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International Journal of Emergency Mental Health and Human Resilience
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A Qualitative Study of Identifying Factors which Contribute and Non-Contribute to Voluntary Blood Donation through Focus Group Discussions (FGDs) among Blood Donors and Non-Blood Donors

Umakanth Siromani Ph D1*, T Thasian Ph D2, Rita Isaac MD2, KG Selvaraj Ph D3, Dolly Daniel MD1, Joy John Mammen MD1, Sukesh Chandran Nair MD1

1John Scudder Memorial Blood Bank, Departments of Transfusion Medicine and Immunohematology

2RUHSA (Rural Unit for Health and Social Affairs)

3Bio-Statistics Christian Medical College, Vellore, Tamil Nadu South India

*Corresponding Author:
Umakanth Siromani Ph D
Email: [email protected]

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Abstract

Background: Blood donation is a divine act that serves a humanitarian cause. Blood transfusion saves lives and improves health of many patients. Every component of blood can be used and it plays an important role in saving the lives of different individuals in the community. Blood banks urge everyone to respond to the needs of patients so that they can increase the stock and able to meet the demand of patients across the country. Objective: To collect the information on what is known and not known, their beliefs and practice among blood donors and nonblood donors in respect to voluntary blood donation. Materials and methods: There were four Focus group discussions (FGD’s) were conducted among Voluntary Blood Donors and non-blood donors. There were nine voluntary blood donors non-blood donors participated in each group. The discussions were conducted in a separate place with a closed room and the whole sessions were recorded with their permission. The discussions were conducted in local language and later the verbatim translations were done into English. Results and Conclusion: The majority of the donors said, they are donating blood to save an ill person. Donors who work in the IT companies, preferred to donate in the blood donation camp rather than in blood bank because of time factors. There were common myths, fears and superstitions about blood donation, as with previous study results such as giving blood causes weakness in the human body, medical problems, fear of needles, general apprehension, and fear of after-effects. Donors experienced the joy of blood donation and seriously discussed the matter of waiting time. A few donors suggested that a short film could be used to create awareness. Many blood donors observed that advertisement and information on voluntary blood donation camp was very limited. Blood banks should not always target a high number of blood donors but should organize blood donation camps even for fewer blood donors in the community

Keywords

Focus Group Discussions (FGD’s), contribution, non-blood donors, factors, myths

Introduction

Blood donation is a civilized, a noble gesture and a divine act that serves a humanitarian cause. Blood transfusion saves lives and improves health, but many patients requiring transfusion do not have timely access to safe blood (WHO, 2012). Every component of blood can be used and it plays an important role in saving the lives of different individuals in the community. Modern science has not invented a true substitute for blood and blood products. Artificial blood is still not equivalent to blood in terms of efficiency, not cost effective and not easily available for clinical use across the world.

Recruitment and retention of new blood donors is an important task for blood bank personnel to attain self-sufficiency of blood and blood products. Blood banks urge everyone to respond to the needs of patients so that they can increase the stock and able to meet the demand of patients across the country. To meet the entire blood need of a country we have to establish a transfusion service which totally depends on voluntary blood donors since it is considered to be the safest source (Siromani, Molly, Daniel et al., 2012).

A focus group is an organized discussion – though structured in a flexible way – of between 6 and 12 participants. It usually lasts one or two hours and provides the opportunity for all the respondents to participate and to give their opinions. Dominant and submissive relationships which develop within the group, as well as side conversations, can be controlled. Smaller groups and those with a narrower range of characteristics tend to be more coherent and interactive (ERNWACA, 2014). This group discussion are ideal to collect the information on what is known and not known, their beliefs and practice among blood donors and non-blood donors in respect to voluntary blood donation.

Materials and Methods

There were four Focus Group Discussions (FGD) were conducted, among Voluntary Blood Donors and non-blood donors to study the contributing and non-contributing factors towards blood donation in four localities in Vellore district, Tamilnadu, India. There were 36 participants in total; nine per each discussion were participated. The blood donors were selected from the available donor list from the blood banks and donor’s club in the district. The non-donors were selected in the community those who never agree to donate blood. The educational qualifications of each subject in either group are from higher secondary to bachelor degree level. The group of participants is guided by a moderator through a questionnaire, who introduces topics for discussion and helps the group to participate in a lively and natural discussion amongst themselves. The participants didn’t go through any fear, compulsion or threat to participate in this discussion. The authors gave them choice that their participation in the discussion is purely voluntary and non – participation of the study would not harm or affect them in any manner. The discussions were conducted in a separate place with a closed room and the whole sessions were recorded with their permission. The discussions were conducted in Tamil - local language and later the verbatim translations were done into English.

Results

This discussion ended up with many ideas, suggestions, motivation techniques and commitments to voluntary blood donation. Blood donors are donating blood because they want to help others. A few donors suggested that blood banks should aim to improve their techniques, so that bleeding a donor in a blood bank becomes just as fast as it would be if they went to a blood donation camp. The majority of the donors said, they are donating blood to save an ill person (Ilona, Laimute, Aurelija et al., 2006). Two donors brought an issue saying that they waited long time to donate, but two other donors had finished blood donation within one hour. Donors who work in the IT companies, preferred to donate in a blood donation camp rather than at blood bank because of time factors. Other donors said that even if they had to wait for a long time at the blood bank to donate blood, they still preferred to donate because it would help a fellow human. Some other donors suggested that the blood bank should increase more beds (couches) and provide more space to accommodate more donors. It was also observed that major blood banks in Vellore district had only few beds which was not enough; more beds should be provided with adequate number of staff in future to improve the blood bank services. A different view was that as the bleeding time of a donor took only a few minutes, there was no need to have more staff; the same service can be provided by rotating the staff.

After the completion of FGD with non-blood donors the following reasons, myths and misconceptions for not donating blood came to light. There were common myths, fears and superstitions about blood donation, as with previous study results (Gillespie et al., 2002; Boulware et al., 2002; Olaiya et al., 2004; Mwaba & Keikelame, 1995; Belda Suárez et al., 2004; Fernandez-Montoya et al., 1998; Wiwanitkit, 2002) such as giving blood causes weakness in the human body, medical problems, fear of needles, general apprehension, and fear of after-effects and they not donating blood simply because no one asked them to.

Discussion

Donors experienced the joy of blood donation and seriously discussed the matter of donor waiting time. Many of them were willing to wait an hour to donate, spending an hour for the noble act was not a problem for them, but waiting for more an hour was not acceptable. Of course some donors could understand the reasons for delay; it could be because of change of shift duty, or insufficient space, donor beds (couches) or not enough staff on duty.

Participant 3: We come to donate blood to people whom we do not know. In blood bank they do not take blood immediately as they do in the blood donation camp. I took leave from College to donate blood, but in the blood bank they made me wait saying that I had come to donate for my friends and relatives; this is a minus point and this is disgusting.

Participant 4: I felt comfortable from the time I entered and came out. The technicians are excellent, I did not feel any pain, I liked the way they talked to me, even if you are angry, their approach will calm you down. I liked that approach; a madam handled an angry donor superbly, I really felt even if someone is angry they will become soft in front of her. I was waiting for three hours that’s the only thing I felt bad about; the time I went was the time of handing over of the shift - that may be the reason for the delay, otherwise everything was superb.

Parents don’t generally allow the use of mobile phones by their wards and most institutions too don’t permit their students to carry mobile phones in their premises in order to avoid problems. But a certain donor could help a life by responding to an SMS message only because he was carrying a mobile, so SMS sometimes can play an important role in reaching out to voluntary blood donors.

Participant 9: Whenever there is a need for blood, my friends will send me SMS, at that time I may be in the class room or else where. Twice I got SMS like that. I did not know the sender. I was in a conference but I replied at once saying I am coming at 1.30 in the noon. And I went exactly at that time to the spot and I donated blood. I felt very happy. We have to use mobile in a way that it should be used.

A donor expressed a newer strategy for donor motivation among his friends and relatives.

Participant 9: How we are coordinating blood donors is: as soon as one donates blood, we note down the blood group and date of donation and the next due date for donation and exactly after three months we remind the donors by telling them, ‘you have an opportunity to save a life, please donate’ – this is the way we remind everybody without fail, particularly using the word ‘opportunity’. The word ‘opportunity’ is a powerful word. If we ask someone “why you did not donate blood”, they would say ‘I did not get an opportunity’. Because of this, we use this word to motivate new donors. After the donation is made we appreciate donors by saying, “many people did not get an opportunity to donate, but you got the opportunity and you have used it in a better way, keep it up and we wish you to repeat over and over again”.

Donors have suggested that patient’s relatives should come forward to replace the blood which has been provided for them by the blood bank.

Participant 8: Blood banks are providing blood in emergency and save the patient’s life but after recovery of the patient, no relative would think of the blood bank gave this blood: Let us replace that so it would be useful for other patient’s in need. No one should suffer, if the blood bank has given 8 bottles of blood we have to replace at least 2 units of blood - which we can. Blood bank does not ask for the same group to be replaced, they only ask for any blood group. Your relatives are saved and your family is happy, share that happiness with other patients by donating blood.

Followings are the main findings and identified factors for voluntary blood donation among voluntary blood donors.

i. Awareness should be created among the public one week prior to the voluntary blood donation camp at a particular area.

ii. More advertisement about blood donation should be visible in institutional premises because participants felt that the present methods of propaganda are inadequate.

iii. The available student resource population is not properly tapped by the blood bank, motivators and camp organizers even though there is higher willingness among students to donate.

iv. Teaching staff should be involved in voluntary blood donations since they have a high influence among their students. They can mobilize more students in blood donation drives at their institutions.

v. The name of the blood bank should be displayed during outdoor blood collection by a mobile blood bank for identification and verification.

vi. Authorized letters of recommendation should be given by the particular blood banks to patients’ relatives so that they can bring more blood donors from the institutions.

vii. Steps should be taken to reduce the waiting time of blood donors because long waiting times affect their planned schedules.

viii. Blood donors should be treated by blood bank staff with respect since they are the life savers of many.

A discussion with non-donors ended up turning over many myths and misconceptions, reasons for not donating blood, suggestions to overcome these and how to motivate non-blood donors towards voluntary blood donation. Donors are not donating blood because lack of awareness, subsequent body weakness, fear of pain and other reasons. And also they expressed that celebrities and political personalities could be the role model for future voluntary blood donation campaigns.

For the question regarding knowledge about blood donation they all replied just as: do not know. When asked to discuss any other reasons for non-donation majority of them replied that their relatives will not allow them to donate. For the question ‘are you interested to donate? They replied as follows:

Participant 4: My co-workers have donated and I was also interested but family members said not to donate.

Fears of weakness were discussed:

Participant 5: A person whom I know donated two times and he became ill after he had donated. My family will not allow me to donate but if I go ahead and donate on my own, if something happens even if it is an ordinary fever then everyone in the family will blame me it is because of blood donation.

And they agreed that if they had been aware about blood donation they would have come forward to donate they also suggested that blood banks should come forward to organize many blood donation awareness campaigns.

Participant 8: There is no one to bring awareness to us, the awareness which was brought to us was focused on the wrong statements saying blood donation will affect our health and people mind are saturated with that, there is no one to say that blood donation is good. We need to have awareness programmes if they conduct that often people might gather, at least to know what it is.

Non-donors stated that advertisements regarding blood donation should be improved to match the standards of other programmes. And they suggested that blood banks should come forward to organize voluntary blood donation camps or awareness camps without being too concerned about cost and success ratios. Even if they get just one donor they get they should be happy to organize it again in the same place.

Participant 3: When there is an eye camp they call everyone to have an eye check-up and treatment, they stick up posters. In the same way when there is a polio camp they advertise on TV. So in the same way, if they can do it when there is a blood donation camp and create awareness, saying that no harm comes from donating blood, some will come forward to donate. If you alert a hundred people at least two will come. Those two can inform four people.

Participant 4: They should deliver a good speech about blood donation before they organize the camp. Whoever clearly understands the contents can go and tell their family and make them understand. They should make the elders and the head of the town understand about blood donation, so that they can go to people and create awareness among them. If someone like that speaks, people will listen and at least ten people will donate, at the beginning there might be only five or ten but when there are repeat camps the numbers will increase.

The following are the overall feedback and identified factors for not donating blood among non-blood donors.

1. Many of the non-blood donors said that they had fear about blood donation, and also permission was not given to them by the elders of their family. They also stated the followings:

a) Their spouse did not allow them to donate

b) They had a fear of future body weakness

c) They thought it would involve unbearable pain

d) The non availability of nutritious food held them back

2. Lack of advertisement for voluntary blood donation

i. Information about polio eradication camps, eye camps, health camps and other camps has successfully reached the public. Electronic media also play a major role. But advertisements about voluntary blood donation are very limited, resulting in lots of myths and misconceptions regarding blood donation.

ii. This can be overcome by using effective media

iii. Celebrities, sports personalities and political leaders could be the role models for future blood donation campaigns

iv. It is more effective if local political personalities, religious leaders and social activists request the public to donate blood.

Conclusion

To conclude that focus group discussion is a state of art strategy and a successful tool to identify beliefs, behavior and practice among blood donors and non-blood donors with respect to voluntary blood donation. Blood bank should maintain friendly atmosphere to overcome fears related to blood donation and blood collection procedures. Short film could be used to create awareness among public in future blood donation campaigns. Many blood donors observed that advertisement and information on voluntary blood donation camp was very limited in college campuses. The camp organizers should propagate information regarding the camp venue, date and other information well in advance, so that more students may participate and make the blood donation camp a success. Blood banks and camp organizers should involve the teaching staff in different institutional areas. Teaching staff can be helpful in recruiting new blood donors during an emergency need.

Information, Education and Communication (IEC) materials, posters and other information should be available in blood banks and at the blood donation camp venues. Blood bank should organize awareness talks on voluntary blood donation before the start of every blood donation camp. In addition veteran blood donors may be given a chance to share their experiences at blood donation camps. This will help the first-time blood donors to overcome their anxiety and feel motivated. Blood banks should take responsibility to remind blood donors when they are due for the next donation. Many interested blood donors may forget to donate blood because of their busy schedule. Reminders may help them to donate on time. Blood banks could use social networks like ‘Facebook, Twitter and others and SMS for motivating and creating awareness among blood donors and non-blood donors (Siromani, Thasian, Isaac et al., 2013). Blood banks should continue to improve upon the waiting time (Siromani, Tsuneo, Daniel et al., 2013). Blood banks should care all blood donors alike irrespective of whether they were volunteers or replacement/relative donors. Equal care among blood donors would motivate replacement/relative donors to become voluntary blood donors. Blood banks should not always target a high number of blood donors but should organize blood donation camps even for fewer blood donors in the community without calculating the expenses. Community oriented blood donation camps are the seeds of future success.

The reason for rejection of blood donors should be made known to the individual in order to create awareness among non-donors. Non-blood donors expressed that elders, relatives did not allow them to donate blood, because of the likely consequences such as weakness and pain. The groups thought that political personalities, celebrities and sports personalities could be the role models for future voluntary blood donation campaigns to mitigate and overcome the myths and misconceptions. This would help to provide awareness among nondonors, their relatives and family members. Non-blood donors felt that they had not been requested to donate and they believed that no one would volunteer to donate blood for others unless they are called to do so. Blood banks should train the camp organizers to go to many places to create awareness and request people to donate blood. Direct participation of blood bank staff in meeting non-donors at their localities would help them to adopt this noble cause in near future.

References

BeldaSuárez, I.M., Fernandez Montoya, A., Rodriguez Fernandez, A., Lopez Berrio, A., &Cillero-Penuela, M. (2004). How regular blood donors explain their behavior. Transfusion, 44, 1441-1446.

Boulware, L.E., Ratner. L.E., Ness, P.M., Cooper, L.A., Campbell-Lee, S., LaVeist, T.A., et al. (2002). The contribution of sociodemographic, medical, and attitudinal factors to blood donation among the general public. Transfusion, 42, 669-678.

ERNWACA: Excerpts from guides on qualitative research http://www.ernwaca.org/panaf/RQ/en/discussion.php (Last accessed on 2014 September 17)

Fernandez-Montoya, A., Lopez-Berrio, A., & Luna del Castillo, J.D. (1998). How some attitudes, beliefs and motivations of Spanish blood donors evolve over time? VoxSanguinis, 74, 140-147.

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Mwaba, K., &Keikelame, M.J. (1995).Blood donation behavior and beliefs among a sample of high school students in Mmabatho.Curationis, 18, 2-3.

Olaiya, M.A., Alakija, W., Ajala, A., &Olatunji, R.O. (2004). Knowledge, attitudes, beliefs and motivations towards blood donations among blood donors in Lagos, Nigeria. Transfusion Med, 14, 13-17. 

Siromani, U., Molly, R., Daniel, D., Mammen, J.J., & Nair, S.C. (2012). Ahead to 100% of Voluntary non-remunerated Blood Donation at a tertiary referral hospital blood bank in South India. Asian Journal of Transfusion Science, 6(2), 190.

Siromani, U., Thasian, T., Isaac, R., Daniel, D., Mammen, J.J., & Nair, S.C. (2013). Recruitment and Retention of Voluntary Blood Donors Through Electronic Communication. ActaInformaticaMedica, 21(2), 142.

Siromani, U., Tsuneo, T., Daniel, D., Mammen, J.J., & Nair, S.C. (2013).Perspectives and attitudes to voluntary blood donation in a tertiary referral hospital blood bank.Asian Journal of Transfusion Science, 7(2), 158-159.

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Wiwanitkit, V. (2002).Knowledge about blood donation among a sample of Thai university students.VoxSanguinis, 83, 97-99.

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