Racial differences in motivators and barriers to blood donation among blood donors.
Abstract: * Context.--Nationally, African Americans are underrepresented in community blood donation programs. To increase blood donation by African Americans, differences between motivators and barriers to blood donation between races should be investigated.

Objective.--To investigate motivators and barriers to blood donation in African American and white blood donors.

Design.--An 18-item, anonymous, self-administered questionnaire regarding demographics and motivators and barriers to donation was completed by blood donors at a predominately African American and a predominately white fixed donation site.

Results.--A total of 599 participants (20% African American, 75% white, and 5% other) completed the survey. The most commonly reported reasons to donate included: "because it is the right thing to do" (45% African Americans and 62% white) and "because I want to help save a life" (63% African Americans and 47% white). Unpleasant experiences did not differ as a barrier to continue donation between African Americans and whites. African Americans placed more importance on donating blood to someone with sickle cell disease, convenience of blood donation, treatment of donor center staff, and level of privacy during the screening process.

Conclusions.--These data suggest that in a large metropolitan area, reasons for donation among African American and white donors differ. To retain and increase donation frequency of African American donors, these factors should be considered in creating an African American donor recruitment and retention program.

(Arch Pathol Lab Med. 2009;133:1444-1447)
Article Type: Report
Subject: Sickle cell anemia (Care and treatment)
Blood donors (Demographic aspects)
Organ donors (Behavior)
African Americans (Behavior)
African Americans (Health aspects)
Authors: Shaz, Beth H.
Demmons, Derrick G.
Hillyer, Krista L.
Jones, Robert E.
Hillyer, Christopher D.
Pub Date: 09/01/2009
Publication: Name: Archives of Pathology & Laboratory Medicine Publisher: College of American Pathologists Audience: Academic; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 College of American Pathologists ISSN: 1543-2165
Issue: Date: Sept, 2009 Source Volume: 133 Source Issue: 9
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 230152068
Full Text: Blood collection and transfusion are important to the functioning of a self-sufficient community resource-based health care system in the United States and in the world. In the United States, approximately 15 million whole-blood products are collected each year from voluntary, nonremunerated donors. (1,2) African Americans are underrepresented in this donor population; it is estimated that 4.2% of white adults donate versus 2.4% of African American adults. (3) African Americans donate less frequently than whites; African American donors are younger and are more likely to be first-time donors. (4)

Because African Americans make up an ever-increasing and now-substantial minority in some United States regions, it is important to understand the reason for the observed difference in blood donation. In addition, African American recipients of blood transfusion have a better chance of receiving phenotype-matched or appropriate blood when there is a significant percentage of products in inventory from African American donors. This includes both the specialized (eg, sickle cell disease) patient and the general hospitalized patient. Therefore, the ability to recruit and retain eligible African American donors is fundamental to a continued adequate blood supply in the United States in general, and for the care of African American patients specifically.

To increase blood donation within the African American community, the motivators and barriers to blood donation for African American individuals must be determined. The major motivators to blood donation are altruism, awareness of the need, sense of social obligation, personal social pressure, the need to replace blood used, and increased self-esteem. One study determined that African American donors more likely donated to receive an item and/or gift, to be tested for an infectious agent, or to receive a health screen than white donors. (5,6) Methods reported in young African American women to increase their donation rates were to raise awareness of the need for blood, especially the importance of these donations in the treatment of children with sickle cell disease. (7) The principal barriers to blood donation are fear, inconvenience, perceived medical disqualification, being too busy, not being asked, and apathy. (8) African Americans more often than whites cited bad treatment and poor staff skills as reasons not to donate. (9) In a study of young African American women, the most important reason for not donating was inconvenience, followed by fear of needles and taking too much time. (7) Therefore, differences in motivators and barriers to blood donation among races may exist and affect donor recruitment and retention strategies.

The goal of this study was to determine differences in motivators and barriers between African American and white current blood donors. The resulting differences could then be applied to recruitment and retention campaigns in order to increase the number of blood products donated by African Americans.

MATERIALS AND METHODS

Sample Selection and Data Collection

Data were collected from March to June 2007 using a convenience sample of donors from predominately African American (center 1) and white (center 2) neighborhood fixed donation sites of the American Red Cross Southern Region. Center 1 has approximately 2000 donations per year, whereas center 2 has approximately 12000 donations per year. Information sheets explaining the goals, objectives, and confidentiality of the study accompanied the questionnaire. All donors 18 years or older were asked by American Red Cross Southern Region personnel in the refreshment area after blood donation (either whole-blood or apheresis donation) to complete the self-administered questionnaire.

Survey Instrument

The study sample was assessed using an 18-item, self-administered, anonymous questionnaire, which included questions about demographics, intention for future donation, donation history, and motivators and barriers to blood donation. The questionnaire was developed by diverse members of the American Red Cross Southern Region and the Center for Transfusion and Cellular Therapies at the Emory University School of Medicine.

Analysis

Participants were asked to rate the level of importance to specific questions that could either encourage or discourage their decision to donate using a 5-point Likert scale. A factor that was reported as being somewhat important, important, or extremely important in one's decision to donate was considered a motivator. Analyses were performed to determine whether differences existed between African American and white donors. [chi square] tests of independence were used as a consideration for significant differences. Statistic analyses were performed with SAS version 9.1 for Windows (SAS Institute Inc, Cary, North Carolina).

RESULTS

A total of 599 blood donors (94 from center 1, 504 from center 2, and 1 unknown) completed the questionnaire (Table 1). Center 1 had a high percentage of African American female participants, whereas center 2 had a high percentage of white male participants. Most African Americans and whites (93% of African Americans and 95% of whites) and men and women (93% of men and 96% of women) intended to return to donate blood within the next 6 months. A total of 588 participants (99%) had a prior donation history with the American Red Cross Southern Region.

The most common responses for reasons to donate were "It is the right thing to do" (African Americans, 45%; whites, 62%; P = .004) and "I want to help save a life" (African Americans, 63%; whites, 47%; P = .001), whereas "I enjoy donating" and "I donate to help the community" were less common reasons to donate, regardless of race or sex (Table 2). The most common responses to encourage donation were being mailed reminders to donate (African Americans, 43%; whites, 27%; P < .001) and offering free health screenings (African Americans, 31%; whites, 24%; P = .11; Table 2). Less common responses, which were more favored by African Americans than whites, were race-specific marketing campaigns (African Americans, 21%; whites, 3.4%; P < .001) and community involvement by the American Red Cross (African Americans, 20%; whites, 5%; P < .001). Participants used a 5-point Likert scale to indicate the level of importance each factor was in their decision to donate (Table 3). Treatment by staff and being called to donate in times of shortage were rated important or extremely important by more participants than other presented motivators for both African American and white participants. African American respondents reported that the level of privacy during the screening process, donating regularly to someone with sickle cell disease, and using donated blood to treat other members in their race were more important motivators to blood donation than white respondents. When participants were asked what would prevent them from returning, the responses of poor treatment by staff (African Americans, 30%; whites, 17%) and long wait times (African Americans, 27%; whites, 44%) differed between the two races.

COMMENT

In our study, African American and white donors most commonly reported donating because they believe "it is the right thing to do" or "to help save a life," which is consistent with previously reported data. One Retrovirus Epidemiology Donor Study (REDS) surveyed recent blood donors and reported that a desire or responsibility to help others or the feeling that donating blood is a duty were the primary motivators in more than 90% of participants. (6) Another REDS of repeat whole-blood and plateletpheresis donors reported that most participants donated because they felt "it was the right thing to do." (10) In a third study, 72% of lapsed and current donors cited the primary reason they gave blood was to help others. (11) Our study confirms the previous findings that social responsibility is a common motivator to donate blood.

The factors cited to encourage more frequent blood donation in our study, regardless of race, were receiving mailed reminders and free health screenings. These data are consistent with previously published REDS data, in which 60% were encouraged by reminders to donate that originated from the blood bank. (5) This study also reported that donors could be discouraged by reminders from the donor center, especially by telephone call (14%), and less so from a letter or e-mail (4%). Another REDS reported that health screening was an important or very important reason to donate in 25% of recent blood donors, and it was a more important motivator in minority donors than white donors. (6)

Multiple aspects of the donation experience influence donor return behavior, including staff treatment and waiting time. (12) In our study, participants responded that poor staff treatment was more important to African American donors, whereas longer wait time was more important to white donors in preventing them from returning to donate. Similarly, REDS reported that poor staff treatment and skill were more important reasons for not returning to donate again for African Americans than for white donors; in contrast, both African American and white donors responded equivalently to the process taking too long as a deterrent. (9) A negative donation experience plays an important role in donor return behavior; the specific negative aspect of the donation experience (eg, staff skill, staff treatment, convenience, or adverse reaction) that is the greatest deterrent of African American versus white donors may differ.

Other important factors for African American donors more than white donors included donating regularly to someone with sickle cell disease and using donated blood to treat other members of their race. A common reason individuals do not give blood is because of unawareness of the need for blood and the donation process. (13) One method cited to increase blood donation in the African American community was to increase awareness of need. (7,14) A study of mailed sickle cell disease educational packets to increase blood donation within the African American community resulted in a short-term but not a long-term increase in the number of African American donors. (15) Therefore, recruitment and retention of African American blood donors may require continual education of the African American community regarding the need for blood products, especially in the treatment of sickle cell disease patients.

There are limitations in this study. First, the survey did not require that the participant rank his or her motivators or barriers to donate, and for some questions multiple answers were permitted. Second, the African American and white participant answers were compared, whereas the responses of center 1 versus center 2 participants were not compared. Third, the attitudes and beliefs expressed in this cohort may not be representative of donors from other regions of the country. Fourth, the participants were repeat blood donors with a high likelihood of returning in the near future to donate, and therefore their responses cannot be applied to first-time donors, lapsed donors, or never-donors. Despite these limitations, this study supports the differences in motivators and barriers to African American versus white blood donors and the need to develop race-specific donor recruitment and retention programs.

In conclusion, our study demonstrates that African American donors have different motivators and barriers to blood donation than white donors. African American donors felt it was extremely important to donate when there is a shortage, to help a patient with sickle cell disease, and to be treated well by the donation staff. Like white donors, African American donors felt free health screenings and mailed reminders to donate encourage donation, yet African American donors, unlike white donors, felt race-specific marketing campaigns and American Red Cross community involvement to be important motivators. Our findings will be used to develop race-based marketing campaigns to increase the awareness of the need for blood in the African American community, especially in the treatment of sickle cell disease, with the goal of increasing the number of blood products donated by African American individuals.

The authors thank the staff at the American Red Cross Southern Region Retrovirus Epidemiology Donor Study-II teams, participating sites, and the Center for Transfusion and Cellular Therapies for their valuable help. We also thank Claudine Carnevale for her statistic assistance. This study was supported by a grant from National Heart, Lung, and Blood Institute, Research Supplement to Promote Diversity in Health Related-Research, contract number N01-HB-47170.

References

(1.) Sullivan MT, Cotten R, Read EJ, Wallace EL. Blood collection and transfusion in the United States in 2001. Transfusion. 2007;47:385-394.

(2.) Hillyer CD. Blood Banking and Transfusion Medicine: Basic Principles & Practice. 2nd ed. Philadelphia, PA: Churchill Livingstone/Elsevier; 2007.

(3.) America Blood Centers. Blood donation among African Americans and Hispanics: Background, hypotheses, research questions: Multicultural donor recruitment and marketing plan: Phases I.1 secondary research report. Chicago, IL 2006.

(4.) Wu Y, Glynn SA, Schreiber GB, et al. Retrovirus Epidemiology Donor Study (REDS) Group. First-time blood donors: Demographic trends. Transfusion. 2001; 41:721-728.

(5.) Glynn SA, Kleinman SH, Schreiber GB, et al. Motivations to donate: Demographic comparisons. Transfusion. 2002;42:216-225.

(6.) Glynn SA, Schreiber GB, Murphy EL, et al. Factors influencing the decision to donate: Racial and ethnic comparisons. Transfusion. 2006;46:980-990.

(7.) Grossman B, Watkins AR, Fleming F, DeBaun MR. Barriers and motivators to blood and cord blood donations in young African-American women. Am J Hematol. 2005;78:198-202.

(8.) Glynn SA, Busch MP, Schreiber GB, et al. Effect of a national disaster on blood supply and safety: The September 11 experience. JAMA. 2003;289:2246-2253.

(9.) Schreiber GB, Schlumpf KS, Glynn SA, et al. Convenience, the bane of our existence, and other barriers to donating. Transfusion. 2006;46:545-553.

(10.) Glynn SA, Smith JW, Schreiber GB, et al. Repeat whole-blood and plateletpheresis donors: Unreported deferrable risks, reactive screening tests, and response to incentive programs. Transfusion. 2001;41:736-743.

(11.) Gillespie T, Newman JL, Bellamy M, et al. Donor recruitment and retention. Transfusion. 2002;42:AP20.

(12.) Gillespie T, Newman JL, Bellamy M, et al. National study of blood donation decision-making: Current and lapsed donors. Transfusion. 2002;42:122s-123s.

(13.) Gillespie TW, Hillyer CD. Blood donors and factors impacting the blood donation decision. Transfus Med Rev. 2002;16:115-130.

(14.) Mathew SM, King MR, Glynn SA, et al. Opinions about donating blood among those who never gave and those who stopped: A focus group assessment. Transfusion. 2007;47:729-735.

(15.) Price CL, Boyd JH, Watkins AR, et al. Mailing of a sickle cell disease educational packet increases blood donors within an African American community. Transfusion. 2006;46:1388-1393.

Beth H. Shaz, MD; Derrick G. Demmons, MPH; Krista L. Hillyer, MD; Robert E. Jones, BS; Christopher D. Hillyer, MD

Accepted for publication December 15, 2008.

From the Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia (Drs Shaz and C. Hillyer and Mr Demmons); and the American Red Cross Biomedical Services, Southeastern Division, Douglasville, Georgia (Dr K. Hillyer and Mr Jones).

The authors have no relevant financial interest in the products or companies described in this article.

The data were published and presented in abstract form at the AABB 2007 Annual Meeting, Anaheim, California, October 2007.

Reprints: Beth H. Shaz, MD, Emory University Hospital Blood Bank, 1364 Clifton Rd, NE, Rm C619, Atlanta, GA 30322 (e-mail: bshaz@ emory.edu).
Table 1. Demographic Characteristics by Donor Center

                            Center 1 (n = 94)   Center 2 (n = 504)

Age, y, median (25%, 75%)        49 (37, 56)          46 (33, 58)
Sex, No. (%)
  Male                        38/94 (40.4)       267/498 (53.6)
  Female                      56/94 (59.6)       231/498 (46.4)
Race/ethnicity, No. (%)
  African American            64/93 (68.8)        51/498 (10.2)
  White                       25/93 (26.9)       419/498 (84.1)
  Asian                        0/93 (0.0)         10/498 (2.0)
  Hispanic                     2/93 (2.2)          7/498 (1.4)
  Other                        2/93 (2.2)         11/498 (2.2)
Blood type, No. (%)
  Type A                      21/91 (23.1)       161/499 (32.3)
  Type B                      18/91 (19.8)        64/499 (12.8)
  Type AB                      3/91 (3.3)         10/499 (2.0)
  Type O                      47/91 (51.7)       248/499 (49.7)
  Not sure                     2/91 (2.2)         16/499 (3.2)
Donor status, No. (%)
  Repeat donor                93/93 (100)        495/503 (98.4)
  First time                   0/93 (0.0)          8/503 (1.6)

                            Overall (n = 598)

Age, y, median (25%, 75%)         47 (34, 57)
Sex, No. (%)
  Male                       305/598 (51.5)
  Female                     287/598 (48.5)
Race/ethnicity, No. (%)
  African American           115/591 (19.5)
  White                      444/591 (75.1)
  Asian                       10/591 (1.7)
  Hispanic                     9/591 (1.5)
  Other                       13/591 (2.2)
Blood type, No. (%)
  Type A                     182/590 (30.9)
  Type B                      82/590 (13.9)
  Type AB                     13/590 (2.2)
  Type O                     295/590 (50.0)
  Not sure                    18/590 (3.1)
Donor status, No. (%)
  Repeat donor               588/598 (98.7)
  First time                   8/598 (1.3)

Table 2. Motivators to Blood Donation by Race

                                       African
                                       Overall     American
                                      (n = 592)    (n = 115)

Reasons to donate, No. (%) (b)
  To help save a life                 297 (50.2)   72 (62.6)
  It is the right thing to do         344 (58.1)   52 (45.2)
  I enjoy donating                    124 (21.0)   29 (25.2)
  To help the community               144 (24.3)   26 (22.6)
Motivators to donation, No. (%) (b)
  Free health screening               157 (26.5)   36 (31.3)
  Reminders mailed to donate          176 (26.7)   49 (42.6)
  Race-specific marketing campaigns    45 (7.6)    24 (20.9)
  Community involvement of the
    American Red Cross                 48 (8.1)    23 (20.0)

                                        White               Asian
                                      (n = 445)    P (a)   (n = 10)

Reasons to donate, No. (%) (b)
  To help save a life                 211 (47.4)   .004    4 (40.0)
  It is the right thing to do         276 (62.0)   .001    4 (40.0)
  I enjoy donating                    87 (19.6)     .18    3 (30.0)
  To help the community               115 (25.8)    .48    0 (0.0)
Motivators to donation, No. (%) (b)
  Free health screening               107 (24.0)    .11    6 (60.0)
  Reminders mailed to donate          119 (26.7)   <.001   1 (10.0)
  Race-specific marketing campaigns    15 (3.4)    <.001   2 (20.0)
  Community involvement of the
    American Red Cross                 22 (4.9)    <.001   1 (10.0)

                                      Hispanic    Other
                                      (n = 9)    (n = 13)

Reasons to donate, No. (%) (b)
  To help save a life                 4 (44.4)   6 (46.2)
  It is the right thing to do         4 (44.4)   8 (61.5)
  I enjoy donating                    3 (33.3)   2 (15.4)
  To help the community               2 (22.2)   1 (7.7)
Motivators to donation, No. (%) (b)
  Free health screening               2 (22.2)   6 (46.2)
  Reminders mailed to donate          5 (55.6)   2 (15.4)
  Race-specific marketing campaigns   1 (11.1)   3 (23.1)
  Community involvement of the
    American Red Cross                1 (11.1)   1 (7.7)

(a) African American versus white.

(b) Participants could check more than one response.

Table 3. Significant Relationships Between Barriers and
Motivators According to Race

                               Not Important      Somewhat Important

Barriers and                African               African
Motivators to              American,   White,    American,   White,
Blood Donation              No. (%)    No. (%)    No. (%)    No. (%)

The convenience of            21         133         8         65
  when a blood drive        (18.6)     (30.5)      (7.1)     (14.9)
  takes place
Your blood being used to      46         405        17          3
  treat other members of    (41.1)     (91.8)     (15.2)      (0.7)
  your race
Hearing a request to          91         389        12         21
  donate from a famous      (82.7)     (89.0)     (10.9)      (4.8)
  person
Receiving incentives for      50         228        21         88
  your blood donation       (43.9)     (52.2)     (18.4)     (20.1)
The way you are treated        1          8         12         48
  by the staff               (0.9)      (1.8)     (10.6)     (11.0)
The level of privacy          10         109        13         99
  during the screening       (9.0)     (24.8)     (11.7)     (22.5)
  process
Donating regularly to          6         102         7         46
  help someone with          (5.3)     (23.8)      (6.2)     (10.7)
  sickle cell disease
Being called to donate         7         39          5         51
  when there is a            (6.2)      (8.8)      (4.4)     (11.6)
  shortage

                                Undecided              Important

Barriers and                African               African
Motivators to              American,   White,    American,   White,
Blood Donation              No. (%)    No. (%)    No. (%)    No. (%)

The convenience of             5         18         40         136
  when a blood drive         (4.4)      (4.1)     (35.4)     (31.2)
  takes place
Your blood being used to       7          7         22         22
  treat other members of     (6.3)      (1.6)     (19.6)      (5.0)
  your race
Hearing a request to           3         17          2          8
  donate from a famous       (2.7)      (3.9)      (1.8)      (1.8)
  person
Receiving incentives for      10         41         18         55
  your blood donation        (8.8)      (9.4)     (15.8)     (12.6)
The way you are treated        0          2         31         211
  by the staff               (0.0)      (0.5)     (27.4)     (48.3)
The level of privacy           4         37         38         141
  during the screening       (3.6)      (8.4)     (34.2)     (32.1)
  process
Donating regularly to          5         101        33         119
  help someone with          (4.4)     (23.5)     (29.2)     (27.7)
  sickle cell disease
Being called to donate         3         21         35         190
  when there is a            (2.7)      (4.8)     (31.0)     (43.1)
  shortage

                           Extremely Important

Barriers and                African
Motivators to              American,   White,
Blood Donation              No. (%)    No. (%)

The convenience of            39         84
  when a blood drive        (34.5)     (19.3)
  takes place
Your blood being used to      20          4
  treat other members of    (17.9)      (0.9)
  your race
Hearing a request to           2          2
  donate from a famous       (1.8)      (0.5)
  person
Receiving incentives for      15         25
  your blood donation       (13.2)      (5.7)
The way you are treated       69         168
  by the staff              (61.1)     (38.4)
The level of privacy          46         54
  during the screening      (41.4)     (12.3)
  process
Donating regularly to         62         61
  help someone with         (54.9)     (14.2)
  sickle cell disease
Being called to donate        63         140
  when there is a           (55.8)     (31.7)
  shortage
Gale Copyright: Copyright 2009 Gale, Cengage Learning. All rights reserved.