Increase the Canadian Rate of Altruistic Blood Donation Discussion

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relevant aspects of altruism https://opentextbc.ca/socialpsychology/chapter/understanding-altruism-self-and-other-concerns/

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Efficacy of Interventions Promoting Blood Donation: A Systematic Review Gaston Godin, Lydi-Anne Vézina-Im, Ariane Bélanger-Gravel, and Steve Amireault Findings about the efficacy of interventions promoting blood donation are scattered and sometime inconsistent. The aim of the present systematic review was to identify the most effective types of interventions and modes of delivery to increase blood donation. The following databases were investigated: MEDLINE/PubMed, PsycINFO, CINAHL, EMBASE, and Proquest Dissertations and Theses. Additional studies were also included by checking the references of the articles included in the review and by looking at our personal collection. The outcomes of interest were either blood drive attendance or blood donations. A total of 29 randomized controlled trials or quasiexperimental studies were included in the review, detailing 36 interventions tested among independent samples. Interventions targeting psychosocial cognitions (s = 8, s to represent the number of independent samples; odds ratio [OR], 2.47; 95% confidence interval [CI], 1.42-4.28), those stressing the altruistic motives to give blood (s = 4; OR, 3.89; 95% CI, 1.03-14.76), and reminders (s = 7; OR, 1.91; 95% CI, 1.22-2.99) were the most successful in increasing blood donation. The results suggest that motivational interventions and reminders are the most effective in increasing blood donation, but additional studies are needed to evaluate the efficacy of other types of interventions. © 2012 Elsevier Inc. All rights reserved. LOOD AGENCIES ARE investing much effort to recruit new blood donors and to ensure that those who have donated return for additional donations. This preoccupation is wellfounded given that, according to the American Red Cross, only 3% of the population gives blood [1]. To further complicate matters, blood donation is a cyclic process in which once an individual has donated blood, he/she must wait a certain time (eg, 56 days) before being eligible to give blood again [2]. Moreover, many medical and nonmedical reasons such as foreign traveling can prevent someone from successfully giving blood [2]. This is done to ensure donor and recipient safety [3]. Effective interventions to retain blood donors and recruit new donors are thus imperative to maintain a safe and sufficient level of blood supply. In a previous review on the motives and the characteristics of blood donors, Piliavin [4] made an inventory of potential successful approaches to increase blood donation, particularly among first- time donors. For instance, this author suggested that an increase in the perception for the need of blood in the community and in the perception of the adequate support for blood donation provided in these communities as well as the use of modeling were promising approaches to increase blood donation. The author also observed that face-toface solicitations, the use of personal reminders, and the foot-in-the-door technique (consisting of a small request followed by a bigger one) appeared to be effective techniques to motivate individuals to give blood, given that individuals are sensitive to social pressure. These observations were also supported in a more recent review by Ferguson et al [5], in which the use of reminders and the footin-the-door technique were mentioned as effective strategies to favor blood donation. Mixed evidences were observed concerning the efficacy of interventions aimed at increasing altruistic motives vs the use of different forms of incentives [4]. However, as pointed out earlier by Piliavin [4], the use of incentives might undermine the development of an altruistic motivation and provoke a backfire effect on future donations among active blood donors. Moreover, in a recent review of the literature among active blood donors, Ringwald et al [6] mentioned that the use of incentives might not be the best strategy to keep long-term and committed blood donors given that as a donor advances in his/her career, his/her motives for giving blood become more internalized. The role of altruism also needs some consideration. According to a deeper analysis by Ferguson et al [5] B From the Canada Research Chair on Behaviour and Health, Laval University, Québec, Canada; Faculty of Nursing, Laval University, Québec, Canada; and Department of Social and Preventive Medicine, Laval University, Québec, Canada. The authors declare that they have no conflict of interest. Address reprint requests to Gaston Godin, PhD, Canada Research Chair on Behaviour and Health, Laval University, Québec, Canada G1V 0A6. E-mail: gaston.godin@fsi.ulaval.ca 0887-7963/$ - see front matter © 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.tmrv.2011.10.001 224 Transfusion Medicine Reviews, Vol 26, No 3 (July), 2012: pp 224-237.e6 INTERVENTIONS PROMOTING BLOOD DONATION of previous studies aimed at promoting blood donation with the use of the altruism concept, results seem to provide more support for the use of the moral norm concept or the benevolence response rather than pure altruism. Consequently, the role of altruism in the promotion of blood donation has to be more clearly defined to further increase the efficacy of such interventions. Bednall and Bove [7] also did a review of selfreported motivators and deterrents of blood donation. In particular, they verified that the motives behind blood donation differed among different types of donors (first-time, repeat, lapsed, apheresis, and eligible nondonors). They concluded that, among first-time and repeat donors, the most common motivators were convenience (eg, blood drive nearby), prosocial motivation (eg, altruism), and personal values (eg, moral norm). They also identified several deterrents among which the most frequently mentioned barrier was low self-efficacy to donate (eg, ability to overcome barriers such as lack of time). Notwithstanding the very useful information provided by these previous reviews concerning the potential efficacy of different strategies to increase blood donation, none of them systematically reviewed the literature and provided information on the effect sizes of such approaches. In addition, in the review by Ferguson et al [5], studies whose outcome was the intention or willingness to give blood were also included in their narrative analysis. Acknowledging the scientific evidence that intention is identified as one of the most important determinants of blood donation [2], it is, nonetheless, well documented that not all people will act on their stated intention, that is there is an “intention-behavior gap” [8]. Moreover, in a review by Webb and Sheeran [9] on the effectiveness of interventions to promote health-related behaviors, it was observed that a medium-to-large effect size in increasing levels of intention leads to a small-to-medium effect in changing behaviors. Consequently, the efficacy of interventions on blood donation and not only intention or willingness has to be determined. To our knowledge, there is no systematic review on the efficacy of interventions to promote blood donation. Thus, the objective of the present systematic review was to identify the most effective types of interventions and their modes of delivery to increase blood donation. 225 METHODS Study Eligibility Criteria The focus of the present systematic review was on interventions aimed at increasing blood donation among the general population (ie, recruitment studies) and blood donors (ie, retention studies). Studies aimed at increasing different or specific types of donations such as bone marrow donation or apheresis were not included in the present review. To evaluate the efficacy of interventions, only experimental and quasi-experimental studies were included in the review; studies adopting a 1-group pre-post design were excluded. Studies concerned with different stages in the lifetime experience of blood donors, that is, novice, experienced, lapsed, or temporarily deferred donors, were included. According to Masser [10], individuals who already gave blood once were considered as novice donors (also referred to as first-time donors), and individuals who already gave blood more than once were considered as experienced donors (also referred to as repeat donors) 1. Studies interested in lapsed donors (ie, individuals who already gave blood in the past but who did not donate blood in the past 2 years without any known cause for permanent or temporary deferral [11]) or temporarily deferred donors (ie, individuals who attended a blood center but were not eligible to donate blood for a certain period because of various medical reasons [12]) were also considered in the present systematic review. Studies reporting results on the attendance at a blood drive or the number of successful blood donations after the exposure to an intervention were both included in the present systematic review. Attendance was defined as the number of participants who registered at a blood drive. This outcome was chosen given that although some individuals can be deferred for various medical reasons, attendance takes into account the fact that participants had acted toward their goal of giving blood after the exposure to the intervention [13,14]. To avoid duplication of the results, attendance was primarily used in the statistical analyses in cases where attendance and the number of actual blood donations were both provided in a given study. Studies reporting the results of an 1 Other classifications can be found in the scientific literature (eg, Ferguson and Bibby (2002): occasional, b5 donations; regular, ≥5 donations). 226 GODIN ET AL intervention on the level of intention or willingness as well as studies reporting results in terms of physiologic reaction, stress, and symptoms related to blood donation were excluded from the present systematic review. Search Strategy The following databases were investigated: MEDLINE/PubMed (1950+), PsycINFO (1806+), CINAHL (1982+), and EMBASE (1974+). Proquest Dissertations and Theses (1861+) was also investigated for gray literature (ie, unpublished trials). No restriction was placed on the year of publication of the articles. The search was performed between June 8 and July 31, 2010. In all the databases, the search terms were always related to 2 themes, that is, blood donation and intervention (see Table 1). In MEDLINE/PubMed, a combination of keywords and MeSH terms was used. In PsycINFO, only keywords were used because no psychological index terms corresponded to blood donation and intervention. In CINAHL, a combination of keywords and descriptors was used. In EMBASE, a combination of keywords and Emtree terms was used. Finally, in Proquest Dissertations and Theses, only keywords were used. The search was limited to studies published in English. Additional studies were also included by checking the references of the articles included in the systematic review (ie, secondary references) as well as by looking at our personal collection of articles on blood donation. Data Extraction Data were independently extracted by GG and LAVI using a standardized data extraction form (see Table 2). Disagreements were resolved by discussion. Before extracting the data, several decisions were made. First, in instances where there was more than 1 experimental group in a study, only the group that had the greatest impact on blood donation was Table 1. Search Terms Used for Investigating All 5 Databases Keywords Theme 1: blood donation Theme 2: intervention Blood donation OR Blood donor OR Blood bank Intervention OR Program OR Education considered and compared with the control group. This decision was taken given that the main objective of the present review was to verify which types of intervention were more successful in increasing blood donation and also because this group corresponded to the hypothesis stated in the articles included in the meta-analysis in 90% of the cases. Second, when several tests of an intervention were performed among independent samples but reported in 1 article, these were all included in the analysis (ie, studies 1 and 2). Consequently, the number of independent comparisons in the meta-analysis might be more important than the number of included studies in some of the subgroup analyses. Finally, authors were personally contacted by e-mail for additional information when necessary. Interventions were classified according to an adapted version of the categorization proposed in a recent review by Ferguson et al [5] (see Table 3). These authors regrouped the social interventions into 4 types: (1) altruism-egoism, (2) reminders and commitments, (3) foot-in-the-door, and (4) intention based. Social interventions were aimed at increasing blood donation and were mainly focused on recruitment. They also identified behavioral interventions that can be classified in 3 categories: (5) distraction, (6) muscle tension, and (7) caffeine and water loading. These behavioral interventions are primarily aimed at reducing unpleasant symptoms associated with blood donation and mainly focused on retention of donors. The first category of social interventions included interventions that use manipulations of altruism and egoism to encourage blood donation. In the present review, however, the interventions based on altruism were imbedded in a larger motivational category that included all the interventions aimed at increasing motivation toward blood donation. These studies used techniques such as providing information about positive or negative consequences of blood donation, barriers management, modeling, comparison with the social norm, providing feedback and praise, and other. However, given the importance of the concept of altruism in the literature on blood donation, the independent efficacy of interventions based on altruism was compared with the efficacy of other motivational interventions in the subgroup analyses. The second category included interventions generally focusing on retention that use a reminder, such as a telephone call, before INTERVENTIONS PROMOTING BLOOD DONATION 227 Table 2. Information Contained in the Data Extraction Form Type of information Subcategory Main objective of the study Recruit new donors Encourage donors to return Both objectives Unspecified Potential donors/general population Novice donors Experienced donors Unspecified Randomized, controlled trial Quasi-experimental design Type of assignment Strategy used for assignment Technique used for assignment Person who performed assignment Type of control group Motivational Reminders Measurement of cognitions Incentives Muscle tension Face-to-face By mail (eg, letter) By telephone (eg, telephone call prompt) By e-mail By tape recorder Mix Yes No Registrations at a blood drive Blood donations Both Type of behavioral measure Validation of the measure Size Attrition at postintervention Attrition at follow-up Characteristics of participants at baseline Equivalence of groups at baseline Dropout analysis Statistical test used Intention to treat Covariates Technique to replace missing data Percentage of participants who registered at a blood drive Percentage of participants who gave blood Other Population of the study Study design Group allocation Type of intervention Mode of delivery Use of a theory Behavior measured Behavioral measure Sample Statistical analyses Results of the intervention the blood drive takes place. The third category was the foot-in-the-door [15] or door-in-the-face [16] interventions that are well-known techniques issued from the social psychology literature. The last category, that is, the intention-based category, initially included interventions that manipulated intentions. Given that the intention-based category was too specific to the measurement of intention, a new category was created (ie, measurement of cognitions or the question-behavior effect) to include all studies that measured cognitions with the specific objective of promoting blood donation. Finally, the use of incentives (financial or not) was added as a separate category, and the behavioral categories were classified using the description provided by Ferguson et al [5]. All of 228 GODIN ET AL Table 3. Classification of the Interventions Based on the Categorization of Ferguson et al [5] Type of intervention Motivational Cognitions based Foot-in-the-door/door-in-the-face Altruism Modeling Reminders Measurement of cognitions Incentives Muscle tension Definition Interventions aimed at increasing motivation toward blood donation Interventions targeting psychosocial cognitions related to motivation, such as social norms, attitudes, and barriers Interventions using the foot-in-the-door, the door-in-the-face, or a combination of both techniques to motivate people to give blood Foot-in-the-door involves asking a small request that should be accepted and then asking a critical large request. Door-in-the-face involves asking a large request that should be refused and then asking a critical small request. Interventions using altruistic motives to motivate people to give blood Interventions showing another person giving blood to motivate people to give blood Interventions using reminders about the next eligibility date and/or the next appointment to give blood (eg, telephone call prompt) Interventions using the completion of a questionnaire about the intention to give blood to activate cognitions about blood donation (eg, question-behavior effect) Interventions using incentives for donating blood such as a T-shirt, money, prizes, tickets, and other Interventions using the contraction of muscles during blood donation to avoid dizziness and fainting the interventions were independently classified according to their type by LAVI and ABG, and disagreements were resolved by a third reviewer (GG). Data Analyses Descriptive statistics of the studies, such as frequencies and means, was analyzed using SAS version 9.1 (SAS Institute, Cary, NC). All the other statistical analyses were done using Cochrane's Review Manager 5.1 (The Nordic Cochrane Center, Copenhagen, Denmark) [17] statistical software. To compute pooled effect sizes, a random-effect model using the Mantel-Haenszel method was chosen for all the analyses because we assumed that the magnitude of the effect sizes would vary across studies given the difference in samples and interventions across studies [18]. When computing the pooled effect size, each study was weighted according to its sample size. Between-study heterogeneity was verified by using 2 common statistical approaches: a χ 2 test (Cochran's Q) and the I 2 statistic [19], representing the percentage of total variation in estimated effects that is due to heterogeneity rather than chance. A significant Q statistic (P b .05) indicates significant heterogeneity between the studies, whereas an I 2 statistic of 25% is considered low heterogeneity; 50%, moderate heterogeneity; and 75%, high heterogeneity [20]. To test the robustness of the results, separate 80% prediction intervals (PIs) were calculated for each pooled effect size (see Supplementary file 1 online for the formula used). The computation of PIs is recommended when confronted with a randomeffect meta-analysis that has a low number of studies and high heterogeneity [21]. Prediction intervals show the distribution of effect sizes around the pooled effect size. The effect sizes of intervention studies were reported as odds ratios (ORs) given that most of the outcomes were reported as dichotomous data (ie, the proportion of attendance or blood donation in the experimental group compared with the control group). Unless otherwise stated, all effect sizes are zero order (ie, no covariates are included in the computation of the effect size). The ORs were also converted to Cohen's d [22] to facilitate interpretation and allow comparison with standard effect sizes reported in other studies. A Cohen's d of 0.20 is considered a small effect size; 0.50, a medium effect size; and 0.80, a large effect size [22]. The efficacy of the interventions according to type of intervention and mode of delivery was also examined by means of prespecified subgroup analyses. However, pooled effect sizes were computed only when the category contained results from a minimum of 3 independent samples. Finally, publication bias was assessed by visually inspecting the distribution of the funnel plot in RevMan 5.1 (The Nordic Cochrane Center) in instances where there were about 10 studies per category [23]. INTERVENTIONS PROMOTING BLOOD DONATION RESULTS The results of the search strategy are presented in Figure 1 [24]. A total of 29 studies (k = 29) were included in the present review, detailing 36 different interventions tested among independent samples (s = 36). In the rest of the text, the letter k will be used to represent the number of studies, and the letter s to represent the number of independent samples. Characteristics of the Interventions A summary of the interventions is given in Supplementary file 2. When no effect sizes could be 229 calculated because of missing information such as the number of participants per condition, the original results are reported. Most interventions were aimed at retaining current donors (s = 12) or both recruiting new donors and retaining donors (s = 8). One intervention had the objective to recruit new donors. In 15 interventions, the objective did not clearly specify if it was more about recruiting or retaining blood donors or vice versa. Again, few studies clearly specified the type of donors targeted by the intervention; only 6 studies mentioned this information (novice donors, s = 5; experienced donors, s = 1). Given that more than 3 studies were targeting novice donors, a pooled effect size was Fig 1. Preferred reporting for systematic reviews and meta-analyses flowchart [24]. 230 GODIN ET AL calculated (s = 5; OR, 1.21; 95% confidence interval [CI], 1.10-1.32; Q = 1.68; P = .80; I 2 = 0%); it represented a small effect size (d = 0.11). No significant heterogeneity between the studies was detected. Unfortunately, given the low number of studies, no pooled effect sizes could be calculated for other types of donors, such as experienced, lapsed, and deferred donors. Of the 36 interventions included in the review, 24 were randomized controlled trials, although most of them (s = 16) did not provide information on the randomization procedure. The other 12 interventions either adopted a quasi-experimental design (s = 3) or did not provide information about the design adopted (s = 9). Although it would have been interesting to compare the difference in effect sizes between both pure and quasi-experimental studies, 2 problems arose: (1) many studies did not specify their study design (s = 9) and (2) older studies tended to have little information about their randomization procedure compared with more recent studies; this phenomenon could reflect different editorial requirements through the years. Twenty-one interventions were clearly based on a theory. The theories most frequently used to design interventions promoting blood donations were the self-perception theory [25] (s = 4), the social learning/social cognitive theory [26,27] (s = 4), the theory of reasoned action [28] and its extension, the theory of planned behavior [29] (s = 4), and Schwartz's norm activation theory [30] (s = 2). Characteristics of the Participants Only 12 studies provided information on the age of their participants. The mean age of the participants was 25.72 ± 8.61 years (range, 18-44.3 years). Eighteen interventions were conducted among samples of college students, and 3 others, among samples of high school students. Seventeen interventions indicated the percentage of male participants in their sample. A little less than half (44.8%) of the samples were composed of male respondents. Three interventions mentioned having samples containing participants of both sexes without specifying the percentage of male respondents. One intervention had a sample exclusively of female participants. The typical sample was thus composed of college students with slightly more than half being female students. Efficacy of the Interventions A summary of the pooled effect sizes computed, their heterogeneity, and their robustness is presented in Table 4. Where exact information about numbers of participants or effect sizes were missing [31-35], we attempted to obtain the relevant information directly from the authors. In 3 cases [33-35], we were unable to obtain this information. Thus, of the 29 studies describing 36 Table 4. Pooled Effect Sizes, OR with 95% CIs Variable Type of intervention Motivational Cognitions based Foot-in-the door/door-in-the-face Altruism Reminders Measurement of cognitions Mode of delivery Face-to-face Mail Telephone Mix of modes s n OR (95% CI) 20 8 6 4 7 3 37 102 23 198 1303 7619 286 615 6812 2.09 (1.64-2.67) 2.47 (1.42-4.28) 1.86 (1.02-3.39) 3.89 (1.03-14.76) 1.91 (1.22-2.99) 1.23 (1.06-1.41) 5 4 10 10 239 5536 287 882 15 896 2.57 1.25 2.41 1.60 (1.29-5.11) (1.12-1.40) (1.38-4.20) (1.27-2.00) Q I2 (80% PI) 117.21 ‡ 42.18 ‡ 12.72 ⁎ 51.43 ‡ 19.71 † 3.01 84% 83% 61% 94% 70% 34% (1.23-3.53) (0.88-6.97) (0.74-4.69) (0.30-50.96) (0.91-4.01) (0.85-1.79) 5.14 2.49 84.50 ‡ 40.23 ‡ 22% 0% 89% 78% (1.11-5.95) (0.89-1.76) (0.77-7.50) (1.07-2.39) NOTE. I2 is an indicator of heterogeneity. Twenty-five percent is considered low heterogeneity; 50%, moderate heterogeneity; and 75%, high heterogeneity. ⁎ P b .05, significant heterogeneity (Q statistic). † P b .01, significant heterogeneity (Q statistic). ‡ P b .001, significant heterogeneity (Q statistic). INTERVENTIONS PROMOTING BLOOD DONATION interventions, 26 studies describing 33 interventions among independent samples could be included in the meta-analysis. Motivational Interventions Twenty-two interventions [32,33,36-50] were classified in the motivational category. However, 2 interventions [33,48] did not report the number of participants in their samples and were thus excluded from the meta-analysis. The study of Evans [33] reported nonsignificant results (P = .67), whereas the study of Sarason et al [48] had significant results (P b .01). The pooled effect size (s = 20) indicated that motivational interventions were successful in increasing blood drive attendance, and this represented a small-to-medium effect size (d = 0.41). Significant heterogeneity between the studies was detected, which justified subgroup analyses. The 80% PI indicated, however, that the significant result was robust. Cognitions-Based Interventions Nine interventions [32,33,36,38,41,43,44] were classified as cognitions based because they were targeting psychosocial cognitions related to motivation, such as social norms, attitudes, and barriers. However, 1 intervention [33] could not be entered in the meta-analysis because it did provide the number of participants per condition (ie, in the experimental and control groups). This study reported nonsignificant results (P = .67). The pooled effect size (s = 8) indicated that cognitions-based interventions were successful in increasing attendance at blood drives, and this represented a medium effect size (d = 0.50). Significant heterogeneity was detected, and examination of the 80% PI indicated that the result should be interpreted carefully. Moreover, the examination of the funnel plot (see Supplementary file 3 online) indicated that there is probably a publication bias [23]. Foot-in-the-Door and Door-in-the-Face Techniques A total of 6 interventions [37,40,42,46] were using the foot-in-the-door, the door-in-the-face, or a combination of both techniques to encourage people to give blood. The pooled effect size (s = 6) indicated that these types of interventions were successful at increasing attendance at blood drives. When the pooled OR was converted to Cohen's d [22], it 231 represented a small-to-medium effect size (d = 0.34). The Q statistic indicated that there was significant heterogeneity between the studies, although the I 2 statistic was still below 75%. The 80% PI indicated that the result is not very robust. Altruism Four interventions [39,45,50] aimed to increase blood donation by stressing the altruistic reasons to give blood. The pooled effect size (s = 4) revealed that this kind of intervention was successful in increasing blood drive attendance; this represented a medium-to-large effect size (d = 0.75). Significant heterogeneity between the studies was detected, and the 80% PI was very large, which indicates that the result is not robust at all. Modeling Three interventions [47-49] were using modeling, such as showing a model giving blood, to increase blood donations. However, 1 study [48] did not report the exact number of participants in their experimental and control groups. This study by Sarason et al [48] reported that their intervention had significant results (P b .01). Given that only 2 studies could have been entered in a metaanalysis, no pooled effect size was computed for this type of intervention. Examination of the individual effect sizes of the studies indicated that all the studies reported significant results (Rushton and Campbell [47]: OR, 39.67; 95% CI, 1.281229.87; and Sarason et al [49]: OR, 1.25; 95% CI, 1.06-1.47). Additional studies will be needed before any effect size can be computed about the efficacy of interventions that use modeling to increase blood donation. Reminders Seven interventions [51-55] were using reminders, such as telephone call prompts, as a means to increase blood donations. The pooled effect size (s = 7) for this type of intervention indicated that they were successful in increasing attendance at blood drives, and this represented a small-to-medium effect size (d = 0.36). Significant heterogeneity between the studies was detected, and the 80% PI was close to significance, which indicates that the result is somewhat robust. The inspection of the funnel plot (see Supplementary file 4 online) indicated the likely presence of a publication bias [23]. 232 GODIN ET AL Measurement of Cognitions Modes of Delivery Three interventions [13,56,57] used answering questions about cognitions related to blood donation to increase this behavior. One study [57] reported a continuous outcome (ie, mean number of blood donations), which allowed the calculation of a standard mean difference (SMD). This SMD was then converted to an OR to pool it with the rest of the studies (see Supplementary file 5 online for the formula used). The pooled effect size (s = 3) indicated that interventions using the measurement of cognitions are effective in increasing blood donation and that no significant heterogeneity was detected. Once converted to Cohen's d, the pooled effect size represented a small effect size (d = 0.11). The 80% PI, however, indicated that the result should be interpreted carefully. The efficacy of interventions according to their mode of delivery was also evaluated. In 1 intervention [41], a brochure was used to contact participants, but it was not specified if it was sent by mail or if it was given in person, thereby making it impossible to classify its mode of delivery. Incentives Two interventions [34,58] used incentives, such as tickets to a Broadway play and a college football game, gift certificates, prizes, free meals, and other, to increase blood donation. One intervention [34] did not report the exact number of study participants but stated that the intervention was successful in increasing blood drive attendance (P b .01). The other study by Ferrari et al [58] also had significant results (OR, 3.86; 95% CI, 1.47-10.13). The low number of studies using incentives and the fact that only 1 study reported the information necessary to compute an effect size precluded any meta-analysis. Additional studies will be needed to verify the accuracy of the present finding and before any definite conclusion can be reached about the efficacy of incentives to increase blood donation. Muscle Tension Two interventions [31,59] used muscle tension to decrease negative symptoms associated to blood donation such as dizziness and fainting to increase blood donors return. Given the low number of studies using this technique, no effect size was computed. Examination of the individual effect sizes indicated that both studies had nonsignificant results (Ditto et al [59]: OR, 1.48; 95% CI, 0.95-2.30; and Ditto et al [31]: OR, 1.16; 95% CI, 0.82-1.66). Additional studies will be needed to verify the definite efficacy of muscle tension on blood donation. Face-to-Face A total of 6 interventions [34,37,40,43,47,58] were delivered face-to-face. However, 1 study [34] did not report the exact number of participants in their intervention but still presented significant results (P b .01). The pooled effect size was thus computed on 5 studies, and it indicated that interventions delivered face-to-face are effective in increasing attendance at blood drives. This represented a medium effect size (d = 0.52). No significant heterogeneity between the studies was detected, and the 80% PI indicated that the result is robust. Mail Four interventions [13,46,53] were delivered by mail, such as the mailing of a brochure, a letter, or a questionnaire. The pooled effect size (s = 4) indicated that interventions using this mode of delivery were effective in increasing blood drive attendance, and this represented a small effect size (d = 0.12). No heterogeneity between the studies was detected, and the 80% PI was close to significance, which indicates that the result is somewhat robust. Telephone A total of 11 interventions [32,33,38,40,42,5052,54,55] were delivered by telephone, such as telephone call prompts, making it the most common mode of delivery. However, 1 study [33] did not report the number of participants per condition and was thus excluded from the meta-analysis. This study by Evans [33] reported that its intervention did not significantly increase blood donation in the experimental condition (P = .67). The pooled effect size (s = 10) for interventions delivered by telephone indicated that this mode of delivery was effective in increasing blood drive registration, and this value was very close to a medium effect size (d = 0.49). Significant heterogeneity was detected, and the 80% PI indicated that the results should be INTERVENTIONS PROMOTING BLOOD DONATION interpreted carefully. In addition, the visual inspection of the funnel plot (see Supplementary file 6 online) indicated that there might be a publication bias [23]. Tape Recorder One study [39] that reported 2 interventions carried out on 2 different samples mentioned using a tape recorder to deliver the interventions. Given the low number of studies, no pooled effect size was computed. Examination of the individual effect sizes indicated that this mode of delivery is effective in increasing blood drive attendance (Ferrari and Leippe [39], study 1: OR, 2.24; 95% CI, 0.36-13.78; study 2: OR, 22.14; 95% CI, 2.58190.16). Additional studies are needed before a definite conclusion about the efficacy of interventions delivered by tape recorder can be reached. E-mail Only 1 study [56] mentioned the use of an e-mail to conduct its intervention. Examination of the effect size indicated that this mode of delivery is effective (OR, 2.44; 95% CI, 1.04-5.73) and represents a small-to-medium effect size (d = 0.45). Mix of Modes of Delivery A total of 11 interventions [31,36,40,44,45,48, 49,57,59] were using a combination of different modes of delivery, such as a letter delivered by mail and a telephone call or instructions given face-to-face and a video presentation. However, 1 study [48] did not provide the exact number of participants in its experimental and control groups and was thus excluded from the meta-analysis. This study by Sarason et al [48] reported a significant difference in the number of blood drive registrations between the experimental and the control groups (P b .01). The pooled effect size (n = 10) indicated that interventions using a mix of different modes of delivery were successful in increasing attendance at blood drives. This represented a small-to-medium effect size (d = 0.26). Significant heterogeneity was detected, but the 80% PI indicated that the result is robust. DISCUSSION According to our review, the first studies reporting interventions to increase blood donation were published in the 1970s. Therefore, it is rather surprising that more than 4 decades later, the 233 number of papers available in the scientific literature is low (n = 29). When we look at the flowchart (see Fig 1), this phenomenon does not seem to originate from the fact that many interventions did not report a behavioral outcome (n = 25) or that studies adopted a 1-group pre-post design (n = 3) but, rather, that the literature in blood donation has mainly focused on identifying the motives of blood donors by means of surveys (n = 102). Effective Interventions Earlier reviews [5,60] also identified reminders, such as telephone call prompts to inform donors of the time, date, and location of blood drives, as an effective means to increase blood donation. Moreover, the results of a recent study conducted among first-time donors indicated that a telephone call reminder about the upcoming opportunity to give blood increases the number of donors who return and that they also return more quickly compared with those not telephoned [61]. Telephone calls act as a “cue-to-action,” that is, they represent an environmental cue that is used to remind people to perform a given behavior [62]. In the present review, cognition-based interventions included all interventions targeting psychosocial constructs underlying motivation, such as social norms, attitudes, and barriers (for a complete taxonomy, see Michie et al [63]). The effectiveness of this type of intervention at increasing blood donations provides further support to previous observations that intention, a construct expressing ones' motivation toward a given behavior, is one of the main determinants of blood donation [2,64]. This observation is also in agreement with the theory of planned behavior [29], a model that already has been successfully applied to predict blood donation [64-66]. Interventions based on altruism seemed to be effective in encouraging people to give blood. However, this result should be interpreted carefully given that quantification of the efficacy proved difficult. Earlier reviews [4,60] already noted that most donors cite altruistic motives as the main reason to give blood. It was also suggested that women and young people respond well to altruistic appeals [60]. Thus, given that most interventions were offered at samples of college students with slightly more than half of these samples containing female students, this might explain the efficacy of this type of interventions. It remains to be 234 documented if appeals to altruism are effective among older male samples. In the present review, interventions using the measurement of cognitions were also effective to increase attendance at blood drives. The impact of this type of intervention on behavior is generally considered as the question-behavior effect or the mere-measurement effect. According to the question-behavior effect, asking questions on relevant cognitions can change behavior [67]. It was not surprising that only 3 studies were identified in that category given that the literature on the questionbehavior effect is still in its infancy; only recently has such an effect been observed in blood donation [13,57]. It will thus be important to obtain additional information on the type of questions that provoke taking action as well as the potential moderators of this effect (eg, level of experience with blood donation). Interventions Whose Efficacy Could Not Be Determined Caution should be exercised before concluding that offering incentives is an effective way to encourage blood donation because only 2 studies tested this approach, and no effect size could be computed. It is also noteworthy that incentives were sometime used in combination with other intervention components (eg, altruistic motives to give blood and T-shirt). Other reviews [4,60] have indicated that there was little evidence that the use of incentives such as money, prizes, and similar tokens were effective in increasing blood donation. There is even evidence that they may actually decrease donations by decreasing the altruistic motives to give blood [5,60]. In the present review, the foot-in-the-door and the door-in-the-face techniques emerged as effective methods to increase blood donation, although the result is not very robust. Piliavin [4] already acknowledged that the use of these 2 techniques was yielding to inconsistent results. Ferguson et al [5] also noted that the foot-in-the-door technique appeared a more effective approach than the doorin-the-face technique. In the present study, we did not compute an effect size for each of the 2 techniques separately, given the small number of studies using only 1 of the 2 techniques. Nonetheless, even if such techniques were found effective at increasing blood donations, their use on a large scale can be questioned for ethical or practical reasons. GODIN ET AL Effective Modes of Delivery The present review also quantitatively evaluated which modes of delivery are most effective at increasing blood donations. In this regard, 3 modes emerged as the most promising avenues to deliver interventions on blood donation: face-to-face, by telephone, and by mail. Previous reviews [4,60] had highlighted that face-to-face solicitation was a highly effective recruitment technique that could be up to 4 times more effective than recruitment by telephone. In the present meta-analysis, there was a trend suggesting that the more a mode of delivery was personal, the more effective it was in increasing blood donation. However, given that face-to-face solicitation is more time-consuming and more expensive [60], interventions delivered by telephone might be the most cost-efficient method. Finally, there is a lack of studies using new technologies; only 1 study [56] used an e-mail to carry out its intervention. Therefore, it will be important in the future to document the potential of using e-mail, SMS, and other new technologies as novel approaches to promote blood donation, especially among young blood donors. Areas Where Additional Studies Are Needed Unfortunately, very few interventions were developed to target a specific type of donors (eg, novice donors, regular donors, etc). This is rather surprising given that previous studies have clearly shown that the motives for giving blood differ between types of donors. For example, it has been shown that the determinants of return to give blood again differ between novice and experienced donors [64] and current and lapsed donors [11]. This would suggest that different interventions should be developed for first-time, novice, experienced, and regular donors. Alas, the results of the present review that indicated that interventions among novice donors are effective could not be compared with those of other types of donors. Moreover, most interventions were carried out among samples of college students, thereby making the results hard to generalize to the general population. The present review also revealed that some authors omit important information when describing their intervention. Authors should be required to refer to the Consolidated Standards for Reporting Trials (CONSORT) statement [68]. The CONSORT statement comprises a 25-item checklist of INTERVENTIONS PROMOTING BLOOD DONATION 235 information authors should report in their randomized controlled trials. The use of this checklist should lead to more transparent reporting and facilitate replication of the findings. Another observation is that additional interventions based on modeling and muscle tension are needed before a definite conclusion about their efficacy can be reached. Modeling is a technique grounded in the social learning theory of Bandura [27]. It has already been successfully applied to encourage children to eat more fruits and vegetables [69] and to perform regular physical activity [70]. It remains to be seen if this technique can be applied in adult populations. In addition, behavioral interventions such as applied muscle tension are still a new type of interventions to reduce discomfort (eg, dizziness) associated with donating blood [59]. Although the results obtained were nonsignificant, it could still be an interesting avenue for retaining donors given that it can be implemented directly on site during blood drives. Limitations of the Systematic Review The present review has some limitations that are worth mentioning. First, the relatively small number of studies prevented the computation of some comparisons and affected the robustness of the pooled effect sizes. Second, not all interventions could be included in the metaanalysis because they did not report the information needed to compute an effect size (ie, the number of participants in the experimental and the control groups). CONCLUSIONS Finally, to our knowledge, this is the first study to systematically review blood donation interventions and to quantify their effect. As such, the present review contributes to improve current knowledge, to identify gaps in knowledge, and to suggest new directions for future interventions aimed at promoting blood donation. REFERENCES [1] American Red Cross. Give Blood. 2011 [cited 2011 January 12]; Available from: http://www.redcross.org/portal/site/en/ uitem.mend8aaecf214c576bf971e4cfe43181aa0/?vgnextoid= d0061a53f1c37110VgnVCM1000003481a10aRCRD. [2] Ferguson E. Predictors of future behaviour: a review of the psychological literature on blood donation. Br J Health Psychol 1996;1:287-308. [3] Linden JV, Gregorio DI, Kalish RI. An estimate of blood donor eligibility in the general population. Vox Sang 1988;54:96-100. [4] Piliavin PA. Why do they give the gift of life? A review of research on blood donors since 1977. Transfusion 1990;30: 444-59. [5] Ferguson E, France CR, Abraham C, Ditto B, Sheeran P. Improving blood donor recruitment and retention: integrating theoretical advances from social and behavioral science research agendas. Transfusion 2007;47:1999-2010. [6] Ringwald J, Zimmermann R, Eckstein R. Keys to open the door for blood donors to return. Transfus Med Rev 2010;24:295-304. [7] Bednall TC, Bove LL. Donating blood: a meta-analytic review of self-reported motivators and deterrents. Transfus Med Rev 2011;25:317-34. [8] Sheeran P. Intention-behavior relations: a conceptual and empirical review. Eur Rev Soc Psychol 2002;2:1-36. [9] Webb TL, Sheeran P. Does changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence. Psychol Bull 2006;132:249-68. [10] Masser BM, White KM, Hyde MK, Terry DJ. The psychology of blood donation: current research and future directions. Transfus Med Rev 2008;22:215-33. [11] Germain M, Glynn SA, Schreiber GB, Gelinas S, King M, Jones M, et al. Determinants of return behavior: a [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] comparison of current and lapsed donors. Transfusion 2007;47:1862-70. Riley W, Schwei M, McCullough J. The United States' potential blood donor pool: estimating the prevalence of donor-exclusion factors on the pool of potential donors. Transfusion 2007;47:1180-8. Godin G, Sheeran P, Conner M, Germain M. Asking questions changes behavior: mere measurement effects on frequency of blood donation. Health Psychol 2008;27: 179-84. James RC, Matthews DE. The donation cycle: a framework for the measurement and analysis of blood donor return behaviour. Vox Sang 1993;64:37-42. Freedman JL, Fraser SC. Compliance without pressure: the foot-in-the-door technique. J Pers Soc Psychol 1966;14: 195-202. Cialdini RB, Vincent JE, Lewis SK, Catalan J, Wheeler D, Darby BL. Reciprocal concessions procedure for inducing compliance: the door-in-the-face technique. J Pers Soc Psychol 1975;31:206-15. Review Manager (RevMan) 5.1 ed. Copenhagen: The Nordic Cochrane Center, The Cochrane Collaboration; 2008. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Introduction to meta-analysis. Chippenham: John Wiley & Sons; 2009. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002;21:1539-58. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327:557-60. Higgins JPT, Thompson SG, Spiegelhalter DJ. A re-evaluation of random-effects meta-analysis. J R Statist Soc 2009;172:137-59. 236 [22] Cohen J. A power primer. Psychol Bull 1992;112:155-9. [23] Sutton AJ, Duval SJ, Tweedie RL, Abrams KR, Jones DR. Empirical assessment of effect of publication bias on metaanalyses. BMJ 2000;320:1574-7. [24] Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151:264-9. [25] Bem DJ. Self-perception theory. Adv Exp Soc Psychol 1972;6:1-62. [26] Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 1977;84:191-215. [27] Bandura A. Social learning theory. Prentice-Hall: Englewood Cliff; 1977. [28] Fishbein M, Ajzen I. Belief, attitude, intention and behavior: an introduction to theory of research. Don Mills: Addison-Wesley; 1975. [29] Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process 1991;50:179-211. [30] Schwartz SH. Normative influences on altruism. Adv Exp Soc Psychol 1977;10:221-79. [31] Ditto B, France CR, Holly C. Applied tension may help retain donors who are ambivalent about needles. Vox Sang 2010;98:e225-30. [32] Sinclair KS, Campbell TS, Carey PM, Langevin E, Bowser B, France CR. An adapted postdonation motivational interview enhances blood donor retention. Transfusion 2010;50:1178-786. [33] Evans DE. Development of intrinsic motivation for voluntary blood donation among first-time donors [Ph.D.]. Wisconsin: The University of Wisconsin – Madison; 1981. [34] Jason LA, Jackson K, Obradovic JL. Behavioral approaches in increasing blood donations. Eval Health Prof 1986;9:439-48. [35] Sarason IG, Sarason BR, Pierce GR, Shearin EN. A social learning approach to increasing blood donations. J Appl Soc Psychol 1991;21:896-918. [36] Chamla JH, Leland LS, Walsh K. Eliciting repeat blood donations: tell early career donors why their blood type is special and more will give again. Vox Sang 2006;90: 302-7. [37] Cialdini RB, Ascani K. Test of a concession procedure for inducing verbal, behavioral, and further compliance with a request to give blood. J Appl Psychol 1976;61: 295-300. [38] Clee MA, Henion KE. Blood donorship and psychological reactance. Transfusion 1979;19:463-6. [39] Ferrari JR, Leippe MR. Noncompliance with persuasive appeals for a prosocial, altruistic act: blood donating. J Appl Soc Psychol 1992;22:83-101. [40] Foss RD, Dempsey CB. Blood donation and the foot-inthe-door technique: a limiting case. J Pers Soc Psychol 1979;37:580-90. [41] Gimble JG, Kline L, Makris N, Muenz LR, Friedman LI. Effects of new brochures on blood donor recruitment and retention. Transfusion 1994;34:586-91. [42] Hayes TJ, Dwyer FR, Greenwalt TJ, Coe NA. A comparison of two behavioral influence techniques for improving blood donor recruitment. Transfusion 1984;24:399-403. [43] Jason LA, Rose T, Ferrari JR, Barone R. Personal versus impersonal methods for recruiting blood donations. J Soc Psychol 1984;123:139-40. GODIN ET AL [44] LaTour SA, Manrai AJ. Interactive impact of informational and normative influence on donations. J Mark Res 1989;26: 327-35. [45] Reich P, Roberts P, Laabs N, Chinn A, McEvoy P, Hirschler N, et al. A randomized trial of blood donor recruitment strategies. Transfusion 2006;46:1090-6. [46] Royse D. Exploring ways to retain first-time volunteer blood donors. Res Soc Work Pract 1999;9:76-85. [47] Rushton J, Campbell A. Modelling, vicarious reinforcement and extraversion and blood donating in adults: immediate and long-term effects. Eur J Soc Psychol 1977;7:297-306. [48] Sarason IG, Sarason BR, Pierce GR, Shearin EN, Sayers MH. A social learning approach to increasing blood donations. J Appl Soc Psychol 1991;21:896-918. [49] Sarason IG, Sarason BR, Pierce GR, Sayers MH, Rosenkranz SL. Promotion of high school blood donations: testing the efficacy of a videotaped intervention. Transfusion 1992;32:818-23. [50] Upton WE. Altruism, attribution, and intrinsic motivation in the recruitment of blood donors [Ph.D.]. New York, NY: Cornell University; 1973. [51] Ferrari JR, Barone RC, Jason LA, Rose T. The effects of a personal phone call prompt on blood donor commitment. J Community Psychol 1985;13:295-8. [52] Lipsitz A, Kallmeyer K, Ferguson M, Abas A. Counting on blood donors: increasing the impact of reminder calls. J Appl Soc Psychol 1989;19:1057-67. [53] Pittman TS, Pallak MS, Riggs JM, Gotay CC. Increasing blood donor pledge fulfillment. Pers Soc Psychol Bull 1981;7:195-200. [54] Whitney JG, Hall RF. Using an integrated automated system to optimize retention and increase frequency of blood donations. Transfusion 2010;50:1618-24. [55] Wiesenthal DL, Spindel L. The effect of telephone messages/prompts on return rates of first-time blood donors. J Community Psychol 1989;17:194-7. [56] Cioffi D, Garner R. The effect of response options on decisions and subsequent behavior: sometimes inaction is better. Pers Soc Psychol Bull 1998;24:463-72. [57] Godin G, Sheeran P, Conner M, Delage G, Germain M, Bélanger-Gravel A, et al. Which survey questions change behavior? Randomized controlled trial of mere measurement interventions. Health Psychol 2010;9:636-64. [58] Ferrari JR, Barone RC, Jason LA, Rose T. The use of incentives to increase blood donations. J Soc Psychol 1985;125:791-3. [59] Ditto B, France CR, Albert M, Byrne N, Smyth-Laporte J. Effects of applied muscle tension on the likelihood of blood donor return. Transfusion 2009;49:858-62. [60] Oswalt RM. A review of blood donor motivation and recruitment. Transfusion 1977;17:123-35. [61] Godin G, Amireault S, Vezina-Im LA, Germain M, Delage G: The effects of a phone call prompt on subsequent blood donation among first-time donors. Transfusion, Epub aehad of print, June 9, 2011. DOI: 10.1111 (http://www.ncbi.nlm.nih.gov/pubmed/21658045). [62] Abraham C, Michie S. A taxonomy of behavior change techniques used in interventions. Health Psychol 2008;27: 379-87. [63] Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A. Making psychological theory useful for INTERVENTIONS PROMOTING BLOOD DONATION [64] [65] [66] [67] implementing evidence based practice: a consensus approach. Qual Saf Health Care 2005;14:26-33. Godin G, Conner M, Sheeran P, Belanger-Gravel A, Germain M. Determinants of repeated blood donation among new and experienced blood donors. Transfusion 2007;47:1607-15. Godin G, Sheeran P, Conner M, Germain M, Blondeau D, Gagne C, et al. Factors explaining the intention to give blood among the general population. Vox Sang 2005;89:140-9. Armitage CJ, Conner M. Social cognitive determinants of blood donation. J Appl Soc Psychol 2001;31: 1431-57. Dholakia UM. A critical review of question-behavior effect research. Rev Mark Res 2010;7:145-97. 237 [68] Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med 2010;152:726-32. [69] Lowe CF, Horne PJ, Tapper K, Bowdery M, Egerton C. Effects of a peer modelling and rewards-based intervention to increase fruit and vegetable consumption in children. Eur J Clin Nutr 2004;58:510-22. [70] Hardman CA, Horne PJ, Fergus Lowe C. Effects of rewards, peer-modelling and pedometer targets on children's physical activity: a school-based intervention study. Psychol Health 2011;26:3-21. [71] Brehm JW. A theory of psychological reactance. New York: Academic Press; 1966. [72] Titmuss RM. The gift relationship: from human blood to social policy. London: Allen & Unwin; 1970. INTERVENTIONS PROMOTING BLOOD DONATION 237.e1 APPENDIX A Supplementary file 1. Formula used to calculate 80% PIs and transformations applied. The following formula and transformations were applied given that the effect sizes of the present review were OR: pffiffiffiffiffiffi PI ¼ M *  t T 2 þ Vm * PI = e x (exponential of the result obtained) Effect size [M*] = lnOR t = t value T 2 = τ 2 (an indicator of heterogeneity computed automatically by RevMan) Variance [Vm⁎] = (lnCIupper − lnOR)/1.96 = SE 2 Source: Borenstein et al [18]. 237.e2 Supplementary File 2. Summary of the Studies Included and Their Results Reference Chamla et al [36] Theory used Objective of the study Population Study design Sample Type of intervention Mode of delivery Retention of donors RCT N = 316 42.1% ♂ Cognitions based Mail and telephone SCT Unspecified N = 189 College students of both sexes Foot-in-thedoor/door-in-theface Face-to-face RCM OR (95% CI) Unspecified Cioffi and Garner [56] Unspecified Unspecified RCT † N = 1121 College students Measurement of cognitions E-mail FPP Clee and Henion [38] Retention of donors Novice donors RCT † N = 338 Cognitions based Telephone RT Ditto et al [59] Retention of donors RCT Video and faceto-face – Retention of donors Muscle tension Video and faceto-face – Potential, novice, and experienced donors RCT Cognitions based Telephone EAT F2,440 = 0.392, P = .67 Ferrari et al [51] Recruitment and retention of donors Unspecified Unspecified RCT † N = 1209 Age, 21.9 ± 3.4 y 49.6% ♂ N = 726 Age Exp: 22.2 ± 6.8 y Age Cont: 21.7 ± 5.8 y 41% ♂ N = 488 Age, 18 y 40.2% ♂ N = 68 Age, 18-20 y Muscle tension Ditto et al [31] Novice and experienced donors Experienced donors Reminders Telephone – Ferrari et al [58] Unspecified Novice and experienced donors RCT † Incentives Face-to-face – Exp: prompt condition Cont: nonprompt condition 13.91 (1.68-114.82) Exp: E condition Cont: C condition 3.86 (1.47-10.13) Evans, 1981 [33] (study 2) RCT N = 80 College students of both sexes Exp: experimental Cont: control 2.08 (1.14-3.80) Exp: extremethen-critical request condition Cont: criticalrequest-only control 1.17 (0.36-3.78) Exp: active-no response option Cont: no message sent 2.44 (1.04-5.73) Exp: HN/LI Cont: LN/HI 1.52 (0.64-3.62) Exp: upper body Cont: no treatment 1.48 (0.95-2.30) § Exp: applied tension Cont: no treatment 1.16 (0.82-1.66)) ⁎⁎ GODIN ET AL Cialdini and Ascani [37] Novice and experienced donors Unspecified Potential and donors † RCT † Unspecified Potential and donors † RCT † Foss and Dempsey [40] (study 1) Recruitment and retention of donors Potential and donors † Unspecified Foss and Dempsey [40] (study 2) Recruitment and retention of donors Potential and donors † Unspecified Foss and Dempsey [40] (study 3) Recruitment and retention of donors Recruitment and retention of donors Potential and donors † Unspecified Novice, experienced, and temporary deferred donors RCT Godin et al [13] Retention of donors Novice and experienced donors RCT † Godin et al [57] Retention of donors Novice donors RCT Hayes et al [42] Recruitment and retention of donors Potential, novice, and experienced donors Jason et al [43] (study 1) Unspecified Jason et al [43] (study 2) Jason et al [34] Gimble et al [41] N = 84 Age: 19.6 y 30.1% ♂ N = 112 Age, 18.8 y 19.6% ♂ N = 76 Dormitory residents 47.8% ♂ N = 135 Dormitory residents of both sexes Tape recorder NAT Exp: combined condition Cont: no message 2.24 (0.36-13.78) Exp: low RD/no access Cont: high RD/no access 22.14 (2.58-190.16) Exp: 3-d delay Cont: control condition 1.75 (0.39-7.95) Exp: poster request Potential and donors ¶ Cont: control condition 1.07 (0.06-18.04) Exp: poster request Cont: control condition 7.73 (1.54-38.66) Exp: group E Cont: group C 1.11 (1.02-1.21) Altruism Tape recorder NAT Foot-in-thedoor/door-in-theface Foot-in-thedoor/door-in-theface Face-to-face SPT Telephone SPT N = 163 Dormitory residents of both sexes N = 65 874 Age, 38-40 y Exp: 57%-63% ♂ Cont.: 57-59% ♂ N = 4672 Age Exp: 44.7 ± 11.8 y Age Cont: 43.8 ± 12.1 y Exp: 61.7% ♂ Cont: 61.3% ♂ N = 4391 Age, 30.4 ± 12.9 y 47% ♂ Foot-in-thedoor/door-in-theface Cognitions based Face-to-face and telephone SPT Unspecified CIPT Measurement of cognitions Mail TPB Exp: experimental group Cont: control group 1.24 (1.09-1.41) †† Measurement of cognitions Mail and telephone TPB RCT † N = 914 Adults Telephone SPT Unspecified RCT † N = 300 College students Foot-in-thedoor/door-in-theface Cognitions based Mail and telephone – Recruitment of donors Unspecified QE N = 64 College students Cognitions based Face-to-face – Unspecified Unspecified QE Unspecified N Workers and university students Incentives Face-to-face – Exp: implementation intention Cont: control condition 1.16 (0.98-1.36) Exp: FID Cont.: control request 2.82 (1.69-4.69) Exp: ML Cont: M 4.13 (0.45-37.57) Exp: friends Cont: strangers 2.86 (0.80-10.24) F1,25 = 12.30, P b .01 (continued on next page) 237.e3 Altruism INTERVENTIONS PROMOTING BLOOD DONATION Unspecified Ferrari and Leippe [39] (study 1) Ferrari and Leippe [39] (study 2) 237.e4 Supplementary File 2. (continued) Reference Objective of the study Population Study design Unspecified Unspecified LaTour and Manrai [44] (study 2) Unspecified Unspecified RCT ⁎ Lipsitz et al [52] (study 1) Unspecified Unspecified RCT ⁎ L i p s i t z e t a l [ 52 ] (study 2) Unspecified Unspecified RCT ⁎ Pittman et al [53] (study 1) Unspecified Unspecified RCT ⁎ Pittman et al [53] (study 2) Unspecified Unspecified RCT ⁎ Reich et al [45] Retention of donors Novice donors RCT Royse [46] Retention of donors Novice donors RCT ⁎ Unspecified Unspecified Unspecified Sarason et al [48] Recruitment and retention of donors Potential and novice donors Sarason et al [49] Recruitment and retention of donors Potential and novice donors Rushton and Campbell [47] Type of intervention Theory used Mode of delivery OR (95% CI) N = 680 Residents of a Midwestern community Cognitions based Mail and telephone TRA N = 1200 Residents of a Midwestern community Cognitions based Mail and telephone TRA N = 156 College students Reminders Telephone – N = 156 University students Reminders Telephone – N = 284 College students, faculty, and staff N = 122 College students, faculty, and staff N = 6919 52.5% ♂ Reminders Mail – Reminders Mail – Altruism Telephone and e-mail – N = 1003 Median age, 22 y 46% ♂ N = 43 Age, 18-21 y All ♀ Foot-in-thedoor/door-in-theface Modeling Mail SPT Face-to-face SLT Unspecified N = 9378 High school students Modeling Face-to-face and video SLT Unspecified N = 4970 High school students 48% ♂ Modeling Face-to-face and video SLT Exp: informational and normative influences Cont: no informational nor normative influences 13.70 (4.74-39.65) Exp: strong informational influence and normative influence Cont: no informational nor normative influence 4.17 (2.01-8.66) Exp: experimental Cont: control 2.63 (1.27-5.42) Exp: experimental condition Cont: control condition 2.86 (1.01-8.10) Exp: 3-name reminder Cont: 1-name reminder 1.59 (0.96-2.64) Exp: group reminder) O Cont: 1-name reminder 2.27 (0.79-6.49) Exp: script A Cont: script B 1.23 (1.09-1.38) # Exp: volunteer group Cont: control group 1.12 (0.79-1.59) Exp: vicarious punishment condition Cont: no-model condition 39.67 (1.28-1229.87) Combined treatment (55.4%) vs control (44.6%) = P b .013 ‡‡ Exp: videotape Cont: control presentation 1.25 (1.06-1.47) GODIN ET AL LaTour and Manrai [44] (study 1) RCT ⁎ Sample Retention of donors Novice and experienced donors RCT N = 427 Age, 31.1 ± 13.5 y Exp: 46.2% ♂ Cont: 35.8% ♂ Cognitions based Telephone – Upton [50] Retention of donors Experienced and lapsed donors Unspecified N = 1261 82% ♂ Altruism Telephone TOA Whitney and Hall [54] Retention of donors Novice and experienced donors QE N = 285 879 54% ♂ Reminders Telephone – Wiesenthal and Spindel [55] Retention of donors Novice donors Unspecified N = 209 Reminders Telephone – Exp: motivational interview group Cont: no-interview control group 1.61 (0.93-2.78) Exp: low reward/ high motivation Cont: high motivation/ high reward 6.91 (4.22-11.34) Exp: heard message Cont: did not hear message 1.09 (1.07-1.12) Exp: experimental condition 1 Cont: control group 1.84 (0.76-4.49) INTERVENTIONS PROMOTING BLOOD DONATION Sinclair et al [32] ‡ The symbol (♂) represents the percentage of the sample that is male. Abbreviations: NAT indicates norm activation theory [30]; CIPT, consumer information processing theory; Cont, control group used to compute the effect size; EAT, endogenous attribution theory; Exp, experimental group used to compute the effect size; FPP, feature-positive paradigm; QE, quasi-experimental design; RCM, reciprocal concession model [16]; RCT, randomized, controlled trial; RT: reactance theory [71]; SCT, social cognitive theory [26]; SLT, social learning theory [27]; SPT, self-perception theory [25]; TOA, theory of altruism [72]; TPB, theory of planned behavior [29]; TRA, theory of reasoned action [28]; HN/LI, high need/low implication; LN/HI, low implication/high need; low RD, low reponsibility denial; high RD, high responsibility denial; FID, foot-in-the-door; ML, media plus a personal letter; M, media only. ⁎ No information on the randomization procedure. † The authors did not specify which type of donors was included in their study. ‡ Although the study had a 12-month follow-up, we only used the 9-month outcome to have intention-to-treat results. § The results of men and women were combined within the control and the experimental groups. O The group reminder condition was used as the experimental group to compute the effect size to differentiate it from the study 1 of Pittman et al [53]. ¶ The poster request condition was used as the experimental group to compute the effect size, given that it was testing the effect of the foot-in-the-door technique. # The results reported are for the second donation (ie, percentage of first-time donors who returned for a second donation). ⁎⁎ Analyses controlled for age, sex, previous blood donations, experience, and body mass index. †† Analyses controlled for age. ‡‡ Analyses controlled for school, blood center, donation history, and size. 237.e5 237.e6 Supplementary file 3. Funnel plot of cognitionbased interventions (s = 8). GODIN ET AL Supplementary file 5. Formula used to convert SMD into OR. pffiffiffi logOR ¼ dðπ= 3Þ d = SMD Source: Borenstein et al [18]. Supplementary file 6. Funnel plot of interventions delivered by telephone (s = 10). Supplementary file 4. Funnel plot of interventions using reminders (s = 7). Efficacy of Interventions Promoting Blood Donation: A Systematic Review Gaston Godin, Lydi-Anne Vézina-Im, Ariane Bélanger-Gravel, and Steve Amireault Findings about the efficacy of interventions promoting blood donation are scattered and sometime inconsistent. The aim of the present systematic review was to identify the most effective types of interventions and modes of delivery to increase blood donation. The following databases were investigated: MEDLINE/PubMed, PsycINFO, CINAHL, EMBASE, and Proquest Dissertations and Theses. Additional studies were also included by checking the references of the articles included in the review and by looking at our personal collection. The outcomes of interest were either blood drive attendance or blood donations. A total of 29 randomized controlled trials or quasiexperimental studies were included in the review, detailing 36 interventions tested among independent samples. Interventions targeting psychosocial cognitions (s = 8, s to represent the number of independent samples; odds ratio [OR], 2.47; 95% confidence interval [CI], 1.42-4.28), those stressing the altruistic motives to give blood (s = 4; OR, 3.89; 95% CI, 1.03-14.76), and reminders (s = 7; OR, 1.91; 95% CI, 1.22-2.99) were the most successful in increasing blood donation. The results suggest that motivational interventions and reminders are the most effective in increasing blood donation, but additional studies are needed to evaluate the efficacy of other types of interventions. © 2012 Elsevier Inc. All rights reserved. LOOD AGENCIES ARE investing much effort to recruit new blood donors and to ensure that those who have donated return for additional donations. This preoccupation is wellfounded given that, according to the American Red Cross, only 3% of the population gives blood [1]. To further complicate matters, blood donation is a cyclic process in which once an individual has donated blood, he/she must wait a certain time (eg, 56 days) before being eligible to give blood again [2]. Moreover, many medical and nonmedical reasons such as foreign traveling can prevent someone from successfully giving blood [2]. This is done to ensure donor and recipient safety [3]. Effective interventions to retain blood donors and recruit new donors are thus imperative to maintain a safe and sufficient level of blood supply. In a previous review on the motives and the characteristics of blood donors, Piliavin [4] made an inventory of potential successful approaches to increase blood donation, particularly among first- time donors. For instance, this author suggested that an increase in the perception for the need of blood in the community and in the perception of the adequate support for blood donation provided in these communities as well as the use of modeling were promising approaches to increase blood donation. The author also observed that face-toface solicitations, the use of personal reminders, and the foot-in-the-door technique (consisting of a small request followed by a bigger one) appeared to be effective techniques to motivate individuals to give blood, given that individuals are sensitive to social pressure. These observations were also supported in a more recent review by Ferguson et al [5], in which the use of reminders and the footin-the-door technique were mentioned as effective strategies to favor blood donation. Mixed evidences were observed concerning the efficacy of interventions aimed at increasing altruistic motives vs the use of different forms of incentives [4]. However, as pointed out earlier by Piliavin [4], the use of incentives might undermine the development of an altruistic motivation and provoke a backfire effect on future donations among active blood donors. Moreover, in a recent review of the literature among active blood donors, Ringwald et al [6] mentioned that the use of incentives might not be the best strategy to keep long-term and committed blood donors given that as a donor advances in his/her career, his/her motives for giving blood become more internalized. The role of altruism also needs some consideration. According to a deeper analysis by Ferguson et al [5] B From the Canada Research Chair on Behaviour and Health, Laval University, Québec, Canada; Faculty of Nursing, Laval University, Québec, Canada; and Department of Social and Preventive Medicine, Laval University, Québec, Canada. The authors declare that they have no conflict of interest. Address reprint requests to Gaston Godin, PhD, Canada Research Chair on Behaviour and Health, Laval University, Québec, Canada G1V 0A6. E-mail: gaston.godin@fsi.ulaval.ca 0887-7963/$ - see front matter © 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.tmrv.2011.10.001 224 Transfusion Medicine Reviews, Vol 26, No 3 (July), 2012: pp 224-237.e6 INTERVENTIONS PROMOTING BLOOD DONATION of previous studies aimed at promoting blood donation with the use of the altruism concept, results seem to provide more support for the use of the moral norm concept or the benevolence response rather than pure altruism. Consequently, the role of altruism in the promotion of blood donation has to be more clearly defined to further increase the efficacy of such interventions. Bednall and Bove [7] also did a review of selfreported motivators and deterrents of blood donation. In particular, they verified that the motives behind blood donation differed among different types of donors (first-time, repeat, lapsed, apheresis, and eligible nondonors). They concluded that, among first-time and repeat donors, the most common motivators were convenience (eg, blood drive nearby), prosocial motivation (eg, altruism), and personal values (eg, moral norm). They also identified several deterrents among which the most frequently mentioned barrier was low self-efficacy to donate (eg, ability to overcome barriers such as lack of time). Notwithstanding the very useful information provided by these previous reviews concerning the potential efficacy of different strategies to increase blood donation, none of them systematically reviewed the literature and provided information on the effect sizes of such approaches. In addition, in the review by Ferguson et al [5], studies whose outcome was the intention or willingness to give blood were also included in their narrative analysis. Acknowledging the scientific evidence that intention is identified as one of the most important determinants of blood donation [2], it is, nonetheless, well documented that not all people will act on their stated intention, that is there is an “intention-behavior gap” [8]. Moreover, in a review by Webb and Sheeran [9] on the effectiveness of interventions to promote health-related behaviors, it was observed that a medium-to-large effect size in increasing levels of intention leads to a small-to-medium effect in changing behaviors. Consequently, the efficacy of interventions on blood donation and not only intention or willingness has to be determined. To our knowledge, there is no systematic review on the efficacy of interventions to promote blood donation. Thus, the objective of the present systematic review was to identify the most effective types of interventions and their modes of delivery to increase blood donation. 225 METHODS Study Eligibility Criteria The focus of the present systematic review was on interventions aimed at increasing blood donation among the general population (ie, recruitment studies) and blood donors (ie, retention studies). Studies aimed at increasing different or specific types of donations such as bone marrow donation or apheresis were not included in the present review. To evaluate the efficacy of interventions, only experimental and quasi-experimental studies were included in the review; studies adopting a 1-group pre-post design were excluded. Studies concerned with different stages in the lifetime experience of blood donors, that is, novice, experienced, lapsed, or temporarily deferred donors, were included. According to Masser [10], individuals who already gave blood once were considered as novice donors (also referred to as first-time donors), and individuals who already gave blood more than once were considered as experienced donors (also referred to as repeat donors) 1. Studies interested in lapsed donors (ie, individuals who already gave blood in the past but who did not donate blood in the past 2 years without any known cause for permanent or temporary deferral [11]) or temporarily deferred donors (ie, individuals who attended a blood center but were not eligible to donate blood for a certain period because of various medical reasons [12]) were also considered in the present systematic review. Studies reporting results on the attendance at a blood drive or the number of successful blood donations after the exposure to an intervention were both included in the present systematic review. Attendance was defined as the number of participants who registered at a blood drive. This outcome was chosen given that although some individuals can be deferred for various medical reasons, attendance takes into account the fact that participants had acted toward their goal of giving blood after the exposure to the intervention [13,14]. To avoid duplication of the results, attendance was primarily used in the statistical analyses in cases where attendance and the number of actual blood donations were both provided in a given study. Studies reporting the results of an 1 Other classifications can be found in the scientific literature (eg, Ferguson and Bibby (2002): occasional, b5 donations; regular, ≥5 donations). 226 GODIN ET AL intervention on the level of intention or willingness as well as studies reporting results in terms of physiologic reaction, stress, and symptoms related to blood donation were excluded from the present systematic review. Search Strategy The following databases were investigated: MEDLINE/PubMed (1950+), PsycINFO (1806+), CINAHL (1982+), and EMBASE (1974+). Proquest Dissertations and Theses (1861+) was also investigated for gray literature (ie, unpublished trials). No restriction was placed on the year of publication of the articles. The search was performed between June 8 and July 31, 2010. In all the databases, the search terms were always related to 2 themes, that is, blood donation and intervention (see Table 1). In MEDLINE/PubMed, a combination of keywords and MeSH terms was used. In PsycINFO, only keywords were used because no psychological index terms corresponded to blood donation and intervention. In CINAHL, a combination of keywords and descriptors was used. In EMBASE, a combination of keywords and Emtree terms was used. Finally, in Proquest Dissertations and Theses, only keywords were used. The search was limited to studies published in English. Additional studies were also included by checking the references of the articles included in the systematic review (ie, secondary references) as well as by looking at our personal collection of articles on blood donation. Data Extraction Data were independently extracted by GG and LAVI using a standardized data extraction form (see Table 2). Disagreements were resolved by discussion. Before extracting the data, several decisions were made. First, in instances where there was more than 1 experimental group in a study, only the group that had the greatest impact on blood donation was Table 1. Search Terms Used for Investigating All 5 Databases Keywords Theme 1: blood donation Theme 2: intervention Blood donation OR Blood donor OR Blood bank Intervention OR Program OR Education considered and compared with the control group. This decision was taken given that the main objective of the present review was to verify which types of intervention were more successful in increasing blood donation and also because this group corresponded to the hypothesis stated in the articles included in the meta-analysis in 90% of the cases. Second, when several tests of an intervention were performed among independent samples but reported in 1 article, these were all included in the analysis (ie, studies 1 and 2). Consequently, the number of independent comparisons in the meta-analysis might be more important than the number of included studies in some of the subgroup analyses. Finally, authors were personally contacted by e-mail for additional information when necessary. Interventions were classified according to an adapted version of the categorization proposed in a recent review by Ferguson et al [5] (see Table 3). These authors regrouped the social interventions into 4 types: (1) altruism-egoism, (2) reminders and commitments, (3) foot-in-the-door, and (4) intention based. Social interventions were aimed at increasing blood donation and were mainly focused on recruitment. They also identified behavioral interventions that can be classified in 3 categories: (5) distraction, (6) muscle tension, and (7) caffeine and water loading. These behavioral interventions are primarily aimed at reducing unpleasant symptoms associated with blood donation and mainly focused on retention of donors. The first category of social interventions included interventions that use manipulations of altruism and egoism to encourage blood donation. In the present review, however, the interventions based on altruism were imbedded in a larger motivational category that included all the interventions aimed at increasing motivation toward blood donation. These studies used techniques such as providing information about positive or negative consequences of blood donation, barriers management, modeling, comparison with the social norm, providing feedback and praise, and other. However, given the importance of the concept of altruism in the literature on blood donation, the independent efficacy of interventions based on altruism was compared with the efficacy of other motivational interventions in the subgroup analyses. The second category included interventions generally focusing on retention that use a reminder, such as a telephone call, before INTERVENTIONS PROMOTING BLOOD DONATION 227 Table 2. Information Contained in the Data Extraction Form Type of information Subcategory Main objective of the study Recruit new donors Encourage donors to return Both objectives Unspecified Potential donors/general population Novice donors Experienced donors Unspecified Randomized, controlled trial Quasi-experimental design Type of assignment Strategy used for assignment Technique used for assignment Person who performed assignment Type of control group Motivational Reminders Measurement of cognitions Incentives Muscle tension Face-to-face By mail (eg, letter) By telephone (eg, telephone call prompt) By e-mail By tape recorder Mix Yes No Registrations at a blood drive Blood donations Both Type of behavioral measure Validation of the measure Size Attrition at postintervention Attrition at follow-up Characteristics of participants at baseline Equivalence of groups at baseline Dropout analysis Statistical test used Intention to treat Covariates Technique to replace missing data Percentage of participants who registered at a blood drive Percentage of participants who gave blood Other Population of the study Study design Group allocation Type of intervention Mode of delivery Use of a theory Behavior measured Behavioral measure Sample Statistical analyses Results of the intervention the blood drive takes place. The third category was the foot-in-the-door [15] or door-in-the-face [16] interventions that are well-known techniques issued from the social psychology literature. The last category, that is, the intention-based category, initially included interventions that manipulated intentions. Given that the intention-based category was too specific to the measurement of intention, a new category was created (ie, measurement of cognitions or the question-behavior effect) to include all studies that measured cognitions with the specific objective of promoting blood donation. Finally, the use of incentives (financial or not) was added as a separate category, and the behavioral categories were classified using the description provided by Ferguson et al [5]. All of 228 GODIN ET AL Table 3. Classification of the Interventions Based on the Categorization of Ferguson et al [5] Type of intervention Motivational Cognitions based Foot-in-the-door/door-in-the-face Altruism Modeling Reminders Measurement of cognitions Incentives Muscle tension Definition Interventions aimed at increasing motivation toward blood donation Interventions targeting psychosocial cognitions related to motivation, such as social norms, attitudes, and barriers Interventions using the foot-in-the-door, the door-in-the-face, or a combination of both techniques to motivate people to give blood Foot-in-the-door involves asking a small request that should be accepted and then asking a critical large request. Door-in-the-face involves asking a large request that should be refused and then asking a critical small request. Interventions using altruistic motives to motivate people to give blood Interventions showing another person giving blood to motivate people to give blood Interventions using reminders about the next eligibility date and/or the next appointment to give blood (eg, telephone call prompt) Interventions using the completion of a questionnaire about the intention to give blood to activate cognitions about blood donation (eg, question-behavior effect) Interventions using incentives for donating blood such as a T-shirt, money, prizes, tickets, and other Interventions using the contraction of muscles during blood donation to avoid dizziness and fainting the interventions were independently classified according to their type by LAVI and ABG, and disagreements were resolved by a third reviewer (GG). Data Analyses Descriptive statistics of the studies, such as frequencies and means, was analyzed using SAS version 9.1 (SAS Institute, Cary, NC). All the other statistical analyses were done using Cochrane's Review Manager 5.1 (The Nordic Cochrane Center, Copenhagen, Denmark) [17] statistical software. To compute pooled effect sizes, a random-effect model using the Mantel-Haenszel method was chosen for all the analyses because we assumed that the magnitude of the effect sizes would vary across studies given the difference in samples and interventions across studies [18]. When computing the pooled effect size, each study was weighted according to its sample size. Between-study heterogeneity was verified by using 2 common statistical approaches: a χ 2 test (Cochran's Q) and the I 2 statistic [19], representing the percentage of total variation in estimated effects that is due to heterogeneity rather than chance. A significant Q statistic (P b .05) indicates significant heterogeneity between the studies, whereas an I 2 statistic of 25% is considered low heterogeneity; 50%, moderate heterogeneity; and 75%, high heterogeneity [20]. To test the robustness of the results, separate 80% prediction intervals (PIs) were calculated for each pooled effect size (see Supplementary file 1 online for the formula used). The computation of PIs is recommended when confronted with a randomeffect meta-analysis that has a low number of studies and high heterogeneity [21]. Prediction intervals show the distribution of effect sizes around the pooled effect size. The effect sizes of intervention studies were reported as odds ratios (ORs) given that most of the outcomes were reported as dichotomous data (ie, the proportion of attendance or blood donation in the experimental group compared with the control group). Unless otherwise stated, all effect sizes are zero order (ie, no covariates are included in the computation of the effect size). The ORs were also converted to Cohen's d [22] to facilitate interpretation and allow comparison with standard effect sizes reported in other studies. A Cohen's d of 0.20 is considered a small effect size; 0.50, a medium effect size; and 0.80, a large effect size [22]. The efficacy of the interventions according to type of intervention and mode of delivery was also examined by means of prespecified subgroup analyses. However, pooled effect sizes were computed only when the category contained results from a minimum of 3 independent samples. Finally, publication bias was assessed by visually inspecting the distribution of the funnel plot in RevMan 5.1 (The Nordic Cochrane Center) in instances where there were about 10 studies per category [23]. INTERVENTIONS PROMOTING BLOOD DONATION RESULTS The results of the search strategy are presented in Figure 1 [24]. A total of 29 studies (k = 29) were included in the present review, detailing 36 different interventions tested among independent samples (s = 36). In the rest of the text, the letter k will be used to represent the number of studies, and the letter s to represent the number of independent samples. Characteristics of the Interventions A summary of the interventions is given in Supplementary file 2. When no effect sizes could be 229 calculated because of missing information such as the number of participants per condition, the original results are reported. Most interventions were aimed at retaining current donors (s = 12) or both recruiting new donors and retaining donors (s = 8). One intervention had the objective to recruit new donors. In 15 interventions, the objective did not clearly specify if it was more about recruiting or retaining blood donors or vice versa. Again, few studies clearly specified the type of donors targeted by the intervention; only 6 studies mentioned this information (novice donors, s = 5; experienced donors, s = 1). Given that more than 3 studies were targeting novice donors, a pooled effect size was Fig 1. Preferred reporting for systematic reviews and meta-analyses flowchart [24]. 230 GODIN ET AL calculated (s = 5; OR, 1.21; 95% confidence interval [CI], 1.10-1.32; Q = 1.68; P = .80; I 2 = 0%); it represented a small effect size (d = 0.11). No significant heterogeneity between the studies was detected. Unfortunately, given the low number of studies, no pooled effect sizes could be calculated for other types of donors, such as experienced, lapsed, and deferred donors. Of the 36 interventions included in the review, 24 were randomized controlled trials, although most of them (s = 16) did not provide information on the randomization procedure. The other 12 interventions either adopted a quasi-experimental design (s = 3) or did not provide information about the design adopted (s = 9). Although it would have been interesting to compare the difference in effect sizes between both pure and quasi-experimental studies, 2 problems arose: (1) many studies did not specify their study design (s = 9) and (2) older studies tended to have little information about their randomization procedure compared with more recent studies; this phenomenon could reflect different editorial requirements through the years. Twenty-one interventions were clearly based on a theory. The theories most frequently used to design interventions promoting blood donations were the self-perception theory [25] (s = 4), the social learning/social cognitive theory [26,27] (s = 4), the theory of reasoned action [28] and its extension, the theory of planned behavior [29] (s = 4), and Schwartz's norm activation theory [30] (s = 2). Characteristics of the Participants Only 12 studies provided information on the age of their participants. The mean age of the participants was 25.72 ± 8.61 years (range, 18-44.3 years). Eighteen interventions were conducted among samples of college students, and 3 others, among samples of high school students. Seventeen interventions indicated the percentage of male participants in their sample. A little less than half (44.8%) of the samples were composed of male respondents. Three interventions mentioned having samples containing participants of both sexes without specifying the percentage of male respondents. One intervention had a sample exclusively of female participants. The typical sample was thus composed of college students with slightly more than half being female students. Efficacy of the Interventions A summary of the pooled effect sizes computed, their heterogeneity, and their robustness is presented in Table 4. Where exact information about numbers of participants or effect sizes were missing [31-35], we attempted to obtain the relevant information directly from the authors. In 3 cases [33-35], we were unable to obtain this information. Thus, of the 29 studies describing 36 Table 4. Pooled Effect Sizes, OR with 95% CIs Variable Type of intervention Motivational Cognitions based Foot-in-the door/door-in-the-face Altruism Reminders Measurement of cognitions Mode of delivery Face-to-face Mail Telephone Mix of modes s n OR (95% CI) 20 8 6 4 7 3 37 102 23 198 1303 7619 286 615 6812 2.09 (1.64-2.67) 2.47 (1.42-4.28) 1.86 (1.02-3.39) 3.89 (1.03-14.76) 1.91 (1.22-2.99) 1.23 (1.06-1.41) 5 4 10 10 239 5536 287 882 15 896 2.57 1.25 2.41 1.60 (1.29-5.11) (1.12-1.40) (1.38-4.20) (1.27-2.00) Q I2 (80% PI) 117.21 ‡ 42.18 ‡ 12.72 ⁎ 51.43 ‡ 19.71 † 3.01 84% 83% 61% 94% 70% 34% (1.23-3.53) (0.88-6.97) (0.74-4.69) (0.30-50.96) (0.91-4.01) (0.85-1.79) 5.14 2.49 84.50 ‡ 40.23 ‡ 22% 0% 89% 78% (1.11-5.95) (0.89-1.76) (0.77-7.50) (1.07-2.39) NOTE. I2 is an indicator of heterogeneity. Twenty-five percent is considered low heterogeneity; 50%, moderate heterogeneity; and 75%, high heterogeneity. ⁎ P b .05, significant heterogeneity (Q statistic). † P b .01, significant heterogeneity (Q statistic). ‡ P b .001, significant heterogeneity (Q statistic). INTERVENTIONS PROMOTING BLOOD DONATION interventions, 26 studies describing 33 interventions among independent samples could be included in the meta-analysis. Motivational Interventions Twenty-two interventions [32,33,36-50] were classified in the motivational category. However, 2 interventions [33,48] did not report the number of participants in their samples and were thus excluded from the meta-analysis. The study of Evans [33] reported nonsignificant results (P = .67), whereas the study of Sarason et al [48] had significant results (P b .01). The pooled effect size (s = 20) indicated that motivational interventions were successful in increasing blood drive attendance, and this represented a small-to-medium effect size (d = 0.41). Significant heterogeneity between the studies was detected, which justified subgroup analyses. The 80% PI indicated, however, that the significant result was robust. Cognitions-Based Interventions Nine interventions [32,33,36,38,41,43,44] were classified as cognitions based because they were targeting psychosocial cognitions related to motivation, such as social norms, attitudes, and barriers. However, 1 intervention [33] could not be entered in the meta-analysis because it did provide the number of participants per condition (ie, in the experimental and control groups). This study reported nonsignificant results (P = .67). The pooled effect size (s = 8) indicated that cognitions-based interventions were successful in increasing attendance at blood drives, and this represented a medium effect size (d = 0.50). Significant heterogeneity was detected, and examination of the 80% PI indicated that the result should be interpreted carefully. Moreover, the examination of the funnel plot (see Supplementary file 3 online) indicated that there is probably a publication bias [23]. Foot-in-the-Door and Door-in-the-Face Techniques A total of 6 interventions [37,40,42,46] were using the foot-in-the-door, the door-in-the-face, or a combination of both techniques to encourage people to give blood. The pooled effect size (s = 6) indicated that these types of interventions were successful at increasing attendance at blood drives. When the pooled OR was converted to Cohen's d [22], it 231 represented a small-to-medium effect size (d = 0.34). The Q statistic indicated that there was significant heterogeneity between the studies, although the I 2 statistic was still below 75%. The 80% PI indicated that the result is not very robust. Altruism Four interventions [39,45,50] aimed to increase blood donation by stressing the altruistic reasons to give blood. The pooled effect size (s = 4) revealed that this kind of intervention was successful in increasing blood drive attendance; this represented a medium-to-large effect size (d = 0.75). Significant heterogeneity between the studies was detected, and the 80% PI was very large, which indicates that the result is not robust at all. Modeling Three interventions [47-49] were using modeling, such as showing a model giving blood, to increase blood donations. However, 1 study [48] did not report the exact number of participants in their experimental and control groups. This study by Sarason et al [48] reported that their intervention had significant results (P b .01). Given that only 2 studies could have been entered in a metaanalysis, no pooled effect size was computed for this type of intervention. Examination of the individual effect sizes of the studies indicated that all the studies reported significant results (Rushton and Campbell [47]: OR, 39.67; 95% CI, 1.281229.87; and Sarason et al [49]: OR, 1.25; 95% CI, 1.06-1.47). Additional studies will be needed before any effect size can be computed about the efficacy of interventions that use modeling to increase blood donation. Reminders Seven interventions [51-55] were using reminders, such as telephone call prompts, as a means to increase blood donations. The pooled effect size (s = 7) for this type of intervention indicated that they were successful in increasing attendance at blood drives, and this represented a small-to-medium effect size (d = 0.36). Significant heterogeneity between the studies was detected, and the 80% PI was close to significance, which indicates that the result is somewhat robust. The inspection of the funnel plot (see Supplementary file 4 online) indicated the likely presence of a publication bias [23]. 232 GODIN ET AL Measurement of Cognitions Modes of Delivery Three interventions [13,56,57] used answering questions about cognitions related to blood donation to increase this behavior. One study [57] reported a continuous outcome (ie, mean number of blood donations), which allowed the calculation of a standard mean difference (SMD). This SMD was then converted to an OR to pool it with the rest of the studies (see Supplementary file 5 online for the formula used). The pooled effect size (s = 3) indicated that interventions using the measurement of cognitions are effective in increasing blood donation and that no significant heterogeneity was detected. Once converted to Cohen's d, the pooled effect size represented a small effect size (d = 0.11). The 80% PI, however, indicated that the result should be interpreted carefully. The efficacy of interventions according to their mode of delivery was also evaluated. In 1 intervention [41], a brochure was used to contact participants, but it was not specified if it was sent by mail or if it was given in person, thereby making it impossible to classify its mode of delivery. Incentives Two interventions [34,58] used incentives, such as tickets to a Broadway play and a college football game, gift certificates, prizes, free meals, and other, to increase blood donation. One intervention [34] did not report the exact number of study participants but stated that the intervention was successful in increasing blood drive attendance (P b .01). The other study by Ferrari et al [58] also had significant results (OR, 3.86; 95% CI, 1.47-10.13). The low number of studies using incentives and the fact that only 1 study reported the information necessary to compute an effect size precluded any meta-analysis. Additional studies will be needed to verify the accuracy of the present finding and before any definite conclusion can be reached about the efficacy of incentives to increase blood donation. Muscle Tension Two interventions [31,59] used muscle tension to decrease negative symptoms associated to blood donation such as dizziness and fainting to increase blood donors return. Given the low number of studies using this technique, no effect size was computed. Examination of the individual effect sizes indicated that both studies had nonsignificant results (Ditto et al [59]: OR, 1.48; 95% CI, 0.95-2.3...
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Plan to Increase the Canadian Rate of Altruistic Blood Donation

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Plan to Increase the Canadian Rate of Altruistic Blood Donation
Altruism is a fundamental behavior in society. It refers to the behaviors whose objective
is to enhance another individual's welfare; notably, the individual who performs these behaviors
does not seem to receive a direct reward for these actions. Altruism is a behavior that is primarily
automatic, reflexive, and intuitive (Jhangiani et al., 2014). The essence of this plan is to focus on
blood donation, a fundamental altruistic behavior in society, and formulate an innovative and
comprehensive campaign for increasing blood donation rates in Canada. The basis of this
specific plan is the identification of four aspects of altruistic behavior, namely, reciprocity norm,
emotions, kinship, and social responsibility norm – these aspects will be utilized in defining
appropriate content, media, and strategic approaches towards the objective, increased blood
donation rates.
The first aspect of altruistic behavior in the plan is the reciprocity norm. This aspect is
based on the concept that individuals help others based on the anticipation of similar responses if
the roles were reversed. Reciprocation is a fundamental social...


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