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. Author manuscript; available in PMC: 2021 Nov 17.
Published in final edited form as: Transfusion. 2021 Jun 30;61(9):2650–2657. doi: 10.1111/trf.16568

Evaluating Blood Donor Experiences and Barriers/Facilitators to Blood Donation in the United States Using YouTube Video Content

Christine Tagliaferri Rael 1,*, Dominique Pierre 2,*, Victoria Frye 3,4, Debra Kessler 4, Louisa Duffy 4, Nick Malos 4, Hong Van Tieu 4
PMCID: PMC8597980  NIHMSID: NIHMS1723065  PMID: 34196004

Abstract

Background:

Understanding donor perception of the blood donation experience is central to maintaining an adequate blood supply. Studies that use questionnaires to assess barriers/facilitators to donation may be influenced by response bias. To address this, we conducted an innovative study integrating quantitative informatics techniques with qualitative data analysis of YouTube video content to explore donor experiences and barriers and facilitators to whole blood donation.

Methods:

Sampling of YouTube videos was conducted using search parameters for identifying relevant videos, based on donors’ language used to describe their whole blood donation experiences (e.g. blood donation, blood donor, donated blood, gave/give blood, etc.). We eliminated duplicate videos; filtered out non-English videos, those made outside the U.S., and those with no transcripts; and restricted the time period during which videos were posted from 2015 to 2019. Search parameters were fed into a Python script, which downloaded video transcripts for all search results. The final sample was 102 non-commercial and 34 commercial transcripts. The subsequent transcriptions were uploaded into qualitative analysis software and coded two coders. A third coder randomly selected transcripts to review to ensure consistency.

Results:

Barriers to whole blood donation include having prior negative experiences with donation, and donation-related fear. Facilitators included altruism, having a personal connection to donation, donation center incentives, and positive experiences with blood center staff.

Conclusion:

Themes identified in this study were similar to those in the existing literature. This suggests that current questionnaires to address barriers/facilitators to donation are unlikely to be meaningfully impacted by response bias.

Introduction

Maintaining a safe and adequate blood supply is a core function of the blood donation systems in the United States (US).(Dhingra & Carolan, 2010) Blood transfusion is critical to patient care; this is especially true among patients with blood diseases that require chronic transfusion, such as sickle cell disease and thalassemia.(Yazdanbakhsh, Ware, & Noizat-Pirenne, 2012) Blood shortages require that blood banks must appeal to individuals who are diverse in multiple ways, including age, race/ethnicity, socioeconomic background, geographic location, and other factors.(MacIntyre, 2017) Thus, understanding what influences a broad range of donors to give blood on an ongoing basis is of continued importance. YouTube.com (henceforth called YouTube) is a free, web-based video platform that allows anybody to create or consume videos about topics that meet their user guidelines(YouTube, 2019). The free and open-access nature of the platform allows us to further understand barriers and facilitators to blood donation in a unique way. Specifically, content about blood donation experiences in YouTube videos focuses on the priorities of the donor, and is not influenced by research questionnaire content, or biased by the effect of interviewing with research personnel (e.g., response bias). Thus, this approach allows us the opportunity to explore barriers and facilitators to blood donation as they are experienced and prioritized by a broad set of donors themselves. Findings from this research will help us to identify if and how, 1) the structure of future questionnaires about blood donation experiences should be changed to more fully capture the priorities of donors, and 2) messaging about blood donation should be amended to address topics that resonate with potential donors.

Barriers and motivators to blood donation are well documented in the literature. Barriers include low self-efficacy to donate, perceived inconvenience of donation, perceived or experienced negative donation services experience (e.g., pain during phlebotomy) lack of knowledge or community marketing around donation, and ineffective incentives, temporary deferrals, and adverse reactions related to donation.(Bednall & Bove, 2011; Beerli-Palacio & Martín-Santana, 2015; Finck, Ziman, Hoffman, Phan-Tang, & Yuan, 2016; France et al., 2020; Piersma, Bekkers, Klinkenberg, De Kort, & Merz, 2017; Schreiber et al., 2006) Motivators include, altruism (e.g., the potential to “save lives” through donation), convenience of donation, appropriate non-monetary incentives, and having knowledge about donation.(Bednall & Bove, 2011; Chell, Davison, Masser, & Jensen, 2018; Finck et al., 2016; France et al., 2014; Glynn et al., 2003; Hughes, Sheon, Siedle-Khan, & Custer, 2015; Piersma et al., 2017; Steele et al., 2008; Vahidnia et al., 2016) Observational and other research has found that negative experiences during the donation are associated with reduced likelihood of future donation.(Amoyal et al., 2013; Ferguson, France, Abraham, Ditto, & Sheeran, 2007) Alternatively, having a good experience could facilitate subsequent donations. In this study, we reviewed YouTube videos on blood donation experiences in the U.S. and compared content creators’ barriers and motivators to blood donation to those that are currently presented in the literature.

Methods:

Sampling of YouTube videos

Search parameters for identifying relevant YouTube videos, based on donors’ language used to describe their blood donation experiences (e.g., blood donation, blood donor, donated blood, gave/give blood, etc.) were fed into a Python™ script, which downloaded video transcripts for all search results. To recognize these terms in YouTube transcripts, the sentiment language vocabulary system recognizes sets of words and phrases using string matching and regular expressions that operate directly on text without pre-processing (e.g., spelling correction, part-of-speech tagging, word sense disambiguation). Additionally, scripts were run to eliminate false positives (e.g., videos returned by the search that do not contain key terms such as “I donated blood”). Videos fell into two categories based on how content was presented: YouTube member/subscriber-created content exclusively (non-commercial) or institution led education videos and TV news coverage (commercial). To encourage consistency, both video types broadly were intended to include information about donor experiences or recommendations. The transcripts were then processed through selected sentiment vocabulary engine(s) through RESTful API using Python. All relevant output was recorded back in the datastore with unique transcript identifiers. We restricted the time period during which videos were posted from 2015 to 2019, and the location where the blood donation experience occurred to the United States (US).

The video transcripts were then read manually by two independent coders, DP and CR. Videos that met any of the exclusion criteria were removed from the final sample. First, duplicate videoclips were eliminated (multiple postings of the same video) (n=2500). Second, videos that were not in the English language, or without a legible transcript were removed (n=750). Third, videos that did not take place in the United States or were irrelevant (that did not include information relevant to blood donation or any keywords) were eliminated (n= 136).

Analysis

Study staff identified the specific concepts recognized by the software that are associated with blood donation, catalogued them into specific categories (e.g., barriers, facilitators, motivators), and reported the frequency of each concept mentioned. A priori codes were developed by study staff following the major concepts identified by the software. Two independent coders (CTR, DP) coded the transcripts using the qualitative analysis software package, Dedoose. Coders began to identify themes and concepts from the transcripts and made ongoing edits to the code book based on content creator’s experiences. To ensure high inter-rater reliability, an independent coder (HVT) reviewed coding of randomly selected interview transcripts, and discrepancies were discussed with CTR and DP until a consensus was met.

Results

A total of 102 non-commercial and 34 commercial video transcripts were identified and included in this analysis. Of these, 17 were made by content creators who reported donating blood for the first time, and 30 were made by creators who were regular donors. It was unclear in which of these categories the remaining videos belonged. A total of 14 content creators indicated they were in high school, and another 7 indicated they donated blood in college. We identified multiple barriers and facilitators to whole blood donation, which are discussed below.

Barriers to whole blood donation

Prior negative experiences with blood donation

Content creators reported two main types of negative experiences during donation. The first negative experience some content creators reported was fainting or feeling faint during donation (N=12 unique videos).

“…apparently I blacked out and I don’t even remember blacking out. I don’t even remember feeling like I was blacking out… like I guess you can’t really feel that and sense that. I don’t know. I just was blacked out and then I remember when I woke up and the nurses were like over me and they’re like, ‘do you know where you are’?” (NC011)

“…I was feeling fine right after and then maybe like an hour later I started to get really dizzy and nauseous and my vision was blurry and so they had me sit down I didn’t pass out that they were being really cautious of me.” (NC015)

Other content creators reported experiencing multiple or painful sticks during phlebotomy (N=8 unique videos),

“…so funny thing is this lady that I trusted with my veins it’s actually a trainee. So I was like oh oh oh okay so what happens next is this training supervisor comes up she pulls the needle out a little bit and they’re like, ‘okay we’re gonna pull the needle out a little bit because the blood isn’t coming out fast enough’ … and I’m like, ‘yeah okay pull it out a little bit.’ I know it was gonna hurt a little but, imma be okay imma be okay. So they pull it out a little bit and it’s not that bad I could deal with this I can deal with pain. I’m okay. I have a high tolerance for pain. So I’m like, ‘all right. Cool.’ I’m cool. It kind of hurt, but it’s cool, and a couple minutes later you know the lady comes back and she’s like, she gets the needle that’s inside of me right and she pullsit in and out in and out and she keeps doing it until the bag of blood was full. I was like, ‘holy crap’ the entire time… Tears almost came down my face. Seriously - I’ve never been in so much pain in my life. Not even when I had appendicitis did it hurt that bad. Literally a piece of metal coming in it out of your vein for like ten minutes…” (NC020)

“They were poking me like crazy. My skin’s so white you can’t even see it. I’m a ghost. They kept poking me everywhere in my arm. They kept poking me in my arm because they weren’t getting enough blood flow..” (NC013)

Donation-related fear

Content creators reported three different fears related to whole blood donation. Some content creators reported a fear of needles (N=9 unique videos).

“…I never donated blood because I’m kind of afraid of needles. Like, I’m not gonna lie. I’m afraid of needles and shit like getting my blood sucked out of me. It’s fearful. It was fearful, bro.” (NC030)

“…so the thing is I’m not very good with syringes. I don’t know, blood really doesn’t bother me. It’s just the idea of something going into you and taking blood out…” (NC017)

Other content creators reported fearing passing out or throwing up (N=5 unique videos).

“I figured if it was anything like getting your blood drawn, I didn’t have much to worry about. I was honestly more afraid of fainting and vomiting more than anything else.” (NC024)

I was really concerned about feeling nauseous or lightheaded, and I got pretty much to the end before I started feeling faint, which was a good. It was good for me because I was anticipating, like, the minute it went in, I was gonna be pale and ready to die and pass out…” (NC031)

Some content creators reported a feeling general nervousness about blood donation (N=6 unique videos).

“I was sitting in the booth and I felt more nervous… I started shaking a little, but a little low key, so they wouldn’t notice because if they saw that they were probably gonna kick me out with something. But honestly I just started watching people’s stories and everything. I called my mom as well just to distract myself.” (NC009)

“I’ve seen inside the room and it looks scary as shit it was scary shit I’m not gonna lie you know our you’re walking past the room and you see everybody laying on this table it’s like a fucking teen from saw like everybody looks like they’re dying” (NC033)

Facilitators of whole blood donation

Altruism

Many content creators donated blood for altruistic reasons. For example, some content creators reported donating because they felt that this was a way to help “save lives” (N=44 unique videos).

“What you’re about to do has the chance to save someone’s life. That’s the reality of it. Have you ever done anything in your life that you could say had a chance directly of saving someone’s life? Um, no. I don’t think so, It’s one of those things that I can see why people have done it a hundred times because once you’ve done it once, it’s really an experience. And we were just told you can save up to three lives with one donation…” (NC021)

“I definitely want to donate more blood because I think it’s really awesome that one pint of blood is saving three people’s lives. So I saved through people’s lives and I’m really excited!” (NC015)

Other content creators reported that they donated whole blood to “give back,” or to help other people (N=31 unique videos).

“I think it’s a really important part of giving back. I think it’s a really easy way to give back, which is I think it’s important. I’m just really passionate about this. It’s a simple way to give back that can help somebody. It’s like to save someone’s life that that just seems so simple and a really easy way to just do your part to… make the world a better place” (NC003)

“…it’ll just be it for a good cause. I think you don’t need to be personally impacted by knowing somebody who needs something to realize that you can make a difference in the world and in people’s lives with something that you are just fortunate enough to have. And that you really are fortunate enough to have it and that it is part of our essence as humans to share and to help other.” (C011)

Some content creators reported that they donate blood because it is a simple and/or kind thing to do (N=7 unique videos).

“…it’s really simple you know, so the stages to giving blood are so simple and the need is so great it just seems like such a win-win to me…” (NC003)

“donating blood is a very simple act of human kindness, and to ask someone not to do it [due to the MSM ban] just felt entirely foreign to me. I want to help and save lives and change laws.” (NC028)

Some content creators cited the blood supply shortage as their primary motivation to donate blood (N = 6 unique videos).

“There’s such a huge need especially for my type and some people they donate their time and talents with community service maybe their foster parents or they’re picking up trash on the side of highways my deal is right here it’s not that painful but it is asking to sacrifice so I invite you guys to come do the same” (NC029)

“It’s really simple you know so the stages to giving blood are so simple and the need is so great it just seems like such a win-win to me right like you get to give blood and you get to help save someone’s life” (NC019)

Personal connection: Someone close received a transfusion, influencing decision to become a regular donor

Several content creators discussed how a close friend or family member being transfused influenced their decision to regularly donate blood themselves (N= 6 unique videos).

“I remember thinking at the time why I never thought to give blood or you don’t realize what people do until you need it until you’re desperate you never know when you’re going to be the one that needs it and I’ve donated for 22 years now on Charlotte’s first birthday we had a blood drive in honor of Charlotte” (NC035)”

“Wayne and I think about blood donors every day we know that you’re the reason Emily is with us that’s why we give blood ourselves” (C015)

Incentives from blood centers

Some content creators reported donating whole blood partly because of the incentives offered by blood centers (N=31 unique videos).

“I’ll see you get free food and a t-shirt. And sometimes I know the one that I see in my college you can get free movie tickets…get some really cool stuff. So I definitely think that donating blood is a great idea.” (NC014)

“They also had tons of cookies and snacks and chips and stuff like that, so you know if you’re not following the keto diet, you know there’s a buffet of stuff there afterwards. So that may be worth the trip just in itself.” (NC022)

Positive experiences with blood donation staff

Content creators indicated that they had a positive experience donating due to blood center staff’s kindness and ‘bedside manner’ (N = 8 unique videos).

“Found out that the nurse that was taking my blood was my neighbor and that was amazing and she just really made me feel really at ease so shout out to Sylvia she really made me feel at ease and made me feel comfortable and you know what before I knew it was actually over” (NC038)

“It was really a simple process it was actually enjoyable the staff was amazing real personable it was it was a lot of fun” (NC021)

Discussion

The findings of this study illuminate the blood donation experiences of content creators on YouTube. Reviewing this content allows us to gain insight into donors’ self-identified barriers and facilitators to blood donation, rather than those themes prioritized by researchers in questionnaires. Furthermore, this approach allows us to eliminate response bias, since content creators are speaking candidly, rather than answering a researcher’s questions. In addition to this, this novel technique provides a template for researchers to synthesize large amounts of information from social media (e.g., online videos), and is likely time and cost-saving.

Results show that the barriers and facilitators identified are consistent with much of the published literature.(Bednall & Bove, 2011; Bednall, Bove, Cheetham, & Murray, 2013; Beerli-Palacio & Martín-Santana, 2015; Beyerlein, 2016; Bloch, Mast, Josephson, Klein, & Eder, 2017; Chell et al., 2018; Finck et al., 2016; France et al., 2016; France et al., 2020; France et al., 2014; Glynn et al., 2003; Hughes et al., 2015; Klinkenberg et al., 2019; Piersma et al., 2017; Robbins et al., 2015; Schreiber et al., 2006; Steele et al., 2008; Vahidnia et al., 2016; Wevers, Wigboldus, van Baaren, & Veldhuizen, 2014) Overall, negative experiences with prior donations (fainting or feeling faint, experiencing multiple or painful sticks during phlebotomy) and fear related to giving blood (e.g., needles, passing out or throwing up, general nervousness about donation) were the most prominent barriers to blood donations among content creators. Facilitators included altruism, incentives from blood centers, somebody close to the content creator having a transfusion, and positive experiences with blood donation staff. The content of the videos was diverse and included perspectives from both first time and regular donors. While the majority of creators did not identify their race, age, or education level, a minority of videos detailed high school and college donation experiences.

Our findings show that having a negative prior donation experience (e.g., an adverse reaction), such as fainting or feeling faint, and/or experiencing multiple or painful sticks during phlebotomy, are barriers to subsequent donations. Adverse reactions to donation have been shown to deter future likelihood of donation in other studies.(Bednall et al., 2013; Piersma et al., 2017) However, conversely, having positive interactions with blood donation staff (e.g., having good “service quality”) have been shown to be facilitators to future donations in prior studies,(Bednall et al., 2013) as well as in this YouTube review. A 2013 systematic review and meta-analysis of antecedents of blood donation behavior(Bednall et al., 2013) found that “service quality” is characterized by staffing competent and courteous donation personnel. Though we can only speculate since we did not directly investigate this theme, it is possible that prioritizing the donor service quality after an adverse event (e.g., ensuring a rapid and appropriate response to the adverse event, showing empathy and kindness to the donor) could minimize donor trauma, and increase the likelihood of a return donation. Related to this, we recommend that first-time donors donate with an experienced phlebotomist, since this too could facilitate positive donation experiences and encourage subsequent returns.

Prioritizing service quality could also mitigate the other major barrier to donation in our study: fear related to giving blood. This has been cited as a barrier to donation in other work.(Bednall & Bove, 2011) The Patient Empathy Project posits that fear in clinical settings typically revolves around two factors: a loss of control, and depersonalization of the medical encounter.(Kadens & Herms, 2015) Improving service quality through staff awareness and empathy towards donor fear, donor involvement in the donation process, and support by donation personnel could help to overcome fear related to giving blood.(Kadens & Herms, 2015) A more practical recommendation could include having first-time donors complete brief surveys upon arrival to match them to technicians with more or less experience in order to minimize the likelihood of a “bad experience” that discourages future donation.

The major facilitator to donation we identified in this study is altruism. This was operationalized in a number of ways, including wanting to, “save lives,” “give back,” to perform a simple act of kindness, or donating in response to the need for blood. Pro-social and altruistic motivations for donation are well documented in the blood donation literature.(Finck et al., 2016) (Beerli-Palacio & Martín-Santana, 2015; Beyerlein, 2016; Hughes et al., 2015) Given this, messaging to encourage donation could prioritize how donation is helpful to others or the community. Some blood donation centers, such as the New York Blood Center, already personalize ad campaigns by featuring blood recipients on their marketing materials.(NYBC, 2020) Featuring real recipients as part of advertising campaigns could also have the effect of helping potential donors to identify with the end goal of donation (e.g., getting blood products to patients who need them). Specifically, our study found that some donors began giving blood because someone close to them received a transfusion. Humanizing recipients through showing photographs, sharing their names, and limited information about them could potentially replicate this experience for potential future donors who have not had a transfused family member.

The incentives associated with donation were also important motivators. Other work supports this finding, and showed that some incentives are particularly enticing, such as discount tickets, small gifts, and paid time off work.(Chell et al., 2018) While these are important, the content creators in our study also enjoyed the selection of snacks and drinks that are typically provided to donors. A subset of videos indicated that providing name brand snacks (e.g., Oreos) is preferrable to generic brands.

Prior studies have identified barriers and facilitators that were not represented in our YouTube review. Unrepresented barriers and facilitators of note include (Note: items on this list can act as both barriers or facilitators to donation): convenience of donation, the role of marketing communication, reputation of the blood donation organization, and blood donation self-efficacy.(Bednall & Bove, 2011; Bednall et al., 2013; Piersma et al., 2017) Another factor that is only a barrier to donation (rather than overlapping between the barriers and facilitators groups) that was not represented our study is having a deferral (e.g., iron deficiency, male-male sexual contact within the legally defined timeframe).(Custer et al., 2015; Liszewski, Terndrup, Jackson, Helland, & Lavin, 2017; Piersma et al., 2017) The lack of representation of these themes could be because all content creators included in our sample had already donated blood (and therefore were already efficacious donors) and were discussing their experiences. Because of this, they presumably had already determined that the donation site’s marketing materials and reputation were acceptable; they may have also already known about their deferral status. Alternatively, blood donors may not be intuitively aware of these themes, or how they factor into their decision to donate.

That first-time and other donors make videos documenting their experiences may be a communication approach that blood banks wish to leverage. Some have “photo booths” or other backdrops available at donation sites, encouraging donors to photograph themselves waiting to donate or after donating. Blood banks might take this further by encouraging video stories or guided post-donation video interviews that donors can post to their social media or other sites.

Limitations

Non-English language videos were excluded from the sample; the study did not consider comments from viewers, or how viewers access/share the video clips (impact of the video). Additionally, we were not able to get a sense of individual’s blood donation experiences with respect to their race, age, or education level, as very few content creators volunteered this information in their videos. This information relative to race is perhaps the most important piece of missing information, since donors from racial and ethnic minority groups are especially underrepresented in the US blood supply. Our inability to collect race/age/education data is a function of the approach used in this study. That is, a limitation of this analysis technique is that we are only able to capture those data that content creators decide to share, rather than those important to research priorities.

Additionally, while analyzing YouTube videos eliminates some types of bias (e.g., response bias) it produces others that could influence how blood donation is discussed online. One important type of bias is “mimicry.” Specifically some content creators may consciously or unconsciously “mimic,” (e.g., reproduce or repeat) words or statements they have previously heard (Ki, 2018) about blood donation, which in some cases could obscure their true thoughts or experiences. Related to this, “social signaling” could act as an additional form of bias. For example, content creators may use their donation experience to imply the favorable components of their online identity (Park & Jiang, 2020), rather than provide an accurate account of their encounter. Lastly, the inclusion of commercial videos in our sample could also produce bias, since these videos are intended to motivate donation, rather than provide impartial information. Additionally, these videos likely have a higher production quality and present a curated set of experiences, also potentially introducing bias.

Despite these limitations, we believe our novel approach makes an important contribution to the literature, since this is the first study of its kind to focus entirely on the self-identified priorities of donors through examination of YouTube videos.

Conclusions

The novelty of this study lies in the communication of whole blood donation experiences on YouTube, a social-media based platform. As members document their experience and share them with a broad audience, these publicly available videos can inform recruitment campaigns and efforts by blood banks to retain these donors. It is important to note that the barriers and facilitators we identified were spontaneously reported by content creators in their videos about their blood donation experiences. Barriers included prior negative experiences with blood donation, and donation-related fear; facilitator included altruism, incentives from blood centers, positive experiences with blood donation staff, and positive experiences with blood donation staff. Some of these facilitators could be structured in practice as a response to barriers. For example, ensuring that donors have a positive experience with donation staff (e.g., service quality is a priority) could help to overcome negative experiences with donation and donation-related fear. Future studies, questionnaires, and donor outreach campaigns could consider focusing their content and messaging on the themes identified in this work, since it is possible to posit that they resonate the most with existing and potential future blood donors.

Acknowledgements

This research was supported by a seed grant from the New York Blood Center. The co-first author (Rael) is supported by a K01 Award (K01 MH115785; PI: Rael) from the National Institute of Mental Health. Dr. Rael is also supported by a Gray Matters Fellowship from the Columbia University Department of Psychiatry. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.

Footnotes

Disclosures

The authors have no conflicts of interest to declare

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