Abstract
Background
Understanding the factors that motivate donors to donate will facilitate improvements in recruitment programmes. Donation incentives are often used to improve the effect of recruitment programmes. This cross-sectional study was designed to understand donors’ attitudes toward incentives.
Material and methods
Participants (n=421) were recruited among volunteer donors at the Shiraz Blood Transfusion Centre when they registered for blood donation. They completed a questionnaire with items regarding demographic characteristics, donation status (first-time donor or regular donor), and their motivation for donating, their attitude towards incentives, and the best type of incentives. Multiple logistic regression and chi-squared tests were used to analyse the data with Statistical Package for the Social Sciences (SPSS) software.
Results
The majority of donors (85.6%) donated blood for altruistic reasons. One quarter of the donors (25.3%) believed that incentives should be offered to encourage them to donate. Most donors (84.5%) believed that the most effective incentive was offering specific blood tests. Donors who had donated for non-altruistic reasons were more interested in receiving incentives. The desire to receive incentives was more widespread among younger, married, first-time donors, donors with a lower educational level and donors with a history of more than five donations. The desire to receive incentives decreased as age increased.
Discussion
Most of the donors (74.7%) had no desire to receive incentives, and this was even more apparent among donors who donated for altruistic reasons. Non-monetary incentives may be effective in attracting younger, married, first-time donors, donors with a lower educational level and donors with a history of more than five donations.
Keywords: motivation, blood donors, recruitment activity, blood disease, blood safety, attitude
Introduction
Although blood banks are charged with preparing adequate and safe blood supplies1, they have to contend with a permanent shortage of blood2. Despite the increasing demands for blood due to advanced surgery, cancer treatment, seasonal shortages and ageing of the donor population, the number of blood donors is declining3–4. This decline is due to strictly enforced screening guidelines and improved screening for transfusion-transmitted diseases. The number of eligible donors is restricted to make sure that donated blood will not harm the donors or recipients2,5. Blood collection should, therefore, be prioritised for blood banks6. Understanding the factors that motivate donors to give blood would facilitate improvements in recruitment programmess3.
Many studies have examined the various motivations of donors7–11 and have found that altruism is the most important factor12–14. Donation incentives are often used to improve the effectiveness of recruitment programmess15–19. However, the results of these incentive-based efforts have not been clarified6. Incentives may dramatically affect blood safety by attracting high-risk donors who may intentionally fail to identify risk behaviours during the donation interview in order to obtain the incentives6. On the other hand, certain incentives could also deter donors whose prime motivation is for altruistic reasons6. Some studies showed a higher prevalence rate of transfusion-transmitted diseases among paid donors20,21. According to these findings, cash incentives or incentives that can be easily converted to cash should not be used22.
Donors’ attitudes towards incentives should be surveyed at our sites where all donations are based on voluntary non-remunerated donation. Attitudes towards incentives may differ according to donors’ characteristics. In this study we aimed to assess donors’ attitudes towards incentives and determine their potential value for enhancing donation rates in our community. We hope that this research will aid the planning of future donor recruitment programmes and thus benefit the medical services supported by blood banks.
Materials and methods
This cross-sectional study was conducted at Shiraz Blood Transfusion Centre, one of the main blood transfusion services in southern Iran. The centre prepares most the of the blood supply for the south of the country. Shiraz Blood Transfusion Centre operates a blood donation service based on voluntary non-remunerated donation. The participants who enrolled in this survey between 1 March and 1 December 2009 were all volunteers whose ages ranged from 17 to 65 years.
This analysis was restricted to blood donors who responded to the questionnaire survey. We used a sample size of 385 based on an estimated 50% of donors who would wish to receive incentives, with 5% precision and 95% confidence intervals. To increase the power of the study 421 donors was selected. The questionnaires were given to volunteer donors when they were referred to blood centres at the time of their registration for blood donation.
An anonymous questionnaire was generated from two previous studies and modified for the Iranian setting10,11. The questionnaire solicited information on demographic characteristics, donation status (first-time or regular donor) and motivation for blood donation. It also contained items regarding whether participants would be encouraged to donate again in the future if offered a variety of incentives, and which type of incentives they found most attractive. Responses to the possibility of receiving incentives were categorised as encouraged or discouraged. Incentives were classified into four groups: (i) screening tests for fasting blood sugar, cholesterol or haemoglobin; (ii) compensation-payment incentives such as cinema, park or concert tickets; (iii) tokens of appreciation in the form of a plaque, pin or certificate for different donation rates; (iv) gifts such as a mug, T-shirt or other small item bearing the blood donation emblem. Then we compared their motivation towards different incentives according to demographic characteristics. We used multiple logistic regression and chi-squared tests to analyse the data with Statistical Package for the Social Sciences (SPSS v.16) software.
Results
Of the 500 questionnaires distributed, 421 were completed and returned (84.4% response rate). The donors ranged in age from 18 to 63 years (mean 37.76±9.72). Based on the data, 94.5% of the participants were men, 79.5% were married, 14.3% were first-time donors and 58.3% had donated regularly. The mean number of lifetime blood donations was 8.7±1.14, and the mean number of blood donations per year was 2.33±1.21. Mean age at first blood donation was 23.8±7.92 years. One third of the participants (33.7%) had a high level of education (higher than high-school diploma). Most donors (85.6%) donated blood for altruistic reasons.
The motivations for blood donation are summarised in Table I. One quarter (25.3%) of the donors believed that incentives should be offered to donors to encourage them to donate blood and 84.9% of donors reported that specific laboratory tests (such as cholesterol, fasting blood sugar and haemoglobin) were the most attractive incentives. Donors’ opinions towards the type of incentives are summarised in Table II. The desire for incentives was lower among blood donors who donated for altruistic reasons. The desire for incentives decreased as age increased (odds ratio, OR=0.971; confidence interval, CI=0.957–0.984). The desire for incentives was greater among married donors (OR=2.47 CI=1.720–3.565), donors with a low educational level (OR=1.264 CI=1.006–1.586), first-time donors (OR=3.531 CI=2.258–5.521) and donors with a history of more than five donations (OR=1.815 CI=1.299–2.322). Those who donated blood for non-altruistic reasons were more interested in receiving incentives (OR=1.568 CI=1.199–2.052).
Table I.
Blood donors’ motivation for giving blood.
| Motivations for giving blood | All donors | Donors who donated regularly | Donors who did not donate regularly | Low level of education | Higher level of education | Age ≤25 years | Age >25 years |
|---|---|---|---|---|---|---|---|
| Altruistic reason | 360 (85.6%) | 217 (88.2%) | 143 (81.3%) | 97 (82.8%) | 235 (86.6%) | 16 (88.8%) | 174 (84.4%) |
| Positive effect of donation on their health | 48 (11.3%) | 24 (10.1%) | 24 (13.6%) | 15 (12.8%) | 32 (11%) | 1 (5.6%) | 26 (12.6%) |
| Free laboratory tests | 5 (1.2%) | 0 | 5 (2.8%) | 1 (0.9%) | 4 (1.4%) | 1 (5.6%) | 3 (1.5%) |
| Curiosity about blood donation | 4 (1%) | 2 (0.4%) | 2 (1.1%) | 2 (1.7%) | 1 (0.3%) | 0 | 1 (0.5%) |
| Religious reason | 3 (0.7%) | 2 (1.3%) | 1 (0.6%) | 1 (0.9%) | 2 (0.7%) | 0 | 2 (1%) |
| Peer pressure | 1 (0.2%) | 0 | 1 (0.6%) | 1 (0.9%) | 0 | 0 | 0 |
| Total | 421 (100%) | 245(100%) | 176 (100%) | 117 (100%) | 274 (100%) | 18 (100%) | 206 (100%) |
Table II.
Preferences for different types of incentives according to donation history and the donors’ motivation for giving blood.
| Incentives for blood donation | Tests for fasting blood sugar, cholesterol, haemoglobin | Payment or compensation (cinema, park or concert tickets) | Token of appreciation (plaques, pins, or certificates) | Gifts (mug, T-shirt or other small item bearing the blood donation emblem) | Total |
|---|---|---|---|---|---|
| All donors | 322 (85.2%) | 22 (5.8%) | 17 (4.5%) | 17 (4.5%) | 378 (100%) |
| Donors who donated regularly | 151 (83.4%) | 8 (4.4%) | 11 (6.1%) | 11 (6.1%) | 181 (100%) |
| Donors who did not donate regularly | 123 (89.1%) | 8 (5.8%) | 3 (2.2%) | 4 (2.9%) | 138 (100%) |
| Donation for altruistic reason | 244 (87.8%) | 11 (4%) | 13 (4.7%) | 10 (3.5%) | 278 (100%) |
| Donation for non-altruistic reason | 40 (75.5%) | 6 (11.3%) | 3 (5.7%) | 4 (7.5%) | 53 (100%) |
Discussion
In order to ensure a sufficient blood supply and overcome blood shortages, some blood transfusion services offers donation incentives to enhance the effectiveness of donor recruitment6,22,23. Knowledge of factors that can encourage blood donors and potential blood donors who have never donated blood is essential for donor recruitment24. In this study, 74.7% of donors indicated that they had no desire to receive any incentives for blood donation. The low desire for incentives among our donors was a positive point. The RetroEpidemiology Donor Study (REDS) showed that donors who reported being encouraged to donate due to incentives were 1.6 times more likely to be at risk of infectious diseases (OR=11.56 CI=1.05–2)25. Another study showed that there was a significant difference in the relative risk between paid and unpaid donors26. The low desire to obtain incentives may be due to the fact that most of our donors (85.6%) donated primarily for altruistic reasons. Other studies have shown that offering permanent incentives to donors may distract them from the main purpose of donating blood. Some donors may not consider the social benefits and, therefore, donate less frequently27,28.
Among the incentives most valued by our donors were screening tests for haemoglobin (as an indicator of possible anaemia), cholesterol and fasting blood sugar. This finding was similar to that of a study in the USA6. In contrast, another study showed free cholesterol testing did not increase donation rate in donors and non-donors29.
Screening tests have proven to be an effective recruitment instrument that has beneficial effects for the donor because it alerts some of them to the need to seek medical evaluation11,12. On the other hand, using screening tests as an incentives may endanger blood safety because some donors may assume that blood banks are a place where they can obtain a human immunodeficiency virus (HIV) test. This idea is not, however, well supported, as previous studies showed that the offer of non-monetary incentives such as screening tests had no effect on blood safety30.
The desire to receive incentives was lower among donors who donated for altruistic reasons. This finding is in agreement with another study in the USA6. Donors who donate for the sole purpose of benefit to the society are not persuaded by incentives.
Donors with a low level of education were more interested in receiving incentives. This illustrates the need to educate donors regarding the importance of donating for altruistic reasons.
The desire to receive incentives was greater among donors with a history of more than five donations, which suggests that regular donors deserve special consideration. Perhaps their selfless action and its benefits for society should be highlighted and they should be shown greater appreciation.
In spite of the importance of the voluntary nature of blood donation for blood safety, some donors still believed that incentives were potentially beneficial. It seems that offering incentives to encourage donors should be handled with caution because offering incentives may attract high-risk donors and subsequently endanger blood safety.
Previous studies showed that the impact of incentives on recruiting blood donors was unclear, that the effect of incentives on blood donation and preference for the method of incentive might differ according to the socio-demographic characteristics of donors and that the short and long-term effects of incentives on donation might vary31–33.
In Iran 93% of blood is collected from males and 7% is donated by females (Statistics Committee of IBTO, 2010, unpublished data). It seems that the main reason why women refuse to give blood is the fear of becoming anaemic. However, overall about 38% of females who attempt to donate blood are deferred because they do not meet the donation criteria. Approximately one-third of these deferrals are due to a low haemoglobin level based on finger stick capillary samples (Statistics Committee of IBTO, 2010, unpublished data).
Our analysis had some limitations. Firstly, our questionnaire only measured donors’ attitudes toward incentives, and these attitudes may be directly associated specifically or directly with different blood donation actions. Secondly, the effect of incentives on non-donor recruitment was not surveyed. This study involved only donors, so possible differences in attitudes between donors and non-donors were not investigated. We are, therefore, not able to generalise our results as representative of the whole population.
Conclusions
In the context of this particular study, most of the donors did not show any desire to receive incentives, and this disinclination was especially apparent among donors who donated for altruistic reasons. It seems that offering incentives to encourage donor recruitment should be handled with caution, because offering incentives may attract high-risk donors and subsequently endanger blood safety. Our survey suggests that using non-monetary incentives may be effective in attracting younger, first-time donors, those with a lower educational level, and donors with a history of more than five donations. Long-term studies are needed to shed more light on the significance of incentives and their influence on donor participation and blood safety.
Acknowledgements
We would like to thank Dr Alireza Tavassoli the head manager of Fars BTO for his help with the research, Maryam Shirmohammadi for data entry and Azade Mosallai for typing the manuscript. We thank Dr. Mehrdad Vosugh and Dr Peyman Jafari for the data analysis, Dr. Mosleh Shirazi and Alison Imani for editing the manuscript, and K. Shashok (AuthorAID in the Eastern Mediterranean) for improving the use of English in the manuscript. In addition, we thank the donation ward staff for their generous help in data collection.
Footnotes
The Authors declare no conflicts of interest.
References
- 1.Majeed Al-drees Abdul. Attitude, belief and knowledge about blood donation and transfusion in Saudi population. [Accessed on 17 Nov 2010];Pakistan Journal of Medical Sciences. 2008 24:74–9. Available from: http://pjms.com.pk/issues/janmar08/article/article15.html. [Google Scholar]
- 2.Sojka BN, Sojka P. The blood-donation experience: self-reported motives and obstacles for donating blood. Vox Sang. 2008;94:56–63. doi: 10.1111/j.1423-0410.2007.00990.x. [DOI] [PubMed] [Google Scholar]
- 3.Blood supply and demand. Lancet. 2005;365:2151. [PubMed] [Google Scholar]
- 4.Gilcher RO, McCombs S. Seasonal blood shortages can be eliminated. Curr Opin Hematol. 2005;12:503–8. doi: 10.1097/01.moh.0000180436.98990.ce. [DOI] [PubMed] [Google Scholar]
- 5.Whyte G. Quantitating donor behavior to model the effect of changes in donor management on sufficiency in the blood service. Vox Sang. 1999;76:209–15. doi: 10.1159/000031053. [DOI] [PubMed] [Google Scholar]
- 6.Glynn SA, Williams AE, Nass CC, et al. Attitudes toward blood donation incentives in the United States: implications for donor recruitment. Transfusion. 2003;43:7–16. doi: 10.1046/j.1537-2995.2003.00252.x. [DOI] [PubMed] [Google Scholar]
- 7.Misje AH, Bosnes V, Gåsdal O, Heier HE. Motivation, recruitment and retention of voluntary non-remunerated blood donors: a survey-based questionnaire study. Vox Sang. 2005;89:236–44. doi: 10.1111/j.1423-0410.2005.00706.x. [DOI] [PubMed] [Google Scholar]
- 8.Glynn SA, Kleinman SH, Schreiber GB, et al. Motivations to donate blood: demographic comparisons. Transfusion. 2002;42:216–25. doi: 10.1046/j.1537-2995.2002.00008.x. [DOI] [PubMed] [Google Scholar]
- 9.Belda Suárez IM, Fernández-Montoya A, Rodríguez Fernández A, et al. How regular donors explain their behavior. Transfusion. 2004;44:1441–6. doi: 10.1111/j.1537-2995.2004.04102.x. [DOI] [PubMed] [Google Scholar]
- 10.Boulware LE, Ratner LE, Ness PM, et al. The contribution of sociodemographic, medical, and attitudinal factors to blood donation among the general public. Transfusion. 2002;42:669–78. doi: 10.1046/j.1537-2995.2002.00120.x. [DOI] [PubMed] [Google Scholar]
- 11.Breckler SJ, Wiggins EC. Scales for the measurement of attitudes toward blood donation. Transfusion. 1989;29:401–4. doi: 10.1046/j.1537-2995.1989.29589284138.x. [DOI] [PubMed] [Google Scholar]
- 12.Hupfer ME, Taylor DW, Letwin JA. Understanding Canadian student motivations and beliefs about giving blood. Transfusion. 2005;45:149–61. doi: 10.1111/j.1537-2995.2004.03374.x. [DOI] [PubMed] [Google Scholar]
- 13.Schreiber GB, Schlumpf KS, Glynn SA, et al. Convenience, the bane of our existence, and other barriers to donating. Transfusion. 2006;46:545–53. doi: 10.1111/j.1537-2995.2006.00757.x. [DOI] [PubMed] [Google Scholar]
- 14.Kasraian L. Causes of discontinuity of blood donation among donors in Shiraz, Iran: cross-sectional study. Sao Paulo Med J. 2010;128:272–5. doi: 10.1590/S1516-31802010000500006. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Chrisman JC. Incentives for blood donation: do they work? MLO Med Labs Obs. 1988;20:51–3. [PubMed] [Google Scholar]
- 16.Ferrari JR, Barone RC, Jason LA, Rose T. The use of incentives to increase blood donations. J Soc Psychol. 1985;125:791–3. doi: 10.1080/00224545.1985.9713559. [DOI] [PubMed] [Google Scholar]
- 17.Murray C. Evaluation of on-site cholesterol testing as a donor recruitment tool. Transfusion. 1988;28(Suppl):56S.6. [Google Scholar]
- 18.Rzasa M, Gilcher R. Cholesterol testing: incentive or health benefit? Transfusion. 1988;28(Suppl):56S.7. [Google Scholar]
- 19.Kunin CM. Serum hepatitis from whole blood: incidence and relation to source of blood. Am J Med Sci. 1959;237:293–303. doi: 10.1097/00000441-195903000-00003. [DOI] [PubMed] [Google Scholar]
- 20.Allen JG, Dawson D, Sayman WA, Humphreys EM, et al. Blood transfusions and serum hepatitis: use of monochloroacetate as an antibacterial agent in plasma. Ann Surg. 1959;150:455–68. doi: 10.1097/00000658-195909000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Domen RE. Paid-versus-volunteer blood donation in the United States: a historical review. Transfus Med Rev. 1995;9(1):53–9. doi: 10.1016/s0887-7963(05)80030-6. [DOI] [PubMed] [Google Scholar]
- 22.Lacetera N, Macis M. Incentives for altruism? The case of blood donations. Research-based poli analysis and commentary from leading economists. 2008. [Accessed on 17 Nov 2010]. Available from: http://www.voxeu.org/index.php?q=node/2512.
- 23.American Red Cross. Red Cross encourages blood donors to ‘give a little, buy a lot!’ with chance to win a $1000 shopping free, Sep 2008. [Accessed on 17 Nov 2010]. Available from: www.nwnc-redcross.org/Press%20Releases/2008/giveALittle08.pdf.
- 24.Seifried E, Klueter H, Weidmann C, et al. How much blood is needed? Vox Sang. 2011;100:10–21. doi: 10.1111/j.1423-0410.2010.01446.x. [DOI] [PubMed] [Google Scholar]
- 25.Eastlund T. Monetary blood donation incentives and the risk of transfusion-transmitted infection. Transfusion. 1998;38:874–82. doi: 10.1046/j.1537-2995.1998.38998409009.x. [DOI] [PubMed] [Google Scholar]
- 26.van der Poel CL, Seifried E, Schaasberg WP. Paying for blood donations: still a risk? Vox Sang. 2002;83:285–93. doi: 10.1046/j.1423-0410.2002.00239.x. [DOI] [PubMed] [Google Scholar]
- 27.Abolghasemi H, Hosseini-Divkalayi NS, Seighali F. Blood donor incentives: A step forward or backward. Asian J Transfus Sci. 2010;4:9–13. doi: 10.4103/0973-6247.59385. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Lacetera N, Macis M. Do all material incentives for pro-social activities backfire? The response to cash and non-cash incentives for blood donations. J Economic Psychol. 2010;31:738–48. [Google Scholar]
- 29.Goette L, Stutzer A, Yavuzcan G, Frey BM. Free cholesterol testing as a motivation device in blood donations: evidence from field experiments. Transfusion. 2009;49:524–31. doi: 10.1111/j.1537-2995.2008.02007.x. [DOI] [PubMed] [Google Scholar]
- 30.Rodriguez del Pozo P. Paying donors and the ethics of blood supply. J Med Ethics. 1994;20:31–5. doi: 10.1136/jme.20.1.31. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31.Buyx AM. Blood donation, payment, and non-cash incentives: classical questions drawing renewed interest. Transfus Med Hemother. 2009;36:329–39. doi: 10.1159/000235608. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Goette L, Stutzer A, Frey BM. Prosocial motivation and blood donations: a survey of the empirical literature. Transfus Med Hemother. 2010;37:149–54. doi: 10.1159/000314737. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Yuan S, Hoffman M, Lu Q, et al. Motivating factors and deterrents for blood donation among donors at a university campus-based collection center. Transfusion. 2011 May 16; doi: 10.1111/j.1537-2995.2011.03174.x. [DOI] [PubMed] [Google Scholar]