title: Evolving strategies to encourage repeat donations among first time voluntary and replacement blood donors in southern Ghana
Creators: name: Asamoah-Akuoko, Lucy
Publisher: name: University of Liverpool Repository
Year: 2019

description: Low- and middle-income countries have about 81% of the world’s population, but contribute only about 50% of the 112.5 million donations of blood collected annually worldwide. In Ghana, there is shortage of blood all year round, with a deficit of about 35% of the national requirement of 250,000 units. Voluntary non-remunerated blood donors (VNRBDs) are uncommon and contribute only about 36% of the donated blood. Repeat donations constituted only 38.2% of donations by VNRBDs at the Southern Area Blood Centre of the National Blood Service, Ghana (NBSG) in 2016, despite the recognition that repeat donors are safer. To increase the safety and adequacy of blood supply in low- and middle-income countries, locally relevant evidence is needed about how to better motivate blood donors. This study examined the perceptions about blood and blood donation; motivators for, and deterrents to blood donation; first-time blood donors’ intention to return to donate blood; and recommended interventions to promote blood donation in Ghana. Two scoping literature reviews, 24 individual in-depth interviews, five focus group discussions with a total of 39 participants, and a cross-sectional survey of 250 first time VNRBDs and 255 first-time family replacement blood donors (FRDs) were conducted in southern Ghana. A sequential exploratory mixed methods design was used. Key perceptions that influence blood donation in Ghana were the perception that blood is life, the symbolism of blood as a spiritual, religious and cultural entity, the knowledge of blood as a physical/biological substance; and that blood donation is a good and lifesaving act with health benefits and negative health effects. Key motivating factors were altruism, collectivism, education, awareness, publicity/advertisement, reminders, and some non-monetary incentives. Important deterrents were: fear, negative service experience, negative influence of other persons, inconvenience, discouraging religious and cultural beliefs. First time donors were young (median age, 25 years; interquartile range 21-31 years), with 87.4% below 35 years of age, male (72.5%), single (73.3%), Christian (93.7%), employed (58.8%), with at least a basic education (98%), and lived with parents/family (54.3%). VNRBDs were younger (median, 23 years; interquartile range 20-29 years) than FRDs (median, 28 years; interquartile range 23-33 years). Most FRDs considered themselves as VNRBDs (82.6%). Factors that positively predicted intention to return to donate were: convenient access to donation sessions (OR=2.6, 95% CI 1.5–4.6; p=0.001); if Ghana needs blood (OR=2.5, 95% CI 1.1–6.0; p=0.033); if it makes one feel good about himself/herself (OR=1.8, 95% CI 1.0-3.2; p=0.040); SMS/email reminders (OR=2,7, 95% CI 1.5–4.8; p=0.001); TV, radio or newspaper advertisement (OR=2.9, 95% CI 1.6–5.1; p&lt;0.001). Factors that negatively predicted intention to donate again included blood credits (OR=0.4, 95% CI 0.2–0.8; p=0.013); free TTI test results (OR=0.4, 95% CI 0.2–0.9; p=0.018); and not knowing what happens to the donated blood (OR=0.5, 95% CI 0.3-0.9; p=0.028). This study describes original research which suggests that interventions and recommendations that are likely to increase first-time donor return in Ghana include those aimed at education, improving access to donation sites, and encouraging FRDs to become regular donors; a functioning donor contact centre; and evaluation, rationalising and implementation of an incentive system. There are examples in the literature of successful interventions for motivating blood donors in Ghana, but the challenge is a lack of quality evaluations and scale-up studies.