BLOOD DONORS AND BLOOD COLLECTION The African American church as a donation site: motivations and barriers _2570
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B.H. Shaz, A.B. James, D.G. Demmons, G.B. Schreiber, and C.D. Hillyer
BACKGROUND: In the United States, African Americans donate at approximately half the rate of whites and therefore are underrepresented in the volunteer blood donor pool. The goal of this study was to identify motivators and barriers to African Americans donating blood. STUDY DESIGN AND METHODS: A consortium of 15 predominantly African American churches of varying denominations in metropolitan Atlanta, Georgia, participated in an 81-item self-administered survey. The questionnaire was designed to assess participant’s demographic background, blood donation frequency, motivators and barriers to donation, knowledge and beliefs regarding donation, and overall health status. RESULTS: A total of 930 participants completed the survey: 72% female, 55% age 40 or older, 99% African American, and 58% college-educated. The most frequent reported motivators were donating to help save a life (96%) and donating because blood is needed (95%), while the most frequent barriers were that they rarely think about it and they were afraid, nervous, or anxious to give blood (35%). The association of barriers with donation status, age, gender, and education level was stronger than for motivators. Fear was more common in nondonors than lapsed and current donors, youngest compared to older adults, and women than men and less in those with higher income. CONCLUSION: Motivators and barriers to blood donation in African American church attendees differ depending on the respondents’ demographics. To increase the effectiveness of church drives, donor recruitment should focus on addressing these barriers and motivators.
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lood collection and transfusion are crucial to the functioning of a self-sufficient communitybased 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 volunteer donors. African Americans are underrepresented in this donor population; it is estimated that among white adults, 4.2% donate versus only 2.4% of African American adults.1 In the Atlanta metropolitan area, the blood donor rate (number of blood donors per population) was 11 per 1000 population for whites, 6 per 1000 for African Americans, and 3 per 1000 population for Hispanics and the blood donation rate (number of units donated by population over the total population) was 77 donations per 1000 population for whites, 22 per 1000 population for African Americans, and 10 per 1000 population for Hispanics.2 To address this discrepancy, the reasons for these differences in blood donation rates must be understood. Since African Americans make up an ever-increasing and now substantial minority in metropolitan Atlanta, it is
ABBREVIATION: REDS = Retrovirus Epidemiology Donor Study. From the Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University, and SciMetrika, Atlanta, Georgia; Westat, Rockville, Maryland; and New York Blood Center, New York, New York. Address correspondence to: Beth Shaz, MD, Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, 1364 Clifton Road NE, Room D655, Atlanta, GA 30322; e-mail:
[email protected]. Supported by the National Heart, Lung, and Blood Institute, Research Supplement to Promote Diversity in Health Related-Research, Contract N01-HB-47170. Some of the study data were presented at the 2009 AABB annual meeting, New Orleans, Louisiana. Received for publication October 21, 2009; revision received November 16, 2009, and accepted November 16, 2009. doi: 10.1111/j.1537-2995.2009.02570.x TRANSFUSION 2010;50:1240-1248.
MOTIVATORS TO DONATION IN AFRICAN AMERICANS
increasingly important to recruit African American donors to ensure an adequate blood supply for the entire community. In addition, red blood cell (RBC) products donated by African Americans are especially important for the treatment of sickle cell disease patients.3 RBC transfusions are frequently used to prevent or treat complications of sickle cell disease. Sickle cell disease patients are best transfused with phenotype-matched RBC transfusions to prevent the formation of RBC alloantibodies, which can result in hemolytic transfusion reactions and difficulty finding appropriate allogeneic RBCs for future transfusions. The phenotype-matched RBC products are garnered from donors of similar genetic background, that is, African Americans donors, and therefore there must be an adequate supply of RBC products donated by African Americans to fulfill this need. To increase blood donation within the African American community, it is critical to understand their motivators and barriers to blood donation. Historically, the major motivators to blood donation have been altruism, awareness of the need to donate, a sense of social obligation, personal social pressure, need to replace blood used, and increased self-esteem.4 A previous study determined that African American donors were more likely than white donors to donate to receive an item and/or gift, to be tested for an infectious agent, or to receive a health screen.5 Another study of African American and white donors demonstrated that African American donors more often donated because it is the right thing to do and preferred mailed reminders, race-specific marketing, and donor center community involvement.6 In a small sample of young African American women, the primary donation motivator was to increase awareness about the need for blood, with an emphasis on the importance of transfusions for the treatment of children with sickle cell disease.7 In another study of African American female college students, motivators for donors and nondonors were similar and included convenience, university involvement, and feeling of self-satisfaction.8 Historically, the principal barriers to blood donation are fear, inconvenience, perceived medical disqualification, being too busy, not being asked, and apathy.4 African Americans, more often than whites, cited bad treatment and poor staff skills as reasons to not donate.9 In the above 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 In another study of African American college students, donors were more likely to be afraid of donation and more likely to be concerned about the safety of the blood supply.8 Racial/ ethnic differences in motivators and barriers to blood donation undoubtedly exist and need to be addressed for recruitment and retention strategies. African American churches appear to be good places to recruit blood donors10 and are frequently the focus of
blood drives, because more than 90% of African Americans report a religious affiliation and more than 50% of African Americans attend religious services at least once a week.11 To better understand specific motivators and barriers to giving blood, members of predominantly African American religious institutions were surveyed. While we are assessing a specific group, we believe that insights into factors in the African American community that influence donating blood will be learned. The results from this study will aid in the creation of African American donor recruitment and retention programs, to improve blood donation rates.
MATERIALS AND METHODS Population and study design An anonymous, self-administered questionnaire was completed at predominantly African American religious institutions in metropolitan Atlanta. A consultant group (known for their affiliation with religious institutions) was hired to identify a convenience sample of churches and to offer expertise in providing knowledge about each religious institution’s dynamics, cultures, and scheduled activities. The introductory package that included a letter explaining the study’s significance and an invitation to an informational breakfast, and contact information was mailed to pastors of religious institutions. Pastors and other church leaders were asked to select a day in which they would promote and administer the questionnaire to their congregation. The questionnaire was distributed between January and April 2008.
Questionnaire The 81-item questionnaire evaluated the following five categories: •
•
• •
•
Demographics of survey participants (n = 9): addressed the participant’s demographics (race, gender, age), socioeconomic status (education, income, health insurance), marital status, and donation history. Medical factors (n = 21): addressed perceived and potential medical ineligibility, attitudinal factors, and trust in the health care system. Recruitment options (n = 22): assessed different strategies for blood donor recruitment. Motivations and barriers to donation (n = 24): assessed motivators to blood donation, including convenience, incentives, awareness, and altruism and barriers to blood donation, including inconvenience, apathy, ignorance, and fear. Knowledge of blood donation and the blood supply (n = 5): addressed the participant’s knowledge about the blood donation process, the blood supply, and myths and facts about blood donation. Volume 50, June 2010
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The motivator and barrier questions as well as some of the marketing questions (n = 35) were on a 5-point Likert scale. These questions used three different response categories: 1) “strongly agree,” “agree,” “neither agree or disagree,” “disagree,” and “strongly disagree”; 2) “very important,” “important,” “neutral,” “somewhat important,” and “not important”; or 3) “strongly encourage,” “encourage,” “neutral,” “discourage,” and “strongly discourage.” Donor status was defined as current blood donor—an individual who donated in 2007; lapsed donor—an individual who had donated blood in the past, but not in 2007; and nondonor—an individual who had never donated blood.
Statistical analysis Descriptive analysis was used to analyze responses. For the Likert scale responses 1 and 2 were combined and 4 and 5 were combined (i.e., combine into two groups: agree and disagree, important and unimportant, and encourage and discourage). The Pearson’s chi-square and the Mantel-Haenszel test statistics were used to analyze categorical variables by donor status. A p value of less than 0.05 was considered significant. Bivariate data analysis was performed using computer software (SPSS Version 17.0, 2008, SPSS, Inc., Chicago, IL).
RESULTS Demographics The majority of the 930 respondents were female (72%) and African American (99%). The mean age was 47 ⫾ 14 years: age 15 to 19 (1%), 20 to 29 (9%), 30 to 39 (21%), 40 to 49 (26%), 50 to 59 (24%), and 60 to 92 (19%). Marital status was married or living with partner (41%), never married (30%), divorced or separated (24%), and widowed (4%). The highest level of education achieved was less than high school (3%), high school (39%), college (36%), and postgraduate (22%). Annual household income was less than $25,000 (16%), $25,000 to $50,000 (29%), $50,000 to $75,000 (21%), $75,000 to $100,000 (15%), and more than $100,000 (19%). Participants were from 15 churches (range of percentage of participants per church, 3%-27%) that had eight denominations (range of percentage of participants, 2%-61%) with American Methodist Episcopal Church (61%) most common. The churches were in the four main counties of metropolitan Atlanta (Fulton 59%, Dekalb 9%, Gwinnett 5%, and Cobb 27%).
Donation history Sixty percent of respondents were donors while 40% were nondonors. Among the donors, 24% donated once, 18% twice, 27% three to five times, and 27% six or more times. 1242 TRANSFUSION
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Thirteen percent of the respondents were current donors; of these 50% had donated once, 23% twice, 20% three to five times, and 1% six or more times in 2007.
Donor eligibility When asked if their current health status permits them to donate blood, 27% answered no, 54% answered yes, and 19% were not sure. Forty-two percent of participants gave a reason for not being able to donate. The most common reasons were low hemoglobin or iron (15%), high blood pressure (6%), medication (3%), foreign travel or lived in foreign country (2%), and low body weight (2%).
Motivators and barriers to blood donation Participants were most likely to provide reasons to give blood that were altruistic. The motivators most commonly stated were donating to help save a life (80% of participants strongly agreed) and donating because blood is needed (73% of participants strongly agreed). The motivators with the lowest level of responses were donating to receive free gifts (5% of participants strongly agreed) and donating for special recognition or award (8% of participants strongly agreed; Table 1). Participants were most likely to state that reasons not to give blood were related to fear. The barriers most acknowledged were afraid of needles, pain, or discomfort (16% of participants strongly agreed) and afraid of feeling faint, dizzy, or unwell and afraid, nervous, or anxious to give blood (both 12% of participants strongly agreed). The least-supported barrier was that the respondent does not have time (5% of participants strongly agreed; Table 1). Three percent of participants strongly agreed with “I would never donate blood.”
Donor status Only two of the 10 motivators demonstrated significant differences between donors and nondonors, while seven of the 11 barriers demonstrated statistical differences between donors and nondonors (Table 2). Nondonors were more likely to disagree with donating to receive a free gift (p = 0.05) and that donating is good for my health (p = 0.01). Nondonors were more likely to not donate due to fear; they were more likely to be afraid of needles, pain, or discomfort (p < 0.01); afraid of feeling faint, dizzy, or unwell (p < 0.01); afraid, nervous, or anxious to give blood (p < 0.01); afraid of not being able to donate (p = 0.01); and afraid that they may catch a disease by donating (p = 0.01). In addition, nondonors were more likely to rarely think about donating (p < 0.01) and state they would never donate blood (p = 0.01). When comparing responses between current, lapsed, and nondonors, nondonors were more likely to agree with barriers than lapsed donors, and lapsed donors were more likely to agree than current donors (Fig. 1).
MOTIVATORS TO DONATION IN AFRICAN AMERICANS
TABLE 1. Responses (%) to motivators and barriers to blood donation Motivators and barriers to blood donation Motivators to blood donation Donating to help save a life Donating is the right thing to do Donating to help the community Donating for special recognition or award Donating to receive free gifts Donating because blood is needed Donating is good for my health Donating to be tested for infectious diseases Donating for a free health screening Encouragement from friends or family members to donate Barriers to blood donation Did not want or care to donate Did not know it was important to donate No one ever asked me to give blood Afraid of needles, pain, or discomfort Afraid of feeling faint, dizzy, or unwell Don’t have time Rarely think about it It is not convenient Don’t know where to donate blood Afraid, nervous, or anxious to give blood May catch a disease by donating May find out I have a disease Afraid of not being able to donate I would never donate blood
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
80 64 63 8 5 73 18 22 14 33
16 28 29 5 3 22 16 18 17 31
2 6 5 14 13 2 47 23 27 26
0 0 1 27 27 1 12 20 23 6
2 1 1 46 52 2 7 17 18 5
7 10 7 16 12 5 9 6 6 12 8 6 6 3
13 15 13 20 21 14 26 19 20 23 14 9 11 4
25 14 16 16 17 25 25 28 21 18 17 20 25 16
29 33 37 27 28 30 22 28 33 25 31 34 32 29
26 28 27 21 22 25 17 20 19 22 30 31 27 48
TABLE 2. Responses to donation motivators and barriers in donors versus nondonors Motivators and barriers Motivators Donating to help save a life Donating is the right thing to do Donating to help the community Donating for special recognition or award Donating in order to receive free gifts Donating because blood is needed Donating is good for my health Donating to be tested for infectious diseases Donating for a free health screening Encouragement from friends or family members to donate Barriers Did not want or care to donate Did not know it was important to donate No one ever asked me to give blood Afraid of needles, pain, or discomfort Afraid of feeling faint, dizzy, or unwell Don’t have time Rarely think about it Don’t know where to donate blood Afraid, nervous, or anxious to give blood May catch a disease by donating May find out I have a disease Afraid of not being able to donate I would never donate blood Convenient locations and times to donate blood
Age group Responses to motivators were compared by age (Table 3). The youngest adults (15.7%; defined as 16-34 years old) were more likely to agree to donating to receive a free gift
Donors
Agree (%) Nondonors
Disagree (%) Donors Nondonors
p value
95.6 92.2 95.6 11.0 6.3 92.6 35.3 38.5 30.9 62.6
89.0 84.4 89.0 13.7 9.1 85.8 25.3 37.4 29.6 56.7
1.9 2.3 1.9 70.8 78.4 2.1 16.9 33.6 40.0 11.0
1.3 0.8 1.3 65.1 68.5 2.2 21.0 35.8 37.6 8.6
0.62 0.14 0.62 0.15 0.05 0.82 0.01 0.56 0.92 0.54
16.9 23.1 14.6 29.2 26.8 17.6 29.8 23.9 26.8 18.4 13.9 13.9 4.4 47.2
19.4 21.8 22.3 37.6 33.9 17.7 36.3 23.9 39.5 22.0 13.4 17.5 7.5 86.8
58.8 58.8 65.1 49.5 52.0 55.4 41.4 52.2 50.1 63.4 65.3 60.2 78.7 1.5
39.5 51.6 50.5 36.3 38.4 45.2 27.2 42.2 32.0 48.4 52.4 44.6 69.1 0.8
