Transfusion and Apheresis Science 48 (2013) 87–93

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Transfusion and Apheresis Science

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Blood donations motivators and barriers: A descriptive studyof African American and white voters

Adelbert B. James a, George B. Schreiber b, Christopher D. Hillyer c, Beth H. Shaz a,c,⇑a Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USAb Independent Consultant, Annapolis, MD, USAc New York Blood Center, New York, NY, USA

a r t i c l e i n f o

Article history:Received 6 February 2012Received in revised form 19 June 2012Accepted 25 July 2012

Keywords:DonationAfrican AmericanMotivatorsDeterrents

1473-0502/$ - see front matter � 2012 Elsevier Ltdhttp://dx.doi.org/10.1016/j.transci.2012.07.005

⇑ Corresponding author at: New York Blood CenteYork, NY 10028, USA. Tel.: +1 212 570 3460; fax: +1

E-mail address: bshaz@nybloodcenter.org (B.H. S

a b s t r a c t

African American adults are half as likely to donate blood than whites. In order to under-stand this difference, African American and white participants completed a survey regard-ing demographics, medical and donation history, and motivators and barriers. The mostagreed upon motivators to blood donation were more convenient place and times, beingasked and taking less than hour. Motivator responses which differed by race includeddonating for infectious disease test and reward, and assurance donating is safe. The mostagreed upon barriers were not having a convenient place, not knowing where (responsediffered by race) and fear of needles, pain and feeling faint.

� 2012 Elsevier Ltd. All rights reserved.

1. Introduction

Blood collection and transfusion are crucial to the func-tioning of a self-sufficient community based healthcaresystem in the United States (US) and the world. In theUS, approximately 15 million whole blood products arecollected each year from volunteer donors. African Ameri-cans are underrepresented in this donor population; it isestimated that among white adults 4.2% donate versus2.4% of African American adults [1]. In the Atlanta metro-politan area, the blood donor rate (number of blood donorsper population) was 11/1000 population for whites, 6/1000for African Americans and 3/1000 population for Hispanics,and the blood donation rate (number of units donated bypopulation over the total population) was 77 donations/1000 population for whites, 22/1000 population for AfricanAmericans and 10/1000 population for Hispanics [2]. Toaddress this discrepancy in blood donation rates, the rea-

. All rights reserved.

r, 310 E 67th St., New212 570 3092.

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sons for these differences, particularly differences in donormarketing and recruitment, must be understood.

Since African Americans make up an ever-increasingand now substantial minority in metropolitan Atlanta, itis increasingly important to recruit African American do-nors to ensure an adequate blood supply for the entirecommunity. In addition, red blood cell products donatedby African Americans are especially important for thetreatment of sickle cell disease patients [3]. Red blood celltransfusions are frequently used to prevent or treat com-plications of sickle cell disease. Sickle cell patients are besttransfused with phenotype-matched red blood cell prod-ucts to prevent the formation of red blood cell antibodies.The presence of alloantibodies increases the risk of hemo-lytic transfusion reactions. The phenotype-matched redblood cell products are garnered from donors of similargenetic background, i.e. African Americans donors, andtherefore there must be an adequate supply of red bloodcell products donated by African Americans to fulfill thisneed. The difficulty of finding phenotype compatibleproducts for patients with sickle cell disease as well asother alloimmunized patients was highlighted in an articleusing DNA analysis to determine the donor red blood cell

88 A.B. James et al. / Transfusion and Apheresis Science 48 (2013) 87–93

phenotype in order to create an adequate hospital inven-tory [4]. In order to obtain this adequate inventory a highpercentage of products must be donated by AfricanAmericans.

To increase blood donation within the African Americancommunity, it is critical to understand their motivatorsand barriers to blood donation. Historically, the majormotivators to blood donation have been altruism, aware-ness of the need to donate, a sense of social obligation, per-sonal social pressure, need to replace blood used, andincreased self-esteem [5]. A previous study determinedthat African American donors were more likely than whitedonors to donate to receive an item and/or gift, to be testedfor an infectious agent, or to receive a health screen [6].Another study of African American and white donors dem-onstrated African American donors more often donated be-cause it is the right thing to do and preferred mailedreminders, race-specific marketing, and donor center com-munity involvement [7]. In a small sample of young Afri-can American women, the primary donation motivatorwas to increase awareness about the need for blood, withan emphasis on the importance of transfusions for thetreatment of children with sickle cell disease [8]. In an-other study of African American female college students,motivators for donors and non-donors were similar and in-cluded convenience, university involvement, and feeling ofself-satisfaction [9]. In a study of African American churchattendees, the most agreed upon motivators were to helpsave a life and because blood is needed [10].

Historically, the principal barriers to blood donation arefear, inconvenience, perceived medical disqualification,being too busy, not being asked, and apathy [5]. AfricanAmericans, more often than whites, cited bad treatmentand poor staff skills as reasons to not donate [11]. In thestudy of young African American women, the most impor-tant reason for not donating was inconvenience, followedby fear of needles and taking too much time [8]. In thestudy of African American college students, non-donorswere more likely than donors to be afraid of donationand more likely to be concerned about the safety of theblood supply [9]. In the study of African American churchattendees, the most common cited barrier to blood dona-tion was fear.

Racial/ethnic differences in motivators and barriers toblood donation undoubtedly exist and contribute to thedifference in blood donation rates. A better understandingof these differences would then result in improved recruit-ment and retention strategies. Thus, the aim of this studywas to investigate, by way of survey, detailed factors thatserve as motivators and barriers to blood donation amongAfrican American and white individuals.

2. Methods

2.1. Study population

The study population consisted of African American andwhite registered voters residing in the four major countiesof metropolitan Atlanta, Georgia. Registered voter demo-graphic and contact information was obtained from the

Georgia Secretary of State 2008 voter registration database.Demographic information selected from the database in-cluded race, age, gender and county residence.

2.2. Selection of participants

A total of 4000 voters between 18 and 69 years old wererandomly selected by stratified sampling to participate inthe survey. Voters were stratified based upon race (AfricanAmerican and white), gender (male and female) andcounty of residence (Fulton, DeKalb, Gwinett, and Cobb).Each participant had self-identified their race on the voterregistration card. An equal number of African Americansand whites as well as males and females were selected toreceive the survey. All other races were excluded. Thus,in each county, 1000 voters were randomly selected andconsisted of 50% male/female and 50% African American/white.

2.3. Survey

A pilot survey was designed and tested to assess themajor issues of the questionnaire. A final draft was com-pleted following recommendations from the pilot surveyand mailed out to 4000 registered voters in the fall of2009. Survey packets consisted of an introductory letterexplaining the survey, an anonymous and self-adminis-tered questionnaire, and a pre-addressed and prepaid re-turned envelope. The questionnaire was printed on anOptical Mark Read (OMR) form developed by Scantron(Scantron Corporation, 2009, Minneapolis, MN). All partic-ipants were provided informed consent via self-consent bycompleting and returning the survey. A follow-up thankyou and reminder postcard was mailed out to each partic-ipant 2 weeks later. The study received Emory UniversityInstitutional Review Board Exempt Approval.

The 51-item questionnaire evaluated the following fivecategories:

Demographics of survey participants: (n = 7) addressedthe participant’s demographics (race, gender, age),socioeconomics (education, income, health insurance),marital status, and donation history.Medical factors: (n = 9) addressed perceived and poten-tial medical eligibility, attitudinal factors, and trust ofblood centers.Recruitment options: (n = 12) assessed different strate-gies for blood donor recruitment.Motivations and barriers to donation: (n = 21) assessedmotivators to blood donation, including convenience,incentives, awareness, and altruism and barriers toblood donation, including inconvenience, apathy, igno-rance and fear. These questions were on 5-point Likertscale and consisted of the following responses:‘‘strongly agree’’, ‘‘agree’’, ‘‘neither agree nor disagree’’,‘‘disagree’’ and ‘‘strongly disagree’’.Knowledge of blood donation and the blood supply: (n = 2)addressed the participant’s knowledge about the blooddonation process, the blood supply, and myths and factsabout blood donation.

Table 1Respondent demographics.

Variable AfricanAmerican(n = 111)(%)

White(n = 158)(%)

Total(n = 281)(%)

GenderMale 29 29 30Female 62 68 70

Age group<20 years old 2 0 120–29 years old 13 7 930–39 years old 22 18 2040–49 years old 22 24 2250–59 years old 24 36 30P60 17 15 15

Household income<$75,000 56 30 39P$75,000 25 48 37

Marital statusSingle 60 37 45Married 40 61 50

EducationHigh school or

less50 25 33

College or more 50 75 62

CountyCobb 25 20 22DeKalb 26 30 28Fulton 32 25 29Gwinnett 14 23 19Other 3 1 2

Health insuranceYes 70 89 79No 25 8 15

Note: Percentage may not add up to 100% due to missing data.

A.B. James et al. / Transfusion and Apheresis Science 48 (2013) 87–93 89

2.4. Statistical analyses

Data results from each survey were tabulated using anOMR scanner and reported into a text file. Data were importedand analyzed into SPSS statistics 17.0 (SPSS Inc., 2008,Chicago, IL). Frequency calculations and cross tabulationswere used to analyze the data. Responses were comparedby demographic groups using Chi-squared analysis and thosewith a p value <0.05 are presented in the result section.

3. Results

3.1. Respondent demographics

Two-hundred eighty one (7%) of the 4000 mailed surveywere returned by the US postal service due to incorrectaddress or no forwarding address and 281 out of 3719 pre-sumed to be received (7%) were completed and returned.Respondents were predominately white (59%) versusAfrican American (41%), married (53%) versus single(47%) and female (70%) versus male (30%) (Table 1).

3.2. Donation history

Twenty two percent of respondents had never givenblood in their life (non-donors). Of the 78% who had do-

nated previously (donors): 13% donated once (more com-mon in adults P40 years old 13% versus <40 years old27%), 45% 2–10 times, 8% 11–20 times, and 12% 20 or moretimes in their life. The demographics of donor versus non-donor respondents were: race (61% versus 53% white), gen-der (70% versus 69% female), age (70% versus 71%P40 years old), income (49% versus 46% more than$75,000), marital status (56% versus 47% married), educa-tion (70% versus 47% college degree) and county (24% ver-sus 16% Cobb, 29% versus 27% DeKalb, 25% versus 32%Fulton, 19% versus 18% Gwinnett). Thus donors comparedto non-donors were more likely to be white than AfricanAmerican, married versus single, and college educated ver-sus lower educated.

The length of time since the last blood donation variedamong donors: 14% donated less than 1 year ago (less com-mon in African American 9% versus white 23%), 32% 1–5 years ago, 19% 6–10 years ago, and 29% more than10 years ago.

Current donors were defined as individuals who haddonated blood within the past year. Lapsed donors weredefined as individuals who had previously donated butnot within the past year. The percent of current donors,lapsed donors and non-donors were 14%, 6% and 22%,respectively. These percentages differed by race: AfricanAmerican respondents were 7% current donors, 68% lapseddonors and 25% non-donors; white respondents were 20%current donors, 61% lapsed donors and 19% non-donors.Among males, the percent of current donors, lapsed andnon-donors were 15%, 63% and 22%, respectively; amongfemales, the percent was 14%, 64% and 22% respectively.Among younger adults less than 40 years of age, the per-cent of current donors, lapsed and non-donors were 14%,66%, and 20%, respectively; among older adults, the per-cent was 15%, 63% and 22% respectively. Among individu-als who reported an annual household income of lessthan $75,000, the percent of current donors, lapsed andnon-donors was 13%, 67% and 20%, respectively; amongindividuals who reported an annual household income of$75,000 or more, the percent was 19%, 63% and 18%,respectively. Among singles, the percent was 9%, 65% and26%, respectively; among married individuals, the percentwas 19%, 63% and 18%, respectively. Among individualswith a high school education, the percent was 10%, 58%and 32%, respectively; among individuals with a collegedegree, the percent was 17%, 67% and 16%, respectively.Thus white versus African American, higher versus lowerincome, and married versus single individuals were morelikely to be current donors.

Thirty seven percent of respondents reported very satis-fying, 21% somewhat satisfying, 23% neither unsatisfyingnor satisfying, 8% somewhat unsatisfying, and 11% veryunsatisfying to the question ‘‘how was your last blooddonation experience’’? Eighty five percent of male versus75% of female donors agreed to a very or somewhat satis-fying blood donation experience.

3.3. Deferrals

Forty one percent of participants were told they couldnot donate blood. Of these, 62% learned they could not do-

90 A.B. James et al. / Transfusion and Apheresis Science 48 (2013) 87–93

nate blood via blood center, 23% via medical provider, 4%via friend or coworker and 2% via pamphlet or newspaper.When participants were asked if they thought they wereeligible to donate, 77% reported yes and 23% reported no.Seventy eight percent of respondents had previously at-tempted to donate, 21% had not previously attemptedand <1% were not sure about previous attempts to donate.

Forty three percent of respondents who had previouslybeen differed selected reasons they were told they couldnot donate; of these 31% had a second reason and 8% thirdreason. The percent per participant was: 16% low hemoglo-bin or low iron, 10% foreign travel/lived in a foreign country,6% medical condition, 4% did not weigh enough, 4% on med-ications, 4% cancer, 3% unable to see or feel vein, 3% hyper-tension, 1% male to male sex, 1% did not feel well, 1% don’tknow, 1% tattoo/body piercing, 1% pregnancy, 1% hypoten-sion, <1% each vaccination, teeth cleaning, skin graft, posi-tive syphilis test, mononucleosis as child, low vitamin D,just worked out, high temperature, dated African, bloodtransfusion and blood crystals, and 10% never told. Thus,the majority of deferral reasons were for temporary (69%)in contrast to indefinite/permanent (31%) deferral reasons.

Among respondents who were deferred due to lowhemoglobin or low iron, 62% were white, 76% were40 years old or more, 43% reported a household incomeof less than $75,000, 60% were married and 65% had a col-lege degree; 20% of females versus 0% of males reportedlow hemoglobin level deferral. Among respondents whowere deferred due to foreign travel, 69% were female,82% were 40 years old or more and 62% were married;15% of whites versus 4% of African Americans, 14% of an-nual household income of at least $75,000 versus 5% of an-nual household income less than $75,000, and 14% ofcollege degree versus 4% of high school reported deferralfor foreign travel.

When participants were asked if they thought they werein good health, 86% responded yes, 9% no and 5% not sure;responses differed by gender (males 96% versus females87%), race (whites 94% versus African Americans 85%), in-come (annual household income of at least $75,000 95% ver-sus annual household income less than $75,000 85%), andeducation (college degree 95% versus high school 81%).Among individuals who thought they were in good health,69% were white, 81% were female, 76% were at least 40 yearsold, 41% reported a household income of less than $75,000,53% were married and 78% had a college degree. Amongindividuals who had previously attempted to donate bloodand were told they could not donate blood, 84% consideredthemselves to be in good health, 8% reported not in goodhealth and 8% were not sure.

3.4. Motivators of blood donation

The major motivators to blood donation were less thanan hour to donate (76% agreed), being asked (75% agreed),assurance that donation is safe (70% agreed), and beingchecked for high blood sugar (61% agreed). The most dis-agreed motivators were for special recognition or award(59% disagreed), to receive free gifts (57%), to be testedfor infectious diseases (27% disagreed) and to be checkedfor high blood sugar (23% disagreed) (Table 2).

Each motivator was analyzed by race, age group, house-hold income, and marital and donation status and the fol-lowing significant differences were observed: Agreeing todonate for special recognition or rewards (African Ameri-cans 22% versus white 11%) and if assured that donatingblood is safe (African American 86% versus white 59%), (Ta-ble 3); Agreeing to donate to receive free gifts (youngeradults less than 40 48% versus older adults 19%), to betested for infectious disease (younger adults less than 4080% versus older adults 60%) and if child care was available(younger adults less than 40 71% versus older adults 51%);Agreeing to donate to receive free gifts (annual householdincome was at less than $75,000 37% versus annual house-hold income was at least $75,000 18%); Agreeing to donateto receive free gifts (single respondent 34% versus marriedrespondents 21%), to be tested for infectious disease (singlerespondent 77% versus 57%) and to be checked for highblood sugar (single respondent 80% versus married respon-dents 67%); Agreeing to donate in order to receive a freegift (donors 32% versus non-donors 11%); and Agreeingto having childcare available (donors 54% versus non-do-nors 80%). Thus, differences in blood donor motivators ex-ist by age, race, household income and marital status.

Sixty eight percent of individuals responded ‘‘yes’’ tothe question ‘‘if you knew of a need for blood in your com-munity, would you donate’’, 5% said ‘‘no’’ and 23% were notsure. There was no difference in response by demographicgroups.

3.5. Barriers to blood donations

The major barriers to donation were not having a conve-nient place (32% agree) and fear of needles, pain or discom-fort, fear of feeling faint or dizzy, and not knowing where todonate (24% agree). The barriers with the most disagree-ment were not believing donation is important (95% dis-agree), not thinking there is a need (94% disagree), neverdonating (89% disagree), blood centers exaggerate the needfor blood (88% disagree), may get HIV (85% disagree) anddistrust of blood center (82% disagree), (Table 2).

Each barrier was analyzed by race, age group, house-hold income, and marital and donation status and the fol-lowing significant differences were observed: Agreeing tonot knowing where to donate differed by race (AfricanAmericans 31% versus white 19%) (Table 3); age (<40 yearsold 40% versus P40 years old 22%), household income(<$75,000 41% versus P$75,000 16%), and education (highschool education 40% versus college degree 21%); Agreeingto being afraid of feeling faint, dizzy or sick differed by age(<40 years old 43% versus P40 years old 22%); Agreeing tonot have time to donate blood differed by age (<40 yearsold 31% versus P40 years old 15%); and Agreeing to nothave a convenient place to give blood differed by age(<40 years old 53% versus P40 years old 32%) and house-hold income (<$75,000 48% versus P$75,000 27%). Re-sponses to barriers were compared by donor status.Donors agreed they were less afraid of contracting HIV orAIDS from giving blood than non-donors (3% versus 10%).Thus, barriers to blood donation exist among race, age,household income and education.

Table 2Motivators and barriers to donation.

Stronglyagree (%)

Agree (%) Neither agreenor disagree (%)

Disagree (%) Stronglydisagree (%)

Motivators to blood donationDonating for special recognition or award 3 11 26 28 31Donating in order to receive free gifts 5 17 21 25 32Donating to be tested for infectious diseases 27 25 21 11 16To be checked for high blood sugar 27 35 17 13 10Being asked to give blood 34 42 19 4 2More convenient place to give blood 42 38 15 3 1More convenient times for donating blood 32 47 15 3 1Having a blood mobile come to your place of work 36 34 22 3 2Assurance that donating is safe 39 31 22 3 4If donating took less than 1 hour 35 40 20 3 1Having childcare available 12 13 58 9 9

Barriers to blood donationI would never donate blood 4 1 6 32 57I do not believe it is important to donate 2 1 2 26 69No one ever asked me to give blood 4 12 9 34 41I am afraid of needles, pain or discomfort 9 15 13 31 33I’m afraid of feeling faint, dizzy 8 16 14 33 29I do not have time to donate 2 13 20 39 25I do not know where to donate 6 18 15 36 26I do not have a convenient place 6 26 18 30 21I might catch a disease by donating 1 5 12 34 49I might find out I have a disease by giving blood 3 6 14 34 43I am afraid of not being able to give blood 3 10 16 37 34I might get HIV or AIDS from giving blood 1 3 11 29 57I distrust the blood center 2 3 14 34 48I don’t think there is a need to donate blood 2 1 3 28 67Blood centers exaggerate the need for blood 1 2 9 29 59

Table 3Motivators and barriers to donation by race.

African American White

Agree (%) Disagree (%) Agree (%) Disagree (%)

Motivators to blood donationDonating for special recognition or award 22 53 11 62Donating in order to receive free gifts 28 53 17 59Donating to be tested for infectious diseases 65 26 43 27To be checked for high blood sugar 63 22 60 22Being asked to give blood 77 5 75 6More convenient place to give blood 87 4 77 5More convenient times for donating blood 85 5 79 5Having a blood mobile come to your place of work 76 7 71 4Assurance that donating is safe 86 3 59 10If donating took less than 1 hour 75 4 77 5Having childcare available 32 13 20 21

Barriers to blood donationI would never donate blood 5 91 5 87I do not believe it is important to donate 4 92 2 97No one ever asked me to give blood 21 70 13 79I am afraid of needles, pain or discomfort 27 57 22 68I’m afraid of feeling faint, dizzy 18 64 29 61I do not have time to donate 15 69 16 63I do not know where to donate 31 54 19 67I do not have a convenient place 37 46 28 55I might catch a disease by donating 6 77 5 86I might find out I have a disease by giving blood 11 73 9 78I am afraid of not being able to give blood 16 66 12 73I might get HIV or AIDS from giving blood 5 79 3 90I distrust the blood center 6 77 3 86

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3.6. Marketing and blood center knowledge

The most convenient places to give blood were: work(43% of participants), religious center (19%), blood center

(15%), school (10%), mall (7%) and other (6%). The mostpreferred methods of contact to be asked to donate bloodwere via: 37% email, 16% letter, 13% social networking,11% television, 5% radio, 5% telephone, 4% text messaging,

92 A.B. James et al. / Transfusion and Apheresis Science 48 (2013) 87–93

and 3% newspaper. The most preferred methods of contactbetween African Americans and whites were, respectively(email 21% versus 44%, letter 24% versus 13%, social net-working 15% versus 12%, television 12% versus 10%, radio6% versus 5%, telephone 9% versus 4%, text messaging12% versus 0%, and newspaper 0% versus 4%). There wereno notable differences between other demographics.

Eighty eight percent of individuals believed the follow-ing statement was true: ‘‘blood centers make sure peopleare not harmed by giving blood’’; 1% believed it was falseand 11% were not sure. Ninety percent of individuals be-lieved the following statement was true: ‘‘donated bloodis tested for infectious disease before being given to otherpeople’’; <1% believed it was false and 10% were not sure.There were no significant differences to response by demo-graphic factors.

3.7. Intention to donate blood

Sixty two percent of respondents indicated that theydid not plan to donate blood within the next 6 months.Twelve percent of these individuals said they had a bloodtransfusion, 86% said no and 2% were not sure. The re-sponse was compared by race, gender, age group, house-hold income, marital status and education. The responsediffered by age (<40 years old 5% versus P40 years old15%) and education (high school education 19% versus col-lege degree 8%).

Forty two percent of individuals said they knew of a rel-ative or friend who had received a blood transfusion, 46%said they did not know and 12% did not respond. Amongindividuals who knew of a relative or friend, 51% werewhite, 51% were females, 50% were at least 40 years old,54% reported a household income of at least $75,000, 50%were married and 57% had a high school degree; reportedknowledge of a relative or friend (household income of atleast $75,000 54% versus household income of less than$75,000 39%).

4. Discussion

In a group of predominately female previous blood do-nors who responded to a mailed survey performed inmetropolitan Atlanta, the most cited motivators to blooddonation were more convenient place and times, and beingasked, and the most cited barriers were fear of catching adisease and feeling faint/dizzy, and not have time or know-ing where to donate. In a recent meta-analysis of self-re-ported motivators and deterrents to donating blood,convenient location was the most frequently cited motiva-tor while marketing communications was a motivator onlyfor lapsed donors [12]. Also in this meta-analysis, lifestylebarriers and inconvenience were the most cited barrierswhile lack of knowledge of donation site was less fre-quently cited [12]. Convenience as the major motivatorand fear as the major barrier are consistent with otherstudies [8,11].

Racial differences in motivating factors previously iden-tified include African Americans more likely than whitedonors to donate to receive an item/gift and be tested for

infectious disease, and less likely because it was the rightthing to do, it would benefit their health or encouragedby friends, family, or coworker [6]. Although overall freegifts (22% agreed), special recognition (14%), screening forinfectious (52%) or noninfectious disease (62%) were theleast frequent agreed motivators in the study. This findingis similar to another study of African American churchattendees were these motivators were the least frequentreasons to donate (44% infectious disease testing, 31%health screening, 13% special recognition, and 8% free gift)[10]. Thus, African Americans cite different reasons to do-nate than whites, yet these differences are not the primarymotivators, such as convenience, which are similar in Afri-can Americans and whites.

Racial differences in barriers determined in a survey oflapsed donors include fear and difficulty finding veins [11].In the current study the only barrier cited more frequentlyin African Americans than whites was not knowing whereto donate, which was also commonly cited in whites. Fearand distrust was not more common in African Americans.Studies of primarily African Americans frequently cite fearand distrust, particularly in nondonors [13].

The survey included questions in order to determinemethods to overcome convenience. The most convenientplace to donate was work, which did not differ by demo-graphics. A study of lapsed donors also determined work-place as the most convenient location [11]. Othermotivators frequently cited included more convenientplace and times, having a blood mobile come to the work-place, and if donation took less than 1 hour. Having child-care available was not a frequently cited motivator, butwas more frequently cited as a motivator in younger thanolder adults and in nondonors than donors.

The majority of respondents did not intend to donatewithin the next 6 months. History of transfusion did notcorrelate with history or intent of donating. Deferral orperceived ineligibility has been previously shown to de-crease likelihood of donation [5,14]. Bad experience hasalso been association with not returning donate, as wellas being treated badly and poor staff skills, particularlyfor minorities [11]. In the current study, 41% were told theycould not donate; the majority learned this via blood cen-ter or medical provider. Half of the participants, particu-larly females, had been deferred in the past. The primarycause of deferral was low hemoglobin, particularly in wo-men, followed by travel. Although the majority of donorswere in good health and had been deferred for temporaryreasons, the majority did not intend to donate unless theyknew of a need for blood in the community.

The major limitation of the study was a low responserate. In comparison another mailed survey regarding blooddonation in Quebec had a 38% response rate [15]. Third, theuse of registered voter population may bias the responsesto individuals with more social capital, thus who are morelikely to be blood donors. In this study 78% of respondentshad previously given blood which is higher than otherstudies: 59% had previously given blood in a telephone-survey of Maryland households [16], and 56% in a mailedsurvey of people living in Quebec [15].

In conclusion, convenience remains a major motivatorto donation. Blood centers can overcome convenience by

A.B. James et al. / Transfusion and Apheresis Science 48 (2013) 87–93 93

hosting drives in the workplace, communicating the needfor blood and where to give blood, and assuring the dona-tion process takes less than an hour. Fear remains a deter-rent, but through education and assurance, this barrier canbe surmounted.

Authorship

All authors have made substantial contributions to thestudy design, analysis and manuscript.

Source of funding

National Blood Foundation grant.

Conflict of interest statement

The authors have no conflict of interest.

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