|Year : 2014 | Volume
| Issue : 2 | Page : 85-89
A perspective study on the attitude to and practice of voluntary blood donation in a tertiary referral hospital in South India
Umakanth Siromani1, Tsuneo Tsubaki2, Dolly Daniel1, Joy John Mammen1, Sukesh Chandra Nair1
1 Department of Transfusion Medicine and Immunohaematology, John Scudder Memorial Blood Bank, Christian Medical College, Vellore, Tamil Nadu, India
2 Global Health Fellow, Pfizer Japan Inc., Japan
|Date of Web Publication||13-Nov-2014|
Department of Transfusion Medicine and Immunohaematology, John Scudder Memorial Blood Bank, Christian Medical College, Vellore - 632 004, Tamil Nadu
Source of Support: This work was supported by Health Volunteer Overseas, Washington DC, USA and Pfi zer Inc. NY, USA. with regards Umakanth S,, Conflict of Interest: None
Background: Indian blood donation system currently operates using both bloods from voluntary and replacement donors. Indian government has aimed to achieve 100 per cent voluntary non-remunerated blood donation due to safety concerns in the near future. Objectives: To determine behaviours and attitudes towards voluntary blood donation among residents at Vellore, Tamil Nadu, India and understanding the reasons for donating and not donating blood, appropriate communication techniques for motivation among the local residents, appropriateness of messages, and evaluation of the blood bank service as a step towards improving effectiveness of voluntary blood donor recruitment and retention strategy. Materials and Methods: 435 subjects were participated in the study. Donors and non-donors were asked to complete a self-administered questionnaire on blood donation for data collection. Statistical data reliability checked using Chi-squared tests, Fisher's exact test, Wilcoxon two-sample tests at a level of significance <0.05. Results: The results of this study showed that voluntary blood donors give blood because they "want to help others" from their altruism behaviour. On the other hand, the main reasons cited by non-donor were: "never asked, don't know where/how to give, don't know anyone in need", "weakness", and "nervousness" from fear and anxiety, attitudes due to myths and misconceptions about blood donation. Conclusion: The donors and non-donors were found to vary in their behaviors as well as their attitudes and beliefs. Perceptions in blood donation were pronounced among Vellore residents, which indicated a need for improved awareness on these issues. Overall evaluations of the blood bank services were satisfactory. However blood bank should reduce waiting time and improve donor care. The blood bank should launch promotional programs to address the value of blood donation and to correct some of the misconceptions among residents in Vellore.
Keywords: Altruism, attitude, behavior, myths, voluntary nonremunerated blood donation
|How to cite this article:|
Siromani U, Tsubaki T, Daniel D, Mammen JJ, Nair SC. A perspective study on the attitude to and practice of voluntary blood donation in a tertiary referral hospital in South India. Afr J Med Health Sci 2014;13:85-9
|How to cite this URL:|
Siromani U, Tsubaki T, Daniel D, Mammen JJ, Nair SC. A perspective study on the attitude to and practice of voluntary blood donation in a tertiary referral hospital in South India. Afr J Med Health Sci [serial online] 2014 [cited 2019 Mar 26];13:85-9. Available from: http://www.ajmhs.org/text.asp?2014/13/2/85/144568
| Introduction|| |
Blood is a national resource; it is the responsibility of the government to ensure that blood supply is safe, adequate and available to meet the needs of all patient populations.  There has been a steady decline of blood donation, while the demand for transfusion continues to rise.  The shortage of safe blood is compounded by the shortage of donors in developing countries, where that blood is needed most.  Recruitment and retention of donors to sustain and increase the donor base are critical for blood banks.  Donors to the John Scudder Memorial Blood Bank, Christian Medical College Hospital, catering to all its patients' needs, are either voluntary or replacement donors. It is an acknowledged fact that the former will greatly enhance blood safety. , Currently 30% of the blood bank supplies come from voluntary blood donations.  Our donor base comprised predominantly of replacement donors till 2002, when focused effort was put into trying to increase our voluntary donor numbers. Replacement blood donation should be avoided as far as possible to maintain the ethical code of anonymity between the donor and the recipient. However, this process has been slow and although over a 4 year period, volunteer donors have increased from 5% to 30%, this is still not enough. To see how we could improve our voluntary donor recruitment strategies, a study was designed to investigate reasons for donating and not donating blood, appropriate communication techniques for local people, appropriateness of messages, evaluation of the blood bank service, and whether specific demographic factors of local people can differentiate between donors and nondonors.
| Materials and Methods|| |
A total of 500 questionnaires were randomly distributed to blood donors and nondonors, and they were asked to return the completed questionnaires. The donors were selected based on available donor registry from blood banks and Non-Governmental Organizations who involved as cause ambassadors toward voluntary blood donation. Those who were unwilling to donate blood not even a single time were selected as nondonors. The study period lasted for 14 weeks from the 1 st week of February to the 2 nd week of May 2007. The four-page questionnaires were self-administering and comprised of 60 items for blood donors and 55 items for nonblood donors, designed to yield information on socio-demographic variables, reasons for donating and not donating blood, evaluation of the messages to encourage blood donation and evaluation of the blood bank services.
Chi-squared tests were conducted to assess differences between the donors and nondonors with respect to gender demographic variables. Wilcoxon two-sample tests were conducted to assess differences between the donors and nondonors with respect to the age, education and demographic variables. Fisher's exact tests were performed to assess differences between the donors and nondonors with respect to the respondents' demographic data. P < 0.05 was considered as significant. The Proc-StatXact 5 Statistical Package (Cytel incorporated, Cambridge Massachussets, USA) was used for analysis.
The demographic variables included gender, age, education, birth region, and frequency of donation. Reasons for donating and not donating blood and evaluation of the blood bank services were measured with a 3-point rated scale that featured "agree," "disagree" and "not sure." We performed a pretest with 50 volunteers in another region, who did not participate in the final study.
| Results|| |
Results were based on the questionnaires of 435 subjects. Among the 500 subjects selected, 435 questionnaires were returned; giving a response rate of 87%. The results of sociodemographic variables were shown in [Table 1]. The donor and nondonor groups differed significantly in gender and religion (P < 0.05). The donor and nondonor groups did not differed significantly in age or education.
About 91.8% of donors were male, and rest were female (8.2%). 62.6% of donors were between the age group of 20 and 29 years. Fifty-five percent of donors were under graduates, and 45% of donors had a higher level of education up to postgraduate level. 57.3% of donors belonged to the Hindu religion, followed by Christian (39.7%). Whereas, 58.7% of nondonors were female and rest were male (41.3%). 65.5% of nondonors were between the age group of 20 and 29 years. About 54.2% of nondonors were undergraduates, and 43.95% of nondonors had a higher level of education up to postgraduate level. Seventy-two percent of nondonors belong to Hindu religion, followed by Christian 28.9%.
Results of the reasons for donating blood were shown in [Table 2]. Seventy-five percent of donors reported that they agreed with the statement "makes me feel good/good thing to do," "wanting to help people," "service to community/helping the community" (within the theme of altruistic behavior), "Help friend or relative/encouragement from friends," "help anonymous person" (within the theme of humanitarian sprit) and "responding to blood donation camp" (within the theme of convenience).
Results of the reasons for not donating blood are shown in [Table 3]. Sixty-seven percent of respondents reported "They have never been asked to donate blood," "don't know how to give." Over half of the nondonors (50%) reported that they agreed with the reasons of "weakness," "nervousness" because of the fear and anxiety, "never thought of it," "do not know the location and time of blood donation camp," and "do not know anyone in need." On the other hand, less than one-third of the nondonors (33%) agreed that the reasons "tradition/superstition," "medical disqualification," "religious beliefs," "too busy," "negligence," "sight of blood" were reasons for not donating.
Overall, 80% of the donors agreed that they were satisfied with the process of giving blood, staff behavior, time taken for blood donation, tidiness and cleanliness of facilities, post donation care. However, 10-20% of donors found that the donation was unpleasant. Overall evaluations of the blood bank services were satisfactory.
| Discussion|| |
Our study supports findings from previous reports. Donors tend to be motivated due to altruism, humanitarian reasons, peer pressure, and curiosity, whereas nondonors cite the following reasons for not donating: Medical problems, fear of needles, general apprehension, and fear of after effects.  In addition, according to statistics, 90% of nondonors do not know the location of blood banks and more than 70% do not donate blood simply because no one has ever asked them.  In harmony with previous reports, altruism, humanitarian, and convenience are needed as the most important reasons for donating. In our study, 56.1% of the donors had donated more than twice. This study showed that voluntary blood donors give blood because they "want to help others." This indicates that the commitment to donate blood to save an ill person is higher among our Vellore donors' population.  Satisfaction from blood donation would seem to come from an "inner joy" from contributing to someone's health, or saving another person's life.
We need to develop a measurement tool to help understand our success or otherwise in driving voluntary blood donation. This could provide us with a better outcome for evaluating the motivational practice of blood donors.
Our study results suggest various promotional messages can be used for different groups. It is important to remind the blood donors to maintain a certain behavior to donate blood through promotional messages. The donor and nondonor groups did not differ about which were the compelling messages. Messages about blood donation need to be focused on clear, captivating, interesting, and above all feature appropriate content. The message should be presented in the local language, so that the information reaches the right people in the most effective way.
Blood banks, however, should continue to improve waiting times and donor care. Asking for donors' opinions, comments and suggestions is a dimension of customer service that helps to enhance regular blood donations. A key factor in meeting the needs of the donor is ensuring that the time and venue of blood donation camps should be convenient to the majority of existing potential blood donors.
The educational level and religion among males were similar to those of female. The educational level and religion in donors were similar to those of the nondonors. When considering previous blood donations, the number of previous donations ranged from "zero" to more than "twice." The first time donors were 43.9%, and donors who had donated more than twice were 56.1%. Blood banks should work hard to convert first-time donors to become regular donors. Strategies aimed at encouraging current donors to donate more frequently during the 1 st year may help to establish regular donation behavior. 
We collected 73.3% of the questionnaires from educational institutions. Our blood donors' socio-demographic characteristics were found to be similar to those of the average population in Vellore. In the study, 43.9% of the first-time donors were under 29-year-old. This suggests a potential value in encouraging first-time donors to return as frequently as possible to increase the potential for long-term donation patterns. 
Ownby findings indicate that the recruitment of donors, above the age of 30 provides more opportunity to convert them into regular donors who can develop a long-term relationship with the blood bank.  Furthermore, effective promotional program should be designed to encourage the younger and higher educated potential donors to convert first-time donors or replacement donors to become regular voluntary donors.
Our study indicates that a variety of reinforcement systems can be used in increasing blood donations at the blood bank and blood donation camps. While many donors give blood for altruistic-humanitarian reasons, it appears that recognition also help to motivate individuals to donate blood. Social influencing variables might have played a key role influencing the participants. Many factors need to be considered when setting up a blood donation program. Regular co-operation and interaction from the participating institute in blood donation program is needed with the camp organizers. If these individuals are committed to the blood donation camp, and work well with each other, the effort to mobilize support for upcoming blood donation camps will be enhanced. If the colleagues are unmotivated or interpersonally ineffective, the blood donation camps will be less effective.
According to the interviews from local people, there were common myths, fears and superstitions about blood donation, such as: Giving blood causes weaknesses in the human body. ,,,,, Young people were likely to be better educated than their parents and typically had different attitudes. The relationship between inter donation intervals and the number of future donations appear to be useful in understanding return behavior and developing donor recruitment and retention strategies.  Overcoming negative attitudes about blood donation must be a major focus of any recruitment plan. Although the risks are small, there is a need to continue to improve the screening process to further reduce transfusion transmissible infections. Our study results suggest that blood banks should reduce the perceived risks associated with blood donation outcomes, whether they be physical (fear of AIDS), psychological (fear of the unknown), social (moral responsibility), or practical (waiting time). However, if the blood bank attempts to incorporate risk-reducing information into publicity, they actually may remind donors of the associated risks. Strategies that focus on retaining donors and transforming first-time donors into repeaters will be beneficial. 
| Conclusion|| |
Our study results indicate that the typical blood donors are younger, with a higher level of education, Christian or Hindu, and have an altruistic and humanitarian motivation. The donors and nondonors were found to vary in behaviors as well as their attitudes and beliefs. Perceptions in blood donation were strong among Vellore residents, and these indicated a need for improved awareness on donation issues. We concluded the findings of this study were not substantially different from those of previous studies.
Blood banks should launch promotional programs to address the value of blood donation and to correct some of the misconceptions in India. Overall evaluations of our blood bank services were satisfactory. However, blood bank should reduce waiting time and improve donor care. These findings correlate with other studies and have implications for setting up blood donor recruitment program. Further studies of donor motivations, experiences, and evaluation of motivational factors will help us to understand ways to direct donor recruitment and retention efforts to encourage first-time donors to develop a donation habit.
| References|| |
Watanabe KK, Schreiber GB, Hayes A, Williams AE. Factors influencing the recruitment and retention of young donors. Transfusion 1999;39 Suppl:A3-20.
Developing countries face safe blood shortage. Bull World Health Organ 2004;82:558.
Bhalodia JN, Patel KA, Oza HV. Psychosocial variables of highly motivated voluntary blood donors at blood bank of a medical college. Natl J Med Res 2012;2:39-41.
Beal RW, van Aken WG. Gift or good? A contemporary examination of the voluntary and commercial aspects of blood donation. Vox Sang 1992;63:1-5.
Gibbs WN, Corcoran P. Blood safety in developing countries. Vox Sang 1994;67:377-81.
Siromani U, Rajaiah M, Daniel D, Mammen JJ, Nair SC. Ahead to 100% of voluntary nonremunerated blood donation at a tertiary referral hospital blood bank in South India. Asian J Transfus Sci 2012;6:190.
Gillespie TW, Newman JL, Bellamy M, Hillyer KL, Strong M. National study of blood donation decision-making: Current and lapsed donors. Transfusion 2002;42:122s-3.
Buciuniene I, Stonienë L, Blazeviciene A, Kazlauskaite R, Skudiene V. Blood donors′ motivation and attitude to non-remunerated blood donation in Lithuania. BMC Public Health 2006;6:166.
Schreiber GB, Sharma UK, Wright DJ, Glynn SA, Ownby HE, Tu Y, et al
. First year donation patterns predict long-term commitment for first-time donors. Vox Sang 2005;88:114-21.
Ownby HE, Kong F, Watanabe K, Tu Y, Nass CC. Analysis of donor return behavior. Retrovirus epidemiology donor study. Transfusion 1999;39:1128-35.
Boulware LE, Ratner LE, Ness PM, Cooper LA, Campbell-Lee S, LaVeist TA, et al.
The contribution of sociodemographic, medical, and attitudinal factors to blood donation among the general public. Transfusion 2002;42:669-78.
Olaiya MA, Alakija W, Ajala A, Olatunji RO. Knowledge, attitudes, beliefs and motivations towards blood donations among blood donors in Lagos, Nigeria. Transfus Med 2004;14:13-7.
Mwaba K, Keikelame MJ. Blood donation behaviour and beliefs among a sample of high school students in Mmabatho. Curationis 1995;18:2-3.
Belda Suárez IM, Fernández-Montoya A, Rodríguez Fernández A, López-Berrio A, Cillero-Peñuela M. How regular blood donors explain their behavior. Transfusion 2004;44:1441-6.
Fernández-Montoya A, López-Berrio A, Luna del Castillo JD. How some attitudes, beliefs and motivations of Spanish blood donors evolve over time. Vox Sang 1998;74:140-7.
Wiwanitkit V. Knowledge about blood donation among a sample of Thai university students. Vox Sang 2002;83:97-9.
Gillespie TW, Hillyer CD. Blood donors and factors impacting the blood donation decision. Transfus Med Rev 2002;16:115-30.
[Table 1], [Table 2], [Table 3]