Should men who have ever had sex with men be allowed to donate blood in Brazil?

Many countries have modified their policies on banning or deferring blood donation by men who have sex with men (MSM) in light of ethical concerns and new evidence about transfusion risks. In Brazil, MSM were not eligible to donate blood unless they had been celibate for the previous 12 months. However, in May 2020, the Brazilian Federal Supreme Court overturned this restriction. Many authors have attempted to stress possible risks of transfusion-transmitted infection under various scenarios of changes in bans or restrictions on donations by MSM using mathematical models, but we consider that it is a difficult task due to the wide variety of sexual behaviors, attitudes, and practices. Among these factors, we highlight sex under the influence of illicit drugs, and the fact that people with an undetectable human immunodeficiency virus viral load have the potential to transmit should their blood be transfused. Despite these possible risks, we believe that some MSM can donate blood regardless of the time elapsed since their last sexual contact, especially because blood donations by MSM were occurring even when there were time-based deferral rules. Blood banks should always seek to use screening algorithms to identify high-risk sexual behaviors using gender-neutral criteria, and education about transfusion risks should be offered to healthcare workers and MSM.

Mobile dating apps use and sexual risk behavior among Brazilian undergraduate students.

INTRODUCTION: One of the most popular ways to meet new people in the modern world is through dating apps. However, its use may facilitate casual sexual encounters and quick partner changes, both of which associated to endangering sexual health in different populations. OBJECTIVE: To describe the use of mobile dating apps among undergraduate students at a major Brazilian public university and investigate its associations with sexual risk behaviors and sociodemographic factors. METHODS: This is a cross-sectional study based on a web survey. The link for participation was made available to students enrolled in undergraduate courses in the eight units of the University of São Paulo, Campus Ribeirão Preto. Use of dating apps, sociodemographic/behavioral profile, and sexual risk behaviors were among the variables studied. The distribution of apps users was calculated for each variable of interest, and prevalence ratios (PRs) were used for comparisons. PRs were reported with 95% confidence intervals. RESULTS: A total of 487 students participated, with 32.9% reporting using dating apps. Male participants were more likely to use. The use of dating apps was associated with having multiple sexual partners and risky behaviors such as smoking, alcohol consumption, and substance abuse. CONCLUSION: It is critical to describe the pattern of app use in undergraduate students and understand their influence on sexual health in order to avoid stigmatizing users. Additionally, this information can be helpful in directing the creation of strategies for using these apps as resources to promote health, such as the information-sharing regarding the sexual health.

Knowledge and perceptions on the existence of Voluntary Counseling and Testing (VCT) Centers and associated factors among Brazilian LGBT+ individuals.

In Brazil, the advent of voluntary and counseling testing (VCT) has provided many benefits in the fight against AIDS. A sectional open web survey was conducted to investigate the Brazilian LGBT+ individuals' knowledge and perceptions of the existence of VCT centers and their associations with risk behavior and other variables of interest. The study instrument included questions on sociodemographic and behavioral variables, knowledge on VCT, access to and use of it, beliefs about HIV infection, test results, and risk perception. The Risk Behavior Score for HIV infection (RBS) was also used. A total of 1,630 volunteers participated in the survey, of whom 56.8% were men. Of these, 96.1% declared themselves as (MSM). Almost 50% of the participants had never heard about the existence of VCT, which was a higher knowledge score among MSM. A low frequency of participants had a clear perception of the risks to which they are exposed, whereas those with higher RBS were aware of the existence of VCT. As VCT is critical for the implementation of policies to combat and prevent HIV and other sexually transmitted diseases, our results can contribute to a better understanding of the influence of VCT on the frequency of testing, serological surveillance, and routine counseling for key populations.

Knowledge and perceptions on the existence of Voluntary Counseling and Testing (VCT) Centers and associated factors among Brazilian LGBT+ individuals / Conhecimento e percepções sobre a existência dos Centros de Testagem e Aconselhamento (CTA) e fatores associados em pessoas LGBT+ brasileiras

Abstract In Brazil, the advent of voluntary and counseling testing (VCT) has provided many benefits in the fight against AIDS. A sectional open web survey was conducted to investigate the Brazilian LGBT+ individuals' knowledge and perceptions of the existence of VCT centers and their associations with risk behavior and other variables of interest. The study instrument included questions on sociodemographic and behavioral variables, knowledge on VCT, access to and use of it, beliefs about HIV infection, test results, and risk perception. The Risk Behavior Score for HIV infection (RBS) was also used. A total of 1,630 volunteers participated in the survey, of whom 56.8% were men. Of these, 96.1% declared themselves as (MSM). Almost 50% of the participants had never heard about the existence of VCT, which was a higher knowledge score among MSM. A low frequency of participants had a clear perception of the risks to which they are exposed, whereas those with higher RBS were aware of the existence of VCT. As VCT is critical for the implementation of policies to combat and prevent HIV and other sexually transmitted diseases, our results can contribute to a better understanding of the influence of VCT on the frequency of testing, serological surveillance, and routine counseling for key populations.

Resumo No Brasil, o advento dos centros de testagem e aconselhamento (CTA) trouxe muitos benefícios na luta contra a Aids. Um estudo transversal do tipo web survey foi realizado para investigar o conhecimento e as percepções dos indivíduos LGBT+ brasileiros sobre a existência dos CTAs e suas associações com comportamentos de risco e outras variáveis de interesse. O questionário incluiu questões sociodemográficas e comportamentais, conhecimento sobre o CTA, acesso e uso, crenças sobre a infecção pelo HIV, resultados de testes e percepção de risco. O escore de comportamento de risco (RBS) também foi utilizado. Participaram 1.630 voluntários (56,8% homens). Destes, 96,1% se autodeclararam homens que fazem sexo com homens (HSH). Quase 50% dos participantes não conhecem os CTAs, sendo este conhecimento maior entre os HSHs. Uma baixa frequência de participantes tem percepção clara dos riscos a que estão expostos, e os HSHs com maior pontuação no RBS estão cientes da existência dos CTAs, que são fundamentais na implementação de políticas de combate e prevenção ao HIV e outras doenças sexualmente transmissíveis. Nossos resultados contribuem para a melhor compreensão da sua influência na frequência de testagem, na vigilância do status sorológico e no aconselhamento em populações-chave.

Barriers and facilitators to utilizing digital health technologies by healthcare professionals.

Digital technologies change the healthcare environment, with several studies suggesting barriers and facilitators to using digital interventions by healthcare professionals (HPs). We consolidated the evidence from existing systematic reviews mentioning barriers and facilitators for the use of digital health technologies by HP. Electronic searches were performed in five databases (Cochrane Database of Systematic Reviews, Embase®, Epistemonikos, MEDLINE®, and Scopus) from inception to March 2023. We included reviews that reported barriers or facilitators factors to use technology solutions among HP. We performed data abstraction, methodological assessment, and certainty of the evidence appraisal by at least two authors. Overall, we included 108 reviews involving physicians, pharmacists, and nurses were included. High-quality evidence suggested that infrastructure and technical barriers (Relative Frequency Occurrence [RFO] 6.4% [95% CI 2.9-14.1]), psychological and personal issues (RFO 5.3% [95% CI 2.2-12.7]), and concerns of increasing working hours or workload (RFO 3.9% [95% CI 1.5-10.1]) were common concerns reported by HPs. Likewise, high-quality evidence supports that training/educational programs, multisector incentives, and the perception of technology effectiveness facilitate the adoption of digital technologies by HPs (RFO 3.8% [95% CI 1.8-7.9]). Our findings showed that infrastructure and technical issues, psychological barriers, and workload-related concerns are relevant barriers to comprehensively and holistically adopting digital health technologies by HPs. Conversely, deploying training, evaluating HP's perception of usefulness and willingness to use, and multi-stakeholders incentives are vital enablers to enhance the HP adoption of digital interventions.

The global effect of digital health technologies on health workers' competencies and health workplace: an umbrella review of systematic reviews and lexical-based and sentence-based meta-analysis.

Systematic reviews have quantified the effectiveness, feasibility, acceptability, and cost-effectiveness of digital health technologies (DHTs) used by health-care workers. We aimed to collate available evidence on technologies' effect on health-care workers' competencies and performance. We searched the Cochrane Database of Systematic Reviews, Embase, MEDLINE, Epistemonikos, and Scopus for reviews published from database inception to March 1, 2023. Studies assessing the effects of DHTs on the organisational, socioeconomic, clinical, and epidemiological levels within the workplace, and on health-care workers' performance parameters, were included. Data were extracted and clustered into 25 domains using vote counting based on the direction of effect. The relative frequency of occurrence (RFO) of each domain was estimated using R software. AMSTAR-2 tool was used to appraise the quality of reporting, and the Confidence in the Evidence from Reviews of Qualitative research approach developed by Grading of Recommendations Assessment, Development and Evaluation was used to analyse the certainty of evidence among included studies. The 12 794 screened reviews generated 132 eligible records for assessment. Top-ranked RFO identifiers showed associations of DHT with the enhancement of health-care workers' performance (10·9% [95% CI 5·3-22·5]), improvement of clinical practice and management (9·8% [3·9-24·2]), and improvement of care delivery and access to care (9·2% [4·1-20·9]). Our overview found that DHTs positively influence the daily practice of health-care workers in various medical specialties. However, poor reporting in crucial domains is widely prevalent in reviews of DHT, hindering our findings' generalisability and interpretation. Likewise, most of the included reviews reported substantially more data from high-income countries. Improving the reporting of future studies and focusing on low-income and middle-income countries might elucidate and answer current knowledge gaps.

Knowledge, attitudes, and practices towards COVID-19 among the population of the state of São Paulo, Brazil.

BACKGROUND: The population's adherence to COVID-19 preventive measures is influenced by their knowledge, attitudes, and practices (KAP) towards the disease, making research into people's awareness of the disease essential. The present survey was designed to assess KAP towards COVID-19 among the population of the state of São Paulo, Brazil. METHODS: An online questionnaire was disseminated via social media between September 14 and October 5, 2020. The intended population was Brazilians over the age of 18, living in the state of São Paulo. RESULTS: A total of 1,111 individuals completed the questionnaire. The majority were women (71.6%), 31.6% were aged 31-40 years old, and 82.8% had higher education. Among the participants, 17.5% reported that they had taken some medication without a medical prescription to prevent COVID-19. The participants showed good knowledge about the transmission and prevention of the disease. The knowledge mean score was lower among participants with complete high school or less, with poor self-perception of their health status, who almost never seek information about COVID-19, and those who are not sure to belong to a risk group for the disease. Only 51.3% of the participants believed that COVID-19 would finally be successfully controlled, and 56.6% were confident that Brazil could win the battle against the virus. CONCLUSIONS: Participants demonstrated good knowledge of COVID-19 but were pessimistic about the pandemic's future. The findings of this study can help in the development of effective health communication strategies to promote better knowledge and a positive attitude about prevention measures.

Influence of risk perception on attitudes toward blood donation among Brazilian men who have sex with men who donated blood.

BACKGROUND: We hypothesize that awareness of individuals' risk behaviors may influence aspects of attitude toward blood donation (i.e., intentions and self-efficacy). Investigating this association in the population of MSM was the objective of the present study. STUDY DESIGN AND METHODS: This is a cross-sectional study based on an open web survey. The online survey was developed and applied on the Research Electronic Data Capture (REDCap) platform. The study's information, invitation to participate, and link to access the online survey were disseminated using social media. Analyses were performed using structural equation modeling. RESULTS: A total of 764 young adults MSM participated, with the majority self-reporting as homosexual, single, in good health, and having completed higher education. A total of 297 (39.5%) reported having donated blood at least once in their lives. Among blood donors, 72.0% admitted to lying about their sexual behavior during the blood donation clinical screening interview; 81.0% did not believe that their behaviors put them at risk for HIV infection; 83.7% believed that their blood is safe enough to be transfused. Structural equation analysis provided evidence that the perception of being at risk for HIV and the perception of having non-safe blood to be transfused contributed to an attitude against future blood donation (explained variance 50%). DISCUSSION: Attitude plays an important role in blood donation decision-making by young adults MSM. This is the first study to provide evidence that the self-perceptions of being at risk for HIV and having non-safe blood may deter MSM from blood donation.

Cross-cultural adaptation, content validity, and item analysis of the Objective and Subjective Knowledge and HIV Testing Scale for the Brazilian population.

OBJECTIVES: To propose a Portuguese version of the Objective and Subjective Knowledge and HIV Testing Scale (OSK-HIV-TS), assess its content validity, and perform item analysis after administration to a sample of undergraduate students. METHODS: Three translators translated the OSK-HIV-TS into Portuguese. Judges evaluated each item of a consensus version of the translated instrument for semantic, idiomatic, cultural, and conceptual equivalence. A consensus committee reviewed a back-translation against the original version of the OSK-HIV-TS. Content validity was calculated with the content validity index (CVI) and item analysis was conducted using Classical Test Theory (CTT). RESULTS: The translated scale achieved semantic, idiomatic, conceptual, and cultural equivalence to the original version. A total of 491 undergraduate students participated and the distribution of students' responses to the OSK-HIV-TS revealed a high proportion of correct answers. All items were classified as easy or very easy and only item 16 was classified having strong discrimination power according to the discrimination index. CONCLUSION: The OSK-HIV-TS is a novel instrument in the Brazilian literature for assessing human immunodeficiency virus (HIV) knowledge and should inspire more research into HIV/acquired immunodeficiency syndrome (AIDS) behavior and associated factors, which, despite being essential and necessary, is still lacking in the Brazilian literature.

Perceptions and practices of the Brazilian LGBT+ population toward blood donation.

In May 2020, after years of demands by activists and in light of COVID-19-related blood shortages, the Brazilian Federal Supreme Court abolished the rules that demanded a 12-month celibacy period for men who have sex with men (MSM) to donate blood. The objective of this open web survey was to assess the perceptions and practices regarding blood donation and blood donation rules among members of the Brazilian LGBT+ community. The data collection was conducted between October 2019 and March 2020, before the changes in the rules for blood donation and before the onset of the COVID-19 pandemic in Brazil. A total of 1639 adult individuals, self-declared as LGBT+ , participated (54.3 % MSM, 2.2 non-MSM, 43.5 % women). As expected, most of the study participants did not agree with the 12-month deferral period for MSM donate blood. Blood donation was already practiced by MSM, even before the abolition of the restrictions on donation. Among MSM and women, 38.7 % and 41.0 % have already donated blood, respectively. A significant number of participants reported lying in screening interviews at blood banks in order to be able to donate, and many said they knew people who were MSM and disobeyed the rules for donation, even though they knew them. Therefore, the practice of blood donation was already present among these people, even before the restriction policy change, confirming the need for revised rules for blood donation.

Cross-cultural adaptation, content validity, and item analysis of the Objective and Subjective Knowledge and HIV Testing Scale for the Brazilian population

Abstract Objectives To propose a Portuguese version of the Objective and Subjective Knowledge and HIV Testing Scale (OSK-HIV-TS), assess its content validity, and perform item analysis after administration to a sample of undergraduate students. Methods Three translators translated the OSK-HIV-TS into Portuguese. Judges evaluated each item of a consensus version of the translated instrument for semantic, idiomatic, cultural, and conceptual equivalence. A consensus committee reviewed a back-translation against the original version of the OSK-HIV-TS. Content validity was calculated with the content validity index (CVI) and item analysis was conducted using Classical Test Theory (CTT). Results The translated scale achieved semantic, idiomatic, conceptual, and cultural equivalence to the original version. A total of 491 undergraduate students participated and the distribution of students' responses to the OSK-HIV-TS revealed a high proportion of correct answers. All items were classified as easy or very easy and only item 16 was classified having strong discrimination power according to the discrimination index. Conclusion The OSK-HIV-TS is a novel instrument in the Brazilian literature for assessing human immunodeficiency virus (HIV) knowledge and should inspire more research into HIV/acquired immunodeficiency syndrome (AIDS) behavior and associated factors, which, despite being essential and necessary, is still lacking in the Brazilian literature.

Brazilian Adults' Attitudes and Practices Regarding the Mandatory COVID-19 Vaccination and Their Hesitancy towards Childhood Vaccination.

BACKGROUND: This study investigated the attitudes and practices of Brazilian adults regarding the mandatory COVID-19 vaccination and their hesitancy towards the vaccination of children. METHODS: Between March and May 2022, Brazilian adults answered an online questionnaire distributed through social media. The SAGE-WG questionnaire was adapted to measure hesitancy to the vaccination of children. RESULTS: Of the 1007 participants, 67.4% believed that adult COVID-19 vaccination should be mandatory. Just over half of the participants (51.5%) believed that parents and/or guardians should decide if their children should be vaccinated against COVID-19 or not and 9.1% were unsure. Individuals who were younger, non-religious and had higher awareness of COVID-19 risks and critics of the federal government's performance in combating the pandemic were more likely to agree with mandatory adult vaccination. However, less agreement among parents and/or guardians concerning children's vaccination was observed, with lower scores for hesitancy to the vaccination of children. CONCLUSION: In Brazil, there is still far from a consensus on mandatory COVID-19 vaccination for adults and a significant proportion of the population believes that parents and/or guardians should be free to decide on their children's vaccination. These views are associated with age, religion, knowledge of COVID-19 risks and political inclination.

Panorama of COVID-19, risk perception and vaccine confidence in São Paulo State population, Southeast Brazil.

In 2021, the COVID-19 pandemic remained uncontrolled in Brazil, with more than 17.6 million cases diagnosed and more than a half a million deaths in total. It is known that an accurate risk perception by populations and a consequent adherence to preventive measures can increase the effectiveness of policies to contain the transmission of infectious diseases. The objective of this study was to draw a panorama of COVID-19 in São Paulo State and investigate the population's risk perception about the new coronavirus, attitudes regarding preventive measures and vaccine confidence through an open web survey. A total of 1111 individuals participated (71.6% females). Of those, 15% declared themselves unemployed, almost 6% lost their jobs during the pandemic, and more than 30% suffered a decrease in their monthly income. As for the COVID-19, almost 32% of the participants were tested sometime in 2020, and 11.3% reported a confirmed diagnosis for a level of hospitalisation of 5%. As for the risk perception, it was observed that situations with crowds of people were more frequently considered as of high risk and cause of greater concern with contamination of family members than with themselves. Almost 23% of the participants questioned whether they would take the vaccine when available and do not know if the COVID-19 vaccine will be safe for the population. Almost 70% disagreed with the statement that the actions of the country's health authorities are effective in combating COVID-19. Considering the Cramer's V coefficient, these variables were not associated with gender or educational level.

Health complexity assessment in primary care: A validity and feasibility study of the INTERMED tool.

BACKGROUND: Health complexity includes biological, psychological, social, and health systems. Having complex health needs is associated with poorer clinical outcomes and higher healthcare costs. Care management for people with health complexity is increasingly recommended in primary health care (PHC). The INTERMED complexity assessment grid showed adequate psychometric properties in specialized settings. This study aimed to evaluate INTERMED's validity and feasibility to assess health complexity in an adult PHC population. METHOD: The biopsychosocial health care needs of 230 consecutive adult patients from three Brazilian PHC services were assessed using the INTERMED interview. Participants with a total score >20 were classified as "complex". Quality of life was measured using the World Health Organization Quality of Life BREF (WHOQOL-BREF); symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS); social support using the Medical Outcomes Study-Social Support Survey (MOS-SSS); comorbidity levels using the Charlson Comorbidity Index (CCI). We developed two questionnaires to evaluate health services use, and patient perceived feasibility of INTERMED. RESULTS: 42 participants (18.3%) were classified as "complex". A moderate correlation was found between the total INTERMED score and the total scores of WHOQOL-BREF (rho = - 0.59) and HADS (rho = 0.56), and between the social domains of INTERMED and MOS-SSS (rho = -0.44). After adjustment, the use of PHC (ß = 2.12, t = 2.10, p < 0.05), any other health care services (ß = 3.05, t = 3.97, p < 0.01), and any medication (ß = 3.64, t = 4.16, p < 0.01) were associated with higher INTERMED scores. The INTERMED internal consistency was good (ω = 0.83), and the median application time was 7 min. Patients reported satisfaction with the questions, answers, and application time. CONCLUSION: INTERMED displayed good psychometric values in a PHC population and proved promising for practical use in PHC.

Does Religiosity Predict Blood Donation in Brazil?

The aim of this study was to investigate the association of religiosity with blood donation in a representative/stratified sample of primary healthcare users of Ribeirão Preto, São Paulo, Brazil. A cross-sectional study was conducted using the Duke University Religious Index-DUREL (dimensions: organizational, non-organizational, and intrinsic religiosity). Odds ratios adjusted by sex and age were used as measures of association. A total of 1055 individuals participated (79.7% females; mean age = 40.6 years); 23.3% had previously donated blood. Most reported having a religion and grew up in a religious environment. High frequencies of religiosity were observed. Similar DUREL scores were observed among participants who donated blood and those who did not. Family members and close friends had significant influence on participants' blood donation practices. Religiosity was not directly associated with blood donation despite the high prevalence and scores of religiosity. However, possible associations between religion and blood donation should consider mediating variables in future studies.

Seasonal variations in incidence of femoral fractures in the state of Rio Grande do Sul, southern Brazil / Variações sazonais na incidência de fraturas do fêmur no estado do Rio Grande do Sul, sul do Brasil

Abstract Introduction Femoral fractures are a major cause of morbidity and mortality, mainly among older people. Objective To examine the effect of seasonality on hospitalizations due to femur fracture among people residing in the Rio Grande do Sul state, southern Brazil, from 2008 to 2019. Methods Ecological study based on secondary data from the SUS Hospital Information System (SIH/SUS). A total of 74,374 reports of hospital admissions was considered. The generalized additive model (GAM) approach was employed to assess the seasonality of the time series, with stratification by sex and age groups and considering the monthly average number of events of femoral fractures per day as a dependent variable. Results A considerably higher incidence of femoral fractures in women aged 70 years or more was described. Among people aged less than 50 years, there is not an apparent seasonal effect. Men aged 70 years or older and women aged 50 years or older have a higher frequency of hospitalizations due to femur fractures in the colder months. Conclusion Among older people, more femoral fractures occurred during the winter compared to summer. This supports findings from other studies, although reasons for this seasonal variation are uncertain. The knowledge of these seasonal variations can help to plan the health care in the public health system.

Resumo Introdução As fraturas de fêmur são uma das causas principais de morbidade e mortalidade, principalmente entre as pessoas idosas. Objetivo Examinar o efeito da sazonalidade nas hospitalizações devido à fratura do fêmur entre residentes do estado do Rio Grande do Sul, sul do Brasil, de 2008 a 2019. Métodos Trata-se de um estudo ecológico baseado em dados secundários do Sistema de Informação Hospitalar do SUS (SIH/SUS). Um total de 74.374 relatórios de internações hospitalares foi considerado. O modelo aditivo generalizado (GAM) foi usado para avaliar a sazonalidade da série temporal, com estratificação por sexo e grupos etários e considerando a média mensal de eventos de fraturas do fêmur por dia como uma variável dependente. Resultados Descreveu-se uma incidência consideravelmente maior de fraturas do fêmur em mulheres com 70 anos de idade ou mais. Entre as pessoas com menos de 50 anos de idade, não há um efeito sazonal aparente. Homens com idade de 70 anos ou mais e mulheres com 50 anos ou mais têm maior frequência de hospitalizações devido a fraturas do fêmur nos meses mais frios. Conclusão Entre as pessoas mais idosas, as fraturas do fêmur ocorreram mais frequentemente durante o inverno em comparação ao verão. Isto reafirma os resultados de outros estudos, embora as razões para esta variação sazonal sejam incertas. O conhecimento destas variações sazonais pode ajudar no planejamento da assistência médica no sistema público de saúde.

Recommendations for application and interpretation of the Blood Donor Satisfaction Questionnaire (BDSQ)

ABSTRACT Background: The level of satisfaction of donors with the blood donation system is an important factor which influences their intent to return for future donation. A 25-item questionnaire on the satisfaction of blood donors has been recently proposed to assess the donor satisfaction with the service provided by a blood bank. The objective of this study was to present a proposal for application and interpretation of a BDSQ considering a sample of blood donors of a Brazilian blood bank. Methods: A sample of 1019 blood donors at the Regional Hemotherapy Center of Franca, Brazil, answered the BDSQ. A top-box analysis was used to assess the associations between the variables characterizing the profiles of blood donors and their overall satisfaction with the service provided by the blood bank. We proposed the use of a performance-importance plot (PIP) for the interpretation of the 25 items of the BDSQ. Results: Older donors are more likely to report lower overall satisfaction with the service provided by the blood bank. PIP allows us to classify the items of BDSQ into longand short-term improvement opportunities as well as into motivational and hygiene factors. Motivational factors (i.e. attributes that promote overall satisfaction when present) tend to be associated with the treatment offered by the blood bank staff. Donors seem to give more importance to the interpersonal aspects than to the physical structure of the service and other aspects of convenience. Conclusions: Top-box analysis and PIP proved to be efficient strategies to interpret the results of the BDSQ.