Predicting Blood Donations Among College Students as a Strategy to Design Voluntary Blood Donation Campaigns in China

The current study investigated the voluntary, safe blood donation in China using an extended version of the Theory of Planned Behavior (TPB) (including attitudes, subjective norms, descriptive norms, moral norms, self-identity, and perceived behavioral control), the Health Belief Model (HBM) (including perceived susceptibility, perceived severity, and cues to action), and the Social Amplification of Risk Theory (SART) (including the concept of trust). Attitudes focus on individuals' evaluations of the behaviors. Subjective norms (i.e., perceived social pressure to engage in the behavior), descriptive norms (i.e., individuals' perceptions of what most people do), moral norms (i.e., personal feelings of social responsibility), and self-identity (i.e., individuals' perceptions of their social roles) were expected to form a multidimensional higher-order concept called norms. Perceived behavioral control was hypothesized to be a second-order multidimensional construct with two components: perceived controllability (i.e., individuals' perception that they have control over the behavior) and perceived self-efficacy (i.e., one's confidence in his/her ability to perform the behavior). Perceived susceptibility (i.e., beliefs that a certain negative outcome will occur) and perceived severity (i.e., the evaluation about how serious the outcome could be) were proposed to converge on a higher-order construct called perceived threats. Cues to action were operationalized as the requests for blood donations from various resources (i.e., blood banks, schools, family and friends, and social groups). The concept of trust emphasized the trust in blood banks. The current study hypothesized that blood donation intentions were a positive function of attitudes toward blood donations, norms, perceived behavioral control, threats, and cues to action. Trust in blood banks was hypothesized to be positively related to attitudes toward blood donations. A panel (two-wave) survey was conducted. A convenience sample of 248 undergraduate students was recruited from a large regional university in China. The results supported the extended TPB with additional components, including descriptive norms, self-standard (moral norms and self-identity), and self-efficacy. Subjective norms, descriptive norms, and self-standard converged to create a higher order construct: Norms. The convergence in the perceived behavioral control domain (self-efficacy and controllability) and the threats domain (perceived susceptibility and severity) were not obtained. Norms and self-efficacy appeared to be two primary predictors of intentions to donate blood. The direct effects of trust in blood banks on attitudes were confirmed. The results also revealed the indirect effects of trust in blood banks on blood donations intentions. Self-efficacy and controllability predicted past blood donation frequency directly. In addition, self-efficacy mediated the effects of norms on past blood donation frequency. The HBM components (i.e., perceived susceptibility, perceived severity, and cues to action) appeared to be non-significant predictors of blood donation intentions and past behaviors. This study provided a theoretic basis for designing voluntary blood donation campaigns and identified the beliefs and factors that should be targeted in the future campaigns. The current study results reinforce arguments for blood donation campaigns to appeal to social responsibility. One possible method is to frame blood donation as a socially admirable behavior. In addition, the study findings indicate that future blood donation campaigns should take advantage of the effects of perceived behavioral control on both blood donation intentions and blood donation behaviors. Study results indicate the potential utility of campaign messages that include specific coping strategies such as how to reduce barriers to blood donations. In particular, the current study revealed that several control related beliefs involving personal health issues (e.g. sickness, including colds, flu, anemia, etc), time constraints, the locations and schedules of facilities, including blood mobiles, and lack of awareness of blood donation opportunities should be featured in future campaigns. Donor recruitment materials should also emphasize the safety resulting from clean, well-equipped facilities, strict screening processes, and professional staffs. Moreover, the findings of the current study suggest the importance of beliefs about positive consequences (i.e., health benefits, blood tests results, adequate blood supplies for donors themselves, their family, and their friends, and saving lives) and negative consequences of blood donation (i.e., low resistance to colds, influenza, or infection, and the risk of contracting transfusion-transmitted infections). Beliefs about these consequences were the driving forces behind general attitudes toward blood donations in this study. In particular, these beliefs could serve as the themes of future blood donation campaigns. Finally, the study results indicate that various mass media (i.e., TV, radio, and newspaper) tend to be useful channels that reach a wide range of potential blood donors.