| Abstract|| |
The World Health Organization and National Blood Transfusion Council, Government of India, advocate regular repeat nonremunerated voluntary blood donors as the safest of all donors to meet the blood requirements of the country. Recruitment and retention of individuals as voluntary blood donors requires the adoption of novel and varied strategies protecting the voluntary nonremunerated nature of blood donation. In this review article, we are focusing on how addressing the donor suggestions and concerns has created a win–win situation for blood donors and blood transfusion services.
Keywords: Blood donation, blood donor, donor motivation, donor recruitment, donor retention, donor suggestions
|How to cite this URL:|
Chand S, Amita R, Gupta D. Addressing concerns and suggestions of blood donors: An assured way for donor motivation, recruitment, and retention. Asian J Transfus Sci [Epub ahead of print] [cited 2023 Mar 24]. Available from: https://www.ajts.org/preprintarticle.asp?id=356863
| Introduction|| |
Safe blood plays an important role in rendering proper medical care. There is always an ever-increasing urgent need for blood to save lives. This growing need has to be met by the blood transfusion services (BTSs) by maintaining an adequate inventory of blood and blood components. To ease the strain on the BTS, it is time that we initiate various methods to attract the voluntary blood donor population. The blood collected from voluntary donors is considered to be the safest among all categories of donors. In India, the Supreme Court verdict banned professional blood donors in the year 1996 which was the outcome of the Public Interest Litigation filed by Hari Dev Shourie. A major percentage of the blood centers in developing countries like India are still dependent on replacement donations for maintaining their blood inventory. Therefore, the BTS should focus on educating, motivating, recruiting, and retaining voluntary blood donors to ensure an adequate supply of safe and quality blood and blood components. Encouraging regular donation by the voluntary blood donor pool can ensure a continuous supply of safe blood. With more than 1.3 billion population in India, if 5–7 million people donate four times a year, it will be enough to support the annual blood transfusion requirement of the entire country.
The best and safest method of maintaining the blood inventory is through voluntary nonremunerated regular blood donors. Physical, emotional, and psychological satisfaction obtained from the blood donation process is important for donors to return for future donations. A part that we often give less attention to is donor satisfaction through the blood donation process. A pleasant donation experience will make the donor feel obliged to return for future blood donations. Blood donors need to be kept in the limelight as they form the backbone of any transfusion service. One way of doing it is by offering the donors, an option to express their suggestions and concerns in the blood donation process and attending positively to them.
In this review, we are focusing on various suggestions put forward by our blood donors over a period of 6 months and how we approached them in our monthly internal audit. Out of the 218 donors who gave their suggestions, 92.2% of them were satisfied with the donor services. While 7.8% expressed their dissatisfaction in different areas of blood donation services [Figure 1]. The positive suggestions are being appreciated, and the complaints are reviewed every month in the internal audit, and the possibility of improvement is discussed, and decisions on corrective actions are taken. Blood donors may have various suggestions and complaints when they go through the donation process at a blood center, which needed to be addressed positively. Here, we are discussing them against each contact point in the blood donation process.
|Figure 1: Percentage distribution of the blood donors expressing dissatisfaction in the donation process|
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Assess to the hospital blood center
Few donors, especially those who were coming for the first time to donate blood, faced difficulty in finding the blood center located within the hospital campus. To address this issue, we requested the placing of adequate signboards within the hospital campus to guide the blood donors. The comfort of the donor should be ensured from the time they enter the hospital premises. Friendly security staff can provide proper directions to the donors. Furthermore, the blood center within the hospital should be easily accessible to the public and the donation area should ideally be located on the ground floor of the building.
The lack of a dedicated parking area in the hospital premises for those who come for donating blood was a long-term issue. Many donors find it very difficult to park their vehicle when they come for blood donation and had suggested a separate parking arrangement. To address this issue, policies need to change at the administrative level to allocate parking spaces for voluntary blood donors. Given this issue, we also put forward the request for providing a vehicle exclusively for the department to cater to the travel facilities of the blood donors.
At the hospital entrance
Donors coming for blood donation need to enter through a single hospital entrance along with the patients and walk through the crowded outpatient department to reach the blood center. Some donors suggested employing a separate exclusive entrance for blood donors to reach the blood center. We had taken up this issue in the monthly departmental audit and discussed it in the Hospital Transfusion Committee, but the separate entrance to reach the blood center is currently not possible due to a lack of workforce, and the same was conveyed to the blood donors. In addition, due to the COVID-19 pandemic and the safety protocols in place, all those who enter hospital premises must compulsorily fill in a declaration form as well as undergo thermal screening. This contributed to the delay at the entry point. To avoid the hassle and delay at the hospital entrance, donors can be provided with blood donor identifiers.
An increase in the waiting time for registration and blood donation as often reported by the donors is a matter of concern as delays can negatively affect donor return. To tackle this issue, donors should be kept engaged during their waiting time. One way of doing so is by offering Information, Education, and Communication (IEC) materials. In addition, this can improve knowledge of the blood donation process; as poor information on the blood donation process is an obstacle for blood donation. Providing IEC materials can further boost their confidence in blood donation, especially as a matter of fact for first-time voluntary blood donors. Hence, BTS can put an effort to keep the donors engaged during the waiting period by rendering the availability of informative IEC material and even a television in the donor registration area can keep the potential donors preoccupied. In addition, a medical social worker or counselor at the blood center can engage them during the delay period.
Another approach to tackle this delay is by implementing provisions for prior registration and allocation of a time slot so that the donor can come forward and donate at the specified time interval. The use of an online portal will help with the same. This can also provide focus on donor convenient timings for blood donation thereby addressing yet another demotivating factor among blood donors. We have an online portal for blood donors and donor organizations, which could be optimally used [Figure 2]. We are aiming to popularize the online registration portal so that more donors are aware of the facility and make use of it, thereby avoiding any delay in the blood donation process. People are often coming forward to donate blood amidst their busy schedules. Hence, any delay in the blood donation process can have a negative impact on donor return for future donations. The time and effort of the donors need to be valued by the BTS.
|Figure 2: Online registration portal to book individual blood donation or blood donation camp|
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Counseling of blood donors is done on a one-to-one basis by a designated medical social worker or counselor. As our blood center is located near a major Information Technology (IT) hub, the donor suggestion was for a counselor to have the advantage to handle the multilingual donor population.
A counselor should be competent with sound knowledge of the social system. They should be caring, understanding, and jovial, having a good attitude toward the donors. Only then donors will feel comfortable with the counselor and be true with their answers which can help the BTS in screening out unsafe donations. A positive approach toward donors can also relieve their anxiety about blood donation. The counselors are regularly trained in aspects of handling the donor population.
Donor medical examination
The medical examination of a potential blood donor should be performed by a registered medical practitioner. Blood donor selection and referral guidelines put forward by the National Blood Transfusion Council and National AIDS Control Organization, India, are strictly followed to find suitable donors. Some questions asked by the medical officer overlapped with that of the counselor and were pointed out by a donor as he had to answer the same questions repeatedly. To address this, the counselor can be asked to restrict his/her questions to that concerning donor behavior and focus on donor information, motivation, recruitment, and retention. Nevertheless, to check the consistency of answers, some questions needed to be repeated.
During the medical examination of every potential blood donor, hemoglobin estimation is performed using an invasive spectrophotometric principle-based instrument. Many donors do not prefer this method as they find the lancet prick for hemoglobin estimation more painful than the actual phlebotomy procedure itself. They suggested a noninvasive method similar to a pulse oximeter. Now, as the noninvasive hemoglobin estimation methods are coming up in the market, BTS can slowly switch over to them. However, till the noninvasive methods are validated and suitability for BTS determined, the invasive techniques needed to be continued.
For the apprehension to lie down on the same couch for blood donation, few donors suggested the introduction of disposable bedspreads. Because of the cost involved, we could not introduce the same. However, we regularly clean the donor couches with surface disinfectants after each donation process and the same was conveyed to the blood donors. Overall cleanliness of the blood center and the comfort felt during the donation process can have a positive impact on donor return. Hence, even a small bloodstain should not be overlooked.
The behavior of the blood center staff throughout the donation process was appreciated by many donors. The behavior and skills of the phlebotomist are one factor in donor motivation. Especially, the first-time donors commented on the pleasing behavior of the staff in the donation area that assisted them to overcome fear and inhibition toward donating blood and made their overall donation experience a pleasant one. Donor reactions, as well as fear and concern about them, are demotivating factors in blood donation. A supportive staff during the blood donation process can attenuate the psychological stress felt during blood donation, which can enhance the donation experience and promote donor retention. It has also been shown to reduce the incidence of fainting episodes. Staff should be trained to have good behavior toward the blood donors. Any aggressive behavior is a demotivating factor. If the donors feel that they are cared for, they will develop a belonging to the blood center and are ready to respond to blood center requests for future donations. This can also provide a competitive advantage for the BTS in promoting voluntary blood donation.
Audiovisual aids are used to provide a limited distraction to the donors during the blood donation process. The suggestion to avoid putting news was put forward by few donors as it sometimes carried negative vibes. The donation experience can be improved by playing soothing music which can indirectly help the donor relax and the same was recommended by one of our donors. Regarding this matter, we have discussed with the staff the importance of providing a positive donation environment for reducing the level of stress felt by the blood donors and its role in donor motivation and retention.
Light refreshments are provided to the blood donors after they complete the blood donation process. They are regularly given cookies, along with an option for fruit juice or tea. Few donors who do not like cookies have suggested other options to be given for refreshment and given that we changed to better quality cookies for refreshment. The introduction of nonvegetarian snacks can cause aversion in some donors; hence, BTS should be considerate on that point when introducing refreshments.
Donors are given postdonation instructions, and an adhesive medicated bandage is used to cover the phlebotomy site before they leave the blood center. Initially, we used a large bandage which few donors felt uncomfortable with and considering their suggestion we switched over to a small bandage covering the phlebotomy wound. This was also conveyed to the donors who suggested this change.
Donors often appreciate the behavior of the blood center staff. Communication with the donor is important at each stage of the donation process. From welcoming the donor with a pleasant smile and positive attitude to a simple gesture of “Thank you” when the donor leaves the blood center postdonation can contribute to donor retention. BTS should appreciate the time and effort put by the blood donors and this will help create a psychological attachment and retention of the voluntary donor.
Our center provides blood components to patients against a fixed charge redeemed for the consumables and transfusion-transmitted infections screening processes. Some donors get distressed when they are not provided blood components free of cost. This implies a lack of awareness among blood donors about the functioning of transfusion services. Adequate IEC materials should be made available for the donors to read as well as awareness campaigns can be organized to improve the knowledge among blood donors regarding the working of BTS. Donors need to be counseled regarding service charges in these circumstances.
Blood donation camps
Voluntary outdoor blood donation camps are organized regularly by our blood center. A suggestion register was made available at the camp for the donors to express their views on the donation experience. Since camps are organized in premises not similar to the blood center, space and access constraints have been highlighted by the donors. These suggestions are habitually followed up and improvements in the camp environment are made in discussion with the camp organizers to provide the best possible conditions for outdoor blood donation, which in turn affect donor satisfaction and future blood donations. Prior discussions are also made concerning postdonation snacks provided at the camp by the organizers as they should serve the purpose of providing hydration and refreshment to the blood donors.
| Conclusion|| |
World Health Organization directs its member nations for the recruitment of regular repeat nonremunerated voluntary blood donors to meet the blood requirements of the country. To maintain the regular voluntary donor pool, we require different strategies for donor motivation, recruitment, and retention. One such strategy is introducing a blood donor suggestion register in the blood center as well as in the outdoor blood donation camps for the donors to express opinions on their experience with BTS. Appreciation by the donors is necessary for the goodwill of BTS while complaints need to be taken as a stepping stone for improving blood donor services. Giving importance to donor suggestions and complaints by reviewing them in the monthly internal auditing and taking remedial measures is an indirect way of attracting the voluntary donor pool. Once the changes are made based on their suggestions, letters/messages can be sent to the donors and they can be asked to come forward and donate so that they can see for themselves the remedial measures taken by the blood center. Donors will feel good and connected when their suggestions are being implemented and this will help generate a sense of belonging and psychological attachment with the blood center. Hearing out the suggestions made by blood donors and implementing the relevant changes can help the BTS convert replacement donors to regular voluntary blood donors and maintain its voluntary donor pool. We have observed that donors who have been informed about the changes made based on their suggestions have returned to the blood center for their next donation indicating the effectiveness of donor suggestions as a tool for donor motivation, recruitment, and retention.
All the BTS across the world should practice attending to the need of the blood donor and a blood donor suggestion register should be introduced in every blood center. An internal committee can be formed to address these suggestions every month. When their suggestions are heard and attended to, blood donors will feel that they are a valuable member of the organization and it can positively impact the commitment they feel toward the blood center and blood donation. A sense of attachment felt can motivate the blood donors for regular donations. Regular repeat blood donations are itself a motivating factor making it vicious cycle. Hence, donor suggestions can act as a tool to identify those factors that can potentially affect donor satisfaction, which in turn plays a significant role in modeling future donation behavior of the blood donors.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
New Delhi Bench: S.C. Agrawal, G.B. Pattanaik; 1996. Supreme Court of India. Common Cause vs Union of India and others Writ Petition (civil) 91 of 1992.
Cassen R, Visaria P. India: Looking ahead to one and a half billion people. BMJ 1999;319:995-7.
Newman K, Pyne T. Service quality and blood donors – A marketing perspective. J Mark Manag 1997;13:579-99.
Vavić N, Pagliariccio A, Bulajić M, Marinozzi M, Miletić G, Vlatković A. Blood donor satisfaction and the weak link in the chain of donation process. Transfus Apher Sci 2012;47:171-7.
Zito E, Alfieri S, Marconi M, Saturni V, Cremonesi G. Adolescents and blood donation: Motivations, hurdles and possible recruitment strategies. Blood Transfus 2012;10:45-58.
Mohammed S, Essel HB. Motivational factors for blood donation, potential barriers, and knowledge about blood donation in first-time and repeat blood donors. BMC Hematol 2018;18:36.
Terzieva K, Popov R. Motivating and demotivating factors for blood donation of young people in Bulgaria. Hematol Dis Ther 2021;6:131.
Hanson SA, France CR. Social support attenuates presyncopal reactions to blood donation. Transfusion 2009;49:843-50.
Stewart KR, France CR, Rader AW, Stewart JC. Phlebotomist interpersonal skill predicts a reduction in reactions among volunteer blood donors. Transfusion 2006;46:1394-401.
Hoogerwerf MD, Veldhuizen IJ, De Kort WL, Frings-Dresen MH, Sluiter JK. Factors associated with psychological and physiological stress reactions to blood donation: A systematic review of the literature. Blood Transfus 2015;13:354-62.
Veldhuizen IJ. 'Thank you! Please visit us again'. Reflecting on the donor retention literature – Implications for retention practices: Reflecting on donor retention. ISBT Sci Ser 2010;5:196-200.
Boezeman EJ, Ellemers N. Volunteer recruitment: The role of organizational support and anticipated respect in non-volunteers' attraction to charitable volunteer organizations. J Appl Psychol 2008;93:1013-26.
Tyler TR, Blader SL. Autonomous vs. comparative status: Must we be better than others to feel good about ourselves? Organ Behav Hum Decis Process 2002;89:813-38.
Ben Natan M, Gorkov L. Investigating the factors affecting blood donation among Israelis. Int Emerg Nurs 2011;19:37-43.
France CR, France JL, Wissel ME, Ditto B, Dickert T, Himawan LK. Donor anxiety, needle pain, and syncopal reactions combine to determine retention: A path analysis of two-year donor return data. Transfusion 2013;53:1992-2000.
Department of Transfusion Medicine, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvanan thapuram - 695 011, Kerala
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2]