Motives and barriers to blood donation among adults aged over 50 years: A qualitative analysis

Abstract

Background

Ageing populations will increase demand for blood‐products and donors who supply them. While blood collection agencies (BCAs) typically target younger people to expand supply, recruiting donors aged 50+ is also a potential solution. However, few studies focus exclusively on this group. We aimed to explore motives, barriers, costs, benefits, and BCA support and engagement of donors and non‐donors aged 50+.

Methods/Materials

Semi‐structured interviews were conducted with 31 donors who began or returned to donating (after >25 years) aged 50+, and 28 non‐donors aged 50+ who had never donated or not donated in >30 years. We used reflexive and codebook thematic analysis of data.

Results

Seven themes were generated: awareness of donation, accessibility and ease of donation, health and donation, age or life‐stage and donation, helping self and others, social connections, and inspiration and incentives. Donors discussed their growing capacity for donation while others planned donation around busy lifestyles. Awareness of the need for blood motivated donors, alongside their desire to give back (i.e. reciprocity). Donors uniquely discussed their health privilege enabling donation and feeling obligated to help others less healthy. Non‐donors lacked information and awareness about donating. Donation sites were viewed as inaccessible and family/work priorities limited capacity. Non‐donors uniquely discussed being ‘too old’ to donate. They felt unwanted by and invisible to BCAs who do not target them in messaging/campaigns.

Conclusion

To ensure sustainability of blood supplies and avoid marginalising those aged 50+, BCAs should be more inclusive with greater awareness raising, targeted marketing, and maximising accessible donation opportunities.

1. INTRODUCTION

Globally, those aged 65 and older represent a growing share of populations, ¹ with older Australians projected to comprise almost a quarter of the population by 2066. ² Although older Australians are healthy by international standards, with approximately 74% reporting good to excellent health, ² an ageing population will increase demand for blood products and donors.

Blood collection agencies (BCAs) typically target younger people to expand donor panels and mitigate blood shortages. ³ , ⁴ However, only 62% of those aged <40 years return for a second donation. ⁵ In contrast, over 80% of first‐time Australian donors aged 50+ return, ³ and they return more quickly, donate more frequently, and generally (confer, c.f. [6]), experience fewer adverse events than younger donors. ⁵ , ⁷ Thus, increasing the number of older adults (defined here as those aged 50+) who become donors has the potential to expand the blood supply. ⁴

However, the majority of first‐time donors are aged under 50 years. ³ , ⁸ In Australia, from 2019 to 2025, only 20% of first‐time donors were aged 50+, with this figure not changing markedly after Variant Creutzfeldt‐Jakob disease (vCJD) deferrals were lifted in 2022. ⁹ Furthermore, knowledge of those who (could) donate aged 50+ and the meaning of blood donation to this cohort is limited. ¹⁰ Research typically includes quantitative surveys using pre‐defined measures of motives and/or barriers with existing donors in comparative analyses (<50 vs. 50–65). ⁴ Older non‐donors are not a focus, and studies comprise small proportions of these participants in predominantly donor samples. ⁴

From the limited research (Supplementary Table S1), ⁴ donors aged 50+ share some similar motives and barriers with younger donors (e.g. prosocial motives, ¹¹ , ¹² , ¹³ , ¹⁴ , ¹⁵ , ¹⁶ perceived need for donation, ¹⁴ , ¹⁵ lack of marketing communications ¹⁷ , ¹⁸ ) and/or donors regardless of age (e.g. donor identity, ¹⁴ , ¹⁵ , ¹⁹ low self‐efficacy ¹³ , ¹⁴ , ¹⁸ , ²⁰ , ²¹ , ²² , ²³ , ²⁴ , ²⁵ ). Yet there are also differences potentially reflecting unidentified motives or barriers for this cohort (e.g. knowledge, reputation of BCA, convenience; see Supplementary Table S1). More nuanced differences within broader motives and barriers categories of relevance to those aged 50+ may also be underexplored. ⁴ For instance, within the broader categories of high/low self‐efficacy (Supplementary Table S1), it is unclear if/how age/ageing, life‐stage and health function as motives and/or barriers to donation for those aged 50+. ¹³ , ¹⁴ , ¹⁶ , ²²

While prior research provides some quantitative insights into pre‐defined donation‐related motives and barriers, particularly for donors aged 50+, none focuses exclusively on non‐donors aged 50+ or those who began donating at this age. ⁴ Further, few qualitatively explore perceptions of older donors (c.f. [14, 15]) or non‐donors (c.f. [26]), which can give in‐depth insights into their decisions about donation, identify salient motives and barriers for this cohort, and support future intervention development. If BCAs are to be inclusive of older adults as part of the solution to expanding blood supplies, understanding adults' perspectives on why they begin donating aged 50+, what prevents them donating, and how BCAs can support and engage this cohort is critical. ⁴

Thus, we aimed to explore the perspectives of adults aged 50+ who began donating blood (whole‐blood, plasma, or platelets) at this age, or have never donated, about their donation‐related motives, barriers, perceived benefits and costs, and BCA support and engagement of adults aged 50+.

2. METHOD

We used a qualitative approach informed by a constructivist paradigm to investigate meanings and experiences of donation or non‐donation from participants' perspectives. ²⁷ We interviewed (i) current donors (active in the past 12 months) who began donating aged 50+, and not through vCJD deferral revocation (which may confound motives for those aged 50+ who became newly eligible to donate); and (ii) adults aged 50+ who believed themselves eligible to donate (answered ‘no’ to four questions: under 55, over 75, heart condition, low iron; and ‘yes’ to believing they were eligible to donate), and who had never (or not in 30+ years) donated (non‐donors). We focused on adults aged 50+ given prior age‐related comparisons in quantitative studies, ¹¹ , ²¹ and 50+ is the age Australian adults may begin experiencing life transitions (e.g. parent/grandchild carer responsibilities, retirement/part‐time work). Ethics approval was received from Australian Red Cross Lifeblood (Lifeblood) (2024#14‐LNR) and the University of Queensland (2024/HE000726) Human Research Ethics Committees.

2.1. Participants

We recruited eligible donors via Lifeblood's database. Of 112 donors invited by email (representing varied age, gender, location, donation experience, and donation type), seven opted out (e.g. time constraints), and we called 105. Thirty‐three agreed to participate with 31 completing interviews. We recruited non‐donors via a social media campaign through COTA (Council on the Ageing) Australia. Interested participants completed pre‐screening surveys to check eligibility and record demographic and contact details. We called 313 respondents with most not answering our call or citing time‐constraints. Thirteen were ineligible, 34 agreed to participate, and 28 completed interviews.

2.2. Interviews

Four authors conducted phone or Microsoft Teams interviews from May–October 2024. Participants received information sheets and provided written and verbal consent for interviews and audio‐recording. Interviews averaged 45.5 min (range 16.25–77.57). We used semi‐structured interview guides to support consistency in approach (Table 1).

TABLE 1.

Interview topic guide.

Key topics	Questions for donors	Questions for non‐donors
Donation history/ experience	How long have you been a donor at Lifeblood? What type(s) of donation do you typically make (whole blood, plasma, platelets)? How often do you donate? Where do you usually donate? Thinking back to the first time you donated (after you turned 50), how did you find the experience of donating? And now, how do you find the experience of donating?	Do you know anyone who donates blood? Do you know anyone who receives blood products? If they have donated in the past (over 30 years ago) and stopped: When did you stop donating? How many times did you donate previously?
Motives for donation	Did anything in particular make you decide to begin donating? Did something or someone inspire you?	Have you ever considered donating blood? Why/why not? What do you think would encourage you to consider donating blood? Would something or someone inspire you? If you considered it, what do you think it would take to get you across the line to donate? If they have donated in the past (over 30 years ago) and stopped: Have you considered returning to donation?
Barriers to donation	Have you thought about stopping donating? Is there anything else you can think of that may make it difficult to donate? For you or friends or family around your age. If you were to ever stop donating, why do you think that would be? Why do you think most people your age don't become donors?	Is there anything else you can think of that may make it difficult to donate? For you or friends or family around your age? Why do you think most people your age don't become donors? If they have donated in the past (over 30 years ago) and stopped: Was there a particular reason you stopped donating previously? Did anything in particular make it hard for you to return?
Benefits of donation	Do you think you experience any benefits from donating? Benefits can be any kind of positive impact you may experience.	Do you think you would experience any benefits from donating? Benefits can be any kind of positive impact you may experience.
Costs associated with donation	Are there any costs or negative impacts you experience during or after donating? These costs do not have to be financial, they could be any kind of negative impact you may experience.	Are there any costs or negative impacts you can think of that you may experience during or after donating? These costs do not have to be financial, they could be any kind of negative impact you may experience.
Supporting and engaging donors aged 50+	Do you think Lifeblood provides enough support for people who start donating in later life? What else could Lifeblood do to support people who start donating for the first time in later life (i.e. over 50 years)? How do you think BCA could encourage more people to start donating in later life (i.e. over 50 years)? Is there somewhere in particular BCA should advertise/recruit from? Is there anything about blood donation that you think would appeal particularly to people in later life?	Do you think Lifeblood provides enough support for people who want to start donating in later life? What else could Lifeblood do to support people who start donating for the first time in later life (i.e. over 50 years)? How do you think BCA could encourage people to start donating in later life (i.e. over 50 years)? Is there somewhere in particular BCA should advertise/recruit from? Is there anything about blood donation that you think would appeal particularly to people in later life? When communicating health advice to people donating in later life, how do you think BCA should refer to these people? (e.g. Older donors? Ageing donors? Donors in later life?) Or just use the age that the advice would apply to (e.g. Donors aged 75 and over)?

2.3. Data analysis

Interviews were recorded, transcribed verbatim, and checked for quality. We used a combination of reflexive and codebook thematic analysis to inductively and deductively (based on prior blood donation literature) generate codes and construct themes. ²⁸ Two authors independently open‐coded six transcripts, meeting repeatedly with a third author to agree on code content and data interpretation. The resulting coding framework was added to qualitative data management software NVivo, v.14, ²⁹ with one author subsequently coding using this framework, adjusting where needed (duplication, new codes, clarity). We then constructed seven themes by grouping together codes that explained meanings relating to motives, barriers, costs, benefits, and BCA support/engagement.

3. RESULTS

Most donors identified as male (67.7%), and non‐donors as female (67.8%). Average age of participants was 65 years (range: 56–80). Approximately half worked full‐ or part‐time (Table 2). Participants included 19 first‐time donors (FTD), 12 returning lapsed donors (RLD), resuming after >25 years, 12 who had never donated (ND), and 16 non‐donors who donated >30 years ago (lapsed non‐donors [LND]).

TABLE 2.

Participant demographics.

Participant demographics	Donors (N = 31)	Non‐donors (N = 28)
Australian State
New South Wales	9	5
Queensland	6	8
Victoria	5	8
South Australia	4	3
Tasmania	3	2
Western Australia	2	1
Australian Capital Territory	2	1
Northern Territory	0	0
Age (Years)
Mean	65.4	65.5
Range	56–80	56–74
50–59	6	5
60–69	19	16
70–79	5	7
80–89	1	0
Gender
Male	21	9
Female	10	19
Employment status
Full‐time work or carer	13	5
Part‐time work or carer	3	8
Retired	14	13
Unemployed/Volunteer	1	2

Findings are reported by each of the seven themes: awareness of donation, accessibility and ease of donation, health and donation, age or life‐stage and donation, helping self and others, social connections, and inspiration and incentives. Table 3 provides an overview of themes and sub‐themes. Exemplar quotes are included in text and Table 4, identified by participant group and number, sub‐group, and age‐group (e.g. Donor2‐RLD, 60s).

TABLE 3.

Representation of themes and sub‐themes.

Themes	Awareness of donation	Accessibility and ease of donation	Health and donation	Age or life‐stage and donation	Helping self and others	Social connections	Inspiration and incentives
Motives	Lifeblood marketing or information Perceived need for blood	Easy access to donation site Self‐efficacy Time off work or school Experienced staff	Health improvements Healthy and able to donate Becoming eligible to donate	Having time	Altruism Reciprocity Values		Inspired by others A target or goal
Barriers	Lack of awareness about donation	Access Lack of self‐efficacy Lifestyle factors Travel Low interest or priority Negative experience with BCA	Health condition Impact on health	Age
Benefits			Donating is good for you Health check	Doing something useful or worthwhile	Warm glow Community or others in need benefit Availability of blood	No benefits Social benefits	Incentives
Costs		No costs Inconvenience Lifestyle costs	Impact of donation
Support	Information and promotion of donation	No extra support needed BCA staff support Increased accessibility
Engage		Ease and accessibility appeal		Age or life‐stage appeal	Helping appeal	Social benefit appeal Word‐of‐mouth appeal	Incentives or competition appeal

TABLE 4.

Themes and sub‐themes, participant group/sub‐group discussed, and exemplar quotes.

Themes (sub‐themes)	Motives, barriers, a costs, benefits, BCA support and engagement	Group/sub‐group b	Exemplar quotes	Theoretical link
Awareness of donation	Lifeblood marketing or information (motive)	All	I've gone to the actual point of going online to—I think there's an assessment, this was a few years ago, to see if you're eligible. I've gone online to find out where the vans are locally. And I'm prompted when I see the donate vans around (location) as well. (Non‐donor10‐ND, 50s) More information or probably a public relations campaign because I obviously thought, had perceptions which weren't necessarily correct. So probably public campaign saying anyone can donate blood or you're not excluded unless you've got this. And it'll probably be a very narrow range of exclusions. (Non‐donor27‐ND, 60s)
	Perceived need for blood (motive)	All	I've always thought about it. My old man used to donate all his life sort of thing, my brother donates, or he used to. I don't know if he still does. And it was only the fact I'd always thought about it, but I've always been too slack to go and do it. And I was watching the news, and they had a bit of a story on how they needed X amount of blood donations, so I just said to the missus, “Right, I'm going to go do it”. (Donor16‐FTD, 50s) Knowing how it's helped my mother‐in‐law having all those transfusions, has also really motivated me. I think if people have a personal connection with the benefits of a transfusion, then obviously that's going to motivate them more. (Non‐donor10‐ND, 50s)	Indirect downstream reciprocity
	Lack of awareness about donation (barrier)	Non‐donor (actual barrier), All (potential barrier)	I don't think everyone understands the impact of a blood donation. Like, you know, what happens from point A of donating to where the blood goes, what happens to the blood and then how it's, you know, transported and dispensed up at the other end. (Non‐donor6‐ND, 50s) It probably started off with a just a general search and it… wasn't as easy as I had hoped it might be. I'm not internet naive, I actually run websites for some organisations. So, you know, sometimes you can just put in the wrong term and you end up in the wrong spot. But I'd sort of thought that it would be a lot easier than it was. (Non‐donor13‐ND, 60s)
	Information and promotion of donation (support)	All	So, that—this is the experience of, of giving blood. You know, it's—these days that would be—rather than having to describe it, you just have a little video you walk through and take someone through the whole process and at the end you get your drink or whatever you do and, and even possibly have just—you don't want to scare people away. (Non‐donor16‐LND, 70s) Promote the fact that there's no problem with donating at an older age because I have wondered if there comes a time when you're past this, or your blood's got some deficiency that makes it not great quality. (Donor8‐FTD, 60s) It's one thing to have ads on TV, but they're not specifically pointed to anybody and it should sort of be the people that have got the time, I guess more so, or the people that haven't donated before. (Non‐donor9‐LND, 60s)
Accessibility and ease of donation ([in]accessibility of donation, self‐efficacy for donation, experiences with the BCA, lifestyle factors)	Easy access to donation site (motive)	All	Because I am very close to the city. I was less than 5 km away from the centre, and the fact that you could park for free was a great incentive. And even the place that I'm changing to is probably only 6‐7 km away. (Donor15‐RLD, 60s) I don't want to go somewhere that's 20 kilometres away. So, that would be the sort of thing that will get me much more interested in doing it…Close, close, and able to say…this morning I've got free time perhaps and it's not raining or something like that. And so, oh, look, this is spot at 11:00. I'll go down. (Non‐donor13‐ND, 60s)
	Self‐efficacy (motive)	All	I think it was just the ease of it and the nice environment. Everyone was so kind. There was nothing negative about it, so why wouldn't I do it? I thought this is something simple and hopefully it helps others. (Donor25‐FTD, 60s)
	Time off work or school (motive)	Donor, Non‐donor (LND only)	Lots of people went because they were allowed to go through work time, got paid for it. It didn't come out of their own time. It was so handy. It was, you know, very close to where I worked. (Donor16‐LND, 70s) When I donated back then, I was in a work environment where you went along as a group to donate. I think that's an incentive where people you work with, you know, go as a group to donate. (Non‐donor15‐LND, 70s)
	Experienced staff (motive)	Non‐donor	And also, for people like me with a complicated medical background, I, I want them to be confident and competent that they can handle, can handle that. (Non‐donor10‐ND, 50s)
	Access (barrier)	All (actual, potential barrier), Donor (future barrier)	We had to go to Adelaide to do it (donate). Because Adelaide is 3.5, four hours away for us, so when we go down there, we rarely had enough time to go in and do it. And quite often we just couldn't coordinate booking it, because we didn't know what else was going to happen when we were down there. And it was just too hard to get in and out and do it. (Donor8‐FTD, 60s) So that's the other impediment to actually booking a time to go and donate blood, because I know there's at least a 50% chance I'll cancel and I don't want to be that person. A drop in would be great. (Non‐donor10‐ND, 50s) There would be a lot of people in, in my age bracket who if they did suggest giving blood, they would need the support of somebody else to get them to the blood donation center or they would need somebody to help them. I mean, I've got friends younger than me who would need help. (Non‐donor17‐ND, 60s)
	Lack of self‐efficacy (barrier)	All (actual, potential barrier)	Laziness just like, not putting it in the calendar, just not laziness in a bad way. Just not… I think it's just not a habit, you know what I mean? It's not one of the things they do. (Non‐donor18‐ND, 60s) Say you're 67, you've never given blood, and someone says would you like to go and give blood? I think fear of the unknown would be one thing. (Non‐donor7‐LND, 60s)
	Lifestyle factors (barrier)	All (actual, potential barrier), Donor (future barrier)	I've always probably thought about doing it, but because of my situation with work and kids and so forth, I just put it off. (Donor25‐FTD, 60s) Now we work for a fairly large company. So when the caravan was in the area, they'd give you time off if you wanted to give blood. But then that became job‐restrictive because you never had time to go … with the job being busy. (Non‐donor14‐LND, 70s) My husband has had some health issues, if I did probably care for him, I might be limited. And I've got an elderly mum who lives away. If I had to probably go and spend more time with her, that would make it a bit more difficult. (Donor25‐FTD, 60s)
	Travel (barrier)	All (actual barrier), Donor (future barrier), ND (potential barrier)	Most of my friends from high school who are retiring now, they're all going travelling around the world. So they've got no time to do anything except travel. (Non‐donor18‐ND, 60s) So, there have been times where I haven't been able to give blood because of where I travelled to. So, there's been sizeable gaps between donations, and that's nearly always attributed to travel and locations that I've been. (Donor18‐FTD, 60s)
	Low interest or priority (barrier)	Non‐donor (actual barrier), All (potential barrier)	It's just sort of, you know, wandered through my mind on a vague occasion when I thought it might. And I've sort of thought, I suppose I should look into that. And oh, yeah, tomorrow, next week, whenever. Unfortunately, it never comes. (Non‐donor26‐LND, 70s) I guess I have sort of had a fleeting glimpse at it. And I'd probably say that it's not forefront of mind for several reasons is one, my family, my friends, no one I know has ever been a recipient of blood or blood products. (Non‐donor2‐ND, 60s)
	Negative experience with BCA (barrier)	All (actual barrier)	They called for blood donations and I went along and they did the test sample, and basically said to me at that time that my blood was of a very common type, and was not particularly good quality and I should come back another time, and of course, I never did. (Non‐donor17‐ND, 60s) As soon as you finished, you bound out of the chair and take three steps and face‐planted into the bloody floor because you didn't wait, because you were bulletproof. That was the worst experience. So I never, ever got back to it (donation) until later in life, when I could adjust and deal with it. (Donor4‐RLD, 70s)
	No costs (costs)	All	I don't really care about it (costs). If I go shopping, do I worry about how much it costs me to get to the shops? No, it's just a cost of living, so no, I don't worry about it. (Donor28‐RLD, 50s) I wouldn't say there's any cost at all, if you can work it around your work sort of thing, which I can because they're open till 7 o'clock at night, so it suits me to do it after 4.00 pm. No, no cost. (Donor16‐FTD, 50s)
	Inconvenience (costs)	All	As far as other costs, it's really only time, and that doesn't bother me unless I'm waiting around. When I make an appointment, sitting around waiting for an appointment that I've already made, that does aggravate me. (Donor18‐FTD, 60s)
	Lifestyle costs (costs)	All	My wife is part time, so she needs a car sometimes, you know. So I would have to know, I would have to go around a part time job. (Non‐donor4‐LND, 60s)
	No extra support needed (support)	All	I was really impressed. I think it was even better than – I can remember the setup years and years ago…I remember a big line that we used to get into, and there was people behind tables, and you had your finger prick in front of everybody, you weren't in little cubicles talking to people. Maybe it's like that in some centres, I don't know. But I found it very personal, very respectful of your privacy…looking from a long time ago and looking now I think they've really done well. I don't think there's anything else they could do for me. (Donor10‐RLD, 60s)
	BCA staff support (support)	All	I think the way the staff tend to react with people giving blood, I can't really – I'm pretty easy. I don't need reassurance, but people that do, that's where the staff need to pick up on anyone that's showing levels of anxiety or doubt or whatever. They just need to spend a bit more time with them. (Donor18‐FTD, 60s)
	Increased accessibility (support)	All	We're 20 min out of [city], so I'm not going to get in the car and drive to donate blood, sadly. If there was somewhere, you know, local that you could go donate blood, then that would be an easier option, yeah. (Non‐donor9‐LND, 60s) Subsidise their transport cost somehow to get them to donate, because obviously you have to go somewhere to donate. It's not something that they come to your home to do. They don't do home visits to donate blood, do they? That's just not, that's not practical. So, for a lot of people, like I said, for pensioners…we don't have a lot of spare money after the rent and the groceries and the bills are paid. So, you know, we count every penny that like if I have to take a taxi or something, I have to really make sure that there's no other way that I can get there. (Non‐donor25‐ND, 70s)
	Ease and accessibility appeal (engage)	All	I'm pretty sure they can't make it any more convenient than what it is now because there's so many places where you can give blood, it's just incredible. I think those portable units were absolutely amazing, they were so convenient. And the fact that these places are open until nine o'clock at night, so it's not like you can't find the time to do it at least once a month, or once every six months, or something. (Donor17‐LRD, 60s) There would be times when I would think, oh, I could go and give blood, I've got four hours…This is all before I started actually. I think I went in there once and they didn't have a spot that day in the time that I had available, so I just didn't worry about it. But if they could have the capacity for drop ins… (Donor12‐FTD, 60s)
Health and donation	Health improvements (motive)	Donor, Non‐donor (LND only)	And I thought well, that means it's good for you. It's also not a bad thing, it's actually a good thing. And in their cases, it was a fantastic thing, because it diluted this pollutant out of their blood, and they were much better off than the other people who didn't donate blood. So, that also reinforced that it was a good thing to do, specifically for me, probably. (Donor15‐LRD, 60s) I understood that giving blood actually helps to re – I'm not quite sure exactly what the terms are, but it invigorates your own blood system by allowing it to create newer blood. I'm not quite sure how it works, but I thought well, you're doing a community service, plus it's probably healthy for you as well. (Donor17‐LND, 60s)
	Healthy and able to donate (motive)	Donor	Well, I'm not really concerned about the effects that it might be having on my body. I'm generally pretty healthy for my age, I don't suffer any side effects, and as I said, I'm not scared of needles and I'm not scared of blood, and you're made to feel welcome and as if you're doing something, so why not? (Donor26‐FTD, 70s)	Advantageous inequality aversion
	Becoming eligible to donate (motive)	All	I didn't want to give blood because I had this cancer, you know, five years ago. I wanted to be completely clear to start again. But now I'm completely clear. So I'm ready to go, you know? (Non‐donor4‐LND, 60s)
	Health condition (barrier)	All (actual, potential barrier), Donor (future barrier)	You have been pregnant in the last so many months,’ or, blah, blah, blah. There was always a reason. A reason where I wasn't able to do it. I was not particularly pleased about that, so I thought, well, I won't worry about it. (Donor12‐FTD, 50s) One of the reasons I didn't donate earlier, my wife has been donating for quite a while and she has O‐negative, so she's very popular. But I had – well I still have type 2 diabetes and for a long time there I thought you couldn't donate with diabetes and then later on we found out that we could. (Donor30‐FTD, 50s) So while I was having that treatment I didn't think it was a good idea to be giving blood… And the treatment went on for about three months, so during that period I wasn't able to give blood. (Donor17‐RLD, 60s) Whilst my fitness and health and strength hold out, I will continue to donate. If I am suddenly diagnosed with some dire, life‐threatening disease, that will change things but I'm trying to live my life to forestall any of those events. (Donor19‐FTD, 80s) Most people have heart problems or…taking blood thinners for their hearts, all sorts of things. So again, it all comes back to health. I would say most people my age are not healthy enough. (Non‐donor14‐LND, 70s)
	Impact on health (barrier)	Non‐donor (actual, potential barrier)	Like there was something on, was it Michael Mosley the other night? How our red blood cells multiply, and it was like, millions or something, and I was like, my goodness…You think about giving so much blood and you think, oh, how long is that going to take to replenish? (Non‐donor22‐LND, 60s) They like to keep the blood for themselves. They get to a certain age and think, I can't afford to give my blood away now. I need it all for me. They probably think that if you're giving your vital bodily fluids away, it can't be doing you any good. (Non‐donor1‐LND, 60s) I know a number of people that have contacted them and have said we would be willing to go back and donate if there's at least one day when staff are wearing masks or there's air purifiers in the room… And so, for me, it's that, no, I'm not going to be risking the life of my partner to that (donating blood), because you have to be there for quite some time, people get close to you when they put the needles in. (Non‐donor21‐ND, 50s)
	Donating is good for you (benefits)	All	And somebody did tell me, I think it was one of the nurses beforehand, said that some athletes like to give, or they've been banned from doing this because it gives them an edge. If you donate blood, your body makes new blood cells and they give you a little bit of a high for a little bit afterwards. So I was on the lookout for that afterwards. But I think I've experienced feeling a little bit floaty afterwards, which is very pleasant. (Donor12‐FTD, 60s)
	Health check (benefits)	All	They're checking my blood every three months, and I don't have to pay for it. If there's something awkward going on, they're going to ring an alarm bell and tell me about that. And I'm not being conceited in saying that. It's a fact. (Donor4‐FTD, 70s) I know they take off a little sample of your blood before you actually start the donation, and I know they prick your finger, they take your blood pressure, they ask you general health questions, which is always good that they check. I'd say check your blood sugar level, that sort of stuff. So, you're getting some parts of your health checked as part of the whole process. (Donor23‐FTD, 60s)	Health promotion
	Impact of donation (costs)	All	Plasma takes so much longer than just giving blood. But no, it gets a little bit uncomfortable, but that's about it. I don't really have an issue. Apart from the one, when I had a bruise from the misplaced needle. (Donor21‐FTD, 60s)
Age or life‐stage and donation	Having time (motive)	All	Well, just having a date and a time and I'll make the time. Because as I said, I'm retired. So yeah, you go anytime. (Non‐donor22‐LND, 60s)	Ageing well
	Age (barrier)	Non‐donor (actual barrier), Donor (future barrier), All (potential barrier)	Yes, I'm 70 next year, and I don't know what the donating life is, but I certainly look around and I see the majority of people are probably younger than me. There's always a percentage that are my age. I don't think it's a high percentage. Maybe 20%, 30% that are over 65. I'm just guessing. I'd like to donate for as long as possible. As long there are no physical side effects. (Donor24‐FTD, 60s) And for older people particularly like me, I think they'd think, “Oh, I'm probably a bit old.” So, they don't bother motivating themselves to do it in the first place. (Donor15‐RLD, 60s)
	Doing something useful or worthwhile (benefits)	All	Our self‐confidence, our self‐esteem and all that can suddenly diminish when you stop work, and it's to do with stopping something that you used to do. So the time on your hands, you have to play that up, and you might not be working anymore, you might be not actively contributing to your work, but you can contribute so much and feel good. (Donor10‐RLD, 60s)	Ageing well
	Age or life‐stage appeal (engage)	All	I don't know how you'd voice it, but the general concept that yeah, you may maybe a senior, but you're still useful still and provide something to your community. (Non‐donor19‐LND, 60s) Newly retired people. So people that have thought about in passing, oh yeah, I suppose I could give blood but I'm too busy, I'm running around sort of with my hair on fire at work, I've got the kids to run around after school and at weekends, and I've just got not enough time in the week for other things let alone sitting in a chair for an hour and a half and giving blood or plasma. So newly retired people I think could be a good and fruitful cohort to look at. They've got more time on their hands. (Donor26‐FTD, 70s) People later in life have a greater sense of their mortality than we do. I'm 57, so I sort of look at, OK, I'll probably hope to have another 20–30 years or something. If you've got somebody that's in their 70s, they might not feel that they've got that time left and, and the greater sense of their mortality, they might be more inclined to donate. They might see more of their friends going to hospital or more of their friends suffering issues. And they might think, all right, well, you know, I need to step up and be a part of the process of helping. (Non‐donor11‐ND, 50s) People might be afraid that they're too old to give blood because I was wondering. So that's one of the things about being a senior, and some of the promotional material or the posters that you might have, like you're never too old to receive blood. You're never too old to give blood. (Non‐donor25‐ND, 70s)	Ageing well
Helping self and others	Altruism (motive)	All	I don't do it for the attention. I do it for the privilege of being able to donate blood and help other people. (Donor14‐RLD, 70s) I'm the helper type person so… I think just the gift of the gift of giving without any, getting anything back, you know? (Non‐donor6‐ND, 50s)
	Reciprocity (motive)	Donor	So I saw what people out there that donate have done for my loved ones. There was just no two ways about it, I really needed to donate. But I feel very bad that I left it that long. I don't know why. (Donor10‐RLD, 60s)	Indirect downstream reciprocity
	Values (motive)	All	So, for me, that sense of duty, and I'm very much aware that that's what drives me, right? The sense of doing right, contributing to the community, I'm doing something good. (Non‐donor12‐ND, 50s)
	Warm‐glow (benefits)	All	Just a warm rosy glow, you know, sort of done a nice thing. (Non‐donor26‐LND, 70s) I like contributing blood because I felt that I was helping somebody. I've never met anybody directly or know anybody, but I felt that I was helping someone, so it just made me feel good. (Donor6‐RLD, 70s)	Warm glow
	Community or others in need benefit (benefits)	All	Yeah, the benefit is that I know that that plasma is such an important product, blood product. It's so important, and I know that that's going to help. That's going to help people. I'm giving something to the community. I don't want to work at the Salvos. I don't want to sort clothes. I don't want to pack groceries. That, to me, is mindless, and it's probably selfish that I don't want to do that, but I don't. I'm very selective about what I want to do, in terms of, it's got to be something that's valuable to people. (Donor24‐FTD, 60s)
	Availability of blood (benefits)	All	Well, in the long run, I suppose it means that if I needed a blood transfusion, well, I would hope that other people had done the same. You know, it's all part of being part of a society. I think that's… I was just sort of feeling, you know, if I'm not prepared to do something, well then should I expect other people to? (Donor26‐RLD, 70s)	Reciprocal altruism; voluntary reciprocal altruism
	Helping appeal (engage)	All	People in the older life sometimes get illnesses and things and they may need blood themselves. And so, having a donation means that not just yourself but you can help others. There's possibly a time that you might need it yourself. Yeah, so it's like a tit for tat sort of thing. So, if you donate it's good for somebody else and then if somebody else donates it's good for you if you require it. (Donor30‐FTD, 50s) All I can remember hearing is, urgently need blood now and I would like to hear why. So, some of this is going to a kid with cancer or this is going to Bob, who's just been in a car accident. Make it more personal. (Non‐donor10‐ND, 50s)	Future reciprocity‐self/other
Social connections	No benefits (benefits)	Non‐donors	No, not really. I don't see it as a social occasion. Being an introvert, I'm not particularly into small talk. Especially if I'm anxious waiting for medical procedure. Or afterwards I just, I won't be chatting, I'll be reading or meditating. (Non‐donor10‐ND, 50s)
	Social benefits (benefits)	All	I did enjoy chatting to the ladies as well. So there is that connection thing. And I bet for anyone that's on their own, it would be like that too…I reckon that some of the old guys that do it, I reckon that's possibly the only time they have social contact. (Donor2‐RLD, 60s) An older person, it could be actually could become a little bit of a social event where you've got a little bit of a tea and a coffee area. Um, so you're rehydrating them, you're giving them a little bit of energy, you're giving them a social experience. (Non‐donor2‐ND, 60s)	Ageing well
	Social benefit appeal (engage)	All	You could run the whole interaction with others, meeting new people. Not that they become friends or anything, but just it's a way of interacting with others. (Donor25‐FTD, 60s) For people who do have the time from you know, my age group and do like to sit down and have a cup of tea and some biscuits and a chat, making it more friendly, more open, more sociable would be, would be nice have that option. That you're not being booted out. It's not like—it's very, it feels very clinical and medical. Which is a put off for a lot of people. (Non‐donor10‐ND, 50s)	Ageing well
	Word‐of‐mouth appeal (engage)	All	I find a lot of ads on Facebook quite annoying. I think flyers um, and your best friend is word of mouth. (Non‐donor2‐ND, 60s)
Inspiration and incentives	Inspired by others (motive)	All	It's just trying to do your bit. My grandmother, many years ago, was a lifelong blood donor. It was always something that she did. (Donor30‐FTD, 50s) When I was at college, there was a guy who came down from Queensland, we ended up being good mates, and he was a donor. So, he was going, and he dragged us down; three of us along, and just took it from there. The fellow who was donating basically booked us in. (Donor5‐RLD, 60s)
	A target or goal (motive)	Donor	Donor: No, I haven't really thought I'll stop. I've got a goal that I want to get to and then I'll see how keen I am to follow that. Interviewer: What's the goal? Donor: A hundred and fifty. Interviewer: Are you far off? Donor: About twenty. (Donor7‐RLD, 70s)
	Incentives (benefits)	All	I don't know if there's financial benefits. Or like, a voucher or something. (Non‐donor10‐ND, 50s) I feel fine because I'm looking forward to snacking on a pie and a cup of coffee. I feel really good… And they always do a, “Are you feeling okay?” “Yeah, I'm good, mate. I'm on my second pie. Of course I'm feeling okay”. (Donor4‐FTD, 70s)
	Incentives or competition appeal (engage)	All	Maybe there could be even events. So today all people in [location] come down between 10:00 and 12:00. Or all this week we're targeting 50 and above. Or bring a buddy and you get a prize. Or the 50th person into the donor van gets a prize. (Non‐donor10‐ND, 50s) I believe in the 10 years they probably did, the office I was in, which is a pretty large office, 1200 people, I believe they probably did a couple of blood challenges. So, I think that's a space that ah probably could shake the tree a little bit more. (Non‐donor2‐ND, 60s)

^a Barriers to donation reflect actual barriers experienced by donors and non‐donors that stopped them from donating (i.e. actual barrier), anticipated future barriers that may stop current donors from donating (i.e. future barrier), and donors and non‐donors' perceptions of barriers that other non‐donors in their age cohort may potentially experience (i.e. potential barrier).

^b Group refers to all participants, donors, or non‐donors. Subgroup refers to first‐time donors (FTD), returning lapsed donors (RLD), never donors (ND), or lapsed non‐donors (LND).

3.1. Awareness of donation

Donors and non‐donors frequently discussed their awareness of the need for donation as a motive. Discussion included both broad awareness of the need for blood, such as when blood stocks are low, and specific awareness of the importance of blood from loved ones or friends receiving blood.

My biggest incentive was my grandkids – I know my daughter‐in‐law, when she had her first baby, she needed a transfusion. And so it's just something that sits in the back of your mind, that it's got to come from somewhere, it may as well be from me. (Donor21‐FTD, 60s)

Seeing BCA marketing and information also motivated participants. Donors were prompted to donate by receiving reminders or advertising. Mobile sites encouraged some non‐donors to consider donation, while others believed seeing more information about donation (e.g. campaigns) would prompt them to donate. Some non‐donors were inspired by our study advertisement to find out more about donation.

It might've been on the TV, it might've been on Google, something about donating blood, and I thought, ‘Gosh, there's no excuse, just do it.’ Then I think they sent me some sort of invite or rang me or something like that, and I just said, ‘Yeah, I can do that.’ (Donor10‐RLD, 60s)

Equally, lack of awareness was a barrier for non‐donors and others their age. Most non‐donors had not seen information about where to donate or the donation process. Some noted information was difficult to locate, while others needed the visual prompt of a collection site to find information.

I don't see the van anymore. I don't know whether that still comes to the area or whether it…I have no idea. And you don't see any local advertising for it anymore because we don't get local papers. (Non‐donor21‐ND, 70s)

To combat lack of awareness for those aged 50+, donors and non‐donors suggested BCAs should increase availability of information about blood donation and the process.

I don't know whether it already exists, but it'd be quite nice to see on YouTube a video of the procedure, what happens when you go there so that there are no surprises. (Non‐donor13‐ND, 60s)

3.2. Accessibility and ease of donation

Participants' discussion of accessibility and ease of donating was informed by four sub‐themes: (in)accessibility of donation, self‐efficacy for donation, experiences with the BCA, and lifestyle factors.

(In)accessibility of donation: Donors and particularly non‐donors described easy access to donation sites as motivating them currently or in future. Both groups identified lack of access as a barrier for themselves and others. Access involved the ability to travel (e.g. public transport, mobility), convenient location(s), and/or sufficient car parking. Appointment availability and flexibility (e.g. opening hours, capacity for walk‐ins) were important for those spontaneously deciding to donate. Donors and non‐donors also discussed inconvenience, including location and wait times, as costs of donation.

I'll have to commute 40 minutes into another town unless there's a mobile bus. There'll be mileage cost, car expenses. And then if I was in (city), I'd probably have to pay for parking. It's pretty expensive in (city). (Non‐donor24‐LND, 60s)

Further, some donors and non‐donors thought BCAs should make donation more accessible for those aged 50+ (e.g. provide transport to/from donor centres) and emphasise ease and accessibility in donation appeals.

Self‐efficacy for donation: Some donors and non‐donors were motivated by their personal agency/ability to donate, and described donation as easy, with some donors viewing it as routine or habit. Non‐donors discussed that being organised and reminders would make it easier for them and others their age to donate.

Just my mindset, if I just think to myself, I have to go and donate blood now, I'll go and do that. I guess for want of a better way to put it into my calendar in my head, just make it a priority, which I should do just now that we're talking about it. (Non‐donor18‐ND, 60s)

Conversely, lack of self‐efficacy, particularly fear of needles, prevented some donors and non‐donors, and was believed to prevent others their age, donating initially, or at all.

My three adult children and my husband they all donated blood, but I was too scared, so I went along with my daughter who was giving plasma and thought didn't look that bad, so I've done it. That's why I was so old to start. (Donor27‐FTD, 60s)

Some non‐donors thought donating involved too much effort, or that they and others lacked interest or viewed donating as a low priority. Some thought about donation but forgot to act. Others had never considered donating due to not knowing anyone who needed blood.

Experiences with the BCA: Participant experiences with BCA staff both encouraged and prevented donation. Non‐donors thought donation would be less stressful, and they would be more motivated if staff were experienced phlebotomists.

I would prefer the older person, even if I'm having a flu needle… I have actually stood up and said, ‘no, excuse me, could I have an older person?’ I don't have faith in the young ones. I know they have to learn, but I'm not a good one with needles. (Non‐donor20‐ND, 70s)

Some donors and non‐donors described barriers including negative BCA staff interactions during donation attempts, negative donation experiences (e.g. adverse reactions, bruising), and BCA communications that non‐donors interpreted as their blood type not being needed.

You know when they advertise the blood groups that are required and rare, it's never mine, so there's not a lot of point in me donating. (Non‐donor11‐ND, 50s)

While most donors required no additional support, other donors and non‐donors discussed the importance of staff support and reassurance for positive experiences. Staff were viewed as essential for identifying and supporting those who feel anxious or unwell, and following‐up after first donations.

What happens if I have an episode or I have an anxiety attack, how embarrassing. So, I avoid it for that reason. But if I knew that staff were going to be gentle, trauma informed and non‐judgmental that would be a big help. (Non‐donor10‐ND, 50s)

Lifestyle factors: Some donors and lapsed non‐donors were given time off work or school, and this initially encouraged them to donate. However, most donors and non‐donors frequently discussed that competing commitments, such as family or work, impacted their capacity to donate now and in future, and potentially also made it difficult for others their age to donate.

People my age don't become donors unless they really see a need for it, because we're all busy, we're all running around to look after families and hold down jobs and do all that sort of thing unless there's an actual requirement for it. (Non‐donor11‐ND, 50s)

Current or future travel was also a barrier for donors and non‐donors and others their age. Travel interrupted access to donation sites and routine or resulted in deferral. Although many donors believed costs were mitigated by combining donation with another activity, other donors viewed lifestyle factors as a cost. Donation required time away from their responsibilities (e.g. carer, work), or fitting donation around existing commitments.

If I do (donate) up here, it will be the driving time, the time giving, and the time driving back that I'll be away from my husband. If I take him with me, then he's got to sit somewhere for the time it is, and he's not good at doing that because he's very fatigued. (Donor12‐FTD, 60s)

3.3. Health and donation

A motive unique to some donors was their belief that being healthy obligated them to donate to help those who are not.

I'm extremely healthy and don't have any issues whatsoever myself. Therefore, I see myself as in a privileged position. Therefore, I can at least do something to help people who aren't in that privileged position. (Donor18‐FTD, 60s)

Some donors and non‐donors discussed that resolving health issues or changed criteria by the BCA meant/may mean they were eligible to donate (e.g. finishing treatment). Some non‐donors also wanted reassurance that their blood was suitable to donate.

Maybe a blood tester told me I'm OK to donate… you're cleared to donate blood if you wish that would make things easier. (Non‐donor6‐ND, 50s)

Donors and lapsed non‐donors described being motivated by the perceived health improvements from donating, such as removing toxins from their blood, or generating new blood. Other donors and non‐donors viewed health improvements, such as donation being good for health or feeling physically good after donating, as (potential) benefits associated with donation.

I always feel I sleep better after I've donated blood. (Donor19‐FTD, 80s)

For some donors and non‐donors, donation could provide the benefit of a health‐check, helping them to focus on their health, and inspiring healthier behaviours (e.g. reducing alcohol intake). Some donors and non‐donors suggested BCA appeals should emphasise these benefits.

Feedback on their health, their blood pressure, their iron or whatever it is that they need, just your wellbeing. You get on the scale, your weight, your height. You see what changes over months. People like to keep tabs on their own medical things. (Donor6‐RLD, 70s)

Health was a barrier for some donors and non‐donors when health conditions, medications, or surgery prevented donation temporarily or permanently, or may in future. Some donors and non‐donors were deferred by the BCA when attempting to donate (e.g. due to low iron) and did not return until later in life or at all. Others self‐imposed deferral because they thought it “wasn't a good idea” or “they shouldn't” or couldn't donate.

Non‐donors, particularly, were concerned about potential impacts of donating on their health, having never donated or not donated in a long time. Some were concerned they would be impaired after donating and at risk when they left the donation site.

In the old days you used to take a pint. I don't know if that's still the case. I don't know if that has any short‐term effects if I'm doing something nonphysical. Obviously, you wouldn't do it before a bushwalk…but I don't know if I'd donate then go to the art gallery without being likely to keel over or be hit by a bus. (Non‐donor2‐ND, 60s)

Other non‐donors expressed concern about the potential risk of infection or disease. Some recalled their time in the 1980s during the emergence of HIV and the difficulty of trying to donate blood. Others expressed concern about the COVID‐19 pandemic and what they perceived as inadequate precautions to protect donors' health. Two non‐donors suggested that others their age may feel they need to keep their blood. This need to retain blood was related to potential health‐impacts as a person ages, or volume taken during donation.

As well as a barrier, donors and non‐donors expressed concerns about the cost of donation on their health, such as feeling tired or unwell and whether daily activities may be impeded. Some also discussed discomfort, injuries, or pain they sustained from donating.

Every time I feel flat for the first day, I think, ‘What am I doing this for?’ but anyway, it's helping someone out. (Donor9‐FTD, 50s)

3.4. Age or life‐stage and donation

Some donors and non‐donors discussed having time to donate and this was often associated with lifestyle changes such as retiring from work or reduced work hours.

I'm only working part‐time, I've got time. And if my blood is all right, I'm happy to donate. (Donor15‐RLD, 60s)

Donation could benefit donors and non‐donors by providing a sense of doing something useful or worthwhile with their time and giving back to their community, particularly for retirees.

It makes you feel a bit more worthwhile… you know, gives you a sense of purpose, helping somebody that might need it. (Non‐donor14‐LND, 70s)

However, believing they were ‘too old’ was a barrier for non‐donors, with donors anticipating this as a future barrier. Donors and non‐donors also suggested others their age may think they are too old, and not knowing age‐eligibility requirements may prevent them donating.

I always thought it was for younger people. You know, like up to 40, 50. I never ever thought you could give blood when you get old. (Non‐donor20‐ND, 70s)

One non‐donor noted that family opposition may arise from beliefs that their loved one is too old to donate safely.

If an older person said, “oh, I might donate blood for the first time”, there would be people who would object and say, ‘oh, Mum, you're too old’, or, ‘oh, mum,…what if you faint after you give blood.’…cause they're always worried that we oldies are going to be in mortal danger. (Non‐donor17‐ND, 60s)

Many donors and non‐donors discussed their age group as unrepresented in donation campaigns or appeals. They suggested appeals should focus on life‐stage and having more time to donate, and donation as an activity aligned with their desire to do something worthwhile with their time. Including age eligibility information and emphasising that “you're never too old to donate” was suggested as an important focus for recruitment campaigns.

Whenever you see campaigns for giving blood on the news or whatever, they're generally using athletes, football clubs, netball clubs, those sorts of things. Well, what does that say? It says that the people that are giving blood are young, fit, they're generally high profile…But I would suggest that there might be subliminal messaging there that that's what you've got to be to give blood. Most of the promotion tends to be more around the younger age groups. (Donor18‐FTD, 60s)

3.5. Helping self and others

Donors and non‐donors expressed an altruistic desire to help others generally or through donating. Some also described helping as part of their values or personality, or as a social responsibility that they “should do” to contribute to their community.

I realised that I was the age that I could still donate. And I thought, “Well, why not? I can do it. I should do it.” And yes, I think that we have a communal duty. (Donor15‐RLD, 60s)

Donors discussed their desire to give back for blood loved ones had received. Others discussed their hope that if they/family needed blood, someone would donate for them. Some believed that if they may need blood in future, then they should donate it now.

If I do need it, I would hope others have stepped up. So, if you have that in mind, if you expect to use the products where you need them, you've got to contribute when you don't. (Donor19‐FTD, 80s)

Blood availability was discussed by donors and non‐donors as a benefit for others, and themselves/loved ones, should they need it. A key benefit of donating was they felt/would feel good about themselves (i.e. warm glow) from doing something good, or helping through donating had a “positive effect on their self‐esteem”. Donating also benefitted community, with donors and non‐donors discussing these benefits as life‐saving and tangible.

The main benefit is, you're saving somebody's life. I thought that was quite good too, where you're emailed where your blood might have gone to. It's been used at (location)…So, you just don't donate in isolation…and you can think to yourself, ‘Oh, that's good, that's gone to somebody’. (Donor29‐FTD, 60s)

Donors and non‐donors suggested that appeals should incorporate helping others generally, or in local communities, while also emphasising that people are at an age where they/someone they know may need blood. Helping could be directed towards a cause or theme, or focused on blood shortages.

When I first went back it was, “We're doing this for first responders, and then we're doing this for cancer.” They had a cause that you were donating for, and they had different coloured bandages. (Donor23‐FTD, 60s)

3.6. Social connections

While social connection was not a motive for donation, some participants associated donation with social benefits. Some donors and non‐donors mentioned they enjoyed/would enjoy the opportunity to chat to like‐minded others or staff. While not seeing a social benefit for themselves, some thought others their age may be lonely and appreciate the outing and socialising. In contrast, several non‐donors did not see any social or other benefits associated with donation. They could not conceive of donation as a social occasion or at least not one that would result in long‐term friends or acquaintances.

Not really. I mean, you might meet people down there, but…I mean, you meet people at hospital appointments, but I don't keep in touch with them. I talk to them, but…they wouldn't become a lifelong friend. (Non‐donor23‐LND, 60s)

Some donors and non‐donors believed that emphasising the social aspect of donation or asking donors to tell others about donating may encourage donation.

When we're donating blood, if they have a thing to say, ‘Hey, tell people about it’, because I didn't even think about that. We fill all those forms out…but your last little thing that you have to do is, ‘Hey, you've done great today, but tell others, encourage your mates’. (Donor10‐RLD, 60s)

3.7. Inspiration and incentives

Family or friends encouraged some donors and non‐donors to donate or accompanied them, while others were inspired by knowing a donor. Some donors were motivated by targets or goals, often inspired by competitive dynamics with family or friends. Others competed with themselves to reach a specific number of donations.

A couple of my friends do it (donate), and one of them posted something on social media about a week before I did it, and it, sort of, prompted me to do it…I think he hit 25 donations, and he was a little bit proud of himself, as he should be. And I'm quite competitive, so I thought if he can do that, I can do the same. (Donor28‐RLD, 50s)

Some donors and non‐donors enjoyed/liked the idea of incentives for donation such as post‐donation refreshments, with one donor noting that vouchers or other financial rewards would be beneficial. Donors and non‐donors suggested marketing or appeals could focus on donation benefits, competitions, or incentives.

The best conversation I've had was the keyring, with my blood group on it. It's just a little free gift, which probably cost you guys a couple of dollars to do, and I've got it on my keys all the time. (Donor21‐FTD, 60s)

4. DISCUSSION

In this study we explored the perspectives of adults aged 50+ on donating blood in later life. Broadly, motives and barriers aligned with limited prior research including donors in this age group, ¹¹ , ¹² , ¹³ , ¹⁴ , ¹⁵ , ¹⁶ , ¹⁷ , ¹⁸ , ¹⁹ , ²⁰ , ²¹ , ²² , ²³ , ²⁴ , ²⁵ , ²⁶ and extended findings to show that adults aged 50+ also consider factors such as (in)convenience, fairness and equality, and indirect reciprocity in deciding to donate (Supplementary Table S1). While older donors and younger donors share many similar motives and barriers (e.g. lack of awareness about donation, importance of BCA marketing in soliciting donation ⁸ ; Supplementary Table S1), older donors in this study placed less emphasis on incentives (except health‐related), social connections, and prosocial motivation (except reciprocity). Instead, the overarching themes identified in this study prioritised awareness, access, health, and age or life‐stage, in donors' and non‐donors' choices about donating.

Donors aged 50+ were primed to donate by their awareness of community need for blood, loved ones receiving treatments, and/or reciprocity. Reciprocity encompassed donating for blood received by loved ones (i.e. indirect downstream reciprocity) ³⁰ ; believing they should donate if expecting to receive blood (i.e. reciprocal altruism) ³¹ ; and hoping that someone would donate if they/loved ones needed blood (i.e. future reciprocity‐self/other). ³⁰ In contrast, non‐donors lacked personal connections to donors or recipients, and rarely saw donation information. This created knowledge gaps about where or how to donate, and age and health eligibility. Some donors also did not know the age they could continue donating to. Thus, BCA attempts to connect with those in the 50+ age group should incorporate voluntary reciprocal altruism messaging ³¹ that queries willingness to receive blood, and emphasises the use of blood and need for donors in their age group, along with age‐eligibility information.

Donors described donation as easy and prioritised donation within their routines. Donation was a low priority for non‐donors, with family or work taking precedence. They saw donation appointments as inflexible, with limited or no capacity for walk‐ins, and sites as inaccessible. While some perceived inaccessibility stemmed from limited awareness, others lived in rural or regional areas requiring 1–2 h travel to donation sites. Therefore, BCAs could use Geographic Information System (GIS) technology ³² to identify areas where those aged 50+ live and there is untapped donation potential. Australians aged 50+ are more likely to live in regional and rural areas, ³³ thus increasing proximal donation opportunities (e.g. mobile sites) appears vital for reducing inconvenience and inaccessibility.

Donors felt privileged to have good health that enabled donation and some felt obligated to donate to help those less healthy to address perceived health inequities. ³¹ When connecting with those aged 50+, BCAs should use messaging that emphasises healthy individuals' opportunity to help others who are not (‘advantageous inequality aversion’ messaging). ³¹ This approach has increased donors' and particularly non‐donors' propensity to donate. ³⁴ Unlike donors, non‐donors were uncertain about their health eligibility and worried about the impact of donating on their wellbeing, likely due to limited awareness. ³⁵ However, both donors and non‐donors acknowledged the possible donation‐related health benefits, and the general ‘health check’ that donation provided. Thus, BCAs should incorporate health‐eligibility information in messaging and highlight how donation enables health monitoring. BCAs should also consider offering more comprehensive blood health checks, which field trials show have an enduring positive incentivising effect on donor retention. ³⁶ Expanding testing to include diabetes, cardiovascular, and obesity markers would further support donor and community health. ³⁷

While competing responsibilities hindered donation for many, some donors described an increasing life‐stage alignment where they had more time (often linked to retirement), saw donation as a worthwhile use of their time, and potentially had more exposure to loved ones needing blood. BCAs should partner with superannuation (voluntary retirement) or health insurance schemes to engage people during key transitions, like retirement. Messaging could highlight their increased or possible future capacity to donate, the opportunity to contribute meaningfully to their community, and the growing need for blood.

In contrast to donors who viewed their contribution as valuable, non‐donors frequently believed they were ‘too old’ to donate. This stemmed partly from knowledge gaps about age‐eligibility, but most non‐donors (and many donors) noted that BCA campaigns predominantly featured younger, healthy people, which they interpreted as BCAs not wanting or needing their blood. Although older adults are broadly under‐represented in media and health campaigns, ³⁸ by targeting younger demographics, BCAs may inadvertently marginalise those aged 50+ and perpetuate ageism.

BCAs should instead frame donation as an aspect of ageing well through making valuable contributions and feeling good about themselves. ³⁹ Messaging should emphasise that people aged 50+ are not too old to donate, incorporate age‐eligibility information, and create accessible opportunities that foster social connections. For example, BCAs could expand mobile site visits to include over 50s lifestyle or retirement villages, community clubs or hubs, or fitness/sporting clubs, and increase recruitment of over 50s workplace or community donor teams. As part of this, BCAs need to continue efforts to improve inclusivity and promote donation to older people of diverse genders, sexualities, ethnicities, and mobilities. ⁴⁰

Findings from this study should be interpreted with limitations in mind. Participants self‐selected into the study and were likely more motivated than non‐participants to engage with donation. Most participants were aged in their 60s, identified as male or female, and ethnicity was not reported; potentially limiting applicability of findings to those in their 50s, 70s, and older, from diverse gender identities and ethnicities. More males were donors and more females were non‐donors, meaning group‐based variation in responses may reflect gender, not donor experience. Finally, some non‐donors lacked easy access to donor sites, which may have amplified accessibility discussions. Future quantitative work with those aged 50+ should examine variation in motives and barriers by donor experience, age, gender, and location.

5. CONCLUSION

This study explored perspectives of donors and non‐donors on beginning blood donation aged 50+. Results show that some aged 50+ have growing capacity for donation and could be motivated by awareness of the need for blood, reciprocity, or health privilege that obligates helping others. However, non‐donors aged 50+ lack information and feel unwanted and invisible to BCAs who do not target them in campaigns. This marginalisation, coupled with myths about blood and age, reinforces the belief that donation is not for those aged 50+. Access and inconvenience barriers compound this marginalisation, as gaining access may highlight age‐related inequities in mobility, financial capacity and health costs. To ensure sustainability of the blood supply and avoid marginalising potential donors, BCAs need to be more inclusive through awareness raising, targeted marketing, and maximising accessible donation opportunities for those aged 50+.

AUTHOR CONTRIBUTIONS

All authors were involved in project design. Barbara M. Masser, Rachel Thorpe, Theresa L. Scott, and Tanya E. Davison obtained funding for the project. Barbara M. Masser, Rachel Thorpe, Aaron Akpu Philip, Melissa K. Hyde, and Amanda Salmon were responsible for project management. All authors were responsible for protocol development. Aaron Akpu Philip, Melissa K. Hyde, Barbara M. Masser, Amanda Salmon, and Rachel Thorpe were responsible for data collection. Melissa K. Hyde, Aaron Akpu Philip, Rachel Thorpe, and Barbara M. Masser were responsible for data analysis. All authors were involved in draft manuscript writing and read and approved the final manuscript.

FUNDING INFORMATION

This work was supported by a Linkage grant from the Australian Research Council LP220200819 to authors Prof Barbara Masser, Dr. Rachel Thorpe, Dr. Theresa Scott, and Prof Tanya Davison. Australian governments fund Australian Red Cross Lifeblood for the provision of blood, blood products, and services to the Australian community.

CONFLICT OF INTEREST STATEMENT

Melissa K. Hyde, Barbara M. Masser, Rachel Thorpe, Aaron Akpu Philip, and Tanya E. Davison are current or former employees or affiliates of Australian Red Cross Lifeblood. Barbara M. Masser is a current Associate Editor of Transfusion Medicine. The authors do not have any conflicts of interest to declare.

PATIENT CONSENT STATEMENT

All participants were aged over 18 years. Participants received information sheets and provided written and verbal consent for interviews and audio‐recording.

Supporting information

Table S1. Comparison of prior research studies including donors aged 50+ years and younger donors <50 years, and all ages (reviews).

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.