Development Of Evaluation Scale For Motivation Of Non-remunerated Blood Donation And Study Of Influencing Factors On Donation Behavior

Background:In either developed or developing countries,the requirement for blood products keeps increasing throughout the world.As an active and efficient medical assistance,clinic transfusion saved the lives of millions of peoples every year.Meanwhile,some transfusion diseases may spread in the procedure of transfusion.WHO emphasizes that the periodic blood donation of non-remunerated volunteers is the only way to keep abundant and safe supply of blood products.Currently,the rate of blood donation is less than 1%in China mainland,which occupied one of the 30 countries and districts with the lowest blood donation rate.In order to obtain adequate and safe blood supply to meet the rapidly increasing demand in clinic,it is very important to recruit healthy people to participate in blood donation and set up a stable donation team.Therefore,it is necessary to understand the non-remunerated blood donor’s motivation and analyze the influencing factors on blood donor’s behaviors no matter in the recruitment or developing incentives to encourage blood donation.Most of the domestic research on blood donor’s motivation and influencing factors used the descriptive statistic analysis,which is lack of theoretical explanation and deserves further consideration.And the research on measurement tools of blood donor’s motivation in China has not been reported yet.This paper is organized based on a healthy behavior theory,and aims to develop the measurement tools on non-remunerated blood donor’s motivation and study the influence factors on blood donor’s behaviors.Research results can provide theoretical foundations to incent the motivation for non-remunerated blood donation and motivate the appearance of blood donation relevant behaviors.Research Problems:1.Adopt the systematical technique of scale development,the scale for non-remunerated blood donor’s motivation is developed under the framework of Protective Motivation Theory.Scale is designed for the domestic culture.It will provide a standard tool for studying the non-remunerated blood donor’s motivation in China.2.Carry out the investigations on population with donation-age,examine the scale’s applicability and screen the influencing factors on blood donor’s motivation based on the investigation results.3.Combine the scale for non-remunerated blood donor’s motivation with the investigations on demographic characteristics and the cognition on donation behavior,explore the formation of non-remunerated blood donor’s motivation and the influencing factors on blood donor’s behaviors and intention.Methods:1.Based on the framework of Protective Motivation Theory,analyze the operational definition,the content range and the internal structure of blood donor’s motivation.2.Compile the pool of evaluation items on non-remunerated blood donor ’s motivation by the means of reviewing relevant literatures,seeking for opinions from experts and open interviews,classify the item pool by specified structure.3.According to the importance and representativeness,items are scored by the focus group(donors,non-donors,experts)and the first edition of the scale is formed.4.Using scale of the first edition,carry out pretest at five mobile blood drives in Nanjing,Jiangsu,revise the scale according to results of pretest,and come into the test edition.Scale on prosocial behavior is granted in the process of testing in one of five blood points.Evaluate the level of acceptability and identification by using the response rate and item analysis,adjust the structure validity based on the exploratory factor analysis,evaluate the content validity by the correlation analysis between items and dimensions or between different dimensions,derive the criterion validity based on the correlation coefficient analysis between the score of the prosocial behavior and blood donor’s motivation.In the analysis of the reliability,the scores of two scales with four weeks’ interval are used to evaluate retest reliability,Cronbach a coefficient and split-half coefficient are used in evaluating internal consistency reliability of the scale.5.The investigation is carried out by stratified random sampling at 13 blood points from 4 cities in Jiangsu.Relevant research includes evaluating how well the scale’s measurement coincides with blood donor’s motivation.Analyze the scale’s structure validity by confirmatory factor analysis and the content validity by correlation analysis respectively.The internal consistency reliability is evaluated by split-half reliability coefficient and Cronbach a coefficient.6.Reports on the demographic characteristics and the cognition on non-remunerated blood donor’s motivation are depicted by descriptive statistical analysis.Differences of motivation among different groups are compared by one-way analysis of variance.The impact of blood donor’s motivation on the intention of donation is analyzed by multi-variables linear regression.The influences on blood donor’s behaviors are studied by logistic regression analysis.Results:1.Item pool and the first edition of the scale82 evaluating items on non-remunerated blood donor’s motivation are collected by synthesizing the literatures,interviews and evaluations from experts.The collected items are primarily decomposed into 2 procedures,7 dimensions according to analysis of protective motivation regarding the risk-profit of individual’s behaviors and cognition on the ability to donate blood.After evaluating the importance and the representation of the dimensions by the focus group,50 items are selected and the first edition of the scale is formed.2.Results of the pretest1)519 valid questionnaires are collected in the pretest.The effective collection rate is 91.3%,and the response rate of all items is between 79%and 100%.Item analysis indicates that 4 items have no statistical significance.2)In the analysis of validity,structure of scale with first-order eight factors and second-order two factors are established after four rounds of exploratory factor analysis.The cumulative contribution rates are 0.5402 and 0.5181,respectively.In the analysis of criterion validity,scores of five positive factors are positively associated with prosocial behavior.3)In the reliability analysis,the split-half reliability of first-order eight factors lies between 0.446 and 0.708.Except for Severity and Response Cost,other items’Cronbach a coefficients are higher than 0.7 and the retest reliability lies between 0.483 and 0.781.The adjusted scale is based on the results of the pretest,which includes 8 dimensions and 42 items.3.Scale assessment1)2901 valid questionnaires are collected from the investigation at 4 cities in Jiangsu.According to the blood donation experience,904 of the interviewees have never donated blood(non-donor),1505 of them have donated blood occasionally(occasional donor)and 492 of them donate frequently(fixed donor).The valid collection rate is 90.7%,and the response rate of all items lies between 80.8%and 100%.2)In the confirmatory factor analysis,x2/df exceeds 5 slightly,and other fitting indexes all lie in the acceptable scope.3)In the reliability analysis,the split-half reliability of first-order eight factors lies between 0.351 and 0.72.Except for the Severity and Resistance,other factors’Cronbach a coefficients are larger than 0.7.4)After two rounds of adjustment,the scale includes 8 dimension,2 evaluating procedures and 41 items.4.Univariate analysis of blood donor’s motivationThe differences of blood donor’s motivation among three groups are significant.The analysis shows that blood donors get higher scores in the positive motivation and lower scores in the negative motivation than the non-donors.Motivation of blood donation has low correlation with age.Among the eight first-order factors,only differences of Fear and Self-efficacy between the genders are statistically significant.The blood donor’s motivations among groups with different schooling have statistical significance.5.Cognition difference on non-remunerated blood donationThere are no significant differences among three groups regarding knowledge on blood shortage and price.The knowledge to incentive policies and impact on health of blood donation has statistical differences.However,only 41%of occasional donors and 60%of the fixed donors know the exact quantity of donation with which donors can use blood freely for a life-long time.The level of knowledge for non-remunerated blood donation is positively associated with the educated level.6.Analysis of influencing factors on blood donation intention and behaviorIn the prediction of donation intention based on blood donor ’s motivations,factors entered include Self-efficacy,Intrinsic reward,Severity,Response cost,Extrinsic reward and Fear,totally explain 48.6%variation in the intention of blood donation.In the prediction of blood donor’s behavior,Intrinsic reward,Self-efficacy and Resistance increase the possibility of blood donation,whereas Fear and Severity decrease the possibility of blood donation.Prediction of donation intention and fixed donation behavior has a better effect than prediction of ordinary donation behavior by motivationConclusions:1.The developed scale for non-remunerated blood donor’s motivation contains 8 dimensions:Stress,Intrinsic reward,Extrinsic reward,Self-efficacy Severity,Response cost,Fear and Resistance,which has relatively high reliability and validity and reflect the actual contents and scope of the blood donor’s motivation.Therefore,it is applicable to quantitatively evaluate non-remunerated blood donor’s motivation.2.Fixed donors have the highest positive motivation,followed by occasional donors and non-donors.The result is opposite for negative motivation.The motivation of blood donation explains intention of donation very well buy not for donation behavior.It indicates that determination of motivation to donation behavior is affected by internal and external factors.The effective estimation of personal ability to donate can prompt the formation of blood donor’s behaviors.The main negative contribution of blood donation is the fear in the process of blood donation.The resistance around individuals(companions or family members)and extrinsic reward have little effect on the donors.3.Although the donors and non-donors pay much attention to the return and check of blood from current incentive policies,the attention is generated from the responsibility for personal health but not attracted by policies themselves.In the process of donor’s recruitment,strategies should start from the characteristics of public interest and non profit.According to donors’ motivation,interventions should be designed to enhance sense of self-efficacy and alleviate the psychological pressure among different groups.