaigns in this health context represent propaganda that seek to misrepresent the transplantation process. Information is also provided on the nature and relative power of media campaigns in organ donation promotion.

Using Animated Videos to Increase Patient Knowledge: A Meta-Analytic Review.

This article meta-analyzed 21 studies that tested the effectiveness of animated videos in improving learning in clinical and nonclinical settings compared with standard education. Animation was defined as the use of moving objects that are typically drawn or simulated. Videos ranged from just over 2 min in duration to 16 min in duration in articles published from 2009 through 2020. Mayer's Cognitive Theory of Multimedia Learning provided the theoretical model to frame the current analyses. Findings indicated an overall positive effect (d = 0.35) for use of animation in improving viewers' learning across a variety of health and clinical contexts, including surgery and diabetes. Moderator analyses indicated learning effects were greater in patient samples and samples with a higher proportion of male participants. Study findings were discussed in terms of the theoretical and practical implications for health communication scholars and practitioners.

Click to "like" organ donation: the use of online media to promote organ donor registration.

CONTEXT: Efforts to promote organ donation have traditionally relied on mass-mediated or interpersonal communication to promote donor registration. Despite its popularity, the use of online media has yet to be carefully evaluated as a platform to promote organ donation. OBJECTIVE: To describe results of an intervention to promote donor registration that relies solely on online media to communicate to target audiences. DESIGN: For 3 years, 6 campaigns were implemented in 3 different online media formats. SETTING: Online media formats included (1) traditional online advertising, (2) student seeders' social networking sites campaigns, and (3) challenge campaigns. PARTICIPANTS: Online media campaigns primarily targeted college-aged individuals.Intervention-Each campaign directed individuals to the dedicated project website, where they could access educational material about donation and request a donor registration card. MAIN OUTCOME MEASURES: Unique website visitors, webpages viewed per site visit, time spent on site, and organ donor cards requested/received were tracked in relation to each online media format. RESULTS: Traditional online advertising offered greater message exposure but failed to result in a higher proportion of website visitors who registered their donation intentions. Use of student seeders (ie, motivated students who promote donation by using social networking sites) and challenge campaigns resulted in greater attention to the project website, donor card requests, and subsequent returns. Additional research is recommended to reveal the effect of combining 2 or more varying online media formats within a single campaign.

A sequential decision framework for increasing college students' support for organ donation and organ donor registration.

CONTEXT: Despite the fact that college students support social causes, this age group has underparticipated in organ donor registration. Little research attention has been given to understanding deeper, higher-order relationships between the antecedent attitudes toward and perceptions of organ donation and registration behavior. OBJECTIVE: To test a process model useful for understanding the sequential ordering of information necessary for moving college students along a hierarchical decision-making continuum from awareness to support to organ donor registration. DESIGN AND SETTING: The University of Wisconsin organ procurement organization collaborated with the Collegiate American Marketing Association on a 2-year grant funded by the US Health Resources and Services Administration. A total of 981 association members responded to an online questionnaire. MEASURES: The 5 antecedent measures were awareness of organ donation, need acknowledgment, benefits of organ donation, social support, and concerns about organ donation. The 2 consequence variables were support for organ donation and organ donation registration. RESULTS: Structural equation modeling indicated that 5 of 10 direct antecedent pathways led significantly into organ donation support and registration. The impact of the nonsignificant variables was captured via indirect effects through other decision variables. Model fit statistics were good: the goodness of fit index was .998, the adjusted goodness of fit index was .992, and the root mean square error of approximation was .001. IMPLICATIONS: This sequential decision-making model provides insight into the need to enhance the acceptance of organ donation and organ donor registration through a series of communications to move people from awareness to behavior.

Difficult communication: compliance-gaining strategies of organ procurement coordinators.

Organ procurement coordinators (OPCs) face a formidable communication task when making familial requests for consent to organ donation, because they must provide social support for grieving family members while seeking compliance to the donation request. Structured interviews were conducted with 102 OPCs, representing 16 organ procurement organizations (OPOs) (27.6% of national organizations) across the United States. Responses were transcribed and content-analyzed along four domain areas: (a) establishing credibility, (b) message strategies, (c) timing/setting of requests, and (d) adaptation of messages to diverse families. OPO conversion rates were used as a criterion factor for OPCs' persuasive communication success and regressed onto self-reported strategy use. Results indicate message strategies varied at the OPC level of analysis and 7 techniques significantly predicted 32% of the variance in conversion rates. Two strategies (i.e., gaining early intervention, approaching with additional support) positively influenced conversion rates, whereas 5 strategies (e.g., discussing benefits as a persuasive strategy, emphasizing the need for donation in particular racial/ethnic groups) negatively influenced conversion rates. Future research is recommended to validate the study findings toward the goal of improving OPCs' communication strategies.

Asking the difficult questions: message strategies used by organ procurement coordinators in requesting familial consent to organ donation.

The present study provides an in-depth examination of the messages used by organ procurement coordinators (OPCs) in shaping familial requests for organ donation. OPCs (N = 102), recruited from a national sample of 16 organ procurement organizations, participated in a structured interview designed to uncover the communication strategies used in obtaining familial consent for donation. Analysis of interviews indicates OPCs' messages cover 4 domain areas. Specifically, OPCs report use of messages intended to (a) provide education, (b) discuss the benefits to donation, (c) learn about potential donor families, and (d) persuade families to engage in donation. Within the 4 domain areas, OPCs report use of 15 specific messages (e.g., "positively framing the donor," "social proof," "discuss the benefit of donation to grieving") in requesting consent. The present study provides a detailed examination of strategies and offers recommendations for using message strategies to explore the effectiveness of the consent process from the perspective of OPCs in approaching donor families.