AABB Assesses Perception and Practices of Blood Donation in Guyana

Study Shows General Willingness to Donate but Widespread Uncertainty, Lack of Information

By Laura Fusco

A study conducted recently under the auspices of the President’s Emergency Plan for AIDS Relief (PEPFAR) to capture knowledge, attitudes and practices regarding blood donation in Guyana shows that while many people in the Caribbean country are willing to help others by donating blood, there is a general lack of knowledge with respect to the extent of the need for blood donations. 

According to the study — which was a collaborative effort between AABB and the Guyanese blood community — lack of available blood is the primary concern facing the Guyana National Blood Transfusion Service, with a significant portion of physician requests for blood going unmet every year. Structured interviews and focus group discussions indicated that the practice of replacement donation is one that has grown out of necessity due to permanent blood shortages. “The Blood Transfusion Service is essentially providing a ‘service’ of collecting and processing blood from family/replacement donors recruited through the public hospital system,” stated a report summarizing the findings, which indicate that the lack of available blood can be largely attributed to a general mentality of directed family replacement donation rather than voluntary donation for altruistic purposes.

Knowledge

Of the 915 people interviewed for this study, approximately two-thirds displayed at least a partial knowledge of the physical characteristics of blood and its function. Frequent explanations, however, demonstrate only a very basic understanding, including responses from participants that “blood is life,” “blood is a red liquid,” and “blood keeps us alive.” Only one-third were familiar with the function and role of blood in the circulatory system. The study revealed that the majority of Guyanese also are unable to identify more than one blood type or group, but as many as half could name their own blood type.

When asked about blood transfusion, volunteer donors were the most likely group to report knowledge regarding the process. Individuals who had never seen messages about blood donation were four times more likely to have never heard of blood transfusion and, therefore, were unable to describe the process. As for blood use, “the majority of respondents understood at least that donated blood is used for ‘saving lives,’ the report notes, but very few understood that blood donations can go to anyone who needs it. “This demonstrates a general confusion or misunderstanding regarding the role of the transfusion service,” said Leo Beckerman, study coordinator and AABB project associate. “It also underscores the lack of education the population has regarding a safe blood supply from regular, voluntary, non-remunerated blood donors.”

Lack of knowledge also was evident in questions that examined respondents’ understanding of blood donor eligibility. Focus group discussions revealed a common belief that only people with certain blood types can or should donate, and a perception that men are “better” donors. While donor eligibility remains largely understood, study participants were quick to identify illness as a major factor in donor deferral. Many of the respondents qualified their responses, specifying that HIV-positive people should not donate. Other diseases mentioned included diabetes, anemia, low and high blood pressure, and malaria.

Donation frequency is another issue unfamiliar to many people in Guyana. When study participants were asked how often a person can donate blood, answers ranged from “every day” and “as often as possible” to “every five years” and “once in a life time.” According to the report, “less than 2 percent were aware of the National Blood Transfusion Service policy of permitting blood donation every eight weeks or two months.”

The study’s evaluation of blood donation knowledge also extended to donor and recipient health as well as disease and transfusion.

Attitudes

An assessment of attitudes toward blood donation in Guyana found misperceptions concerning the role of family replacement donors. One in five individuals who volunteered to donate for a family member or friend considered themselves voluntary donors. Others reported no need to donate blood because they have never had a close relative or friend in need of a blood transfusion. “This is not to say that there are no voluntary donors who donate to ‘save lives’ or for any other altruistic reason,” the report notes. “The volunteer subculture certainly exists, and there is large potential to expand on it.”

Interviewee respondents and focus group participants showed a significant willingness to receive public service-type messages about blood donation and become more educated on the issues. “This disposition demonstrates a potentially very receptive audience from which voluntary non-remunerated blood donors and a new culture of voluntary donation can be forged,” the report explains. More than 90 percent of respondents indicated genuine interest in topics related to blood donation.

Education, it appears, may be just what is missing. General fear of the unknown and fear of disease or infection dominate the list of reasons why Guyanese are currently not motivated to donate blood. Divided into multiple categories, fear — including fear of disease, fear of the needle, fear of learning HIV or other disease status, and fear of contracting a disease — account for nearly half of the responses collected in this study. One of the other main deterrents to donation was religion. Although donors from all major religious groups in Guyana were interviewed, it is widely believed that only Jehovah’s Witnesses do not donate blood or receive blood transfusions based on religious beliefs and practices. Inconvenience also was noted as a deterrent for donation, with many people from the regional areas outside of the major cities unaware that their towns have the facilities to accommodate blood donors. Other reasons given for not donating blood include the belief that the practice is not safe, the belief that the body does not have enough blood to tolerate donation and the fear of death.

When assessing donor incentives and enablers, the study found that, in general, people are focused primarily on motivational tools, rather than rewards, to increase blood donation. “This is critical in beginning to change the blood donation culture from one of replacement to that of volunteerism,” the report notes. More than half of the respondents replied that education would encourage more people to donate blood, and the majority cited advertisements, television shows, outreach programs, awareness campaigns, workshops, lectures and general encouragement as ways to increase awareness and boost the blood supply. Less than a quarter of respondents mentioned incentives such as money, gifts or food.

Many money-related topics were raised among discussion groups. Paid donation is not regarded as negatively among the public in Guyana as it is in other regions of the world. Nearly 30 percent of respondents stated that they believe at least some blood donors in Guyana are paid or financially compensated. A general lack of education exists regarding the risks involved in paid donation. Money also is a sensitive topic when it comes to charges for blood transfused at the hospital. The public hospitals in Guyana provide blood to patients at no cost — as long as there is an adequate supply. Private hospitals assess a minimal processing fee. This policy, as well as the amount of the service fee for blood and blood components, is clearly addressed on a poster located at the transfusion service. “Unfortunately, there is still a great deal of confusion regarding the purchasing of blood for transfusion,” the report notes. “Some people express anger that they give their blood for free, but the recipient has to pay for it. These individuals believe that the hospital or transfusion service is profiting from their free donation.”

In studying attitudes, respondents also were assessed for their negative images of blood donation and blood establishments as well as their critiques of the donation experience. Addressing anger or aversion toward phlebotomists and/or hospitals is expected to alleviate these concerns regarding treatment.

Suggestions for Improvement

Analysis of the findings of this study — which was conducted during a six-week period earlier this year — enabled the organizations to define a broad plan of action to help Guyana increase the number of voluntary, non-remunerated blood donors. It is believed that Guyana — which is among the poorest countries in the Western Hemisphere and the only English-speaking country in South America — can improve its situation through advertising, education, increased mobile drives and increased community cooperation. More specifically, the National Blood Transfusion Service must take the lead in developing educational programs and advertising these initiatives through motivational images, stories and donor safety information. Efforts also should be made to increase mobile drives and enhance comfort and convenience for those donating in locations outside of the transfusion service. Placing more emphasis on customer care and treatment will likely lead to increased repeat donation as well. Finally, the National Blood Transfusion Service is encouraged to build more relationships with local organizations to create forums for outreach programs and mobile blood drives.

While less than 1 percent of the population in Guyana currently donates blood, the majority of non-donors surveyed expressed at least some willingness to donate in the future and are considered the prime targets for recruitment as voluntary donors.

Reprinted from the June 2007 issue of AABB News