an investigation into blood donation intentions among non-donors

An investigation into blood donationintentions among non-donorsMike Reid* and Angela WoodDepartment of Marketing, Monash University, Australia

� In broad terms, the donation of blood along with organ and bone marrow donation is

considered to be the ultimate act of humanity involving a voluntary and anonymous

exchange between two people of a life saving commodity. Yet motivating people to donate

blood is a significantly difficult task. The aim of this paper is to use the Theory of Planned

Behaviour (TPB) to examine non-donors on the basis of their likely intention to donate

blood in the future and to identify barriers on these more favourable non-donors. This

exploratory research finds that subjective norm, perceived behavioural control and time

related barriers are related to intent to donate by current non-donors. Differences

between higher and lower intention donors are also explored.

Copyright # 2007 John Wiley & Sons, Ltd.

Introduction

Themaintenance of a safe and sufficient supplyof blood requires the recruitment, retentionand renewal of an active donor pool (Godinet al., 2005). In Australia, around 30% of thepopulation will require the use of stored bloodat some time. Currently the Australian hospitalsector needs 21 000 blood donations eachweek and over 2500 L per day to keep up withdemand. Despite this need, only 3% of the 20million plus population who are eligible areregular blood donors; similar figures are alsoreported for other countries including Canadaand the US (Godin et al., 2005). The low levelof donation amongst the Australian populationremains despite significant on-going marketingefforts by the Australian Red Cross BloodService at both the local and national levels(Table 1).

In attempting to increase blood donation,two broad strategies are available to agencies;(1) increase the frequency of donation fromexisting donors or (2) increase the number ofpeople who donate. Whilst research hasshown that it is often more efficient to retaincustomers rather than attract new ones, thereare factors which limit the application of thisstrategy in the blood market. First, there arelimitations on the number of donations anindividual can make in a year, currently once amonth in Australia. Age restrictions also apply,limiting the donor eligibility to those betweenthe ages of 16 and 70 years and finally, manypeople become ineligible when they fall ill ortake specific medications (ARCBS, 2001).Given that there are limits on the number of

donations that can be made by any one person,the only feasible way to increase the supply ofblood is to encourage non-donors to act. Bloodagencies face three major challenges inachieving this goal. First, the procurement ofblood relies on voluntary donations frompeople who may, despite the best of inten-

International Journal of Nonprofit and Voluntary Sector MarketingInt. J. Nonprofit Volunt. Sect. Mark. 13: 31–43 (2008)Published online 29 January 2007 in Wiley InterScience(www.interscience.wiley.com) DOI: 10.1002/nvsm.296

*Correspondence to: Dr Mike Reid, Department of Mar-keting, PO Box 11E, Clayton Campus, Monash University,Victoria 3800, Australia.E-mail: [email protected]

Copyright # 2007 John Wiley & Sons, Ltd. Int. J. Nonprofit Volunt. Sect. Mark., February 2008

DOI: 10.1002/nvsm

tions, perceive themselves as increasingly timepoor. Second, the fact that blood is extractedthrough an intravenousmethod acts as a strongdeterrent to many potential donors. Finally,since collection agencies operate as non-profitorganisations they often face considerablefinancial and human resource constraintswhich prevents them from launching widescale campaigns with the necessary weight toattract donors or indeed to reward themadequately (ARCBS, 2006).Nevertheless, in broadening the donor base

through targeting the ‘non-donor’ market itmakes intuitive sense to focus on thosenon-donors who have a higher propensity orintention to donate in the future. In developingthis focus it is important for blood agencies tohave greater understanding of the psychologi-

cal antecedents or prerequisites of the decisionto donate by non-donors including attitudes todonation, perceived barriers and perceptionsof control over the act of donation. To aid inthe investigation of non-donors this studyemploys the Theory of Planned Behaviour(TPB) (Ajzen, 1985, 1988, 1991) as a theoreti-cal framework. The TPB has been usedsuccessfully in other studies of health beha-viours including blood donation (Holdershawet al., 2003; Giles et al., 2004; Godin et al.,2005).

Theory of planned behaviour

The TPB has received considerable attention inthe literature (Armitage and Conner, 2001). In

Table 1. Selected ARCBS marketing activities

Month Activities

May 2005 Operation Lifeblood — 3-month new donor recruitment campaign — major mediacoverage secured on programs such as Big Brother

September 2005 ‘Donate with your Mate’ campaign designed to encourage donors to turn up with afriend, partner or colleague and share the experience — other state based initiatives

November 2005 A national media appeal to boost low inventory — coincided with Australia’sWorld Cup qualifier against Uruguay — based on the theme of ‘giving blood likethe Socceroos’

December 2005 The Christmas and New Year period — public relations activity asking Australians tomake an ‘uber’ New Year’s resolution — to give blood!

January 2006 Australia Day 2006 — ‘Aussie spirit’ by profiling donors who had gone the extra mileto give blood — e.g. profiling a donor in South Australia who has travelled 50 000 kmto date to ensure he meets his fortnightly donation appointment

February 2006 Highlighted donor couples who had met each other at a donor centre as part of aValentine’s Day message. Launched Frequent Donor Club — minted lapel pin torecognise frequent donors commitment and to encourage them to keep givinggenerously

March–April 2006 Activities in place to build donor awareness and motivation by leveraging the eventseason (Melbourne’s Commonwealth Games, Labour Day, Clipsal 500, the AdelaideFestival and Fringe, Easter and Anzac Day, amongst others)

May 2006 New brand advertising campaign launched nationally using the tag line of ‘It takessomeone special’.Campaign designed to show that not everyone is eligible to give blood, and toencourage those who can to do so by playing upon the different meanings of‘special’ — executed through radio, TV, public transport and ‘eyelite’ (street) posters.The campaign was timed to support Operation Lifeblood 2006 and give ARCBSmaximum visibility during the new donor recruitment drive

June 2006 Celebrated World Blood Donor Day with a ‘donor mobile’ in Sydney CBD and usedtelevision breakfast television hosts to promote blood donation. Complemented bya ‘Prick-a-Pollie’ Challenge at Parliament House in Canberra

Source: The ARCBS Annual Report 2005–2006 (http://www.arcbs.redcross.org.au).


DOI: 10.1002/nvsm

32 Mike Reid and Angela Wood

a meta-analysis of 185 studies published upuntil the end of 1997, Armitage and Conner(2001) found that the TPB accounted for 27%and 39% of the variance in behaviour andintention, respectively. According to the TPB,behavioural intention is a primary motivator ofindividual behaviour. The intention to behaveis seen as a function of three independentvariables; attitude to the behaviour, subjectivenorm (SN) and perceived behavioural control(PBC) (Ajzen, 1988, 1991, 2001). Attituderefers to a persons overall evaluation of theproposed behaviour including the perceptionsof the consequences of such actions. A positiveattitude would likely see an individual takingpart in an act or behaviour. The SN relates tothe beliefs about whether significant others(including family, friends and peers) approveof the behaviour and whether that approval isimportant to the individual. PBC relates to thedegree to which people think they can controlwhether or not they are able to undertake anaction or a specific behaviour (Giles et al.,2004; Lemmens et al., 2005).The TPB has had strong and growing

application within blood donation research(Ferguson, 1996; Holdershaw et al., 2003).Indeed, the pioneers of the theory, Ajzen andFishbein (1980), used the area of blooddonation as an indicative example of theimpact of attitude and SN on intentions(Burnkrant and Page, 1982). Other studieshave also found support for the use of the TPBin predicting intention to donate in the bloodcontext. Giles and Cairns (1995), for example,found that attitude, SN and PBC accounted for60.5% of the variance in behavioural intentionsof donors. Armitage and Conner (2001)reported on two studies both employing theTPB, finding that approximately 76% of theintention to donate blood could be explainedby the model. In a study of New Zealandstudents, Holdershaw et al. (2003) found PBC,SN and attitude had significant impact onbehavioural intentions (R2¼ 0.52). Theauthors concluded that the motivation todonate blood is influenced by the perceptionof control. Godin et al. (2005) examinedfactors explaining the intention to donate

blood in the general population and found thatPBC and moral norm were the best predictorsamongst a group of individuals known as the‘ever donors’ and suggested that promotionalstrategies should focus on the elimination ofbarriers to action as well as the development ofa higher perception of control.

Understanding non-donors

The specific emphasis of this research is onnon-donors and the factors that influence theirnon-donation and potentially, their willingnessto become a donor. Broadly, research intoblood donation can be categorised into threemain themes; investigations into the use ofincentives to encourage donation; a focus ondetermining what leads people to donate thefirst time and become regular donors (includ-ing personality characteristics of donors), andfinally a focus on attitudes and motivations ofdonors and non-donors and the factors thatinhibit donation (Holdershaw et al., 2003).Recognising that an understanding of the

characteristics of non-donors is a necessaryinsight for managers, a number of studies setout to investigate this area (Godin et al., 2005).Piliavin (1990) in a review of the literaturefound that non-donors often cited medicalissues as a reason for non-donation. Otherreasons used to explain non-donation includefear of needles, fear of the sight of blood,weakness, dizziness, disequilibrium of circularsystems (Oswalt, 1977) fear of the unknown(Oborne and Bradley, 1975) assessment of risk(Allen and Butler, 1993), lack of incentives(Cialdini and Ascani, 1976), inconvenience,time and real or perceived medical disqualifi-cation (ARCBS, 2001).It can generally be concluded that non-

donors are not homogenous (Piliavin, 1990).Whilst some may identify fear as a barrier todonating, others simply attribute their lack ofaction to a perceived lack of time. What muchof the research does not attempt to do is toexamine non-donors closely in order todetermine if there are groups that have moreor less propensity to donate (Lemmens et al.,


DOI: 10.1002/nvsm

Blood donation intentions 33

2005). Indeed, the lack of consistency in thefindings relating to what constitutes a typicalnon-donor lends support to the idea that theremay in fact be segments within the large poolof non-donors who differ not only with respectto the influence of these factors but also interms of their willingness to donate (Piliavin,1990; Godin et al., 2005).The review of literature on non-donor

characteristics as well as the review of theuse of the TPB enables the proposal of a seriesof hypotheses related to differences betweennon-donors whomay be more or less willing tobecome donors:

H1: Higher intenders will have a more

favourable attitude to donation than

lower intenders.

H2: Higher intenders will exhibit greater

self-perceived control (PBC) over the act of

donation than lower intenders.

H3: Higher intenders will exhibit a higher

belief that significant others would encou-

rage them to participate in the act (SN)

than lower intenders.

H4: Higher intenders will exhibit lower

perceived time barriers than lower inten-

ders.

H5: Higher intenders will exhibit lower

perceived distance barriers than lower

intenders.

H6: Higher intenders will exhibit less fear

of needles barrier than lower intenders.

H7: Higher intenders will exhibit less fear

of catching an infectious disease than

lower intenders.

In summary, this study is exploratory indesign and examines the relationship betweenPBC, SN, attitude, barriers to the act of blooddonation and likely donation intentionamongst non-donors. The study is not designedto test the efficacy of the TPB with regard to

blood donation, rather it provides the frame-work for understanding non-donors with thepurpose of considering how this understand-ingmight contribute to the design of marketingcampaigns to increase the donor base.

Method

Sample and data collection

The population studied was defined as Aus-tralian citizens who were between the ages of18–70 years and who were eligible to donateblood. A sample of 1000 households wasdrawn from a major capital city using thetelephone book as the sampling device.Inherent in such an approach is a bias tothose households with listed telephone num-bers. Each household was sent a self-administered questionnaire, an accompanyingletter of explanation and a reply-paid envelope.The respondent was to be the person in thehousehold over the age of 18 with the mostrecent birthday. One week later a reminderletter was sent to the total sample and thisincluded a pamphlet on blood donationprovided by the ARCBS. University ethicsrequirements covering data de-identificationand anonymity meant that no determination ofthose individuals who had completed andreturned the questionnaire could be assessedwhich meant that the follow-up letter wasmailed to the total sample.

Of the 1000 questionnaires mailed out, 278were returned completed. A number ofrespondents were disqualified from thisanalysis for reasons related to medical con-ditions, age and exposure to vCJD. Further-more, given that the focus of the study wasnon-donors, 42 people who fitted the categoryof a current donor (i.e. had donated within thelast year) were also excluded from the finalsample. Thus, the final available sample wasreduced to 197, yielding an effective responserate of 19.7%. Given the type of analysis to beundertaken including hierarchical regressionand MANOVA, an analysis of multivariateoutliers identified a further nine respondents


DOI: 10.1002/nvsm


that should be removed. Overall 188 respon-dents representing non-donors were enteredinto the analysis.

The questionnaire

The design of the questionnaire allowed formeasurement of themain constructs containedwithin the TPB and followed the conventionsof Giles and Cairns (1995). The questionnairewas pretested firstly through interviews withthe ARCBS to ensure the questions capturedthe appropriate behaviours and beliefs relatingto blood donation and to determine if any otheritems needed to be included. This resulted inan additional two questions relating toexpected level of service at a donation facilityas well as the need for a financial reward asincentive to participate. Second, the ques-tionnaire was completed by a conveniencesample of students and staff based at theUniversity. No changes were made to thequestionnaire as a result of this process. Unlessotherwise stated, the items employed seven-point response scales.

Intention

The questionnaire incorporated two distinctmeasures of intention. The first measure ofintention was obtained via the use of thestatement, ‘I intend to give blood in the future’.The use of this question was supportedthrough the use of a the Juster probabilityscale which is an 11-point interval scale basedon odds or chances out of ten that a saidbehaviour will be performed in the future(adapted from Riquier et al., 1997). Thecorrelation between both measures was0.75. A multiplication of both items was usedto create an overall measure of the intention todonate blood.

Attitude (H1)

The general approach to attitude in the TPB isto employ a battery of items which are thencombined to form an overall belief basedmeasure of attitude to blood donation. The

attitude items used in this study were derivedfrom previous research (Pomazal and Jaccard,1976; Burnett, 1982; Giles and Cairns, 1995)and confirmed through interviews with repre-sentatives of the ARCBS. This study adopted aslightly different approach to other work in thearea (Giles and Cairns, 1995, Giles et al., 2004)in that the 17 initial items were factor analysedto determine the underlying structure ofrespondent attitudes. The resulting four fac-tors, Anxious (three items, alpha¼ 0.71),Altruism (three items, alpha¼ 0.70), satisfac-tion (2 items, alpha¼ 0.82), Life Impact (threeitems, alpha¼ 0.66) were used in the finalanalysis. A fifth factor consisting of the twoadded items of service and reward wasdropped from analysis because of a lowCronbach Alpha (two items, Alpha¼ 0.50).

Subjective norm (H2)

In line with previous applications of thisconstruct, respondents were asked a seriesof questions relating to how they believedpeople who were important to them wouldfeel about their donating blood (Ajzen andFishbein, 1980). Further questions related tothe respondents’ personal normative beliefsabout their ability to donate blood (Giles andCairns, 1995).

Perceived behavioural control (H3)

The question of perceived control wasapproached directly by asking respondentsto evaluate the degree to which they felt incontrol of donating blood and how difficultthey thought it would be for them to do so. Thethree items in this area were averaged toprovide an overall measure for the level of PBCover donating blood (Giles and Cairns, 1995).

Barriers to donating — control beliefs

(H4–7)

Previous investigations into blood donationbehaviour identified a number of factors thatact as deterrents or barriers to donating blood.The following four factors were identified as


DOI: 10.1002/nvsm


significant barriers to donation by currentnon-donors and were included in this investi-gation — a lack of time, having to travel longdistances, a fear of needles, and a fear ofinfectious diseases (Giles and Cairns, 1995;ARCBS, 2001).

Past behaviour and demographics

Past behaviour was measured using categoricalquestions placed at the beginning of thequestionnaire. If a ‘yes’ response was elicitedto a question related to past donation beha-viour, then respondents would proceed to aseries of follow up questions relating to howlong it had been since the respondent had lastdonated. These questions were used to aid inthe determination of the main set of non-donors (i.e. those who had not donated in thelast year). Other demographic questionsinclude age, gender, income, family situation,education, occupation, blood type, ethnicityand postcode. A series of questions related touse of various media were also included inorder to determine the extent to which higheror lower intention groups could be specificallytargeted through media choices.

Results

Data were analysed using SPSS v11. Demo-graphics are presented first followed bydescriptive analysis including means, standarddeviation and correlation analysis (Table 2).Hierarchical multiple regression was thenemployed to explore the relationship betweendependent and independent variables(Table 3). Finally, the sample was split intotwo groups representing non-donors who hada higher or lower intention to donate. Anassessment of demographic differences wasundertaken along with an examination of basicmedia usage differences (using a t-test betweengroups — Table 4). A multivariate analysis ofvariance (MANOVA) was also undertaken todetermine which items associated with thedeterminants of intention differentiated thehigher and lower intention groups (Table 5). T

able

2.Mean

s,SD

andcorrelationsbetw

eenmainvariables

Variables

MSD

12

34

56

78

910

Intention

24.69

19.54

–Anxiety

(yes)

2.76

1.45

�0.19�

Satisfaction(yes)

5.28

1.00

0.23��

0.10

Lifeim

pact(yes)

5.88

1.17

0.09

�0.13

�0.18�

Altruism

(yes)

6.46

0.58

0.11

0.00

0.24��

0.04

Subjectivenorm

(SN)

3.32

1.26

0.31��

�0.08

0.36��

�0.11

0.01

Perceivedcontrol(PBC)

5.07

1.20

0.33��

�0.26��

0.15�

�0.01

0.09

0.24��

Tim

ebarrier(yes)

4.61

1.79

�0.30��

0.10

�0.15�

0.61��

0.08

�0.25��

�0.12#

Travelbarrier(yes)

5.08

1.54

0.09

0.05

0.07

0.42��

0.12

�0.11

0.13#

0.55��

Needlesbarrier(yes)

3.45

2.10

�0.17�

0.60��

0.05

0.03

�0.12

�0.09

�0.06

0.07

�0.05

Diseasebarrier(yes)

2.90

1.76

�0.06

0.14�

�0.01

�0.22��

�0.04

�0.09

0.05

�0.13#

�0.19��

0.28��

� p<0.05;��p<0.01;�� p

<0.001;#p<0.10.


DOI: 10.1002/nvsm


Demographics

In terms of the overall demographics of thesample 69.1% were women and 30.1% men.8.5% were aged between 18 and 29, 55.9%were aged between 30 and 49, and 35.6%between the ages of 50 and 70. With regard tofamily status, 43% of the respondents were incouple relationships with dependant children,17.6% were single, 14.9% were childlesscouples, 6.4% single parents and another14.9% were couples with non-dependentchildren. Respondents (50%) reportedincomes between $25 000 and 50 000, 21%with incomes between $55 000–$100000, and12.2% reported incomes above $100 000. From

an educational perspective the 30.9% reportedhaving school-leaving certificate only. At theother end of the scale 16.5% had a Bachelordegree, and 16.6% had a higher researchdegree.

Descriptive and correlation analyses

Table 2 presents the means, standard devi-ations and correlations for the extendedattitudinal factors, the remaining TPB variablesof SN, behavioural control (PBC), and the fourbehaviourally based donation barriers. Overall,respondents had a low intention to donate(mean, 24.49 out of a maximum range of 77)but with a significant standard deviation

Table 3. Hierarchical multiple regression of intention on main variables

Step/variable entered Model 1 Beta Model 2 Beta Model 3 Beta Model 4 Beta

Step1Anxiety �0.219�� 0.189�� 0.132# �0.014Satisfaction 0.227�� 0.135# 0.115 0.117Life impact �0.078 �0.066 �0.064 0.127Altruism 0.062 0.082 0.067 0.070

Step 2Subjective norm 0.244�� 0.201�� 0.139#

Step 3Perceived control 0.227�� 0.237��

Step 4Time barrier �0.300��

Travel barrier �0.008Needles barrier �0.103Disease barrier �0.038

R2 0.108 0.159 0.204 0.261

R2 change 0.108 0.051 0.045 0.057

F 5.54 6.87 7.72 6.24F change 5.54�� 10.99�� 10.24�� 3.41��

�p< 0.05; ��

p< 0.01; ��p< 0.001; #

p< 0.10.

Table 4. Mean differences in media usage

Mean lower intenders Mean higher intenders t

Television viewing frequency 5.76 5.51 1.769Radio listening frequency 6.57 6.53 0.237Internet usage level 3.89 4.67 2.013�

Paper readership 6.03 5.96 0.337Magazine readership 3.54 3.79 0.974

�p< 0.05; ��

p< 0.01; ��p< 0.001; #

p< 0.10.


DOI: 10.1002/nvsm


suggesting that at least two groups may exist,one of whom may have a higher intention todonate blood and greater likelihood of becom-ing first time donors.The correlation analysis indicates that six of

the ten factors have a significant relationshipwith overall intention to donate, with thestrongest positive associations being PBC(0.33, p< 0.001), SN (0.31, p< 0.001) andthe satisfaction attitude factor (0.23,p< 0.001). Negative associations were foundfor the time-related barrier (�0.30, p< 0.001,i.e. having perceived time constraints), theanxiety attitude factor (�0.19, p< 0.05) andthe fear of needles barrier (�0.17, p< 0.05).Correlations between other variables are

also presented. Anxiety has a strong positivecorrelation with a fear of needles barrier (0.60,p< 0.001) but is negatively correlated withPBC (�0.23, p< 0.001) suggesting that anxietyis driven by a perception of fear and painassociatedwith needles and is reinforcedwhenpeople feel that have little control over the actof giving. The satisfaction attitude factor ispositively correlated with altruism (0.24,p< 0.001) and with SN (0.36, p< 0.001); thebelief that others will be supportive of the actand feel that the individual should participatein the behaviour. The perception that donationwill impact ones’ life (life impact attitude

factor) was strongly correlated with theperception that donation will take significanttime (0.61, p< 0.001; 0.42, p< 0.001) and thusmay act as a potential inhibitor of the act ofdonation. Other correlations indicate arelationship between PBC and SN (0.24,p< 0.001); between travel and time-relatedbarriers (0.55, p< 0.001), and between diseasebarriers and needles barriers (0.28, p< 0.001).

Prediction of intention

A hierarchical regression analysis (Table 3) wasconducted in order to further explore therelative importance of main independentvariables in the prediction of intention todonate. In this analysis intention was regressedon attitudes related to donation in Step 1, SN inStep 2, PBC in Step 3 and perceived barriers inStep 4.

The results indicate that the attitude factorsalone explained 10.8% of the variance inintention to donate [F(4, 183)¼ 5.54, p<0.001]. SN entered on Step 2 accounted foran extra 5.9% of the variance explained [F(1,182)¼ 10.99, p< 0.001]. Together, the atti-tude factors and the SN are the basicparameters for the Theory of Reasoned Actionwhich predated the more robust TPB. The PBC

Table 5. Differences between higher and lower intendersa

Step/variable entered Mean lowerintention (n¼ 116)

Mean higherintention (n¼ 72)

eta F-value p-value Accept/reject

H1: Attitude AcceptAnxiety 2.922 2.500 0.020 3.817 0.052#

Satisfaction 5.095 5.574 0.054 10.662 0.001��

Life impact 5.896 5.861 0.000 0.041 0.840 nsAltruism 6.379 6.590 0.031 5.934 0.016�

H2: Subjective norm 3.055 3.755 0.074 14.815 0.000�� AcceptH3: Perceived control 4.842 5.449 0.061 12.144 0.001�� AcceptH4: Time barrier 4.862 4.208 0.032 6.071 0.015� AcceptH5: Travel barrier 5.121 5.028 0.001 0.161 0.688 ns RejectH6: Needles barrier 3.716 3.028 0.025 4.840 0.029� AcceptH7: Disease barrier 2.966 2.806 0.002 0.364 0.547 ns Reject

�p< 0.05; ��

p< 0.01; ��p< 0.001; #

p< 0.10.aA three-groupmodel was also examined but failed to adequately differentiate between themiddle and higher intendergroups.


DOI: 10.1002/nvsm


variable entered at Step 3 accounted for afurther 4.5% of variance explained [F(1,18)¼10.24, p< 0.001] whilst the inclusion of thedonation barriers in Step 4 contributed 5.7%[F(4, 177)¼ 10.99, p< 0.05]. Overall the finalmodel accounted for 26.1% of the variance inintention to donate by non-donors.An examination of the final model suggests

that the time barrier has the strongestassociation with the likelihood or intentionof current non-donors to donate (or not). ThePBC variable is also noted as having a strongassociation with intention to donate andsupports the assertion that individuals whofeel they have control over the act are morelikely to have a higher intention to donate.Very mild significance was also found for theSN variable, with individuals who felt thatsignificant others would support theirdonation decision having a greater likelihoodof donating.

Differences between high and low

intenders

To explore differences amongst respondentswith regard to their intention to donate(hypotheses 1–7) the sample was divided intotwo groups. The division was based on aK-means cluster analysis around the aggregatedintention variable and results in 116 lowerintenders and 72 higher intenders. An initialexploration of the demographic and media useprofile was undertaken to determine if anysignificant differences or trends were appar-ent. In demographic terms there is noabsolutely clear distinction between the twogroups, nevertheless in terms of general trendsthe higher intender group appeared to beskewed towards younger respondents with ahigher proportion being between 20 and49 years of age. The higher intender groupalso tended to have a higher proportion offemales and was more highly represented bycouples with dependent children (49%).Higher intenders were also more likely tohave higher incomes (e.g. 8.3% earning over$100k compared with 3.4%), professionaloccupations (42% vs. 31%) and university

degrees (43% vs. 28%). Lower intenders wereover represented in occupations such ashomemakers, labouring and self-employment,and tended to have basic school leavingqualifications or technical college diplomas.With regard to media usage, respondents

were asked to report on their level of televisionviewing, radio listening, Internet usage, news-paper readership and magazine readership.Data for this were subjected to a t-test(Table 4). Overall the groups reported rela-tively high usage of all the main media. Theonly significant difference found between thetwo groups was on the level of Internet usage,with the higher intender group reporting ahigher frequency of use. Overall the demo-graphic differences do not adequately explainthe difference between the groups related todonation.A MANOVA (Wilkes Lambda¼ 0.006;

F¼ 2938.8; p< 0.05) was then conducted onthe attitude factors, SN, PBC and donationbarriers to examine any significant differences(Table 5). The results of this analysis suggestthat a number of significant differences discri-minate between the two groups. In terms ofthe attitude factors, higher intenders felt theywould exhibit a higher perceived level ofsatisfaction from donation and are also moreinclined to believe that the act of giving bloodis an altruistic act than the lower intendergroup. A weak difference is also noted bet-ween the two groups on the anxiety attitudefactors. Although no difference existed bet-ween the two groups on the life impact factorwe argue that higher intenders appear to havea more favourable attitude towards the act ofblood donation and thus accept H1.With regards motivation and moral factors,

the higher intender group exhibited a signifi-cant difference from the lower intenders onboth the SN and PBC. The higher intendergroup was more likely to feel that significantothers would approve of their decision todonate blood. Similarly, the higher intendergroup felt that they had greater control overtheir ability to participate in the act of blooddonation. The results for this section of theanalysis enable us to accept both H2 and H3.


DOI: 10.1002/nvsm


With regard to the behavioural beliefbarriers, the higher intender group exhibitedtwo main significant differences from thelower intender group. First, this group feltthey had less of a time barrier and believed thatthe act of donation would not take up toomuch of their available time. Second, thehigher intender group had less fear of needlesand the perception that donation would bepainful. These differences enable us to accepthypotheses H4 and H6. No differences werefound between the groups on the issues oftravel related barriers (the need to travel a longdistance to donate) although both groupsexhibit a high mean indicating that this is aconsideration or potential barrier for bothgroups in donation. No differences weredetected related to disease perceptions (thatan individual might contract a disease throughdonating blood). Based on these results wecannot accept H5 and H7.Overall, there does appear to be some

significant differences in the psychology andbasic demographics between the two groupsthat could be used by blood agencies in deve-loping campaigns to increase the likelihood ofdonation from a non-donor population.

Discussion

As blood donation organisations struggle togrow or indeed maintain the necessary stocksof blood, it is important to consider alternativeapproaches to motivate citizens to donate. Inattempting to grow bloodstocks, the basicstrategic choices are to increase the frequencyof donation or increase the number of donors.Increasing frequency, however, is problematicas donation restrictions apply. In reality theonly real strategy for the future is broadeningthe base of donors by attempting to motivatenon-donors to become active. This researchserves to highlight that not all non-donors arethe same and that recruitment campaigns maybe better implemented if they take intoaccount such differences.In this study, the regression analysis high-

lights the contribution made by each group of

factors with regard to intention to donate andfinds that perceived control, perceived timeconstraints and SN are the most significantpredictors. This is borne out in the analysis ofdifferences between higher and lower inten-ders. The difference between groups indicatesthat the differences regarding perceived satis-faction from donating, altruism and a fear ofneedles are significant. The issue of perceivedcontrol has also been identified in other studiesas significantly important in the determinationof intention to donate (Giles and Cairns, 1995;Armitage and Conner, 2001; Godin et al., 2005;Lemmens et al., 2005). Low intenders seethemselves as having a lack of control over theact of donation and also see themselves ashaving higher time-related barriers, whereasthe opposite is true of the higher intenders;although the means are still high for the higherintender group.

Amongst the group with a higher intentionto donate it is possible to identify the existenceof a higher sense of personal obligation (e.g.altruism — will save lives, SN — importantothers would approve). As Godin et al. (2005)suggest, this may mean that internalisation ofpersonal values towards blood donation islikely to be an important determinant ofdonation behaviour. Barriers to donationbrought about by beliefs related to time,distance, fear and risk of infectious diseaseswere also examined to identify any significantdifferences. Higher intenders felt they hadmore available time than lower intenders andalso felt less fear of needles, whilst nodifferences were found across distance anddisease barriers. Both groups, however, didfeel that perceived distance to a donationcentre was a significant issue. These results areconsistent with other research that looks atdifferences between donors and non-donors(Giles and Cairns, 1995; Armitage and Conner,2001; Godin et al., 2005; Lemmens et al.,2005).

From a communication and media perspect-ive the significant difference between thegroups is around the level of Internet usage.This may suggest that email and Internetchannels may be increasingly useful for


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targeting groups. Further, given their propen-sity for Internet this may extend to possible useof SMS and MMS as part of overall connectivity.Given the professional occupation skew in thedemographics the continued use route trafficplacement of posters and metrolites in areaswhere professionals are employed may alsofacilitate message exposure. The findings alsolend support for continuing the ARCBS’current program of attending workplaces fordonations. On-going use of other mass mediaformats is still likely to be necessary to drivesufficient frequency.From a message perspective marketers in

the area of blood donation will need to giveconsideration to the types of message strategyand execution tactics to employ. The strengthof the SN, PBC and Time Barrier Beliefs inexplaining intention provide insight into thepossible approaches to designing the messageaspect of motivating non-donors to activate.Similarly, the attitudinal differences betweenthe two groups suggest that message andcreative executions that link to self-satisfactionand altruism should be considered. It couldalso be argued that to further motivate thehigher intent group the appropriate messagesand imagery should:

� Link to positive emotions by reinforcing andillustrating the degree to which significantothers endorse and support blood donationand indeed positively portray the self-satis-faction to be gained from an altruistic act.

� Link to rational thoughts by reinforcing thecontrol that potential donors have over theact of giving, and establishing that the act ofgiving blood does not need to take too muchtime and is more convenient thanis currently perceived.

The findings from this exploratory studygive rise to a number of implications for furtherresearch. From a theoretical perspective, theregression results suggest that attitudinalvariables in the TPB had little relationshipwith intention to donate and that SN, PBC andone Control belief; time, were the mostsignificant predictor variables. These results

are generally in line with Giles and Cairns(1995), Holdershaw et al. (2003) and Godinet al. (2005) who similarly argued that themotivation to donate blood is influenced by theperception of self-control. In their 2004 paper,Giles et al. separate self-efficacy from PBC andprovide strong support for inclusion of this infurther research. Given the support for PBCwealso suggest that more work be done aroundthis area. Overall, we also support the con-tention that the TPB rather than the Theory ofReasoned Action tends to be the more app-ropriate model for investigating blood donation.To improve the overall explanation and

insight from studies of this type, it would beuseful to include a broader set of variables.Godin et al. (2005) for example, have devel-oped a more comprehensive model whichadds a greater number of external variables anddeepens attitudes to include cognitive andaffective components, and also includes ameasure of moral norm and descriptive normto the area of normative beliefs. Lemmens et al.(2005) also provide an extended TPB modelthrough the inclusion of perceived andassessed knowledge about blood donation todetermine how well informed prospectivedonors are about the act of donation. Suchinformation may be useful in the design ofmessages targeting different donor or non-donor groups. Further insight may also bederived from inclusion of items related to otherdonation behaviour in order to determine ifindividuals have a general propensity todonate.This research also used the Juster probability

scale as one mechanism for determininglikelihood of donation and whether groupsor segments can be formed around perceivedintention of non-donors. The Juster scaleattempts to capture probability of intentionto behave using the concept of ‘odds out often’ and is said to have good predictive validity(Day et al., 1991; Riquier et al., 1997). Whilstthe scale seemed to perform well in ourresearch we would suggest ensuring that thetimeframe around which intent to behave isframed is very specifically defined, forexample, shortening the likelihood of donation


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to ‘donating in the next week or two weeks’and possibly following through to determine ifactual behaviour has taken place. In line withboth Giles et al. (2004) and Holdershaw et al.(2003), the ability to examine the link betweenintent and behaviour would add further valueto the research, particularly if differentmessage or media strategies were employed.In conclusion, whilst the research has

identified that even within non-donors thereare those with a greater and lesser propensityfor donation, the question remains; just howdo blood agencies get higher intender non-donors to actually act on their positive feelingsand beliefs? The relatively diverse demo-graphic nature of non-donors means that it isa difficult task to have a sufficiently motivating‘one size fits all’ creative solution. Similarly,getting the message to such groups alsoremains difficult. Clearly, however, recognis-ing differences between the characteristics ofnon-donors, and more particularly those non-donors with a greater likelihood (or intention)to donate is not only a necessary butpotentially cost effective first step for man-agers in their attempts to satisfy the evergrowing need for blood donations.

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