AABB News: Understanding Why Individuals Donate Blood Could Lead to Better Donor Recruitment

January 14, 2021

Note: This article originally appeared in the January 2021 issue of AABB News, a member benefit of AABB.

By Jerilyn Schweitzer, MA
Managing Editor

The COVID-19 pandemic has highlighted an issue that has challenged blood centers for several years: decreasing numbers of blood donors. Understanding more about factors that motivate individuals to donate blood could help explain this trend and could help recruitment professionals develop new strategies for donor outreach. AABB News spoke with several experts on blood donor motivation about the importance of understanding this area and how such knowledge could help provide insight for donor recruitment and retention efforts.

Not a Simple Question

Wim L.A.M. de Kort, MD, PhD, professor of Donor Health Care at the University of Amsterdam, former head of the Department of Donor Studies at Sanquin Research, and retired director of donor services at the Sanquin Blood Bank; and Eva‐Maria Merz, PhD, associate professor of sociology at Vrije University in Amsterdam, have conducted extensive research on  donor motivation. They told AABB News, “Although this may look like a rhetorical question and the answer may seem obvious, the answer is not straightforward. There is an easy part and a more complex part to it.”

The easy part of the answer, said de Kort, is that we need to understand donor motivation because without this understanding, recruiting and retaining donors could be a fruitless and costly enterprise. “The complex part of the answer relates to the translation of this understanding into practice,” Merz explained. “Turning an understanding of motivation into effective strategies is complicated because the data shows that we need to adjust both recruitment and retention strategies in an increasingly diverse manner, based on age, gender, cultural background, social context and other factors. A successful strategy in one situation can be very effective, but completely wrong elsewhere,” they said.

Eamonn Ferguson, PhD, a professor of health psychology with the Personality, Social Psychology and Health Group at the University of Nottingham’s School of Psychology in England, who has researched blood donor motivations for 25 years, agreed that not all blood donors are motivated for the same reasons. “Motivations will vary by the donors’ career stage [new versus experienced donors], gender, age and cultural background.

Theory suggests — and research shows — that if you can match donor recruitment and retention interventions to the donors’ motivation, then campaigns will be significantly more effective. For example, we know that fairness and trust are key motivators for new donors, and, as such, interventions based on trust and fairness beliefs will be most effective for recruiting donors,” he said. “Similarly, we know that motivation based on warm-glow [feeling good as a consequence of donating] is more likely to be cited by experienced donors. Therefore, interventions based on warm-glow works best for retaining donors.”

He compared matching interventions with individual donors to personalized medicine, in that certain treatments work better for some patients, and matching a patient to a treatment maximizes clinical outcomes.

Motivation Does Not Always Result in a Blood Donation

Another complicating factor is that donor motivation does not always equate with donating blood. According to Christopher France, PhD, distinguished professor of psychology at Ohio University in Athens, Ohio, “The relationship between motivation and behavior is complicated. Although one may be positively motivated to engage in a particular behavior, such intentions are influenced by a combination of medical factors, such as blood iron levels; environmental factors, including ease of access to a donation site, available time in one’s schedule relative to other priorities; and both positive and negative psychosocial factors, such as fears, social pressures, moral norms, planning ability and coping skills.” As a result, France said, the direct correlation between a person’s stated intention and their actual behavior can be quite low.

“That said, those who indicate little or no intention probably will not give,” he said. “Those who indicate a positive intention may or may not give, but the chances that they do will increase if we help them with ease of access, help address any psychosocial barriers that they may have and offer incentives.”

Barbara Masser, PhD, a professor and Australian Red Cross Lifeblood chair in the School of Psychology at the University of Queensland in Australia, agreed that the association between motivation to donate and actually donating can be poor unless we factor in barriers to donation. ”The strongest motivation won’t translate into a donation if there is simply no blood collection site within a reasonable distance,” she said.

Ferguson added that donor motivations are good predictors of donor behavior, with the effects being small to medium in size. He said, “I’d estimate that motivation increases predictions of donor behavior by 5-10%. Some might say that this is small, but this needs to be thought of in context. It has been argued that we should think about how well something predicts an outcome in terms of how extensive the intervention is and how difficult the outcome is to change.” He cited chemotherapy as an example, in that its effects on survival are real but not always large. “Applied to blood donation, only 3-4% of the eligible population donates blood, so attracting and retaining donors is difficult, and donation is a behavior that is hard to change — as such even small effects on motivation are important.”

Motivations Throughout The Donor’s Career

Notably, motivations may differ for first-time versus repeat donors. According to Masser, donors at the beginning of their career are thought to be more motivated by external factors, such as the actions or views of family and friends, advertisements and the offer of incentives. “As they gain experience,” she said, “they become more motivated by intrinsic factors, such as the role of being a blood donor becoming an important part of their identity. Those who are intrinsically motivated are typically more habitual, and they will simply keep donating to reinforce their identity.”

De Kort and Merz added that to become a first-time donor, “a strong motivation must be there to overcome anticipated discomfort. Then the next few donations are important to help to imprint motivation into their system, their donor identity. Thereafter, it is important to keep up the routine.”

France noted that the biggest difference between first-time and repeat donors may be that “relative to new donors, experienced donors are more informed about the donation process, and therefore are likely to have fewer questions and concerns about the process itself.” He reiterated that viewing oneself as a regular donor is likely to keep a donor coming back, even in the face of potential obstacles, such as scheduling or transportation challenges. 

Donor Age Also Plays a Role

According to Ferguson, “We need to think of the pool of donors as a heterogeneous group and to target campaigns accordingly. Young people will be motivated by different concerns, and as with any marketing campaign, you need to match the motivation of the donor to the campaign message, and this will be different for different age groups.”

Masser cited an emerging body of evidence that shows that the significance of donating blood differs somewhat by age. “For example,” she said, “older donors seem more likely to view donating as a way to ‘give back’ and to be motivated by understanding the need for blood. Personal health and the health information gained from donating also seems to become more important with age.”

“Younger donors act ‘faster,’ more on an impulse, and with different communication channels,” added de Kort and Merz. “Older donors — say after their 30s — generally act more ‘smoothly,’ while thinking more before acting, and they carry their life experiences and events with them.” They emphasized that it is a misnomer to think that younger people are less motivated to contribute to the public good or to provide their share to society.

Intrinsic Versus External Factors

Developing an identity as a blood donor may be one of the most important factors in turning a first-time donor into a repeat, lifelong donor. France explained, “Lifelong donors are individuals who have developed a self-identity as a blood donor, which is associated with a strong internal motivation to give. Hence, these donors typically do not need external incentives to motivate them to give, and they may not be seeking the approval of others. Rather, they often gain intrinsic satisfaction from the act of donating on a regular basis.”

Ferguson’s research indicates that warm-glow is critical at this point, possibly by reinforcing current donation behavior and shaping future behavior. “Warm-glow is known to activate the brain’s reward centers, does not habituate, and acts to enhance the expectation of future rewards. Thus, a reinforced association is formed between the act of donation and warm-glow,” he said.

External factors can play an important role, as well. According to de Kort and Merz, “First, a donor wants the blood establishment to show some kind of sincere interest in their person, so it is important to get to know them: their birthday; their employment status; their family status, including marriage and new babies, but also serious diseases and deaths. Second, it is equally important that each individual donor is being thanked in an honest way, preferably a way that fits that particular donor.” De Kort added that staff should be “friendly, competent and honest.”

Masser agreed, citing the importance of doing everything possible to ensure that early donation experiences are positive and giving a little extra attention to those donors who are in the early stage of their career.

Addressing Obstacles to Donation

However, even for the most positively disposed donor, life can get in the way of donating, said Masser. “So, the challenge is how to keep a connection with donors, even when they can’t donate right away,” she said. “This may take the form of offering alternative ways to contribute for those deferred but maintaining contact — without asking for donations — and with those for whom life is too busy. Keeping blood donation front of mind may result in those donors  resuming once they have more capacity.”

De Kort added that guiding a donor after deferral is pivotal in terms of retention, not just at the collection site immediately following a donation, but afterwards, as well. “Here, one of our studies shows that information is important,” Merz explained. “Donors need to understand the process of blood donation and donor selection and the importance of all these steps for the safety of both donors and recipients.”

Methods for Recruiting and Retaining Donors

Warm-glow is an important factor to stress when recruiting new donors and working to turn them into repeat donors. According to de Kort and Merz, trying to reignite feelings of warm-glow can be a useful intervention, especially for those with lower initial levels of warm-glow. “Furthermore, getting donors past their fourth donation is the point at which they start to consider being a blood donor as part of their identity,” Merz said. “At this point, they are more likely to become life-long donors.”

De Kort and Merz also recommended bringing more diversity into the recruitment process and suggested treating donors like business customers. Overall, de Kort said, blood centers are selling a “good feeling” and donors are “paying” by donating their blood.

For his part, France believes that blood centers typically do a very good job of addressing the technical issues of informing donors of “when,” “where” and “how” to donate blood. In addition, he said, they always highlight the important altruistic reasons for becoming a donor — namely, helping those in need. “What is not always addressed in recruitment materials,” he said, “is the direct benefit that donors receive in the form of warm-glow. This is sometimes a part of advertising campaigns, but not always.”

Another factor that should be considered more, France continued, is the fear that potential donors (and current donors) may have, and the ways these can be alleviated. “My research over the past 30 years has demonstrated time and again that prospective donors may have many different fears — blood, needles, pain, fainting — and if we acknowledge these fears directly while teaching them ways that they can cope with and overcome them, then the prospective donor is more motivated to give,” he explained. “Talking about someone’s fear doesn’t turn them off if you offer to help them and support them at the same; it does the opposite — it empowers them to face and overcome them.”

Ferguson stressed the importance of developing interventions to recruit and retain blood donors based on a clinical trials model. “That is, a behavioral campaign, like a pharmaceutical intervention, must contain some active ingredients; otherwise, it would not work. Thus, early-stage studies to refine the exact nature of the intervention and identify any potential unforeseen consequences before scaling up would greatly enhance success,” he concluded.

According to Masser, “At Australian Red Cross Lifeblood, we are fortunate to work with a marketing team that facilitates our research trials and very quickly rolls out successful outcomes as business-as-usual practice.” She added that a big gap in their understanding relates to having accurate knowledge about what most people know about blood donation — including who can donate, who cannot, what the donated blood is used for, etc. “If we can identify where the donors’ misperceptions lie and correct them, then we have the opportunity to recruit more donors onto the panels,” she said.