Asian Journal of Transfusion Science
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ORIGINAL ARTICLE  
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Post-donation satisfaction and its associated factors of blood donors attending donor clinics of the National Blood Center, Sri Lanka: A cross-sectional study


1 Postgraduate Institute of Medicine, University of Colombo, Sri Lanka
2 Family Health, Nutrition Communication & Behavior Research Unit, Health Promotion Bureau, Ministry of Health, Sri Lanka
3 Department of Clinical Transfusion Medicine, National Blood Transfusion Service, Sri Lanka

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Date of Submission06-Jan-2022
Date of Decision23-Sep-2022
Date of Acceptance02-Oct-2022
Date of Web Publication12-Dec-2022
 

   Abstract 

BACKGROUND: In Sri Lanka, blood collection is purely from voluntary, nonrewarded, nonremunerated blood donors. To cope with the rising demand, the donor pool, which is at threat of declining, has to be safeguarded. Therefore, knowledge of Post donation satisfaction (PDS) is essential to retain regular safe blood donors.
AIM: The aim of this study was to determine the PDS and its associated factors among blood donors attending donor clinics of the National Blood Center (NBC), Colombo.
MATERIALS AND METHODS: A cross-sectional descriptive study was conducted among 423 blood donors who attended outdoor donor clinics of NBC, Colombo. Participants were selected by a systematic sampling method. A pretested interviewer-administered questionnaire was used. The prevalence of “high” PDS and associated factors with odds ratio (OR) and 95% confidence interval (CI) was determined.
RESULTS: Blood donors were more likely to be young, male, educated up to advance levels, from religious/ethnic majorities, and employed with an average low monthly income. The majority were repeated, nonregular, nonloyal, and unlikely to be retained. Donor clinic-related particulars were adequate for the majority of donors. The prevalence of “high” PDS was 33.3% (95% CI = 29%–38%). The PDS was associated with donor loyalty (OR = 3.4, 95% CI = 2.1–5.3), adequacy of publicity for donor clinic (OR = 7.2, 95% CI = 4.4–11.8), accessibility (OR = 6.8, 95% CI = 4.1–11.3), environment of location (OR = 9.2, 95% CI = 5.4–15.7), convenience of time/duration (OR = 10.8, 95% CI = 6.3–18.8), provision of refreshments (OR = 11.6, 95% CI = 5.9–23.2), and sanitary and other facilities (OR = 12.2, 95% CI = 6.6–22.6).
CONCLUSIONS: Blood donors with “high” PDS were low. Regularizing and updating the available guidelines on outdoor donor clinics would improve the availability of donor clinic-related particulars, enhancing PDS.

Keywords: Blood donation, blood donors, postdonation satisfaction


How to cite this URL:
Muthumala TN, Wijesinghe MS, Jayasekara S. Post-donation satisfaction and its associated factors of blood donors attending donor clinics of the National Blood Center, Sri Lanka: A cross-sectional study. Asian J Transfus Sci [Epub ahead of print] [cited 2023 Jan 28]. Available from: https://www.ajts.org/preprintarticle.asp?id=363198



   Introduction Top


Blood was enlisted under the World Health Organization (WHO) Model List of Essential Medicines, considering its importance for human survival.[1] Since there are no alternatives to replace blood and it is a nonpharmaceutical creation, the unique and exclusive approach to gathering blood is through generous human blood donations.

Sri Lanka embraced Sustainable Development Goals in 2015 and developed many targets under Goal 3, “Good Health and Well being.” Among them, to achieve Goals 3.1–3.4, 3.6, and 3.8, the availability of secure blood as per the WHO recommendations is essential.[2] Adequate availability of blood for transfusion is a primary criterion to be fulfilled in public health emergencies like the dengue epidemic and disaster preparedness like bomb explosions. Furthermore, blood has become a prominent necessitate in many other public health circumstances in Sri Lanka, such as management of postpartum hemorrhage, road traffic accidents, and anemia among adults and undernourished children. In response to demographic transition, advancing human life expectancy, continuous growth in the elderly population, and epidemiological transition in Sri Lanka, demand for transfusion remedies in public health is rising. Moreover, in Sri Lanka, cancer ranks among the top three leading noncommunicable diseases and cancer patients require blood transfusions to replace disrupted blood cells and to continue palliative care.

Postdonation satisfaction (PDS) is one of the main pillars of blood transfusion service.[3],[4],[5] Regular, voluntary, nonrewarded blood donors are the most secure donors because they have less transmissible infection risks.[6],[7],[8] Therefore, to retain them, PDS is important.[9] Unfortunately, although a larger bulk of individuals are eligible, only low percentages donate and even lower percentages do again, primarily due to poor PDS.[10] Therefore, there is a decreased tendency of blood donation in the world, and this situation is more or less similar in Sri Lanka.

Blood donation is a multi-step process; the service received by a donor at each step significantly contributes to postdonation satisfaction. Moreover, productive and powerful communication between the staff and potential donors is essential in determining PDS. Hence, despite the rising demand for blood, retention of safe donors has become a challenge.[11] Therefore, this study aims to measure PDS and its associated factors among blood donors attending donor clinics of the National Blood Center (NBC), Sri Lanka, to get an insight into how services can improve further.

Since 2014, blood donations in Sri Lanka depend 100% on voluntary, nonrewarded, unpaid blood donors.[3],[7] Hence, Sri Lanka's underlying blood requisite can be fulfilled only by voluntary blood donations. However, a significant number of young donors and females get differed due to the early development of diabetes mellitus, hypertension, and low hemoglobin levels, respectively, while some donors irrespective of age or sex get differed due to high-risk behaviors. Furthermore, a notable proportion of donated blood gets positive for transfusion-transmissible infection. As a consequence, even though the total number of individuals presenting to donate blood is adequate to reach the WHO recommendations for the country requirement, a considerable threat to the Sri Lankan donor pool had arisen, reveling the value of safeguarding present donor pool. Therefore, PDS is an essential aspect to retain safe blood donors. Understanding the underlying etiologies of PDS and its associated factors would help to develop public or health staff education and awareness materials for retention of regular blood donors. Moreover, it will provide guidance for additional enhancements in donation processes, to retain blood donors ensuring sustainable blood supply to prevent public health-related events.

Currently, there are no adequate studies available in Sri Lanka and the region on this crucial area; furthermore, though this is not a novel concept, it has not been adequately addressed both locally and regionally.


   Materials and Methods Top


The study design was a descriptive cross-sectional study (institution-based). The study was conducted from March 2019 to February 2020, and data collection was carried out from September 2019 to October 2019.

The study was carried out among blood donors attending donor clinics (outdoor) of the NBC, Colombo, which is the headquarters and the main blood center in Colombo under the National Blood Transfusion Service (NBTS), Sri Lanka. All the blood collected from the spread-out clinics in Colombo is drained into this single institution. NBC is the biggest blood collector in the country. Hence, achieving a sufficient number of samples during the study period was possible. NBC consists of in-house and outdoor donor clinics, held throughout the year. In Sri Lanka, 93% of the annual collection was by outdoor clinics, which were more or less similar to NBC. Hence, the outdoor donor clinics of NBC were selected for the study. Outdoor donor clinics are blood donation sessions organized by NBC temporarily at various locations such as schools, workplaces, religious places, and community centers within the allocated area for the Colombo cluster.[12]

The study population was blood donors attending outdoor donor clinics of NBC, Colombo. Blood donors were between 18 and 60 years. Among both first-time and repeated donors, only those who were accepted as eligible for current blood donation by the clinic medical officer were included. Furthermore, blood donors with a known disability, hearing or vision impairment, and foreign nationals due to communicating barriers and blood donors on psychotherapy for depression (as they may not present mentally sound answers to the questionnaire) were excluded from the study.

A systematic sampling technique was used. The principal investigator (PI) and the other trained data collectors attended outdoor donor clinics daily, according to the NBC donor clinic schedule per the particular month. When the number of outdoor clinics per day was 3 or <3, all clinics were attended. Moreover, when it was more than three outdoor clinics per day, three randomly selected outdoor clinics on that particular day were attended using a random number table. The sample size was calculated using a standard formula.[13] With an estimated 50% prevalence of postdonation satisfaction (PDS) and 10% expected nonresponse, the estimated sample size was 423. The blood donor registration list of each clinic was taken as the sampling frame for the particular clinic participants. A random number was decided by the PI or the trained data collector using an unbiased dice. Every other donor was taken for the day from the list and included in the sample according to inclusion and exclusion criteria. This technique was followed in every donor clinic until the sample size was achieved.

The study instrument was a pretested interviewer- administered questionnaire. Section A consisted of blood donors' sociodemographic characteristics, and Section B consisted of details related to blood donation, including both blood donor-related characteristics and donor clinic-related features. In Section C to determine PDS, 18 different parameters associated with each stage of blood donation were included under six domains with five-point Likert scale items ranging from “very satisfactory” to “very unsatisfactory.” The scale was developed based on many local and international studies.[7],[14]

The PI created the questionnaire using adopted questions from a relevant questionnaire that had been locally validated and with expert opinions of a consultant community physician and a consultant transfusion physician. Moreover, further consideration was given to the conceptual framework for developing the questionnaire, which was built, based on published literature on PDS-associated factors.[3],[11] As a result, the questions were mainly closed-ended with minimal open-ended questions. Furthermore, pretesting of the questionnaire was done prior to the data collection, among 15 randomly selected blood donors, who attended NBC's outdoor donor clinics. Therefore, they were excluded from the study proper.

The composite score of all PDS determinants was taken as the PDS score. The maximum score a donor would obtain was 90, and the minimum was 18. All the PDS scores were plotted in a frequency distribution curve, and the measures for central tendency and interquartile range (IQR) were obtained. The cutoff point for PDS was also decided based on the distribution curve's 75th percentile value. Generally, in a developing country where health services are provided freely, people's satisfactions are high with health procedures and available services.[15] Hence, a high cutoff value of the 75th percentile was considered for all the scores. Therefore, the cutoff value was taken as 88. The donors were appropriately classified into “high” PDS level and “low” PDS level based on the cutoff. The prevalence of “high” PDS was calculated with 95% confidence interval (CI). Inferential statistics were used to describe the associated factors of PDS. The Chi-square test was used to assess the association of categorical variables with statistical significance at P < 0.05 level. The odds ratio (OR) was calculated with 95% CI. To find associations, few categorical variables were amalgamated. Missing data were handled using the listwise deletion method.

There were no conflicts of interest commercially, financially, intellectually, or in any other interest in this study. This was a self-funded research. Ethical clearance was obtained from the Ethics Review Committee of the Postgraduate Institute of Medicine, University of Colombo, and the Research Review Committee of NBTS.


   Results Top


The response rate was 100% (n = 423). [Table 1] shows the basic demographic and socioeconomic characteristics of the blood donors who attended NBC's outdoor donor clinics. The mean age of the donors in the study sample was 32.7 years (standard deviation [SD] = 10.4).
Table 1: Basic demographic and socioeconomic characteristics of blood donors in the sample (n=423)

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[Table 2] illustrates the blood donation-related and repeat donor-related characteristics.
Table 2: Blood donation-related and repeat donor-related characteristics of the sample

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[Table 3] shows the distribution of postdonation satisfaction determinants among the study sample. The mean PDS score was 80.6 (SD = 9.5). The PDS of blood donors in the study group was within the range of 34–90 (range = 56). The Q1-Q3 was 72–88 (IQR = 16). The frequency distribution curve for the scores of PDS was approximately a normal distribution curve. The participants were sorted into two groups based on their PDS score. Namely, the two groups were “high” PDS and “low” PDS. Accordingly, one-third of blood donors (33.3%, n = 141) were found to have “high” PDS. Hence, the prevalence of high PDS in the sample was 33.3% (95% CI = 29%–38%).
Table 3: Distribution of postdonation satisfaction determinants among blood donors in the sample (n=423)

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[Table 4] illustrates the bivariate analysis of factors associated with PDS. The PDS was associated with donor loyalty (OR = 3.4, 95% CI = 2.1–5.3), adequacy of information, advertising modes and publicity for the donor clinic (OR = 7.2, 95% CI = 4.4–11.8), adequacy of proximity, accessibility and familiarity of the locality to the public (OR = 6.8, 95% CI = 4.1–11.3), the environment of the location and cleanliness of surrounding (OR = 9.2, 95% CI = 5.4–15.7), convenience of time and duration of donor clinic (OR = 10.8, 95% CI = 6.3–18.8), provision of refreshments following donation (OR = 11.6, 95% CI = 5.9–23.2), and provision of sanitary and other facilities (OR = 12.2, 95% CI = 6.6–22.6).
Table 4: Factors associated with postdonation satisfaction among blood donors

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   Discussion Top


The eligible age range for blood donation was 18–60 years. The mean age of blood donors attending outdoor donor clinics at NBC was 32.7 years (SD = 10.4), ranging from 18 to 59 years. The highest proportion of blood donors in the sample was from 21 to 30 years of age category. Hence, the donor population was mainly young. With rising age, the donor population was further reduced. In a descriptive cross-sectional study in the Western province, the highest proportion of donors (27.3%) was between 30 and 35 years of age.[3] In this study, blood donors have been selected from both in-house and outdoor clinics. As per the results produced in the cross-sectional study conducted among eligible donors between 18 and 55 years attending outdoor donor clinics in Chennai, India, the majority (61.3%) were between 18 and 25 years of age.[16] Further, in a survey done among 18–65 years, blood donors in the USA, the majority (64%) were above 40 years.[11] Other than due to disparity between study settings, the slight differences observed here could be due to variations in the blood donation eligible age ranges, leading to inequalities in study samples. However, most blood donor populations in the studies mentioned above were young except for the USA study. Furthermore, as stated by Bosnes et al,[17] donor return is likely to be increased with the rising age. However, this finding was not comparable with the current study as the donor population was low after 41 years. This variation might be due to study setting differences, and the data in the abovementioned study have mainly been secondary source generated. However, blood donation influencing health education materials and campaigns should mainly target the middle age group.

The majority of blood donors were male. It may be because most of the females in our country get disqualified by not reaching the optimum hemoglobin level and body weight, respectively, 12.5 g/dl and 50 kg. It may also be due to females being more anxious and worrying about the pain. In a cross-sectional study among donors attending NBC, over 75% of outdoor clinic donors were male.[4] According to the evidence generated by a survey done among blood donors in India, the highest proportion (96.6%) were male.[18] The majority of blood donors (94.5%) were male in a cross-sectional study conducted in Iran.[19] Despite the variations in study settings, the majority of donor populations were male. However, these findings were incomparable with the USA's studies, where sex distribution was equal among the study population.[11] The disparity in results might be since the USA is a developed country with well-developed health services using hemoglobin analyzer to test the hemoglobin level, which is more reliable than the copper sulfate method used in Sri Lanka.

Furthermore, blood donor recruitment and promotional campaigns should be targeted more toward the ethnic minority groups as majority of blood donors were from the ethnic majority group.

The majority of blood donors were repeated donors and were between 21 and 30 years at their first donation. Among the donors, the mean age at first blood donation was 26.7 years (SD = 8.4). This was supported by findings of research conducted at NBC where repeat donors (75%) were higher than new.[7] Initiation of blood donation at a young age is more beneficial for the sustainability of transfusion services. If appropriate measures could be taken to retain these donors, and if they were retained, they would contribute for a long time. The study conducted in Chennai had the highest proportion (54%) of repeat donors, with the majority (75%) being 18–25 years at their first donation.[16] This observed difference may be due to the differences in eligible age ranges and age distribution differences within study populations. In a survey conducted among donors in sub-Saharan Africa, the highest proportion (61%) of blood collection was from repeated donors.[20] Even though repeated donors are higher in a sample of individuals who have voluntarily arrived for blood donation, in a normal population, the proportion of individuals with a history of blood donation is generally low. Mostly, this could be the reason for new donors being less. This reason was supported by the results of a study conducted among undergraduates in Canada which showed that a majority (67.5%) of the sample were nondonors.[21] Hence, blood donation promotions should target the normal population as well. Furthermore, in the survey conducted in Ghana by Mohammed and Essel,[22] most (54%) were first-time donors. This difference could be due to the provision of compensation for blood donations in Ghana, while in Sri Lanka, incentives for blood donation are not encouraged.

In most of the literature, PDS was assessed as a single item on a Likert scale. However, in this study, multiple items were used to determine PDS. The majority of the donors were categorized under “low” PDS based on the composite score. In a survey conducted in the USA, donor satisfaction with entire donation procedure was determined by a single-item five-point Likert scale and majority (75%) were highly satisfied.[10] The differences in this finding could be because PDS was determined based on multiple items and a composite scale in the current study. Furthermore, the other facts that could have predisposed to this disparity could be the difference in the type of study instrument, variations in the study setting, and the study population. In the USA survey, most of the study population were over 40 years, while both sexes were equal in proportion, and the tool was a self-administered questionnaire. Moreover, generally, satisfaction scores concerning free health services in developing countries are very high among the recipients.[15] Hence, in the current study, the cutoff value was set high at the 75th percentile, which may also be a reason for the disparity. Similarly, in a survey conducted in Serbia, PDS was determined by a single-item five-point Likert scale and the majority (81%) was highly satisfied.[4]

Even though the majority was very satisfied with all the parameters, comparatively “very satisfying” proportion with waiting time before donation and vein puncture pain level was less. In the study conducted by Jayasekara,[7] waiting time before the donation was assessed separately over a five-point Likert scale, and the majority (55%) were very satisfied with it. However, the proportion of very satisfied with it was low compared to other statements in the current study. This finding could be supported more by results of the research conducted in Greece, where the majority (97%) were satisfied with provided services and attitudes of staff, while only with waiting time before donation, a low satisfying proportion (48.7%) were found.[23]

In literature, both local and international studies determining PDS-associated factors were limited. The religion, ethnicity, marital status, education level, current occupational category, and monthly income were likely to be associated with PDS. However, none of these associations was statistically significant.

Even though blood donor-related characteristics such as donor status, age at first donation, number of donations per year within the last 2 years, donor regularity, and donors “likely” to be retained were likely to be associated with PDS, they were not statistically significant at 95% significance level. However, the association of donor loyalty with PDS was statistically significant. In the study conducted in the USA, by Nguyen et al.,[11] a significant association between PDS and intention to return was obtained. Intention to return was an item that was used in the current study to determine donor loyalty under the attitudinal domain. This similarity could be explained by the fact that although loyalty has both attitudinal and behavioral components, donor loyalty and intention to return are based on emotions. Hence, differences in study settings may not have influenced it. Furthermore, in the study mentioned above, donor status was significantly associated with postdonation satisfaction (p<0.001), while in the current study, it was not. This fact could be explained by the disparities of first time and repeat donor distribution within two donor populations. In the USA study, more than 90% were repeated donors, while in the current research; it was 69%. Moreover, in the study mentioned above, stratification had been applied to control confounding factors where, in the current study, steps to control confounders were not taken.

Statistically significant associations were obtained between adequacy of advertising modes and publicity for the donor clinic, proximity and accessibility of donor clinic, environment and cleanliness of the surrounding, convenience of time and duration of donor clinic, refreshment provision following donation, and sanitary and other facility provision and PDS level. Unfortunately, in literature, even though many studies have assessed the adequacy of donor clinic-related features, their associations with PDS were not evaluated. However, in the study by Nguyen et al.,[11] statistically significant associations were obtained between PDS with convenient locality and time schedule. Based on this association, regularizing and updating the available guidelines on outdoor donor clinics would improve the availability of donor clinic-related particulars, enhancing PDS.

This study was conducted only in outdoor clinics of NBC, out of 19 blood centers under NBTS. Hence, generalizing the results to total donor population is questionable and external validity may have been affected. This study included an outdoor clinic blood donor population only. Therefore, the exclusion of in-house donors was a limitation. Further, due to the presence of interviewer at the time of the interview, there is a possibility of not getting genuine responses from participants. Due to the absence of a good recording system, it was unable to cross-check responses for certain questions regarding the past days. Hence, minimizing recall bias may have been difficult.


   Conclusions Top


We found that blood donors with “high” PDS were very low. Statistically significant associations were obtained between PDS level and donor loyalty, adequacy of advertising modes and publicity for the donor clinic, proximity and accessibility of donor clinic, environment and cleanliness of the surrounding, convenience of time and duration of donor clinic, refreshment provision following the donation, and sanitary and other facility provision.

Acknowledgments

Our gratitude goes to the Board of Study in Community Medicine, Postgraduate Institute of Medicine, University of Colombo; the Director of National Blood Transfusion Services; the staff of National Blood Center, Colombo; and the blood donors of National Blood Center, Colombo.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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World Health Organization. WHO Model List of Essential Medicines; 2017. Available from: https://www.who.int/medicines/publications/essentialmedicines/20th_EML2017.pdf. [Last accessed on 2019 May 19].  Back to cited text no. 1
    
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Perera DA, Dharmaratne SK, Kendangamuwa KW, Gamini LP. Determine the factors affecting the blood donors of selecting blood donor programme in Western Province, Sri Lanka. Int J Sci Technol Res 2015;4:148-57.  Back to cited text no. 3
    
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Correspondence Address:
Tharushi Nadeeshani Muthumala,
No. 232/6, Makola Road, Kiribathgoda, Colombo
Sri Lanka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajts.ajts_1_22




 
 
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