STATE OF THE ART†
What motivates regular blood donations?
Version of Record online: 20 OCT 2011
© 2011 The Author(s). ISBT Science Series © 2011 International Society of Blood Transfusion
ISBT Science Series
Special Issue: State of the Art Presentations, 22nd Regional Congress of the ISBT – Asia, Taipei, Taiwan, November 19–23, 2011
Volume 6, Issue 2, pages 320–323, December 2011
How to Cite
Tan, C. and Yong, A. (2011), What motivates regular blood donations?. ISBT Science Series, 6: 320–323. doi: 10.1111/j.1751-2824.2011.01506.x
- Issue online: 20 OCT 2011
- Version of Record online: 20 OCT 2011
- blood donors;
Background In 2002, the medical benefits scheme given to blood donors who gave two donations a year was successfully removed. However, those who were already on the scheme continued to enjoy that benefit as long as they keep up with the two donations a year. About 30 000 donors were on the scheme in 2001, but less than 7000 were left on the scheme today. A study was conducted in 2010 to investigate what really motivates this group of blood donors.
Study Design and Methods A questionnaire, in the four official language of Singapore, was sent to all the blood donors on the scheme. A response rate of 41·6% yielded a sample of 2898.
Results Of the 89·9% who agreed blood donation is an act of pure goodwill, 19·2% said they will not donate blood for nothing. Interestingly, 18·5% of those who do not consider blood donation as an act of pure goodwill was willing to donate blood for nothing. Of those who said that they will continue to donate blood in the absence of all rewards or incentives, 70·6% gave more than one donation a year, with 72·7% giving three to four donations and 75·9% giving more than four donations.
Conclusion These findings suggested that regular blood donors are self-motivated. The more they give, the more they value their contributions. This motivation is not related to their income or education levels, but reflected the sense of ‘upmanship’. This revelation can be used to strengthen retention strategies in better acknowledging the contributions of regular blood donors and in enhancing the quality of donor services and donor care, as delighted blood donors will make many happy returns.
Most countries still face the challenge of ensuring an adequate and sustainable supply of safe blood at all times. To increase blood supply, many have used different motivation strategies to attract people to donate blood, and this includes giving souvenirs, time off work, health checks, insurance, travel reimbursement, etc. Although upfront cash payment is not given to blood donors, many have questioned the merits of giving rewards and benefits to attract blood donors. Many countries are also faced with the challenge of developing gift ideas as donors, especially the younger donors question the value of their blood in comparison to the gift voucher or movie ticket they get in exchange for a donation.
Efforts continue worldwide to establish and maintain sufficient numbers of regular, volunteer blood donors to ensure an adequate and safe blood supply. The constant concern with being able to meet the demands for blood is because of the fact that only a small percentage of the eligible population actually chooses to donate blood on a regular basis and that a significant percentage of eligible donors are deferred temporarily or permanently because of strict deferral criteria continuously being added in the name of blood safety (Custer et al., 2004; Riley et al., 2007). At the same time, the demand for blood and blood products in most countries continues to increase because of the rise in human life expectancy and the implementation of new and aggressive surgical and therapeutic methods requiring large quantities of blood and blood products (Provan, 1999; Gillespie & Hillyer, 2002; Currie et al., 2004; Greinacher et al., 2007; Mathew et al., 2007).
The fragile balance between blood supply and demand forces blood banks to constantly search for more efficient ways to recruit blood donors (Ferguson, 1996). The method each country adopts to attract blood donors and to cover its needs in blood supplies varies as a function of its socio-economic structure (Rouger & Hossenlopp, 2005). In spite of all research on the subject, however, the incentives that would motivate most people to become blood donors have yet to be determined (Boulware et al., 2002).
Many studies have been done in this area and here, I cite two reports.
Gifts of T-shirts, lapel pins, coupons or gift cards indeed could be an attraction, but do those motivate blood donors to return to future blood drives? And there are some who say gifts should not be involved at all, because people motivated to donate might not want to feel they are rewarded for giving.
Lacetera says that in some countries, in particular Italy, blood donors are given a day off work for their generosity. That benefit is unlikely in American blood drives, but data show that small gifts for donation do increase turnout at sites. But a question is whether the people donating blood are simply switching from one site to another because of perceived higher monetary value of incentives offered but would have donated anyway, referred to as substitution effects.
Provided by Case Western Reserve University – Nicola Lacetera, assistant professor of economics at the university’s Weatherhead School of Management.
Youth may not bring wisdom but, according to a new study from Canada, it does bring generosity as young adults are found to be the most likely to donate blood. The research, published in BioMed Central’s open access International Journal of Health Geographics, looked at what factors had an impact on donating blood.
The study also showed positive ties between level of education and ability to speak English with donation likelihood, whilst immigrants and the wealthy were less likely to donate. The paper shows that those living in a big city were much less likely to donate blood than those living in smaller cities or towns, coining the phrase ‘the stingy big-city effect’. According to Páez, ‘The fact that those who possessed a higher level of education were more likely to donate lends weight to the assertion that, with 25% of Canadians thinking there are some risks in donating blood, educating the public would help expand the donor database’.
Many studies have been done to determine what motivates blood donation. Most people, when asked, cited altruistic reasons such as helping to save lives, feeling of community attachment or commitment to common good as their motive . Results from a study by Nguyen et al.  showed that amongst all donors, free medical testing was the most popular motivator, followed by a tie between a frequent donor programme, being asked more often, and more convenient locations and time. Additional factors such as knowing a family member or friend who needs blood are also cited as important in deciding to donate blood. .
External factors such as social pressure from family and friends, incentives and rewards have also been described as important early motivators . There is also evidence that first-time donors who donate in response to an external factor are less likely to return . As pointed out by Hupfer et al. , individuals become less influenced by extrinsic factors and are affected more by intrinsic considerations as they move from receptiveness to commitment to habit maintenance; and being a blood donor becomes an important aspect of identity .
Most countries, when faced with the challenge of ensuring an adequate supply of blood during lull collection periods have resorted to using gifts and rewards as a motivator to attract more donors. Some countries have a loyalty programme where donors can pick and choose the kind of gifts they want depending on the number of donations made. Although no upfront cash payment has been given to blood donors, many have questioned the merits of giving rewards and benefits, especially petrol vouchers and food vouchers, to attract blood donors.
Since the 1960s, blood donors in Singapore were given a medical benefits scheme so long as they give at least two donations a year. In 2002, the medical benefits scheme was successfully removed for new donors. To prevent a sudden lost of a large number of blood donors, those who were already on the scheme can keep the medical benefit scheme as long as they keep up with the minimum two donations a year. There were about 30 000 donors on the scheme then, but less than 7000 were left on the scheme today. A study was conducted in 2010 to investigate what really motivates this group of blood donors and to determine if they will continue to donate blood in the absence of all benefits and rewards.
Study design and methods
A questionnaire, in the four official languages of Singapore; consisting of two ‘yes’ or ‘no’ questions: ‘Do you believe that blood donation should be an act of pure goodwill’? and ‘Would you continue the act of blood donation in the absence of benefits and incentives”?, was sent to all the blood donors on the medical benefits scheme. A response rate of 41·6% yielded a sample size of 2898 donors.
In addition, profiling questions such as, gender, age, education level, income level and donation frequency were also asked. The purpose of these questions was to determine the number of blood donors who will continue to donate blood in the absence of all incentives and rewards; who they are; their donation frequencies; and how many will be financially compromised should they loose the medical benefits scheme. Analysis was done using SPSS.
Of the 2898 donors, 2604 or 89·9% of the blood donors believed blood donation is an act of pure goodwill. Of these, 2030 or 78% answered yes to continue donating blood in the absence of benefits or incentives.
Although 22·8% of this donor pool was female, but this represented 91·8% of female donors in the sample pool of 648 female donors, whilst males represent 89% of the sample pool of 2246 male donors. This indicated that females are more likely to perform an act of pure altruism as compared to the males.
Further analysis reviewed that younger people tend to be less altruistic than the older age groups. Although 26 or 81% of those aged 16–25 years old answered yes to blood donation as an act of altruism, only 18 or 69% said yes to continue donating blood in the absence of benefits and rewards as compared to 81% of those aged 26–39 years old; 77% age 40–60 years old and 89% above 60 years old. This reflected the challenge of retaining younger donors as they seemed to place a commercial value on a unit of their blood, as compared to the older aged groups. The findings reflected a study done by Steele et al.,  that altruistic behaviour varied greatly by age; older donors have progressively higher scores as they were most likely socialized during a time when helping a stranger was not considered to be a risky behaviour.
We also looked at the education level of this group of blood donors to determine if education is a factor that determines the altruistic value of an individual. The results suggested that those with higher education, especially the ones in the pre-territory level, are less likely to want to give up their benefits for altruism, contrarily to popular beliefs that those with lower education are less likely forgo rewards and benefits.
|Education level||Sample pool||“YES” to Qn 6,||“YES” to Qn 6, “NO” to Qn 7||“YES” to Qn 6, “YES” to Qn 7||“YES” to Qn 6, “NA” to Qn 7||Percentage|
|“O”/”N” level||984||913 (93%)||164||725||24||79%|
|Cummulative = 499 + 2030 + 75 = 2604|
This information was solicited to satisfy the need to ensure that the total removal of the medical benefits scheme will not result in a financial strain for those in the lower income barrack. Results indicated that those in the lowest income bracket have the least resistance to the removal of all benefits and rewards as compared to those in the highest income barrack.
|Income level||Sample pool||“YES” to Qn 6,||“YES” to Qn 6, “NO” to Qn 7||“YES” to Qn 6, “YES” to Qn 7||“YES” to Qn 6, “NA” to Qn 7||Percentage|
|<$30 000||948||866 (91%)||169||679||18||78%|
|$30 000–$60 000||1155||1048 (91%)||219||800||29||76%|
|$60 000–$100 000||436||370 (85%)||72||284||14||77%|
|>$100 000||207||176 (85%)||26||142||8||81%|
|Cumulative: 499 + 2030 + 75 = 2604|
We examined the donation frequencies of the blood donors to determine if it supports the theory that as more donations are made, the perception of oneself as a donor becomes internalized and acts as a motivating force in the decision to donate again . The results supported the theory as 81% of the blood donors who gave more than four donations a year answered ‘yes’ to blood donation as an act of altruism and ‘yes’ to continue donating blood in the absence of benefits and rewards.
Interestingly, a cross check with those who answered “NO” to blood donation as an act of altruism showed that 23·1% of those who gave 3–4 donations a year and 16% that gave more than four donations a year answered “YES” to continue donating blood in the absence of all benefits and rewards; further supporting the theory that the concept of self-identity increased in potency as more donations are made  and that self-identity and anticipated regret were significant predictors, with anticipated regret exerting the greatest influence on intention to donate blood .
In addition, 83% of these donors gave more than two donations a year, indicating that they do not donate purely to stay on the medical benefits scheme, as the requirement is just two donations a year to stay on the scheme. The value of self-worth far outweighed the benefits they received. Many of them, when asked indicated that they have not used the medical benefits scheme and only see it as an additional safety net.
|Donation frequency||Sample pool||“YES” to Qn 6,||“YES” to Qn 6, “NO” to Qn 7||“YES” to Qn 6, “YES” to Qn 7||“YES” to Qn 6, “NA” to Qn 7||Percentage|
|1 time/year||16||15 (94%)||2||13||0||87%|
|2 times/year||466||400 (86%)||94||290||16||73%|
|3–4 times/year||1763||1594 (90%)||309||1243||42||78%|
|>4 times/year||617||560 (91%)||92||456||12||81%|
|Cumulative: 499 + 2030 + 75 = 2604|
|Donation frequency||Sample pool||“No” to Qn 6,||“NO” to Qn 6, “NO” to Qn 7||“NO” to Qn 6, “YES” to Qn 7||“NO” to Qn 6, “NA” to Qn 7||Percentage|
|Cumulative: 207 + 48 + 5 = 260|
In conclusion, the value of a unit of blood to most regular blood donors is not equated to a dollar value. Those who rationalized the value of a unit of blood will stop donating once that value is removed. However, those who have been donating blood regularly, more than two times a year will still continue to donate as blood donation has helped defined them.
No potential conflict of interests to declare.
- 4Giving blood: the development of an altruistic identity. John Hopkins University Press, Baltimore, 1991, :