awareness and attitudes towards blood transfusion safety in the ...

Official Journal of the British Blood Transfusion Society

Transfusion Medicine

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SHORT COMMUNICATION

Blood donors’ awareness and attitudes towards blood transfusion safety in the Autonomous Province of Vojvodina, Serbia S. Bogdanović,1

P. Ðurić,2 R. Jovanović1,3 & J. Bogdanović3

Blood Transfusion Institute of Vojvodina, Novi Sad, Serbia, 2 Queen Margaret University, Edinburgh, Institute for Global Health and Development, Scotland, United Kingdom, and 3 Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia

1

Received 28 November 2016; accepted for publication 3 February 2017

SUMMARY

INTRODUCTION

Objectives: To assess the awareness and attitudes related to blood transfusion safety among blood donors from the Autonomous Province (AP) Vojvodina, Republic of Serbia.

Blood transfusion safety is a complex process that includes a range of activities from recruitment and selection of blood donors to monitoring the reactions of patients during and after transfusion treatment (Nel, 2008). Despite the implementation of numerous preventive activities, transfusion-transmitted infections (TTI) still pose a risk that is associated with transfusion treatment. Appropriate donor selection and blood collection from voluntary repeat blood donors are very important ways to reduce TTI risk. Effective donor selection should be applied to identify those donors who should not donate blood either temporarily or permanently. This would prevent the collection of blood from donors who are at risk of TTI but who, at the time of blood donation, are without clinical and serological evidence of TTI (Watkins et al., 2012). The active participation of blood donors in the selection process contributes to increasing the safety of blood transfusions and reduces potential risks for the recipients. Self-deferral of the blood donor during the selection processes means that the donors themselves determine that their blood donation could be harmful to the recipient. The decision of the blood donors to self-defer depends on their awareness and attitudes related to TTI and associated risk factors (Steele et al., 2012). In Serbia, blood donation is based on voluntary, nonremunerated donation according to the recommendations of the World Health Organisation and the Council of Europe. The screening of blood donors in this country includes the use of a questionnaire for each donor to identify possible forms of risk behaviour, an interview with a physician and a short physical health examination. Each blood donor answers questions related to his or her knowledge and awareness of, and attitudes towards, TTI risk, as well as his/her socioeconomic status and education. In addition, all the collected blood units undergo laboratory testing for the human immunodeficiency virus, hepatitis B virus, hepatitis C virus and syphilis.

Background: Blood donors are at the initial point of safe blood transfusion systems. The active participation of blood donors in the selection process contributes to increasing the safety of blood transfusions and reduces potential risks for the recipients. Materials and Methods: This cross-sectional survey included 1191 blood donors from AP Vojvodina. The awareness and attitudes regarding safe blood supply were measured as 5-point scales of agreement/disagreement with statements on a Likert scale. The data were analysed using non-parametric methods by frequency modalities. Results: Male blood donors, the youngest age group (18–20 years), those who donate blood for the first time and those with a lower educational level showed the lowest awareness of, and the most negative attitudes about, blood safety. Conclusions: The study found that there is a small but, for the safety of transfusion, significant number of blood donors who do not have a positive attitude or awareness of their own impact on safe transfusion therapy and who are not discovered during standard selection procedures. Key words: attitude, awareness, blood donor, blood safety, cross-sectional survey.

Correspondence: Sanja Bogdanović, Blood Transfusion Institute of Vojvodina, Hajduk Veljkova 9a, 21000 Novi Sad, Serbia. Tel.: +381 21 4877 999; fax: +381 21 4877 978; e-mail: [email protected]

© 2017 British Blood Transfusion Society

doi: 10.1111/tme.12398

2 S. Bogdanovic´ et al. In order to determine the awareness and attitudes related to blood transfusion safety among blood donors from the Autonomous Province (AP) Vojvodina, Republic of Serbia, we conducted a cross-sectional survey.

MATERIALS AND METHODS A cross-sectional survey was performed using non-random volunteer sampling. Participants were recruited at 10 collection sites in AP Vojvodina: The Blood Transfusion Institute of Vojvodina in Novi Sad; blood transfusion services in general hospitals in Subotica, Sombor, Pancevo, Kikinda, Vrsac, Senta, Zrenjanin, Vrbas and Sremska Mitrovica; and in their mobile units. All participants completed a self-administered questionnaire designed and validated for this study. The questionnaire included socio-demographic information (gender, age, number of blood donations, level of education) and five statements about awareness and attitudes related to TTI and risk factors. All five statements were measured on a 5-point scale of agreement/disagreement (Likert scale) to indicate how much they agreed with the statement. Participation in the study was voluntary and anonymous. Male and female blood donors aged between 18 and 65 years, first-time and repeat blood donors, donors with different levels of education and who met the criteria for blood donation according to the guidelines of donor suitability for blood donation were included. Blood donors who did not reply to all the statements were excluded from the study. The study was approved by the Ethics Committee for Medical Research of the Faculty of Medicine, University of Novi Sad, and signed informed consent was obtained from each study participant. Collected data were coded, entered and analysed using non-parametric methods. Variables, scaled in contingency tables, were analysed using multivariate analyses of variance (MANOVA) and discriminant analysis. Calculation of the coefficient of discrimination (C) defined the characteristics that determined the specificity of the subsamples. Associations between agreement or disagreement with statements and socio-demographic variables of participants were analysed using 𝜒 2 tests. The level of statistical significance was set at P = 0·05.

RESULTS A total of 1245 blood donors were included in the study, and 1191 of them responded to all statements (96% response rate). The study sample of 1191 blood donors consisted of 910 males (76·4%) and 281 females (23·6%). Within the sample, 69·5% of blood donors were 21–50 years old (mean age 35·5, median 35·0); 92·3% were repeat donors; 69·7% were high school-educated (Table 1). The data showing associations between agreement or disagreement with statements and demographic characteristics of study participants are summarised in Table 2. The MANOVA showed that the demographic characteristics were significantly

Transfusion Medicine, 2017

Table 1. Characteristics of the study participants (n = 1191) Characteristics Gender

Description

Male Female Age (years) 18–20 21–50 51–65 Number of blood donations First-time donors Repeat donors Education Elementary school and lower High school College or higher

n (%) 910 (76·4) 281 (23·6) 184 (15·4) 828 (69·5) 179 (15·1) 90 (7·7) 1101 (92·3) 85 (7·2) 831 (69·7) 275 (23·1)

associated with agreement or disagreement with the statements of study participants (P < 0·05 for all characteristics). Male blood donors, the youngest age group (18–20 years), those who donated blood for the first time and those with a lower educational level have shown the lowest awareness of and the most negative attitudes towards blood safety.

DISCUSSION This study showed that some blood donors (0·8–6·7% of study participants according to the statements) in AP Vojvodina do not have full awareness of and a positive attitude towards safe blood supply, thus representing a serious risk to the health of blood product recipients. This result has great significance because all the study participants had undergone the standard blood donor selection procedure and had met all the selection criteria. The answers of blood donors depend on several factors: knowledge about blood donation and transfusion treatment, understanding the criteria for donor selection listed in the questionnaire for blood donors, the motivation for blood donation and the impact of social and psychological characteristics (Franklin, 2007; Goncalez et al., 2008; O’Brien et al., 2010a). Blood donors who donate blood solely for altruistic reasons have no reason to conceal answers to questions that may affect their eligibility for blood donation (Sinclair et al., 2010; Wilkinson et al., 2011, 2012). However, some blood donors still conceal answers, usually because the motivation for blood donation is based on personal benefit (O’Brien et al., 2010a). Rugege-Hakiza et al. (2003) found that the knowledge regarding blood safety is less influential than motivational factors of self-deferral of blood donors. Male blood donors constituted the majority of participants in this study and comprise the majority of blood donors in AP Vojvodina. This is in line with the study of Miskulin et al. (2011) among blood donors from East Croatia, where males made up 86·5% of blood donors. In studies from other geographic areas, the number of male blood donors was different: 93% in India (Uma et al., 2013), 52·8% in Norway (Stigum et al., 2001b), 52%


Blood donors’ awareness and attitudes 3 Table 2. Statements and answers of blood donors (n = 1191) about blood transfusion safety; number (%) of those who agree and strongly agree Gender

Statement Blood donor needs to notify a transfusion service if he/she develops any illness during the 6 months after donating I consider my blood is safe for a recipient I would give up blood donation if I knew my blood is not safe for a recipient I give blood only in order to be tested for HIV and other sexually transmitted infections I agree that truthful and accurate answers to the questions on donor questionnaires are essential for the safety of patients who receive that blood

Number of blood donations

Age (years)

Education level

Repeat blood donors

Elementary school and lower

923 (83·8)

75 (88·2)

694 (83·5) 229 (83·3)

878 (96·5) 270 (96·1) 171 (92·9) 800 (96·7) 177 (98·8) 80 (88·9) 1068 (97·0)

81 (95·3)

806 (97·0) 261 (94·8)

867 (95·2) 269 (95·8) 173 (94·0) 787 (95·0) 176 (98·3) 85 (94·5) 1051 (95·5)

76 (89·3)

799 (96·2) 261 (94·8)

Male

Female

18–20

21–50

51–65

First time donors

763 (83·8) 235 (83·6) 152 (82·7) 683 (82·4) 163 (91·1) 75 (83·3)

61 (6·6)

19 (6·8)

13 (7·0)

50 (6·1)

17 (9·5)

7 (7·8)

73 (6·7)

850 (93·4) 265 (94·3) 166 (90·2) 775 (93·5) 174 (97·2) 81 (90·0) 1034 (93·9)

in Brazil (Goncalez et al., 2008) and 48% in the United States (Sharma et al., 2001). In our study, 74 (6·2%) blood donors strongly disagreed or disagreed with the statement that a blood donor needs to notify a transfusion service if they develop any illness during the 6 months after donating. Nine (0·8%) blood donors strongly disagreed or disagreed with the statement that their blood was safe for a recipient. This is a higher percentage than in the study from Canada, which evaluated results of the confidential unit exclusion (CUE) conducted by O’Brien et al. (2010b) and showed that there were 0·15% blood donors who had indicated their blood was not safe for use. Another study conducted by Sümnig et al. (2010) in Germany found 0·26% blood units marked as unsafe by blood donors. A total of 31 (2·6%) blood donors strongly disagreed or disagreed with the statement that they would give up blood donation if they knew their blood was not safe for a recipient, which is less than in the study by Sharma et al. (2001), where 12% of the tested blood donors donated blood knowing it was at risk for human immunodeficiency virus (HIV). Stigum et al. (2001a) found that 2–8% blood donors reported to have donated blood in order to be HIV tested. In our study, 80 (6·7%) blood donors agreed or strongly agreed with the statement that they give blood only in order to be tested for HIV and other sexually transmitted infections. HIV test-seeking blood donors are more often inclined to conceal


8 (9·4)

77 (90·6)

High school

59 (7·1)

College or higher

13 (4·7)

777 (93·6) 261 (94·8)

information about risky behaviours that threaten the system of safe blood transfusion treatment (Goncalez et al., 2008). In the study by Steele et al. (2012) conducted in the United States, 30% of blood donors considered it appropriate to give blood only for testing purposes, whereas the highest risk combination (giving blood for testing only and recent risky behaviour) comprised of 4·2% of blood donors. In another study in the United States, conducted by Sharma et al. (2001), 23% blood donors considered it appropriate to give blood for testing. Truthful and accurate answers to the questions on the blood donor questionnaire are one of the most important elements of blood donor selection. O’Brien et al. (2010a) have been investigating why blood donors conceal answers to issues related to risky behaviour and consider that these blood donors can be identified in the post-donation interview after the positive results of laboratory testing or by an anonymous questionnaire. The reasons for concealing responses are complex, and despite the efforts of transfusion services in the field of transfusion safety, some of the blood donors conceal answers. In our study, 33 (2·8%) blood donors strongly disagreed and disagreed with the statement that truthful and accurate answers to the questions on donor questionnaires are essential for the safety of patients who receive that blood. Stigum et al. (2001b) found in a study of Norwegian blood donors that 1·5% of the donors reported behaviour that would have led to deferral had the behaviour been disclosed at the pre-donation interview.


4 S. Bogdanovic´ et al. This is the first study about awareness and attitudes related to blood transfusion safety among blood donors from the AP Vojvodina, and these findings are in concordance with similar studies (Stigum et al., 2001a; Davison et al., 2015). The results of this study will be of great help in planning future strategies to recruit and retain low-risk blood donors. Information, education and communication activities relating to the impact of blood donors on blood safety can be helpful in reducing blood transfusion risk as well as encouraging regular blood donors to continue their active participation in the selection process. The findings should be used to further improve the selection procedure, possibly by asking more specific questions and giving more specific information during the selection process.

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ACKNOWLEDGMENTS The authors thank Ms. Claire McLellan and Ms. Fiona O’May, Queen Margaret University Edinburgh, Institute for Global Health and Development, for language and grammar editing. We also thank all our colleagues from blood transfusion services in general hospitals in AP Vojvodina for their help in the distribution and collection of the questionnaires. Finally, we thank all the participants for completing the questionnaire. All authors contributed to the conception of the study and design of the questionnaire and wrote the paper.

CONFLICT OF INTEREST The authors have no competing interests.

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