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Transfusion and Apheresis Science j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / t r a n s c i
New donors, loyal donors, and regular donors: Which motivations sustain blood donation? ☆ Paolo Guiddi a,*, Sara Alfieri a, Elena Marta a, Vincenzo Saturni b a b
Università Cattolica del Sacro Cuore di Milano, Italy AVIS, National Blood Donors Association, Milan, Italy
A R T I C L E
I N F O
Article history: Received 13 January 2014 Received in revised form 6 December 2014 Accepted 21 February 2015 Keywords: Blood donation Motivations New donors Loyal donors Volunteer function inventory
A B S T R A C T
Background: The present contribution aims to investigate the motivations underlying blood donation and to probe how these differ on the basis of number of donations and donors’ gender. Materials and methods: A total of 237 Italian donors (64.6% male) were administered a selfreport questionnaire containing socio-demographic variables and Omoto and Snyder’s Motivations for Volunteerism Scale adapted to blood donation. Results and discussion: The results reveal: (a) significant differences between new donors (1–4 donations) and loyal donors (5–15 donations) as well as between new donors and regular donors (more than 16 donations) emerge with respect to social motivations and ego-protection, which increase proportionately to number of donations; (b) gender differences characterize all the motivations except those related to values; (c) value motivations do not vary either with respect to number of donations or to gender. © 2015 Elsevier Ltd. All rights reserved.
1. Introduction In many countries today blood donation is a voluntary, non-remunerated, and anonymous gesture. Specifically in the Italian context, donor recruitment and blood collection are guaranteed by voluntary associations (Law 107/ 1990; Law 219/2005). Among these associations, the largest and most important one is AVIS (Associazione Volontari Italiani Sangue [Association of Italian Blood Donors]), which currently includes more than 3,000,000 volunteer donors distributed throughout the country. The act of donating blood has been studied in the literature as one of the most important gestures of “pure altruism” [1–5] since the person who donates blood does not know the person who will receive it and, therefore,
☆
The findings’ practical implications are discussed. * Corresponding author. Department of Psychology, Università Cattolica del Sacro Cuore, L. Go Gemelli, 1, 20123 Milano, Italy. Tel.: +39 0272342347; fax: + 0272342642. E-mail address: [email protected] (P. Guiddi).
cannot benefit from any form of compensation (by the term altruism we mean the motivation to help another person with no prospect of personal compensation for those who offer assistance). Research on this topic has concentrated mainly on the personality characteristics that may be predictive of this particular type of gift [6–13] but it overlooks additional, important variables. Only beginning in the late 1990s were other interpretive models applied to the donation gesture: these investigated additional variables such as, for example, the setting of the motivational antecedents to donation [14,15]. By the term motivation we mean the process of activating the individual in order to reach a goal (objective), taking into consideration the conditions of the environment in which s/he is situated. In line with this definition, the models mentioned earlier attempted to understand what drives volunteers to engage themselves and, in particular, what spurs blood donors toward the gesture of donation. Among the different models referenced in the literature – most of which come from studies on volunteerism – Omoto and Snyder’s Volunteer Function Inventory has also been used to predict this behavior [16,17].
http://dx.doi.org/10.1016/j.transci.2015.02.018 1473-0502/© 2015 Elsevier Ltd. All rights reserved.
Please cite this article in press as: Paolo Guiddi, Sara Alfieri, Elena Marta, Vincenzo Saturni, New donors, loyal donors, and regular donors: Which motivations sustain blood donation? , Transfusion and Apheresis Science (2015), doi: 10.1016/j.transci.2015.02.018
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Table 1 Presentation of the 5 motivational functions and some examples of items on the questionnaire (Refs. 16 and 17). Motivation typology
Meaning
Item example
Social motivation Values motivation
Connected to the opportunity to meet and know new people The possibility of finding a context in which one can express personal values and those connected to one’s commitment This has to do with a motivational process that is focused on growth and development of oneself, thus allowing for the promotion of self-esteem and self-acceptance This allows, on the one hand, for the reduction of guilty feelings due to one’s sense of being more fortunate than others and, on the other hand, for the resolution of personal problems by shifting attention to the people who benefit from one’s service This concerns the opportunity to learn new things or to experiment with knowledge and abilities that one does not usually use
“The people close to me want me to donate blood” “By donating blood, I could do something for a cause that I feel is important” “Donating blood would increase my self-esteem”
Self-enhancement motivation Ego-protection motivation
Knowledge motivation
Adopting a functionalist approach, the authors claim that volunteerism serves different functions for any one person, who may have different motivations from those held by other people. The motivations underlying voluntary actions may, in turn, be different depending on the function volunteerism has for those who undertake this commitment. In particular, the authors identify six motivations related to: the social sphere, values, self-enhancement, ego-protection, knowledge, and career [18] (see Table 1). This approach assumes that people are moved by a complex combination of motivational orientations that complete one another, considering in a conjoint manner the different motivations that could lead to the action without reducing them to mere presence/absence [19,20]. People do not carry out volunteer activities spurred by only one motivation, but by many. To understand what drives people to engage in volunteer activities, it is thus necessary to consider the combination of these motivations conjointly. Recent studies that have applied this model to blood donation [21] reveal, moreover, that these motivations are not constant but change over time (from mostly egoistical motivations to motivations that are mostly altruistic and related to civic engagement): in summary, blood donation can be understood as a process, and the motivational dimensions that sustain it change during the donor’s career [22–24]. Among the variables studied in the literature, those that are most important for understanding the gesture of donation are (a) gender and (b) number of donations. In a recent literature review [25], it emerges that gender, in particular, plays a fundamental role in the motivation to donate: women seem to be driven by more altruistic motivations while men are spurred by individualistic motivations. Another important variable for donor retention is number of donations because over time a “donor” role identity emerges [26,27], which is one of the strongest predictors of intention to continue to donate [18,28]. Even if recent studies [20] underscore that motivations change over time, it has not yet been shown how they change conjointly with respect to gender and number of donations. The present contribution, therefore, proposes to add to the knowledge about this phenomenon with particular reference to the Italian context. This is a very important topic because knowing what the motivations are that spur people to donate blood can help organizations involved in promoting donor recruitment and retention to better understand
“Donating blood would help me overcome my personal problems”
“By donating blood I could learn a lot about the reason why I am lending a helping hand”
which aspects they should focus on in order to reach their objectives. In particular, in light of the falling numbers of donors after their first donation, a finding reported in the national and international literature [29–31], our results demonstrate that retention building strategies must be implemented from the very first donation. In light of the literature presented here, this contribution proposes to investigate the motivations underlying blood donation on the basis of (a) donor gender and (b) number of donations, using the functionalist approach as its theoretical framework. 2. Materials and methods 2.1. Participants Participants were 237 Italian donors who were representative of all the Italian regions (64.6% male and 35.4% female; range 18–73 years, M = 35.92, SD = 14.33) with number of donations ranging from 1 to 115 (M = 16.60, SD = 19.49). 15.6% of participants have a middle school diploma, 51.6% have a high school diploma, and 32.8% have a university degree. Students represent 15.3% of participants while 61.6% are workers, 11. 1% are retired, and 12% are homemakers. 2.2. Procedure The participants were recruited in the waiting rooms of the blood transfusion services of many AVIS offices by volunteers of the same association. All the participants who were given questionnaires were informed in advance that their participation would be unpaid and voluntary and that all data collected would be used for the sole purpose of research and in an aggregate manner. 2.3. Measures The participants filled out a self-report questionnaire containing:
•
The Motivations to Volunteer Scale [14,15], in an ad hoc adaptation for blood donation: it is a questionnaire composed of 25 multiple choice items (from 1 = not at all to 5 = very much) in which each motivation was measured
Please cite this article in press as: Paolo Guiddi, Sara Alfieri, Elena Marta, Vincenzo Saturni, New donors, loyal donors, and regular donors: Which motivations sustain blood donation? , Transfusion and Apheresis Science (2015), doi: 10.1016/j.transci.2015.02.018
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by 5 items (for the meaning of the different motivations and examples of items for each of them, see Table 1). Omoto and Snyder’s original scale contemplated an additional factor, career motivation, which was not included in the present questionnaire because it would have been difficult to adapt such a motivation to the context of blood donation: in fact, while engaging in volunteer activities could be a way to find a job, donating blood in the Italian context does not allow for this. All of the factors were shown to be reliable according to Cronbach’s test (Social motivation: α = .69; Knowledge motivation: α = .68; Self-enhancement motivation: α = .63; Values motivation: α = .78; Ego-protection motivation: α = .60). Socio-demographic questions (gender, age and number of donations carried out).
2.4. Data analyses In order to obtain indices for the five motivations to donate blood, the weighted means of the items underlying the different motivations were calculated. Thus, the means (M) and the standard deviations (SD) as regards number of donations and gender were calculated. Comparisons between means were carried out through analysis of variance (ANOVA) (F), where instances of statistical significance (p) were also included, and through post hoc tests in order to determine between which donor groups statistically significant differences emerged. Where present, effects of interaction between the independent variables (number of donations and gender) were also brought to bear. All analyses were conducted using the software package SPSS vers.15. 3. Results Donors were divided not only into new and loyal donors, as suggested in recent studies [32]: this second group was also divided into loyal and regular [33] donors on the basis of the number of donations carried out:
• • •
“new donors” (from 1 to 4; 33.3%); “loyal donors” (from 5 to 15; 30.0%); “regular donors” (over 16; 36.7%).
This choice was made in order to better understand possible significant differences in donors’ motivations with the passage of time. Fig. 1 shows the percentage distributions based on number of donations and gender. Females turned out to have a stronger presence as new and loyal donors, but less so as regular donors, a finding that has already emerged in the literature [34,35]. The present work proposes to investigate which motivations underlie blood donation and whether there are differences among donors with respect to (a) gender and (b) number of donations (Fig. 2). To achieve this objective, we conducted five analyses of variance (ANOVA) in which the independent variables are gender and number of donations, and the dependent variables are Omoto and Snyder’s [14,15] five motivations.
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male
30.70%
41.70%
38.10%
new donors
female
23.50%
loyal donors
45.80%
20.20%
regular donors
Fig. 1. Blood donors’ distribution based on number of donations and gender.
The analyses reveal that social motivations increase in a statistically significant way with an increase in number of donations [F (2, 229) = 16.53, p < .001]. The post-hoc tests flag differences between new donors and the other two groups while no differences emerge between loyal and regular donors. Gender differences also emerge: women report higher levels of social motivations compared to men [F (2, 229) = 16.53, p < .001]. Moreover, an interaction effect emerges between number of donations and gender in that the gender differences found among the new donors (where women report higher social motivations compared to men) gradually diminish with an increase in number of donations: for loyal and regular donors, no differences linked to gender emerge [F (2, 229) = 5.54, p < .01]. In addition, egoprotection motivations increase with number of donations [F (2, 229) = 27.12, p < .001]. As in the case of social motivations, the post-hoc tests flag differences between new donors and the other two groups while no differences emerge between loyal and regular donors. Moreover, gender differences also emerge [F (1, 229) = 16.19, p < .001] in that women report higher levels of ego-protection motivations. Finally, an interaction effect emerges between number of donations and gender: male new donors have low levels of ego-protection motivations, which increase when they become loyal donors to then remain unchanged. Female new donors have quite high ego-protection motivations which remain constant over time [F (2, 229) = 11.70, p < .001]. As regards self-enhancement motivations, only differences related to gender, but not to number of donations, emerge: in fact, women report higher mean levels than men for this motivation [F (1, 229) = 10.41, p < .001]. A trend analogous to self-enhancement motivations emerges for knowledge motivations. In this case also, only gender differences emerge in that women report higher levels compared to men [F (1, 229) = 8.62, p < .001]. Finally, statistically significant differences do not emerge with respect either to number of donations or to gender as regards values motivation. 4. Discussion This study has attempted to understand the motivations underlying blood donation by diversifying motivations on the basis of donors’ characteristics, not only by observing gender differences, as has been done in other studies [24,33], but by linking these to number of donations. This choice proved to be very productive. As was mentioned in Introduction 1, in fact, the “donor career” is a process; thus, donors’ motivations change over time, as Finkelstein [22]
Please cite this article in press as: Paolo Guiddi, Sara Alfieri, Elena Marta, Vincenzo Saturni, New donors, loyal donors, and regular donors: Which motivations sustain blood donation? , Transfusion and Apheresis Science (2015), doi: 10.1016/j.transci.2015.02.018
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new donors 5 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0
3.11 3.29 2.25
2.91
3.11
3.28
2.71 2.85 2.86
3.39 3.16
3.09 2.18
loyal donors
2.56
2.65
2.98
regular donors
3.09
2.71
3.23
2.95
3.12
3.36 2.36
2.79 2.93
3.22 2.96
2.82
1.78
2.60%
M
F SOCIAL
M
F VALUES
M
F
SELF ENHANCEMENT
M
F
EGO PROTECTION
M
F
KNOWLEDGE
Fig. 2. Differences among donors based on gender and number of donations.
already pointed out although he took under consideration only the dichotomous passage from self-centered to heterocentered motivations. An initial finding that emerges from the present study is the absence of statistically significant differences between loyal and regular donors. It appears, in fact, that the motivations that spurred people to approach the blood donation community change at first to then remain constant over time. In particular, the findings reveal a gap between new donors and loyal donors as to social and ego-protection motivations, but not between loyal and regular donors. This finding contributes to a deeper and more nuanced understanding of what has already emerged in the literature [22,36,37]. As regards social motivations, which increase with the passage of time, it is possible that donors are able to establish new friendships and to enlarge their circle of acquaintances in the context of AVIS, in particular, and within the organization in which they donate, in general. For these people, therefore, donating blood in a constant and planned way also means spending time with other people who are sharing the same experience, relations that new donors have not been able to establish yet and that regular donors already have and benefit from. This “aggregative” aspect, moreover, is much more important for women than for men, even if the differences that are very evident in the new donors disappear in the loyal and, also, regular donors. With the passage of time, therefore, gender differences as regards the social motivations that emerge in the new donors gradually disappear. As regards the ego-protection motivation, we see an analogous configuration. The context of the donation is configured as the possibility of “escape” from one’s personal world and as an instrument that provides the opportunity to give back some of what one has received in life. In this case, as well, the ego-protection motivation is more intense for women than for men. Once again, the differences that stand out in the new donors (where men report M = 2.71 and women M = 3.39) weaken, without completely disappearing, however, for loyal and even regular donors (Mmen = 2.86 and Mwomen = 3.09), in contrast to what emerges for social motivations. As regards self-enhancement and knowledge motivations, instead, statistically significant differences do not emerge with respect to number of donations, but do emerge for gender. Women, in fact, report higher mean levels compared to men in both motivations. Increasing one’s selfesteem (self-enhancement motivation) and acquiring new
expertise as well as experiencing new capabilities (knowledge motivation) are motivations reported by women to a greater degree. Thus, in order for their commitment to remain constant over time, women feel that it is of fundamental importance that AVIS be a place where they can put these aspects of themselves into action. It is interesting to notice, moreover, that the values motivation intersects number of donations and gender. This motivation can be understood as a sort of ground shared by all the donors, implying the existence of a homogenous characteristic that distinguishes the donor from the nondonor. This finding confirms what the literature has already demonstrated about this gesture, often underscoring that “personal moral norms” are predictive of donor behavior [38]. The findings that emerge from the analyses show that particular attention must be given to gender. As Graph 1 reveals, not to mention the literature on this topic [24,33], women leave the donation community much earlier than men. This can be imputed to different factors that are well known to organizations involved in blood donation, such as the fact that women’s bodies experience more changes over the years as compared to their male counterparts (pregnancies, menopause, body weight not in the range permissible for donation, etc.). Thus, more attention must be focused on women, not so much in the recruitment phase as in the loyalty building phase. In synthesis, these results are of particular interest because over time the donation gesture comes to be configured as part of the person’s identity and as a “routine” gesture that goes on to become a stable behavior. Similar results emerge from analogous research [26,39,40]. In light of these different motivations, therefore, it necessary that recruitment and loyalty building strategies be different and, thus, suitable to the phases of the donation process (new, loyal/regular donors). 4.1. Operative implications The findings that emerge from this study offer important elements for the realization of publicity and information campaigns, not only for the recruitment of new volunteers, but also for strengthening and consolidating people who already donate. In particular, since the phenomenon of the decrease in donors after their first donations is well known [18,41–44], it is fundamental to help and support donors so that the donation gesture is always in sync with the motivations
Please cite this article in press as: Paolo Guiddi, Sara Alfieri, Elena Marta, Vincenzo Saturni, New donors, loyal donors, and regular donors: Which motivations sustain blood donation? , Transfusion and Apheresis Science (2015), doi: 10.1016/j.transci.2015.02.018
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that spur people to donate and so that it is this harmony that produces the constancy of their commitment over time. Strategies for attracting donors and building loyalty must therefore take into account the different motivations that drive people to donate blood, which, as this study has shown, differ with respect to gender and number of donations. This is crucial because an individual’s motivations for donating blood are also requests. In fact, people carry out volunteerism with precise motivations; thus, enhancing their choices and possibilities for experiencing engagement also means offering them spaces in which they can satisfy desires and needs. Given the non-remunerative nature of the donation gesture, offering donors spaces that respond to their more or less explicit requests is one of the responsibilities of organizations involved in blood donation. From these initial findings we can already propose interventions to the organizations involved in donor recruitment and loyalty building. Specifically as regards the different motivational configurations examined in this study, it is possible to propose several operative applications: promoting opportunities for sharing, participation, and aggregation, even if these are not directly connected to donation, help people to remain inside the association over time (increase of social motivation). In our opinion, if the act of donation is perceived only as “one moment,” a discrete, private, and merely physical act, donors who seek aggregation and belonging (social motivations) cannot find in the mechanical repetitiveness of the gesture a feeling of being warmly welcomed and “at home,” which is offered, instead, by those centers that create opportunities for encounter and socialization. In the same way, creating opportunities for expressing gratitude and support for the donation gesture and for valorizing donors’ commitment can be a positive reinforcement and foster an increase in a person’s personal awareness of his/her qualities (ego-protection motivations). In addition, creating opportunities for understanding the transfusional supply chain can promote the involvement of a greater number of women, whose commitment, according to our analyses, is often sustained by knowledge and selfenhancement motivations. It must be pointed out, finally, that in this paper we have simplified, with the term “number of donations”, a concept that in reality goes beyond a mere count of “physical” donations. This is about giving one’s time and passion, about building an identity and putting it into action. It is an important part of the self that is built in the interaction with the organization which must offer not only a space in which to donate, but also a place where people can meet one another and, in giving of themselves, can meet again. 4.2. Limitations The present research has some limitations. The first limitation concerns the sample. In the first place, the sample size could have been larger. In this regard, however, it should be noted that the participants in this study were recruited in different Italian regions; thus, there is a representative distribution of the country’s different
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socio-cultural realities in the sample. In the second place, it would be interesting to expand the research to include donors of other associations as well, and not only those affiliated with AVIS. The second limitation is that this study uses different participants for each of the three groups considered (new donors, loyal donors, and regular donors). It would be interesting, instead, to consider the evolution of motivations over time using the same participants, that is, to be able to carry out a longitudinal research study. Such studies, however, while guaranteeing a greater reliability, are difficult to actualize in that people are rarely willing to continue participating in a statistical data collection in an unpaid manner over time. However, at the moment there are no studies or evidence suggesting possible differences in motivations among donors affiliated with different associations present throughout Italy. Acknowledgements The authors thank Avis Nazionale and, in particular, the Consulta Nazionale Giovani di Avis Nazionale (2009– 2012) for their logistical support for finding participants and collecting data. References [1] Elster J. Selfishness and altruism. In: Mansbridge J.J., editor. Beyond self-interest. Chicago, IL: University of Chicago Press; 1990. p. 44–53. [2] Godbout JT. Quello che circola tra noi. Dare, ricevere, ricambiare. Milano, Italy: Vita e Pensiero; 2008. [3] Lucchini M. Doni di vita. Parma, Italy: La Nuova Italia; 2005. [4] 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. [5] Ferguson E, Farrell K, Lawrence C. Blood donation is an act of benevolence rather than altruism. Health Psychol 2008;27:327–36. [6] Titmuss R. The gift relationship. From human blood to social policy. New York, NJ: Vintage Books; 1971. [7] Boccacin L. La rilevanza relazionale del “dono anonimo agli sconosciuti”. Il caso della donazione del sangue. Milano, IT: Franco Angeli – Sociologia e politiche sociali; 2001. [8] Condie SJ, Warner WK, Gillman DC. Getting blood from collective turnips: volunteer donation in mass blood drives. J Appl Psychol 1976;61:290–4. [9] Drake AW, Finkelstein SN, Sapolsky HM. The American blood supply. Cambridge, MA: MIT Press; 1982. [10] Glynn SA, Kleinman SH, Schreiber GB, Zuck T, Combs SM, Bethel J, et al. Motivations to donate blood: demographic comparisons. Transfusion 2002;42:216–25. [11] Lemmens KP, Abraham C, Hoekstra T, Ruiter RC, De Kort W, Brug J, et al. Why don’t young people volunteer to give blood? An investigation of the correlates of donation intentions among young nondonors. Transfusion 2005;45:945–55. [12] Piliavin JA, Callero P. Giving blood: the development of an altruistic identity. Baltimore, MA: John Hopkins University Press; 1991. [13] Callero P, Howard JA, Piliavin JA. Helping behavior as a role behavior: disclosing social structure and history on the analysis of prosocial action. Soc Psychol Q 1987;50:247–56. [14] Glynn SA, Schreiber GB, Murphy EL, Kessler D, Higgins M, Wright DJ, et al. Factors influencing the decision to donate: racial and ethnic comparisons. Transfusion 2006;46:980–90. [15] Lemmens KP, Abraham C, Ruiter R, Veldhuizen I, Dehing C, Bos AE, et al. Modelling antecedents of blood donation motivation among non-donors of varying age and education. Br J Psychol 2009;100:71– 90. [16] Omoto AM, Snyder M. Sustained helping without obligation: motivation, longevity of service, and perceived attitude change among AIDS volunteers. J Pers Soc Psychol 1995;68:671–86.
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Please cite this article in press as: Paolo Guiddi, Sara Alfieri, Elena Marta, Vincenzo Saturni, New donors, loyal donors, and regular donors: Which motivations sustain blood donation? , Transfusion and Apheresis Science (2015), doi: 10.1016/j.transci.2015.02.018
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New donors, loyal donors, and regular donors: Which motivations sustain blood donation? ☆ Paolo Guiddi a,*, Sara Alfieri a, Elena Marta a, Vincenzo Saturni b a b
Università Cattolica del Sacro Cuore di Milano, Italy AVIS, National Blood Donors Association, Milan, Italy
A R T I C L E
I N F O
Article history: Received 13 January 2014 Received in revised form 6 December 2014 Accepted 21 February 2015 Keywords: Blood donation Motivations New donors Loyal donors Volunteer function inventory
A B S T R A C T
Background: The present contribution aims to investigate the motivations underlying blood donation and to probe how these differ on the basis of number of donations and donors’ gender. Materials and methods: A total of 237 Italian donors (64.6% male) were administered a selfreport questionnaire containing socio-demographic variables and Omoto and Snyder’s Motivations for Volunteerism Scale adapted to blood donation. Results and discussion: The results reveal: (a) significant differences between new donors (1–4 donations) and loyal donors (5–15 donations) as well as between new donors and regular donors (more than 16 donations) emerge with respect to social motivations and ego-protection, which increase proportionately to number of donations; (b) gender differences characterize all the motivations except those related to values; (c) value motivations do not vary either with respect to number of donations or to gender. © 2015 Elsevier Ltd. All rights reserved.
1. Introduction In many countries today blood donation is a voluntary, non-remunerated, and anonymous gesture. Specifically in the Italian context, donor recruitment and blood collection are guaranteed by voluntary associations (Law 107/ 1990; Law 219/2005). Among these associations, the largest and most important one is AVIS (Associazione Volontari Italiani Sangue [Association of Italian Blood Donors]), which currently includes more than 3,000,000 volunteer donors distributed throughout the country. The act of donating blood has been studied in the literature as one of the most important gestures of “pure altruism” [1–5] since the person who donates blood does not know the person who will receive it and, therefore,
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The findings’ practical implications are discussed. * Corresponding author. Department of Psychology, Università Cattolica del Sacro Cuore, L. Go Gemelli, 1, 20123 Milano, Italy. Tel.: +39 0272342347; fax: + 0272342642. E-mail address: [email protected] (P. Guiddi).
cannot benefit from any form of compensation (by the term altruism we mean the motivation to help another person with no prospect of personal compensation for those who offer assistance). Research on this topic has concentrated mainly on the personality characteristics that may be predictive of this particular type of gift [6–13] but it overlooks additional, important variables. Only beginning in the late 1990s were other interpretive models applied to the donation gesture: these investigated additional variables such as, for example, the setting of the motivational antecedents to donation [14,15]. By the term motivation we mean the process of activating the individual in order to reach a goal (objective), taking into consideration the conditions of the environment in which s/he is situated. In line with this definition, the models mentioned earlier attempted to understand what drives volunteers to engage themselves and, in particular, what spurs blood donors toward the gesture of donation. Among the different models referenced in the literature – most of which come from studies on volunteerism – Omoto and Snyder’s Volunteer Function Inventory has also been used to predict this behavior [16,17].
http://dx.doi.org/10.1016/j.transci.2015.02.018 1473-0502/© 2015 Elsevier Ltd. All rights reserved.
Please cite this article in press as: Paolo Guiddi, Sara Alfieri, Elena Marta, Vincenzo Saturni, New donors, loyal donors, and regular donors: Which motivations sustain blood donation? , Transfusion and Apheresis Science (2015), doi: 10.1016/j.transci.2015.02.018
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Table 1 Presentation of the 5 motivational functions and some examples of items on the questionnaire (Refs. 16 and 17). Motivation typology
Meaning
Item example
Social motivation Values motivation
Connected to the opportunity to meet and know new people The possibility of finding a context in which one can express personal values and those connected to one’s commitment This has to do with a motivational process that is focused on growth and development of oneself, thus allowing for the promotion of self-esteem and self-acceptance This allows, on the one hand, for the reduction of guilty feelings due to one’s sense of being more fortunate than others and, on the other hand, for the resolution of personal problems by shifting attention to the people who benefit from one’s service This concerns the opportunity to learn new things or to experiment with knowledge and abilities that one does not usually use
“The people close to me want me to donate blood” “By donating blood, I could do something for a cause that I feel is important” “Donating blood would increase my self-esteem”
Self-enhancement motivation Ego-protection motivation
Knowledge motivation
Adopting a functionalist approach, the authors claim that volunteerism serves different functions for any one person, who may have different motivations from those held by other people. The motivations underlying voluntary actions may, in turn, be different depending on the function volunteerism has for those who undertake this commitment. In particular, the authors identify six motivations related to: the social sphere, values, self-enhancement, ego-protection, knowledge, and career [18] (see Table 1). This approach assumes that people are moved by a complex combination of motivational orientations that complete one another, considering in a conjoint manner the different motivations that could lead to the action without reducing them to mere presence/absence [19,20]. People do not carry out volunteer activities spurred by only one motivation, but by many. To understand what drives people to engage in volunteer activities, it is thus necessary to consider the combination of these motivations conjointly. Recent studies that have applied this model to blood donation [21] reveal, moreover, that these motivations are not constant but change over time (from mostly egoistical motivations to motivations that are mostly altruistic and related to civic engagement): in summary, blood donation can be understood as a process, and the motivational dimensions that sustain it change during the donor’s career [22–24]. Among the variables studied in the literature, those that are most important for understanding the gesture of donation are (a) gender and (b) number of donations. In a recent literature review [25], it emerges that gender, in particular, plays a fundamental role in the motivation to donate: women seem to be driven by more altruistic motivations while men are spurred by individualistic motivations. Another important variable for donor retention is number of donations because over time a “donor” role identity emerges [26,27], which is one of the strongest predictors of intention to continue to donate [18,28]. Even if recent studies [20] underscore that motivations change over time, it has not yet been shown how they change conjointly with respect to gender and number of donations. The present contribution, therefore, proposes to add to the knowledge about this phenomenon with particular reference to the Italian context. This is a very important topic because knowing what the motivations are that spur people to donate blood can help organizations involved in promoting donor recruitment and retention to better understand
“Donating blood would help me overcome my personal problems”
“By donating blood I could learn a lot about the reason why I am lending a helping hand”
which aspects they should focus on in order to reach their objectives. In particular, in light of the falling numbers of donors after their first donation, a finding reported in the national and international literature [29–31], our results demonstrate that retention building strategies must be implemented from the very first donation. In light of the literature presented here, this contribution proposes to investigate the motivations underlying blood donation on the basis of (a) donor gender and (b) number of donations, using the functionalist approach as its theoretical framework. 2. Materials and methods 2.1. Participants Participants were 237 Italian donors who were representative of all the Italian regions (64.6% male and 35.4% female; range 18–73 years, M = 35.92, SD = 14.33) with number of donations ranging from 1 to 115 (M = 16.60, SD = 19.49). 15.6% of participants have a middle school diploma, 51.6% have a high school diploma, and 32.8% have a university degree. Students represent 15.3% of participants while 61.6% are workers, 11. 1% are retired, and 12% are homemakers. 2.2. Procedure The participants were recruited in the waiting rooms of the blood transfusion services of many AVIS offices by volunteers of the same association. All the participants who were given questionnaires were informed in advance that their participation would be unpaid and voluntary and that all data collected would be used for the sole purpose of research and in an aggregate manner. 2.3. Measures The participants filled out a self-report questionnaire containing:
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The Motivations to Volunteer Scale [14,15], in an ad hoc adaptation for blood donation: it is a questionnaire composed of 25 multiple choice items (from 1 = not at all to 5 = very much) in which each motivation was measured
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by 5 items (for the meaning of the different motivations and examples of items for each of them, see Table 1). Omoto and Snyder’s original scale contemplated an additional factor, career motivation, which was not included in the present questionnaire because it would have been difficult to adapt such a motivation to the context of blood donation: in fact, while engaging in volunteer activities could be a way to find a job, donating blood in the Italian context does not allow for this. All of the factors were shown to be reliable according to Cronbach’s test (Social motivation: α = .69; Knowledge motivation: α = .68; Self-enhancement motivation: α = .63; Values motivation: α = .78; Ego-protection motivation: α = .60). Socio-demographic questions (gender, age and number of donations carried out).
2.4. Data analyses In order to obtain indices for the five motivations to donate blood, the weighted means of the items underlying the different motivations were calculated. Thus, the means (M) and the standard deviations (SD) as regards number of donations and gender were calculated. Comparisons between means were carried out through analysis of variance (ANOVA) (F), where instances of statistical significance (p) were also included, and through post hoc tests in order to determine between which donor groups statistically significant differences emerged. Where present, effects of interaction between the independent variables (number of donations and gender) were also brought to bear. All analyses were conducted using the software package SPSS vers.15. 3. Results Donors were divided not only into new and loyal donors, as suggested in recent studies [32]: this second group was also divided into loyal and regular [33] donors on the basis of the number of donations carried out:
• • •
“new donors” (from 1 to 4; 33.3%); “loyal donors” (from 5 to 15; 30.0%); “regular donors” (over 16; 36.7%).
This choice was made in order to better understand possible significant differences in donors’ motivations with the passage of time. Fig. 1 shows the percentage distributions based on number of donations and gender. Females turned out to have a stronger presence as new and loyal donors, but less so as regular donors, a finding that has already emerged in the literature [34,35]. The present work proposes to investigate which motivations underlie blood donation and whether there are differences among donors with respect to (a) gender and (b) number of donations (Fig. 2). To achieve this objective, we conducted five analyses of variance (ANOVA) in which the independent variables are gender and number of donations, and the dependent variables are Omoto and Snyder’s [14,15] five motivations.
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male
30.70%
41.70%
38.10%
new donors
female
23.50%
loyal donors
45.80%
20.20%
regular donors
Fig. 1. Blood donors’ distribution based on number of donations and gender.
The analyses reveal that social motivations increase in a statistically significant way with an increase in number of donations [F (2, 229) = 16.53, p < .001]. The post-hoc tests flag differences between new donors and the other two groups while no differences emerge between loyal and regular donors. Gender differences also emerge: women report higher levels of social motivations compared to men [F (2, 229) = 16.53, p < .001]. Moreover, an interaction effect emerges between number of donations and gender in that the gender differences found among the new donors (where women report higher social motivations compared to men) gradually diminish with an increase in number of donations: for loyal and regular donors, no differences linked to gender emerge [F (2, 229) = 5.54, p < .01]. In addition, egoprotection motivations increase with number of donations [F (2, 229) = 27.12, p < .001]. As in the case of social motivations, the post-hoc tests flag differences between new donors and the other two groups while no differences emerge between loyal and regular donors. Moreover, gender differences also emerge [F (1, 229) = 16.19, p < .001] in that women report higher levels of ego-protection motivations. Finally, an interaction effect emerges between number of donations and gender: male new donors have low levels of ego-protection motivations, which increase when they become loyal donors to then remain unchanged. Female new donors have quite high ego-protection motivations which remain constant over time [F (2, 229) = 11.70, p < .001]. As regards self-enhancement motivations, only differences related to gender, but not to number of donations, emerge: in fact, women report higher mean levels than men for this motivation [F (1, 229) = 10.41, p < .001]. A trend analogous to self-enhancement motivations emerges for knowledge motivations. In this case also, only gender differences emerge in that women report higher levels compared to men [F (1, 229) = 8.62, p < .001]. Finally, statistically significant differences do not emerge with respect either to number of donations or to gender as regards values motivation. 4. Discussion This study has attempted to understand the motivations underlying blood donation by diversifying motivations on the basis of donors’ characteristics, not only by observing gender differences, as has been done in other studies [24,33], but by linking these to number of donations. This choice proved to be very productive. As was mentioned in Introduction 1, in fact, the “donor career” is a process; thus, donors’ motivations change over time, as Finkelstein [22]
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new donors 5 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0
3.11 3.29 2.25
2.91
3.11
3.28
2.71 2.85 2.86
3.39 3.16
3.09 2.18
loyal donors
2.56
2.65
2.98
regular donors
3.09
2.71
3.23
2.95
3.12
3.36 2.36
2.79 2.93
3.22 2.96
2.82
1.78
2.60%
M
F SOCIAL
M
F VALUES
M
F
SELF ENHANCEMENT
M
F
EGO PROTECTION
M
F
KNOWLEDGE
Fig. 2. Differences among donors based on gender and number of donations.
already pointed out although he took under consideration only the dichotomous passage from self-centered to heterocentered motivations. An initial finding that emerges from the present study is the absence of statistically significant differences between loyal and regular donors. It appears, in fact, that the motivations that spurred people to approach the blood donation community change at first to then remain constant over time. In particular, the findings reveal a gap between new donors and loyal donors as to social and ego-protection motivations, but not between loyal and regular donors. This finding contributes to a deeper and more nuanced understanding of what has already emerged in the literature [22,36,37]. As regards social motivations, which increase with the passage of time, it is possible that donors are able to establish new friendships and to enlarge their circle of acquaintances in the context of AVIS, in particular, and within the organization in which they donate, in general. For these people, therefore, donating blood in a constant and planned way also means spending time with other people who are sharing the same experience, relations that new donors have not been able to establish yet and that regular donors already have and benefit from. This “aggregative” aspect, moreover, is much more important for women than for men, even if the differences that are very evident in the new donors disappear in the loyal and, also, regular donors. With the passage of time, therefore, gender differences as regards the social motivations that emerge in the new donors gradually disappear. As regards the ego-protection motivation, we see an analogous configuration. The context of the donation is configured as the possibility of “escape” from one’s personal world and as an instrument that provides the opportunity to give back some of what one has received in life. In this case, as well, the ego-protection motivation is more intense for women than for men. Once again, the differences that stand out in the new donors (where men report M = 2.71 and women M = 3.39) weaken, without completely disappearing, however, for loyal and even regular donors (Mmen = 2.86 and Mwomen = 3.09), in contrast to what emerges for social motivations. As regards self-enhancement and knowledge motivations, instead, statistically significant differences do not emerge with respect to number of donations, but do emerge for gender. Women, in fact, report higher mean levels compared to men in both motivations. Increasing one’s selfesteem (self-enhancement motivation) and acquiring new
expertise as well as experiencing new capabilities (knowledge motivation) are motivations reported by women to a greater degree. Thus, in order for their commitment to remain constant over time, women feel that it is of fundamental importance that AVIS be a place where they can put these aspects of themselves into action. It is interesting to notice, moreover, that the values motivation intersects number of donations and gender. This motivation can be understood as a sort of ground shared by all the donors, implying the existence of a homogenous characteristic that distinguishes the donor from the nondonor. This finding confirms what the literature has already demonstrated about this gesture, often underscoring that “personal moral norms” are predictive of donor behavior [38]. The findings that emerge from the analyses show that particular attention must be given to gender. As Graph 1 reveals, not to mention the literature on this topic [24,33], women leave the donation community much earlier than men. This can be imputed to different factors that are well known to organizations involved in blood donation, such as the fact that women’s bodies experience more changes over the years as compared to their male counterparts (pregnancies, menopause, body weight not in the range permissible for donation, etc.). Thus, more attention must be focused on women, not so much in the recruitment phase as in the loyalty building phase. In synthesis, these results are of particular interest because over time the donation gesture comes to be configured as part of the person’s identity and as a “routine” gesture that goes on to become a stable behavior. Similar results emerge from analogous research [26,39,40]. In light of these different motivations, therefore, it necessary that recruitment and loyalty building strategies be different and, thus, suitable to the phases of the donation process (new, loyal/regular donors). 4.1. Operative implications The findings that emerge from this study offer important elements for the realization of publicity and information campaigns, not only for the recruitment of new volunteers, but also for strengthening and consolidating people who already donate. In particular, since the phenomenon of the decrease in donors after their first donations is well known [18,41–44], it is fundamental to help and support donors so that the donation gesture is always in sync with the motivations
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that spur people to donate and so that it is this harmony that produces the constancy of their commitment over time. Strategies for attracting donors and building loyalty must therefore take into account the different motivations that drive people to donate blood, which, as this study has shown, differ with respect to gender and number of donations. This is crucial because an individual’s motivations for donating blood are also requests. In fact, people carry out volunteerism with precise motivations; thus, enhancing their choices and possibilities for experiencing engagement also means offering them spaces in which they can satisfy desires and needs. Given the non-remunerative nature of the donation gesture, offering donors spaces that respond to their more or less explicit requests is one of the responsibilities of organizations involved in blood donation. From these initial findings we can already propose interventions to the organizations involved in donor recruitment and loyalty building. Specifically as regards the different motivational configurations examined in this study, it is possible to propose several operative applications: promoting opportunities for sharing, participation, and aggregation, even if these are not directly connected to donation, help people to remain inside the association over time (increase of social motivation). In our opinion, if the act of donation is perceived only as “one moment,” a discrete, private, and merely physical act, donors who seek aggregation and belonging (social motivations) cannot find in the mechanical repetitiveness of the gesture a feeling of being warmly welcomed and “at home,” which is offered, instead, by those centers that create opportunities for encounter and socialization. In the same way, creating opportunities for expressing gratitude and support for the donation gesture and for valorizing donors’ commitment can be a positive reinforcement and foster an increase in a person’s personal awareness of his/her qualities (ego-protection motivations). In addition, creating opportunities for understanding the transfusional supply chain can promote the involvement of a greater number of women, whose commitment, according to our analyses, is often sustained by knowledge and selfenhancement motivations. It must be pointed out, finally, that in this paper we have simplified, with the term “number of donations”, a concept that in reality goes beyond a mere count of “physical” donations. This is about giving one’s time and passion, about building an identity and putting it into action. It is an important part of the self that is built in the interaction with the organization which must offer not only a space in which to donate, but also a place where people can meet one another and, in giving of themselves, can meet again. 4.2. Limitations The present research has some limitations. The first limitation concerns the sample. In the first place, the sample size could have been larger. In this regard, however, it should be noted that the participants in this study were recruited in different Italian regions; thus, there is a representative distribution of the country’s different
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socio-cultural realities in the sample. In the second place, it would be interesting to expand the research to include donors of other associations as well, and not only those affiliated with AVIS. The second limitation is that this study uses different participants for each of the three groups considered (new donors, loyal donors, and regular donors). It would be interesting, instead, to consider the evolution of motivations over time using the same participants, that is, to be able to carry out a longitudinal research study. Such studies, however, while guaranteeing a greater reliability, are difficult to actualize in that people are rarely willing to continue participating in a statistical data collection in an unpaid manner over time. However, at the moment there are no studies or evidence suggesting possible differences in motivations among donors affiliated with different associations present throughout Italy. Acknowledgements The authors thank Avis Nazionale and, in particular, the Consulta Nazionale Giovani di Avis Nazionale (2009– 2012) for their logistical support for finding participants and collecting data. References [1] Elster J. Selfishness and altruism. In: Mansbridge J.J., editor. Beyond self-interest. Chicago, IL: University of Chicago Press; 1990. p. 44–53. [2] Godbout JT. Quello che circola tra noi. Dare, ricevere, ricambiare. Milano, Italy: Vita e Pensiero; 2008. [3] Lucchini M. Doni di vita. Parma, Italy: La Nuova Italia; 2005. [4] 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. [5] Ferguson E, Farrell K, Lawrence C. Blood donation is an act of benevolence rather than altruism. Health Psychol 2008;27:327–36. [6] Titmuss R. The gift relationship. From human blood to social policy. New York, NJ: Vintage Books; 1971. [7] Boccacin L. La rilevanza relazionale del “dono anonimo agli sconosciuti”. Il caso della donazione del sangue. Milano, IT: Franco Angeli – Sociologia e politiche sociali; 2001. [8] Condie SJ, Warner WK, Gillman DC. Getting blood from collective turnips: volunteer donation in mass blood drives. J Appl Psychol 1976;61:290–4. [9] Drake AW, Finkelstein SN, Sapolsky HM. The American blood supply. Cambridge, MA: MIT Press; 1982. [10] Glynn SA, Kleinman SH, Schreiber GB, Zuck T, Combs SM, Bethel J, et al. Motivations to donate blood: demographic comparisons. Transfusion 2002;42:216–25. [11] Lemmens KP, Abraham C, Hoekstra T, Ruiter RC, De Kort W, Brug J, et al. Why don’t young people volunteer to give blood? An investigation of the correlates of donation intentions among young nondonors. Transfusion 2005;45:945–55. [12] Piliavin JA, Callero P. Giving blood: the development of an altruistic identity. Baltimore, MA: John Hopkins University Press; 1991. [13] Callero P, Howard JA, Piliavin JA. Helping behavior as a role behavior: disclosing social structure and history on the analysis of prosocial action. Soc Psychol Q 1987;50:247–56. [14] Glynn SA, Schreiber GB, Murphy EL, Kessler D, Higgins M, Wright DJ, et al. Factors influencing the decision to donate: racial and ethnic comparisons. Transfusion 2006;46:980–90. [15] Lemmens KP, Abraham C, Ruiter R, Veldhuizen I, Dehing C, Bos AE, et al. Modelling antecedents of blood donation motivation among non-donors of varying age and education. Br J Psychol 2009;100:71– 90. [16] Omoto AM, Snyder M. Sustained helping without obligation: motivation, longevity of service, and perceived attitude change among AIDS volunteers. J Pers Soc Psychol 1995;68:671–86.
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