Factors Influencing Blood Donation Behaviour. Judith Holdershaw, Philip Gendall, Massey University Malcolm Wright, Victoria University of Wellington

Transcription

1 3:PJ7 Factors Influencing Blood Donation Behaviour Judith Holdershaw, Philip Gendall, Massey University Malcolm Wright, Victoria University of Wellington Abstract Worldwide there is a shortage of active blood donors, and the problem of attracting and retaining sufficient donors to meet demand for blood and blood products is a serious one. This study has identified variables that help explain the decision to donate blood. Thus, the findings offer blood collection agencies guidance with the task of formulating specific strategies to address blood donor shortages. However, accurately predicting who is most likely to donate blood remains problematic, and further research is needed to extend the findings reported in this study. Introduction Health services are dependent on safe and readily available supplies of blood to help save lives. However, tighter screening of blood donors in recent years has led to a decrease in the volume ofblood collected. Despite the fact that the volume ofblood collected has fallen, the demand for whole blood and blood products is increasing, at a rate higher than the collection rate (James and Matthews, 1996; Gillespie and Hillyer, 2002). Unfortunately, worldwide there is a shortage of active blood donors to meet the increased demand for blood (Royse, 1999; Armitage and Conner, 2001; Barkworth, Hibbert, Horne and Tagg, 2002; Gillespie and Hillyer, 2002; Reid and Wood, 2002). Previous studies have investigated the predictive ability of a range of attitude and behaviour variables for the purpose of offering blood collection agencies guidance with formulating specific strategies to address donor shortages. One direction previous blood donation studies has taken is to examine how blood donors differ from non-donors in terms of their demographic characteristics: age, gender, marital status, ethnicity, education and income (see, for instance, Burnett, 1981; Burnett and Leigh, 1986; Gillespie and Hillyer, 2002; Sojka and Sojka, 2003; Hollingsworth and Wildman, 2004). A review of the blood donation literature by Piliavin and Callero (1991) concluded that there are no easily-identifiable characteristics of individuals that can readily predict who will become a regular, altruistic blood donor. More recent studies remain inconclusive, which suggests that demographic factors alone are insufficient to predict willingness to donate blood. Similarly, investigations of psychographic characteristics have not been successful in providing a personality profile of the typical donor as a guide to recruitment. Although numerous personality characteristics have been reported, Piliavin (1990) concluded that no clear picture has emerged to identify a 'typical' donor or potential donor. Not all findings are in the same direction, and the personality traits investigated lack uniform definitions. Clearly, further investigations of the predictability of psychographic variables are likely to be hampered by the difficulty associated with isolating and measuring such indeterminate variables. Arguably, therefore, further studies focussed on this particular research direction are unlikely to advance current knowledge ofblood donation behaviour. 3564

2 Other variables linked to increased willingness to donate blood include: personal association with someone who donates blood (a family member or friend), having received donated blood or knowing someone who has received donated blood, and willingness to become a potential organ donor (Piliavin and Callero, 1991; Lee, Piliavin and Call, 1999). Previous blood donation history including experience as a donor, frequency of previous donations, and recency of last donation have also been associated with predicting future behaviour (see, for instance, Breckler, 1994; Whyte, 1999; Flegel, Besenfelder and Wagner, 2000; Ferguson and Bibby, 2002). The extent to which knowledge of the donation process influences donation behaviour has also been investigated. Findings have been mixed but there is some evidence to suggest that the greater one's knowledge of the blood donation process and the need for donated blood, the more likely one is to donate blood (Chliaoutakis, Trakas, Socrataki Lemonidou and Papaioannou, 1994; Adam and Soutar, 1999). Other variables investigated in previous blood donation studies include: moral obligation to donate blood (a sense that one should act in a particular manner and that failure to do so will produce self-criticism or loss of self-regard); attitude toward blood donation; normative influence of important others in the blood donation process; and the degree of behavioural control one perceives they have over the donation process (Giles and Cairns, 1995; Armitage and Conner, 2001; Holdershaw, Gendall and Wright, 2001). Although various attempts have been made to identify the variables that help explain the decision to donate blood, studies have still not found a reliable way to predict blood donation. Yet, if a reliable method of detecting differences between those who are more likely and less likely to donate were found, blood collection agencies could be assisted with the task of formulating specific strategies aimed at attracting and retaining those who are the most likely prospects. The purpose of this study was to investigate which variables offered the best explanatory power for predicting blood donation. Questionnaire Design and Methodology The data for this study were collected from a convenience sample of 1008 students and staff from four tertiary campuses in the lower North Island of New Zealand where regular mobile blood collection drives are made. Although this sample was not representative ofall blood donors it was, nevertheless, selected from a population commonly targeted by blood collection agencies (Nonis, Ford, Logan and Hudson, 1996). Consequently, drawing a convenience sample from a campus population is a research method that is commonly reported in blood donation studies (see Holdershaw, Gendall and Wright, 2001). A filtering question was used to exclude people who knew they were ineligible to donate blood. Thus, to the best of their knowledge, all respondents who took part in the study could donate blood if they wanted to. First, respondents were asked a series of behaviour and knowledge questions that required the interviewer to record a response to each question. (A knowledge score was constructed by summing the scores from each of seven knowledge questions.) Respondents also self-completed a series of questions based on Ajzen's (1985) theory of planned behaviour, that were designed to measure respondents' attitudes to and feelings about blood donation. Following the mobile blood drive, all respondents who had provided contact details were contacted and asked whether they had donated, or attempted to donate, blood. In total,

3 resjx>ndents (12%) reported that they had donated, or attempted to donate, blood. In a similar study, Pomazal and Jaccard (1976) compared self-reports of behaviour with actual behaviour and found no discrepancy between measures. Whilst acknowledging that use of self-reported behaviour is a limitation, Pomazal and Jaccard's finding offers support for the methodology used in this study. Results and Discussion Correlations among the variables used in this study were examined and highly correlated variables were removed from the final analysis. The remaining variables were entered into a logistic regression equation with the dependent variable self-reported blood donation behaviour. A model was then constructed by including the statistically significant variables. This process resulted in five variables being retained: last donation (the recency of the respondent's last donation), perceived behavioural control (PEe) (respondents' perceived ability to control the factors that help or hinder the act of donating blood), knowledge score (respondents' level of knowledge about blood donation), attitude (respondents' degree of favour towards the act ofdonating blood) and the respondent's age. Correlations among the retained variables and the dependent variable are shown in Table I. The strongest relationship between variables is with attitude and perceived behavioural control (PBC) (r =.55). The next strongest relationship between variables is with last donation and perceived behavioural control (PBC) (r =.47). Table 1 Correlations among Selected Variables Variables Behaviour Attitude PBe Last Donation Knowledge Score Attitude.23** - PBC.29**.55** - Last Donation.32** Al ** Knowledge Score.19**.19**.22**.40 - Age -.08* **.09**.. Correlation is significant at the 0.01 level (2-tailed). * Correlation is significant at the 0.05 level (2-tailed). The results of the logistic regression analysis using self-reported donation behaviour as the dependent variable are shown in Table

4 Table 2 Logistic Regression Analysis* Predictor Variable Coer SE Coer P-value Exp (B) PBC Last Donation Attitude Knowledge Score Age * Nagelkerke R 2 value is.25 The most important variable in predicting respondents' blood donation behaviour was perceived behavioural control (PBe). Perhaps not surprisingly, it was found that the more respondents felt able to control the factors that help or hinder their ability to donate blood, the more likely they were to donate. The odds ratio indicates that for every one-unit increase in perceived control of the factors that help or hinder their ability to donate blood, respondents were 1.4 times more likely to report that they had donated blood. Therefore, it is suggested that blood collection agencies concentrate on identifying and promoting the factors that help or hinder the donation process, such as increasing awareness of donation venues and operating hours, as these factors are likely to impact on a person's ability to donate blood. For example, blood collection agencies could closely evaluate current services and consider whether these are meeting donors' needs in terms ofopportunity to donate. At present, blood donation opportunities are limited to mobile collection drives and hospital location visits. A revision in location strategy, such as the provision of a centrally located venue for donation, may improve donors' opportunities to donate, leading to an increase in current blood donor percentages. Respondents who had donated blood more recently also were 1.4 times more likely to donate blood than those with less recent donation experience. In terms of blood donation research, the finding that the more recently someone last donated, the more likely he or she was to donate blood again is not new. It has earlier been reported that most of the blood given is donated by a small minority of regular, repeat donors (Piliavin, 1990; Gillespie and Hillyer, 2002). From a managerial perspective, the significance of this finding lies in the possibility that parallels exist between repeat blood donation behaviour and low-involvement repeat purchase consumer behaviour. Although monetary reward and inducements are not endorsed by blood collection agencies due to ethical concerns, greater emphasis on the use of appropriate, non-monetary incentives to reward and encourage behaviour may be an effective strategy to increase repeat blood donation behaviour. That is, in the same way that loyalty schemes and other behavioural incentives are used to encourage low-involvement repeat purchase consumer behaviour, comparable strategies may assist blood collection agencies with the task of increasing current rates of repeat donation. Thus, investigation of the use of behavioural incentives to encourage repeat donation behaviour provides an avenue for future blood donation research. The results of this study also suggest that having a positive attitude toward blood donation is associated with greater willingness to donate blood. For every one-unit increase in positive attitude toward the behaviour, respondents were 1.3 times more likely to report that they had 3567

5 donated blood. It is less apparent how this infonnation is best applied from a managerial perspective. However, it is suggested that blood collection agencies could focus on the operational factors that improve the donation experience. For example, use of strategies to decrease waiting time to donate blood might positively influence attitude toward the behaviour, leading to greater willingness to donate blood. This study also found that knowledge score was a significant detenninant of behaviour. The odds ratio indicates that a one-unit increase in respondents' knowledge about blood donation increases the likelihood of donating blood by around 9%. This finding suggests that knowledge and awareness of issues associated with blood donation should be promoted to potentially increase the number of registered blood donors. Anecdotal evidence from this study indicated that, in general, respondents were not very knowledgeable about blood donation issues. For example, in response to the question "What percentage of New Zealand's population currently donates blood?", 81 % of respondents stated a percentage higher than 5%, with responses ranging from 1% to 80%. New Zealand's population percentage of blood donors is in fact around 5%. The results also indicated that younger people demonstrated greater willingness to donate blood than older donors. The negative coefficient suggests that for each one-year increase in age, respondents were around 5% less likely to report that they had donated. Younger populations are currently targeted by blood collection agencies, and the results of this study support continuation of this strategy. It should be noted, however, that the average age of respondents was 22 years, with 50% of the sample aged 20 years or younger, and 80% aged 25 years or younger. Therefore, this finding is not comparable with results based on a donor sample drawn from the general population. Nevertheless, this finding is consistent with a review of earlier studies by Ferguson (1996), which indicated that younger donors are more likely to donate blood, with subsequent donations decreasing for various reasons as people get older. Conclusion This study investigated the factors that help explain the decision to donate blood. The more respondents felt they could control the factors that help or hinder their ability to donate blood, and the more recently respondents had last donated blood, the more likely they were to donate again. Younger donors are also more likely to donate blood than older donors. Moreover, the more respondents knew about blood donation, and the more positive their attitude towards it, the more likely they were to donate blood. These findings offer blood collection agencies guidance with fonnulating specific strategies to address blood donor shortages. However, accurately predicting blood donation behaviour remains problematic, as indicated by the relatively low level of variance explained by the model developed. Furthennore, since providing a dependable supply of blood is a primary mission for most blood collection agencies, continued research attempts to identify which variables are the best predictors ofblood donation behaviour are justified and necessary. 3568

6 References Adam, D., Soutar, G. N., A proposed model ofthe blood donation process. In Cadeaux, 1., Uncles, M., (Eds.). Proceedings ofthe Australian and New Zealand Marketing Academy Conference. Sydney: School ofmarketing, University ofnew South Wales. Ajzen, I., From intentions to actions: A theory ofplanned behaviour. In Kuhl, J., Bechmann, 1., (Eds.). Action control: from cognition to behaviour, Springer-Verlag, Berlin. Annitage, C. 1., Conner, M., Social cognitive detenninants of blood donation. Journal ofapplied Social Psychology 31 (7), Barkworth, L., Hibbert, S., Home, S., Tagg, S., Giving at risk? Examining perceived risk and blood donation behaviour. Journal ofmarketing Management 18, Breckler, S. 1., Memory for the experience ofdonating blood: Just how bad was it? Basic and Applied Social Psychology 15 (4), Burnett, 1. J., Psychographic and demographic characteristics ofblood donors. Journal ofconsumer Research 8, Burnett, 1. J., Leigh, J. H., Distinguishing characteristics of blood donor segments defined in tenns ofdonation frequency. Journal ofhealth Care Marketing 6 (2), Chliaoutakis, 1., Trakas, D. 1., Socrataki, F., Lemonidou, C., Papaioannou, D., Blood donor behaviour in Greece: Implications for health policy. Social Science and Medicine 38 (10), Ferguson, E., Predictors offuture behaviour: A review ofthe psychological literature on blood donation. British Journal ofhealth Psychology 1, Ferguson, E., Bibby, P. A., Predicting future blood donor returns: Past behaviour, intentions, and observer effects. Health Psychology 21 (5), Flegel, W. A., Besenfelder, W., Wagner, F. F., Predicting a donor's likelihood of donating within a preselected time interval. Transfusion Medicine 10 (3), Giles, M., Cairns, E., Blood donation and Ajzen's theory ofplanned behaviour: An examination ofperceived behavioural control. British Journal of Social Psychology 34, Gillespie, T. W., Hillyer, C. D., Blood donors and factors impacting the blood donation decision. Transfusion Medicine Reviews 16 (2), Holdershaw, 1., Gendall, P., Wright, M., Predicting willingness to donate blood. Australasian Marketing Journal II (l), Hollingsworth, B., Wildman, J., What population factors influence the decision to donate blood? Transfusion Medicine 4,

7 James, R. C., Matthews, D. E., Analysis ofblood donor return behaviour using survival regression models. Transfusion Medicine 6 (1), Lee, L., Piliavin, J. A., Call, V. R. A., Giving time, money, and blood: Similarities and differences. Social Psychology Quarterly 62 (3), Nonis, S. A., Ford, C. W., Logan, L., Hudson, G., College students' blood donation behaviour: Relationship to demographics, perceived risk, and incentives. Health Marketing Quarterly 13 (4), Piliavin, J. A., Why do they give the gift ofiife? A review of research on blood donors since Transfusion 30 (5), Piliavin, J. A., Callero, P. L., Giving blood: The development ofan altruistic identity, The Johns Hopkins University Press, USA. Pomazal, R. J., Jaccard, 1. J., An informational approach to altruistic behaviour. Journal ofpersonality and Social Psychology 33 (3), Reid, M., Wood, A., Motivating non-donors to donate blood. In Shaw, R.N., Adam, S., McDonald, H., (Eds.). Proceedings ofthe Australian and New Zealand Marketing Academy Conference. Melbourne: Bowater School ofmanagement and Marketing, Deakin University, Royse, D., Exploring ways to retain first-time volunteer blood donors. Research on Social Work Practice 9 (1), Sojka, B. N., Sojka, P., The blood donation experience: perceived physical, psychological and social impact ofblood donation on the donor. Vox Sanguinis 84, Whyte, G., Quantitating donor behaviour to model the effect ofchanges in donor management on sufficiency in the blood service. Vox Sanguinis 76 (4),