This study compares first time and repeat donations and examines short term donor return behavior at five Chinese regional blood centers. Compared to first time donors, repeat donors tended to be male, older (≥ 25 years), married, employed or self-employed, donated larger volume units (≥300mL) and were heavier in weight. The ratio of repeat donations to first time donations was about one to two. This was lower compared to the annual ratio of nearly four to one (78% to 22%) in the US in 2008 (Unpublished domestic REDS-II data). There were variations between blood centers. Ten percent and 4% more first time donations were collected from Kunming and Urumqi than repeat donations respectively, while more repeat than first time donations were from the other three blood centers.
Among those who donated from January to March, 2008, 14% returned for subsequent WB donations in the following 9 months. Because of the Chinese National Blood Donor Law, donors who made 200mL or ≥300mL whole blood donations are not allowed to return within four or six months, respectively; thus the eligible donation period for the study ranged between 5–7 months for donors with 200mL donations and 3–5 months for donors with ≥300mL donations. This return rate (around 20%) is comparable to the U.S. donors return rate in the first 3 months after renewed eligibility (i.e. the first 3 months after the 56 day deferral in the U.S., as compared to the first 3 months after the 6 month deferral in China (personal communication; D. Wright). Our study is limited in that the follow up time is short; however with ongoing data accumulation, we will be able to explore the donation intensity during a longer period.
Encouraging more donors to make repeat donations is key to maintaining an adequate and safe blood supply.5,6
Moreover, attracting donors who already have donation experience for regular donation may be more cost-effective than attracting those who have never donated.11
Currently, one available theory of donation behavior is that donors become habituated after three to four donations.6
Our data supported this theory in that, after adjusting for demographic and other donation characteristics, donors with more than three previous donations were 11 times more likely to return when compared to first time donors. Several studies have also confirmed that donors who give repeat donations are more likely to give future donations.11,16
Similarly, a study conducted by Zillmer et al, on donor mood states found a decrease in negative feelings about blood donation as donors returned more frequently, thus making donation a habitual process.17
Our study results are consistent with studies in developed countries; repeat donors were more likely to make return donations, and the likelihood of making return donations significantly increased with an increased number of previous donations. Perhaps the first three to four donations are the most important in conditioning donors to develop regular donation habits; thus blood centers should make special efforts to encourage donors who have recently made one or two donations to return. Active follow up may also be effective since the domestic REDS study found that a blood drive organizer/recruiter and a letter or call from the blood bank were the strongest factors influencing donation.18
Our results also showed the need for blood centers to encourage first time donors to return to donate again. Even donors with one previous donation had an odds of future return 3.7 times that of first time donors, which indicates that once donors return they are more likely to return in the future. Our findings in China are different from the U.S. in that donations were mainly from first time donors. These first time donors are potential resources to become repeat donors and deserve recruiting efforts. A study conducted by Glynn et al.18
found that first time donors were 4 times more likely to report being encouraged by family, friends, or coworkers than repeat donors. In addition, Charng, Piliavin and Callero found the number of donations was associated with social responsibility and altruistic behavior scores,19
indicating repeat donors were motivated by intrinsic factors. Therefore the recruiting strategies for first time and repeat donors should be especially tailored to reinforce their different motivations for donating blood. For first time donors, strategies such as student helper or family members sharing donation experiences with peers may be effective to attract more “curious” donors to experience the donation process. As donors become more familiar with donating, education and publication stressing donations as a socially desirable behavior and the medical need for blood may also attract repeat donors to habitually donate.
Not surprisingly, we found donors who donated at mobile collection vehicles were 4 times more likely to return than donors who donated at blood centers. Inconvenient locations were consistently cited as an important reason not to donate, especially by younger donors.16,20,21
Schreiber et al. found that not having a convenient place to donate was a significantly more important factor for donors younger than 25 years than for older donors in the US.20
In China the majority of blood donations were collected in mobile collection vehicles. Unlike the mobile collection vehicles in the U.S., mobile collection vehicles in China usually operate at same “fixed” locations in the most crowded streets of a city, where they can be accessed by more people. They also have more flexible working hours, and work on weekends to allow people to donate while shopping. Mobile collection vehicles also visit universities and colleges to facilitate student donations. As evidenced by our study, mobile collection units were an effective strategy to recruit donors; however more analysis is needed to determine if a mobile collection unit is effective in donor maintenance.
We found female, younger, lower educated, and donors donating a larger volume unit (≥300mL) were more likely to return. Since voluntary donation in China does not have a long history, it is possible that the younger generation receives different education and have a different culture than the older generation, and thus are more likely to become repeat donors in the future. However our results were based on “short-term” return behavior which was limited by the 8-month follow-up period. More studies on longer follow-up data are needed to examine if these results will remain consistent. If studies on the long-term return behavior in Chinese donors show the same results, they will be quite different from the U.S. studies which have consistently shown that older donors and donors with higher education level were more likely to become regular donors.5,6,11,22
Nguyen et al.21
found that different education groups have different motivations for donating. Unfortunately, little information is available on Chinese donors motivations and such studies are needed in order to develop targeted recruitment strategies for each donor group. Although they are deferred for a longer time, large volume donors are 1.4 times more likely to return than small volume donors. Traditionally most WB donations in China have been 200mL. In recent years, blood centers have been encouraging donors to donate larger volume WB donations (300mL or 400mL). It is possible that larger volume donors have more positive attitudes towards donation and are more willing to return.
This study happened in the same year as the 2008 Sichuan earthquake (May 12, 2008). Another paper published by our group found a significant increase in collected blood donations after the earthquake in three blood centers.23
The increase of first time donors was 2.5-fold of the repeat donors in the post earthquake week, suggesting these first time donors could be a potential pool for routine blood supply in the future. The demographic characteristics of donors in the post earthquake week were similar to those who donated during the rest of the year, suggesting the factors related to donor return were probably not affected by the earthquake.
This study has several limitations. First, we only have one year of data, and the eligible period for donors to return is limited. A donor can at most donate four times in theory if he/she donated 200mL every time and the initial donation was in January. In fact this situation was not seen in our data as most return donors donated only twice in 2008 and only two donors donated three times. Our results may therefore actually reflect only the early return rates, whereas long-term return rates may be higher. Therefore, our findings on the factors related to donor return were actually based on only one return donation, and thus may not represent the eventual overall donor return behavior. Because donors who return once are more likely to return in the future in studies of donor behaviors reported elsewhere11,18
, we believe factors related to the initial return may be predictive for future multiple returns. We plan to continue our analysis of return behaviors in the future. However, these early data may be useful to develop strategies for the blood centers to increase the return donations among first time donors. Since only 5 blood centers participated in the study, they may not be representative of all blood donors in China, however, the donors at these centers were similar to the blood centers at other blood collection centers in China.
Second, the number of previous donations is self-reported data. It is possible that first time donors may have reported previous donations or repeat donors did not report previous donations. Actually we found 15 donors who donated twice in 2008, but reported no previous donations each time. Third, there is no linkage between blood centers. If a donor moves from one blood center to another, his/her donation history could not be retrieved. Fourth, we did not measure donor deferrals and were not able to estimate the proportion of donors prevented from regular donation due to health problems.
Our study shows that Chinese donors with self-reported repeat donations were more likely to give future donations.11,16
After adjusting for demographic and other donation variables, the number of previous donations is positively associated with future return, and there is a dose-response relationship. Donors who donated at mobile collection vehicles were more likely to return than those who donated in blood centers. We also found that being female, younger, less educated (<high school), and donors donating a larger volume unit (≥300mL) were more likely to return for additional donations. Future studies on long-term donor return behavior and donor motivations will help the development of improved recruitment strategies.