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A greater understanding of young, first-time donor motivators and barriers is needed to address the ongoing challenge of retaining these essential donors.Structured interviews conducted with 508 young, first-time whole blood donors [66.1% female; Mean Age = 19.4 (SD = 2.5) years] were coded to identify reported motivators and barriers. Reported motivators and barriers were then examined for their association with attempted donation behavior over a 14-month follow-up, and for potential sex, race, and ethnic group differences in the frequency of endorsement.Prosocial motivation (e.g., altruism) was the most commonly reported motivator and fear (e.g., fainting, needles) was the most commonly reported barrier. Donation behavior was unrelated to reported motivators, but was significantly related to four reported barriers including fear of fainting/dizziness, fear of needles/pain, having personal commitments that conflict with donating, and perceiving oneself as unsuited to donate for health reasons. Sex, racial, and ethnic differences were noted with respect to the percentages of donors reporting several donation-related motivators and barriers.The present findings identify donation-related barriers that could be important targets to address in the effort to encourage new young donors and to retain these new donors for the long term. Importantly, these data also highlight the importance of considering individual differences in donor motivation as a function of sex, race, and ethnicity.

With growing discussion about blood donor remuneration, the present study examined the level of payment that may be required to convince individuals to engage in whole blood, plasma, and platelet donations.Anonymous online surveys were completed by a college sample [n = 490; 76.9% female; Mean Age = 20.3 (SD = 4.9) years; 32.9% whole blood donors] and a ResearchMatch sample [n = 323; 70.6% female; Mean Age = 50.7 (SD = 16.6) years; 82.7% whole blood donors]. Level of payment needed to motivate whole blood, plasma, and platelet donation was examined as a function of donation history, sample, and gender. In addition, path analyses examined associations between donation motivators, barriers, and payment level.Across all types of donation, history of whole blood donation was related to a greater willingness to donate without payment. At the same time, however, sizeable portions of prior donors indicated that monetary payment would convince them to donate whole blood (24%), plasma (51%), or platelets (57%). Across all types of donation, donation-related barriers (i.e., anxiety, fear) were indirectly related to higher payment levels via lower self-efficacy and more negative donation attitudes. Donation-related motivators (i.e., warm glow, regret, and altruism) were indirectly related to lower payment levels via higher self-efficacy and more positive donation attitudes.Despite reporting a strong commitment to nonremunerated blood donation, many respondents with and without a history of blood donation indicated that money would convince them to engage in whole blood, plasma, and platelet donation.

BACKGROUND: This study aimed to promote competence, autonomy, and relatedness among first-time whole blood donors to enhance intrinsic motivation and increase retention. STUDY DESIGN AND METHODS: Using a full factorial design, first-time donors (N=2,002) were randomly assigned to a no-treatment control condition or to one of seven intervention conditions designed to promote donation competence, autonomy, relatedness, a combination of two (e.g., competence and autonomy), or all three constructs. Participants completed donor motivation measures before the intervention and six weeks later, and subsequent donation attempts were assessed for one year. RESULTS: There was no significant group difference in the frequency of donation attempts or in the number of days to return. Significant effects of group were observed for 10 of the 12 motivation measures, although follow-up analyses revealed significant differences from the control group were restricted to interventions that included an autonomy component. Path analyses confirmed direct associations between interventions involving autonomy and donor motivation, and indirect mediation of donation attempts via stronger donation intentions and lower donation anxiety. CONCLUSION: Among young, first-time, whole blood donors, brief interventions that include support for donor autonomy were associated with direct effects on donor motivation and indirect, but small, effects on subsequent donation behavior.

BACKGROUND O-negative donors are a critical resource for blood collection agencies, and their recruitment and retention provides an ongoing challenge. Motivational interviewing shows promise as a tool to promote donor retention, although concerns about scalability remain. The current study examined the effect of an automated Web-based interview drawing on motivational interviewing and self-determination theory on O-negative donors' motivation, intention, and behavior. STUDY DESIGN AND METHODS Within 13 days of donating, 2820 O-negative donors completed baseline measures of motivation and intention before being randomly assigned to complete either a motivational interview (MI) or active control interview (ACI). Motivation and intention were assessed at 2 days and at 7 weeks after participation in the MI or ACI, with return behavior tracked for 6 months following trial completion. RESULTS Changes in donor motivation and intention, rate, and time to return did not vary by participation in the MI or ACI. When compared with O-negative donors who experienced business-as-usual practices, donors completing the MI or ACI returned to donate more, and they returned more quickly. However, subsequent exploratory analyses considering the behavior of those who did not accept the invitation to participate and those who completed only baseline measures showed that the improved return behavior of donors in the MI or ACI conditions was likely not due to any specific properties of the MI or ACI activities. CONCLUSIONS Australian O-negative donors were highly internally motivated and committed to donating. An automated Web-based motivational interview appears to be of limited effectiveness in promoting the return of such donors.

Background With growing awareness of the prevalence of nonanemic iron deficiency among blood donors, there is a need to explore the extent of potential negative consequences. This study examined the relationship between various measures of iron status, blood donation history, and neuropsychological and psychosocial functioning in healthy young women. Study design and methods Using a cross-sectional design, 160 female undergraduates completed neuropsychology tests and measures of sleep, fatigue, quality of life, and depression before providing a blood sample. Correlational analyses examined the relationship between iron status (ferritin, iron, hemoglobin, and zinc protoporphyrin) and cognitive and psychosocial functioning. Performance on these measures was also examined as a function of recent blood donation history (zero, one, more than one donation in the past year). Results Iron status (low ferritin, iron, or hemoglobin or high zinc protoporphyrin) was not associated with poorer performance on the cognitive tasks. Further, participants who reported donating once in the previous year performed better, rather than worse, than those with no recent donation history on several measures of executive function, even when controlling for ferritin levels. Although there was some evidence of greater fatigue among those who had donated more than once in the past year, this effect was not accounted for by ferritin levels. Conclusion The present findings are consistent with prior evidence that nonanemic iron deficiency is not associated with cognitive impairment or psychosocial dysfunction in healthy young females. Because these results are based on cross-sectional evidence, further study using longitudinal research is needed to confirm these findings.

BACKGROUND Prior studies have shown donation-related fear to be associated with decreased donor confidence and an increased risk for vasovagal reactions. This study examined the effects of a predonation intervention that provided fearful donors with suggestions for coping. STUDY DESIGN AND METHODS Using a tablet-based application, high school donors (49.4% female) answered a question regarding their fear of having blood drawn. Those who reported fear were randomly assigned to either a control (n = 930) or an intervention (n = 911) group. Donors in the control group rated their confidence in dealing with their fear and then donated as usual. Donors in the intervention group received a brief audiovisual presentation on coping strategies, rated their confidence, and then donated as usual. RESULTS A higher proportion of fearful versus nonfearful donors experienced a vasovagal reaction, even after controlling for other demographic and health predictors (OR, 2.3; 95% CI, 1.655-3.185, p

The current study investigated relationships between a history of blood donation, registration as a non-living and living organ donor, and differential motivations.Motivational commonalities exist between blood and organ donors, but there is no prior data on the relationships between blood donation history and both living and non-living organ donor registration and motivation.Participants completed online surveys assessing blood donation history, organ donor registration and interest, and motivations related to donation behaviour.Blood donation history was not significantly related to registration as either a non-living organ donor (blood donors = 81.4%; non-blood donors = 76.4%) or as a living organ donor (blood donors = 14.0%; non-blood donors = 10.9%). Further, blood donation history was not related to interest in learning more about being an organ donor. Compared to those not registered as an organ donor, those who were registered reported more positive organ donation motivations, but these relationships were unrelated to prior blood donation history.The present findings are consistent with existing research on attitudes, warm glow, and identity as organ donation motivators, and provide novel information regarding the importance of independent assessment of motivations for non-living and living organ donation.

Background The potential for iron deficiency is a known blood donor health concern and suggests the need to inform donors about the potential risks of low iron levels as well as strategies to address these risks. Study design and methods Frequent (n = 904) and young (n = 629) donors were randomly assigned within risk group to either a control (n = 548) or an intervention (n = 985) group. The control group answered questions at baseline and 6-month follow-up regarding their awareness of the risk of donation-related iron depletion and whether they were taking actions to address their iron status. The intervention group answered the same questions at baseline and follow-up, but after completing the baseline survey, they received information regarding their risk of iron depletion and behaviors they could adopt to mitigate this risk. Intervention group participants were also offered the opportunity to develop an action plan to help them supplement their iron intake. Results The intervention enhanced overall awareness of donation-related iron loss (OR = 1.5, 95% CI 1.171-1.864, p = .001), with no negative impact on retention. Reported iron health behaviors (iron supplementation, speaking with a doctor) showed significant increases when action planning was paired with the educational information. Conclusion These findings suggest that it is possible to increase awareness of donation-related risk for iron depletion without negatively influencing retention, and combining education with encouragement to develop an action plan may increase the likelihood of both retention and behavioral changes to promote healthy iron levels.

BACKGROUND Elevated fear and anxiety regarding donation-related stimuli (e.g., needles, pain, blood, fainting) has been associated with reduced blood donor recruitment and retention. The present longitudinal study tests the notion that this inverse relationship may be accounted for by lower donation confidence and more negative donation attitudes among fearful first-time donors. STUDY DESIGN AND METHODS In a sample of 1479 first-time whole blood donors [67.9% female; mean age = 19.3 (standard deviation (SD) = 2.5) years], path analyses were conducted to examine relationships among donor ratings of fear of blood draw and donation anxiety obtained approximately 1 week after donation, donation confidence and attitudes assessed approximately 6 weeks later, and donation attempts over the 14 months following the original donation. RESULTS Path analyses indicated that both fear of blood draws and donation anxiety were associated with fewer attempted donations, and that these effects were indirectly mediated by a combination of lower donor confidence and more negative donation attitudes. CONCLUSION Because retention of new blood donors is essential to maintain a healthy blood supply, the results of the present study suggest that first-time donors should be assessed for fear and anxiety so that appropriate strategies can be provided to address their concerns, bolster their confidence and attitudes, and ultimately promote their long-term retention.

Prior studies suggest that responding to online motivational questions increases blood donation intention. The present studies were designed to extend these findings by (a) exploring the impact of methodologic variations in the content and order of administration of specific questions on donation intention and (b) examining anticipated positive and negative emotional reactions as potential mediators. Study design and methods In the first study, 4709 respondents (51.2% female; mean ± SD age, 38.4 ± 12.1 years) were randomly assigned to one of four motivational questions or a no-question control. In the second study, 5291 respondents (52.7% female; mean ± SD age, 37.3 ± 11.9 years) were randomly assigned to one of six motivational questions or a no-question control. In both studies, the motivational questions were followed by measures of donation intention, anticipated warm glow, and anticipated regret. Results In Study 1, three of the four questions were associated with higher donation intentions, with anticipated warm glow being a potential partial mediator for two of the questions. In Study 2, five of the six questions were associated with higher donation intentions, with anticipated warm glow and anticipated regret being potential partial mediators for three of the questions. These effects were largely consistent among donors and nondonors. Conclusion These studies expand our understanding of the association between particular motivational questions and donation intentions and provide preliminary support for the notion that specific questions may influence donation intention by increasing anticipated positive and negative emotional reactions to the thought of giving or not giving, respectively.

Background Extending existing research on the relationship between predonation fear of having blood drawn and risk for vasovagal reactions among young donors, this study assessed the predictive power of specific donation-related fears. Study design and methods After the health screening, high school whole blood donors (59.5% female) were randomly assigned into one of three groups. Group 1 (n = 881) answered a control question about their prior night's sleep. Group 2 (n = 911) answered the sleep question and a question about fear of having blood drawn. Group 3 (n = 924) answered the sleep question, the fear of having blood drawn question, and four questions about specific donation-related fears (seeing blood, needles, pain, and fainting). Results The proportion of vasovagal reactions did not differ significantly among the groups, indicating that asking one or more fear questions before donation did not promote reactions. Fearful donors were more likely to have a vasovagal reaction, even after controlling for other important demographic and health predictors, with odds ratios ranging from 2.17 (95% confidence interval [CI], 1.44-3.27) for fear of fainting to 3.50 (95% CI, 2.34-5.23) for fear of seeing blood. Hours of sleep was not significantly related to vasovagal reaction risk. Conclusion Predonation fear identifies donors who are more likely to experience a vasovagal reaction and does so without increasing the risk of such reactions. Accordingly, fear should be assessed during screening to identify those who could benefit from instruction in anxiety management and who might require greater attention to help prevent donor injury.

Background Interventions intended to motivate donors to return can be costly and time consuming. The current study examined the effect of a Web-based automated interview, informed by motivational interviewing and self-determination theory, on donor intention, motivation, and behavior in a sample of highly experienced donors. Study design and methods Approximately 1 week after donating, 1177 highly experienced whole blood donors (mean prior donations, 35.5; mean age, 46.9 years; 66.3% female) participated in a study in which they were randomly assigned to either a donor motivational interview (n = 544) or knowledge interview (n = 633). Measures of donor motivation and psychological need support were obtained before the interviews, and again at postinterview assessments conducted approximately 2 days later and 7 weeks later. Blood center records were used to assess repeat donation attempts for 1 year after the interviews. Results Relative to the knowledge interview, participants in the motivational interview had larger increases in donation intention and self-efficacy from preinterview to the first follow-up. Among women only, the motivational interview was associated with greater competence and relatedness increases at both follow-up assessments. Conclusion An automated motivational interview appears to be a feasible way to promote donation intention and self-efficacy. Although the observed effects were small among highly experienced donors, we are currently assessing the potential effect of this intervention among less experienced donors.

BACKGROUND Previous studies have reported a relationship between blood donation and decreased risk for cardiovascular events, and it has been proposed that this may be due to a lowering of blood pressure among hypertensive individuals who donate on a regular basis. STUDY DESIGN AND METHODS With the use of a retrospective longitudinal analysis, predonation blood pressure readings were examined across consecutive whole blood donations for New York Blood Center donors. With blood pressure levels recorded at the first, second, third, and fourth donations, the sample was divided into three subgroups including high (≥140 mmHg), intermediate (>100 and

People overestimate the likelihood that blood donors will experience faint and prefaint reactions, particularly if they are themselves fearful of having blood drawn. This study investigated the influence of making a risk assessment for oneself versus others, and examined whether providing information about the low base rates of reactions affected donation attitude, anxiety, and intention.An anonymous online survey was completed by 3702 individuals (53.9% female; mean age, 36.9 years; standard deviation, 12.1 years; range, 18-84) that included questions about fear of having blood drawn and estimation of the risk of donation-related faint and prefaint symptoms for themselves and others. A random one-half of the respondents received accurate information about the proportion of whole blood donors who experience such reactions before all participants completed questions concerning their donation attitude, anxiety, and intention.Estimates of both faint and prefaint reactions revealed a pattern of lower perceived risk for self versus others among individuals with low fear, and higher perceived risk for self versus others among those with high fear. Provision of accurate information about risk of reactions was associated with more positive donation attitudes (F[1, 3692] = 8.182, p = 0.004) and intentions (F[1, 3692] = 10.137, p = 0.001) but did not significantly affect anxiety.Donation-related fear is associated with inflated expectancies of adverse events, especially regarding oneself. Such fear may be particularly important to address, as it has both a direct and indirect negative effect on donor retention.

Although the risk of fainting and prefaint reactions (e.g., dizziness, lightheadedness) is low during blood donation, there is evidence that this risk remains a concern for many donors. This study sought to measure perceived risk for such reactions within the general population and to relate perceived risk to individual reports of fear of having blood drawn.A sample of 1019 men and women (52.2% male; mean ± SD age, 37.2 ± 12.3 years; range, 18-80 years) completed an anonymous online survey that included questions that asked about their 1) estimation of the frequency of faint and prefaint symptoms experienced by blood donors and 2) fear of having blood drawn.Survey respondents overestimated the risk of both faint and prefaint reactions to blood donation, with estimates of fainting risk being more than 20 times the actual risk. Further, the perceived risk of both faint reactions (F(4,1008) = 25.88, p0.001) and prefaint reactions (F(4,1008) = 17.37, p0.001) was higher among those who reported greater fear of having blood drawn.The general public has inflated expectations of the risk for faint and prefaint reactions to blood donation, suggesting that efforts to educate prospective donors with accurate information may help to reduce this relatively common concern.

A motivational interview may promote blood donor retention, but live interviews can be costly. To address this challenge, we conducted two studies to examine the impact of online delivery of motivational interview content on donation intention.In Study 1, a total of 3883 respondents (52.2% female; mean ± SD age, 35.69 ± 11.3 years) completed a donation commitment measure and were randomly assigned to one of seven motivational interview-based questions or a no-question control group. In Study 2, a total of 2246 respondents (58.4% female; mean ± SD age, 35.5 ± 11.4 years) with a moderate level of donation commitment were randomly assigned to receive zero to four motivational interview-based questions. In both studies, future donation intention was measured immediately after the intervention.The first study revealed a significant effect of interview question on donation intention among participants with moderate blood donation commitment (F(7,1299) = 3.699, p = 0.001), but not among those with low or high commitment (F(7,1233) = 1.411, p = 0.20; and F(7,1327) = 0.964, p = 0.46, respectively). Study 2 replicated the significant effect of interview questions on donation intention (F(1,2230) = 2.168, p = 0.006). Relative to the no-question control condition, follow-up analyses revealed significantly higher donation intentions with 14 of the 15 question combinations (p ≤ 0.05).These findings provide initial support that online survey questions modeled on motivational interview content may elicit personal reflections that enhance donation intention, particularly among individuals with a moderate level of donation commitment.

BACKGROUND In contrast to standard donor retention strategies (e.g., mailings, phone calls, text messages), we developed a brief telephone interview, based on motivational interviewing principles, that encourages blood donors to reflect upon their unique motivators and barriers for giving. This study examined the effect of this motivational interview, combined with action and coping plan components, on blood donor motivations. STUDY DESIGN AND METHODS The design was to randomly assign blood donors to receive either a telephone-delivered motivational interview with action and coping plan components or a control call approximately 6 weeks after their most recent donation. Participants completed a series of surveys related to donation motivation approximately 3 weeks before telephone contact (precall baseline) and then repeated these surveys approximately 1 week after telephone contact (postcall). RESULTS The sample was 63% female, included a majority (52.6%) of first-time blood donors, and had a mean age of 30.0 years (SD, 11.7 years). A series of analyses of variance revealed that, relative to controls (n = 244), donors in the motivational interview group (n = 254) had significantly larger increases in motivational autonomy (p = 0.001), affective attitude (p = 0.004), self-efficacy (p = 0.03), anticipated regret (p = 0.001), and intention (p =

BACKGROUND Increasing repeat blood donation behavior is a critical public health goal. According to self-determination theory, the process of developing internal motivation to give blood and an associated self-identity as a blood donor may be promoted by feelings of “relatedness” or a connection to other donors, which may be enhanced through social relations and interactions. OBJECTIVE The purpose of this report it to describe the development and pilot testing of a social networking-based (Facebook) intervention condition designed to increase feelings of relatedness via virtual social interaction and support. METHODS To develop the intervention condition content, images, text, polls, and video content were assembled. Ohio University college students (N=127) rated the content (82 images/text) presented by computer in random order using a scale of one to five on various dimensions of relatedness. Mean ratings were calculated and analyses of variance were conducted to assess associations among the dimensions. Based on these results, the relatedness intervention was adapted and evaluated for feasibility, acceptability, and preliminary efficacy among 24 first-time donors, aged 18 to 24 years, in a 30-day pilot trial. Paired t-tests were conducted to examine change over time in relatedness and connectedness. RESULTS The intervention condition that was developed was acceptable and feasible. Results of the uncontrolled, preintervention, and postintervention evaluation revealed that feelings of individual-level relatedness increased significantly after the intervention. CONCLUSIONS By promoting first-time blood donor relatedness, our goal is to enhance internal motivation for donating and the integration of the blood donor identity, thus increasing the likelihood of future repeat donation. CLINICALTRIAL ClinicalTrials.gov NCT02717338; https://clinicaltrials.gov/ct2/show/NCT02717338 (Archived by WebCite at http://www.webcitation.org/6ymHRBCwu)

This study aimed to characterize the extent of donation-related fears among donors with different levels of donation experience.A sample of 1054 recent donors (48.3% female; mean ± SD age 33.1 ± 9.8 years) completed an anonymous, online survey of their fear of donation-related stimuli, including blood, needles, pain, and fainting. Respondents also provided information regarding demographics, pain, and vasovagal symptoms associated with their recent donation and confidence and intention with respect to a future donation.The sample was divided into four donation history subgroups, including one, two or three, four or five, or six or more prior donations. A significant negative relationship was observed between donation history and each of the assessed fears, indicating less fear with more experience. However, at least one-third of even the most experienced donors reported some fear for each of the stimuli. Further, greater fear was associated with more pain (r = 0.35-0.56, all p 0.001) and more intense vasovagal symptom reports (r = 0.41-0.61, all p 0.001). Finally, greater fear was associated with less donor confidence (r = -0.24 to -0.33, all p 0.001) and lower intentions of donating again (r = -0.14 to -0.20, all p 0.001).These data provide novel evidence that fear persists for many donors, despite increasing experience, and suggest that a greater appreciation of individual differences in fear is needed to address these concerns and promote long-term donor motivation.

BACKGROUND Based on the hypothesis that self-determined motivation is associated with an increased likelihood of future behavior, the present study examined the ability of a motivational interview to promote internal motivation for giving blood and future donation attempts. STUDY DESIGN AND METHODS A sample of 484 recent whole-blood and double red blood cell donors (62.4% female; age = 30.2 ± 11.8 years) were randomly assigned to either a telephone-delivered motivational interview or a control call approximately 6 weeks after donating. Several weeks before the call and again 1 week after the call, participants completed the Blood Donor Identity Survey, a multidimensional measure of donor motivation, to derive indices of amotivation, external motivation, and internal motivation to give blood. Repeat donation attempts were tracked using blood center records. RESULTS Relative to controls, participants in the motivational interview group showed a shift toward more self-determined motivation, as indicated by significant decreases in amotivation (p = 0.01) and significant increases in external (p = 0.009) and internal (p = 0.002) motivation. Furthermore, those with initially high levels of autonomous motivation were more likely to make a donation attempt in the subsequent year if they completed the motivational interview (71.1%) versus the control call (55.1%). CONCLUSION Motivational interviewing is a potentially useful strategy to enhance retention of existing blood donors, particularly among those who express a greater sense of internal motivation for giving.

Background Blood is a valuable resource, but most people do not donate. One deterrent to blood donation is the anticipation of vasovagal symptoms (e.g., dizziness, nausea, and fainting), despite the fact that such symptoms typically affect a small proportion of donors. The current research examined norm perceptions regarding vasovagal symptom experiences and used a message-framing paradigm to communicate accurate norm information and increase future donation intentions. Study Design and Methods Three studies were conducted using young adult samples. In Study 1, donors and nondonors estimated the percentage of people who experience vasovagal symptoms. In Studies 2 and 3, nondonors and donors (respectively) were provided with accurate, positively framed, or negatively framed norm messages and indicated their intentions to donate. Results In Study 1 we found that participants vastly overestimated how normative it was to experience vasovagal symptoms and this overestimation was stronger among nondonors. In Studies 2 and 3, we showed that positively framed normative messages (“90% of donors do not experience vasovagal symptoms”) were generally more influential than negatively framed messages (“10% of donors do experience vasovagal symptoms”), except among past donors who had unfavorable donation experiences. Conclusion These findings suggest that targeting and correcting norm perception may be a critical step toward improving blood donation rates.

Background Evidence indicates that donor identity is an important predictor of donation behavior; however, prior studies have relied on diverse, unidimensional measures with limited psychometric support. The goals of this study were to examine the application of self-determination theory to blood donor motivations and to develop and validate a related multidimensional measure of donor identity. Study Design and Methods Items were developed and administered electronically to a sample of New York Blood Center (NYBC) donors (n = 582) and then to a sample of Ohio University students (n = 1005). Following initial confirmatory factor analysis (CFA) on the NYBC sample to identify key items related to self-determination theory's six motivational factors, a revised survey was administered to the university sample to reexamine model fit and to assess survey reliability and validity. Results Consistent with self-determination theory, for both samples CFAs indicated that the best fit to the data was provided by a six-motivational-factor model, including amotivation, external regulation, introjected regulation, identified regulation, integrated regulation, and intrinsic regulation. Conclusion The Blood Donor Identity Survey provides a psychometrically sound, multidimensional measure of donor motivations (ranging from unmotivated to donate to increasing levels of autonomous motivation to donate) that is suitable for nondonors as well as donors with varying levels of experience. Future research is needed to examine longitudinal changes in donor identity and its relationship to actual donation behavior.

Background The Theory of Planned Behavior has been widely used in blood donation research, but the lack of uniform, psychometrically sound measures makes it difficult to draw firm conclusions or compare results across studies. Accordingly, the goal of this study was to develop such measures of donation attitude, subjective norm, perceived behavioral control, and intention. Study Design and Methods Exploratory and confirmatory factor analyses (CFAs) were conducted on survey responses collected from college students (n = 1080). The resulting scales were then administered to an independent sample of experienced donors (n = 433) for additional CFAs and to test whether the Theory of Planned Behavior model provided a good fit to the data. Results CFAs conducted on both samples support the use of six-item scales, with two factors each, to measure donation attitude, subjective norm, and perceived behavioral control and a single-factor three-item scale to measure donation intention. Further, structural equation modeling of these measures revealed that the Theory of Planned Behavior provided a strong fit to the data (comparative fit index, 0.976; root mean square error of approximation, 0.041; standardized root mean square residual, 0.055) and accounted for 73.7% of the variance in donation intention. Conclusion The present findings confirm the applicability of the Theory of Planned Behavior to the blood donation context and more importantly provide psychometric support for the future use of four brief measures of donation attitude, subjective norm, perceived behavioral control, and intention.

Background We previously demonstrated that fear of having blood drawn is one of the strongest known predictors of vasovagal reactions among high school blood donors. This report examines the combined effects of donor fear and experience of vasovagal reactions on repeat donation attempts among high school blood donors. Study Design and Methods Immediately after completing the blood donor health screening, 1715 high school students were asked about their fear of having blood drawn. The donor record was then used to collect information regarding their experience of vasovagal reactions at the time of donation as well as their subsequent donation attempts within the following year. Results Fear of having blood drawn and the experience of a vasovagal reaction each contributed to donor attrition, with only 33.2% of fearful donors who experienced a vasovagal reaction returning in the following year compared to 56.7% of nonfearful nonreactors. Path analyses demonstrated that fear has an indirect effect (through vasovagal reactions) on repeat donations among first-time donors and both direct and indirect effects on repeat donation attempts among experienced donors. Conclusion Among high school blood donors, fear of having blood drawn has both a direct negative effect on donor retention and an indirect negative effect by increasing the risk of vasovagal reactions. Accordingly, targeted efforts to reduce donor fear may be particularly efficient in promoting long-term donor loyalty among our youngest donors.

The Blood Donor Competency, Autonomy, and Relatedness Enhancement (Blood Donor CARE) project was designed as a practical application of self-determination theory to encourage retention of first-time donors. Self-determination theory proposes that people are more likely to persist with behaviors that are internally-motivated, and that externally-motivated behavior can evolve and become internalized given the appropriate socio-environmental conditions. According to self-determination theory, motivation to engage in blood donation may become increasingly self-determined if the behavior satisfies fundamental human needs for competence (a sense of self-efficacy to achieve specific goals), autonomy (a sense of volitional control over one's behavior), and relatedness (a sense of connection to a larger group). The primary aim of this randomized controlled trial is to examine the effect of competence, autonomy, and/or relatedness interventions on donor retention. Using a full factorial design, first-time donors will be assigned to a control condition or one of seven intervention conditions. Donation competence, autonomy, and relatedness, along with additional constructs associated with return donation, will be assessed before and after the intervention using online surveys, and donation attempts will be tracked for one-year using blood center donor databases. We hypothesize that, compared to the control condition, the interventions will increase the likelihood of a subsequent donation attempt. We will also examine intervention-specific increases in competence, autonomy, and relatedness as potential mediators of enhanced donor retention. By promoting first-time donor competence, autonomy, and relatedness our goal is to enhance internal motivation for giving and in so doing increase the likelihood of future donation.

Previous studies have reported a relationship between blood donation and decreased risk for cardiovascular events, and it has been proposed that this may be due to a lowering of blood pressure among hypertensive individuals who donate on a regular basis.With the use of a retrospective longitudinal analysis, predonation blood pressure readings were examined across consecutive whole blood donations for New York Blood Center donors. With blood pressure levels recorded at the first, second, third, and fourth donations, the sample was divided into three subgroups including high (≥140 mmHg), intermediate (100 and40 mmHg), and low (≤100 mmHg) systolic blood pressure (SBP). In addition, a computational approach was used to estimate regression to the mean effects for donors with high SBP or high diastolic blood pressure (DBP) at their first, second, or third donation.Visual examination of SBP and DBP patterns across donations revealed that, on average, donors with extreme values at one donation had relatively normal values at the other donations. Further, comparison of computed expected versus observed blood pressure decreases supported the notion of a subsequent regression to the mean among donors with elevated SBP or DBP at Donation 1, 2, or 3.Among individuals who are hypertensive at initial donation, reductions in blood pressure at subsequent donations appear to result from regression to the mean as opposed to a salutary physiologic process.

BACKGROUND: We previously demonstrated in a group of mostly experienced blood donors that fear of blood draws was a significant predictor of vasovagal reactions. Importantly, being asked about one's fear immediately before donation did not increase reaction rates. This study further evaluates the relationship between fear and reactions among high school blood donors, who are known to be at a relatively greater risk for vasovagal reactions. STUDY DESIGN AND METHODS: Immediately after completing the blood donor health screening, 17- and 18-year-old high school students were asked about their fear of having blood drawn. Based on a random selection, the fear question was administered in approximately half of the schools, resulting in a final sample of 1715 donors who did and 1692 donors who did not answer the fear question. RESULTS: Fear was a significant predictor of donor reactions and remained a significant independent predictor (along with estimated blood volume and donor sex) in a logistic regression analysis. There was no difference in the proportion of reactions observed between those who did and did not answer the predonation fear question. CONCLUSION: Consistent with previous evidence in older and more experienced blood donors, these findings indicate that assessing fear of blood draws may help to identify those who are most likely to experience vasovagal reactions among young donors without increasing the frequency of such reactions.

BACKGROUND: Written and video approaches to donor education have been shown to enhance donation attitudes and intentions to give blood, particularly when the information provides specific coping suggestions for donation-related concerns. This study extends this work by comparing Web-based approaches to donor preparation among donors and nondonors. STUDY DESIGN AND METHODS: Young adults (62% female; mean [±SD] age, 19.3 [±1.5] years; mean [range] number of prior blood donations, 1.1 [0-26]; 60% nondonors) were randomly assigned to view 1) a study Web site designed to address common blood donor concerns and suggest specific coping strategies (n = 238), 2) a standard blood center Web site (n = 233), or 3) a control Web site where participants viewed videos of their choice (n = 202). Measures of donation attitude, anxiety, confidence, intention, anticipated regret, and moral norm were completed before and after the intervention. RESULTS: Among nondonors, the study Web site produced greater changes in donation attitude, confidence, intention, and anticipated regret relative to both the standard and the control Web sites, but only differed significantly from the control Web site for moral norm and anxiety. Among donors, the study Web site produced greater changes in donation confidence and anticipated regret relative to both the standard and the control Web sites, but only differed significantly from the control Web site for donation attitude, anxiety, intention, and moral norm. CONCLUSION: Web-based donor preparation materials may provide a cost-effective way to enhance donation intentions and encourage donation behavior.

BACKGROUND: Fear is an important contributor to the risk of presyncopal reactions to blood donation. However, concern that asking donors about their fears may increase the risk of reactions is a potential impediment to incorporating fear assessment into donor screening. STUDY DESIGN AND METHODS: Before donation, participants responded to a series of questions that either did (n = 488) or did not (n = 494) include questions related to fear of seeing blood drawn. Immediately after donation all participants provided ratings of presyncopal reactions. RESULTS: Among those asked predonation fear questions, fear was most strongly related to presyncopal symptoms when compared against other donor characteristics (e.g., age, number of prior donations, body mass index, estimated blood volume, blood pressure, and pulse). However, Mann-Whitney U tests revealed that being asked about fear before donation was not associated with higher reports of presyncopal reactions for the sample as a whole, nor among novice donors. Further, regression analyses indicated that fear remained a significant predictor of presyncopal reactions in final models that included age and number of prior donations as significant predictors. CONCLUSION: Predonation assessment of fear of blood draws may help to identify donors who are most likely to benefit from brief interventions designed to enhance donor coping, reduce risk of presyncopal reactions, and increase donor retention. F or donor safety reasons, individual difference characteristics such as age and weight are routinely used to screen potential blood donors. Although the addition of new screening criteria can be a challenge to the blood collection process and the overall blood supply, recent findings regarding the positive relationship between estimated total blood volume and risk of syncopal and presyncopal reactions 1 has led many blood collection agencies to consider the combination of donor sex, height, and weight in determining eligibility to give blood. Interestingly, despite the fact that convincing reports of the relationship between donor fear or anxiety and the experience of syncopal reactions date back more than 50 years

BACKGROUND: Past blood donation research has relied on explicit (self-report) measures to understand blood donation motivations, but has not yet considered the inherent implicit or automatic processing involved in decision-making. This study addresses this limitation by introducing and validating two novel implicit measures of blood donation attitudes. STUDY DESIGN AND METHODS: Healthy young adults (n = 253) performed both image and word versions of a Single Target Implicit Association Test (ST-IAT) and then completed self-report measures of blood donation attitudes, blood and needle fears, social desirability, and donation intention. RESULTS: These results affirmed the validity of the blood donation ST-IATs in at least three ways. First, as expected, nondonors demonstrated more negative implicit donation attitudes than donors. Second, the implicit measures were significantly related in expected directions with explicit measures of donation attitudes as well as blood and needle fears. Finally, implicit donation attitudes were significantly related to donation intention, and the Image ST-IAT (but not the Word ST-IAT) significantly enhanced prediction of donation intention over and above needle fears and marginally enhanced prediction over and above blood fears. CONCLUSION: Image and word versions of the blood donation ST-IAT offer a valid method of assessing underlying automatic attitudes toward blood donation.

BACKGROUND: Applied muscle tension (AMT), which involves rhythmic tensing of the muscles of the core and lower extremities, has been associated with attenuation of presyncopal reactions among whole blood donors. This study was designed to examine whether the salutary effects of AMT may be mediated by increases in cerebral oxygenation during blood donation. STUDY DESIGN AND METHODS: Seventy-two female blood donors were recruited at mobile blood drives in the American Red Cross Blood Services–Central Ohio Region. Participants were randomly assigned to engage in either AMT or repeated gentle foot flexions (i.e., distraction control) during whole blood donation. Cerebral oxygenation was monitored throughout the donation using near infrared spectroscopy. RESULTS: Participants who engaged in AMT were shown to have attenuated decreases in cerebral oxygenation across the three intervals of the blood draw relative to the distraction manipulation (F(1,70) = 8.144, p = 0.006). Whereas cerebral oxygenation decreased 1.42% (SD, 2.09%) for those in the distraction-control group, oxygenation levels increased 0.13% (SD, 2.56%) in the AMT group. CONCLUSION: AMT is associated with an attenuated decrease in cerebral oxygenation compared to a distraction-control group. Further studies are necessary to establish if the salutary effect of AMT during blood donation may be in part due to an increase in oxygen available to the brain.

BACKGROUND: Prior research has shown that education materials that directly address prospective donor concerns and provide specific coping suggestions are particularly effective at enhancing donation attitudes and intentions to give blood. This study compared the effect of donor coping materials, provided in written and audiovisual formats, as potential tools to enhance recruitment of prospective blood donors. The role of initial attitudes toward blood donation on responses to these materials was also considered. STUDY DESIGN AND METHODS: Young adults (62% female; mean [SD] age = 19.1 [1.4]; mean [range] prior blood donations = 1.32 [0-13]) were randomly assigned to 1) read a brochure addressing common blood donor concerns and suggesting specific coping strategies, 2) view a video addressing blood donor concerns and illustrating coping techniques, 3) read the brochure and view the video, or 4) read a control brochure on healthy eating and exercise. Measures of blood donation attitudes, anxiety, confidence, and intentions to give blood were completed before and after the intervention. RESULTS: Relative to the control brochure, all the intervention groups showed larger reductions in anxiety, more positive changes in attitude, and greater increases in donation confidence and intentions. The combination of the brochure and video outperformed either intervention alone in further improving donation attitudes among participants with high initial donation attitudes. CONCLUSION: Blood donation coping materials, presented in either written or audiovisual formats, significantly enhance willingness to donate blood among young adults regardless of their initial attitudes toward blood donation.

Background: Increasing repeat blood donation behavior is a critical public health goal. According to self-determination theory, the process of developing internal motivation to give blood and an associated self-identity as a blood donor may be promoted by feelings of “relatedness” or a connection to other donors, which may be enhanced through social relations and interactions. Objective: The purpose of this report it to describe the development and pilot testing of a social networking-based (Facebook) intervention condition designed to increase feelings of relatedness via virtual social interaction and support. Methods: To develop the intervention condition content, images, text, polls, and video content were assembled. Ohio University college students (N=127) rated the content (82 images/text) presented by computer in random order using a scale of one to five on various dimensions of relatedness. Mean ratings were calculated and analyses of variance were conducted to assess associations among the dimensions. Based on these results, the relatedness intervention was adapted and evaluated for feasibility, acceptability, and preliminary efficacy among 24 first-time donors, aged 18 to 24 years, in a 30-day pilot trial. Paired t-tests were conducted to examine change over time in relatedness and connectedness. Results: The intervention condition that was developed was acceptable and feasible. Results of the uncontrolled, preintervention, and postintervention evaluation revealed that feelings of individual-level relatedness increased significantly after the intervention. Conclusions: By promoting first-time blood donor relatedness, our goal is to enhance internal motivation for donating and the integration of the blood donor identity, thus increasing the likelihood of future repeat donation. Trial Registration: ClinicalTrials.gov NCT02717338; https://clinicaltrials.gov/ct2/show/NCT02717338 (Archived by WebCite at http://www.webcitation.org/6ymHRBCwu)

BACKGROUND: A randomized controlled trial was conducted to test the effects of hydration and applied muscle tensing on presyncopal reactions to blood donation. Both interventions are designed to prevent the decreases in blood pressure that can contribute to such reactions, but due to the distinct physiologic mechanisms underlying their pressor responses it was hypothesized that a combined intervention would yield the greatest benefit. STUDY DESIGN AND METHODS: Before blood donation, first- and second-time blood donors (mean age, 20.2 years; SD, 4.9) were randomly assigned to 1) standard donation, 2) placebo (leg exercise before venipuncture), 3) predonation water, or 4) predonation water and leg exercise during donation. RESULTS: Main effects of group were observed for phlebotomist classification of vasovagal reactions (χ2(3) = 8.38, p

BACKGROUND: Presyncopal reactions are among the most common systemic reactions experienced by blood donors, occur most frequently in novice donors, and can serve as a deterrent to future donation regardless of donation experience. This report describes the validation of a presyncopal reactions scale that can be used to standardize assessment of the donor's subjective experience. STUDY DESIGN AND METHODS: A psychometric analysis of the Blood Donation Reactions Inventory (BDRI), a measure of presyncopal reactions, was conducted using data obtained from two independent samples of volunteer blood donors. Based on these analyses, a new, brief version of the BDRI is proposed, and psychometric data regarding the reliability and construct validity of this instrument are presented. RESULTS: Results of confirmatory factor analyses indicate that a 4-item version of the BDRI can be used to assess subjective perception of mild, prefaint symptoms. Additional analyses indicate that the BDRI has good internal consistency and demonstrates concurrent validity relative to other indices of donor reactions (e.g., donor chair reclines and loss of consciousness). Construct validity is supported by factor analyses, expected score differences in different donor groups, and convergent validation against measures of donor satisfaction and likelihood of repeat donation. CONCLUSION: The BDRI provides an assessment of subjective ratings of presyncopal symptoms that is brief, easily understood by donors, and quick to administer and score. The BDRI yields important information about the donor's experience that can be used to predict satisfaction and likelihood of repeat donation.

Path analysis was used to examine sex differences in motivation for repeat donation among experienced blood donors. Results confirm the importance of constructs from the Theory of Planned Behavior (e.g., donation attitude, subjective norm, personal moral norm, and donation self-efficacy) and of prior donation experience (e.g., vasovagal symptoms, overall satisfaction) as significant predictors of donation intention. Importantly, the findings also indicate that a consideration of sex differences in donor motivations results in a better prediction model and suggests a framework of possible avenues where interventions could be expected to improve donor return rates.

BACKGROUND: Although little empiric evidence has been published concerning the efficacy of blood donor recruitment materials, research suggests that simple attempts to enhance knowledge may not be sufficient to motivate donation. In contrast, recent donor motivation studies highlight the importance of anxiety, attitudes, and perceived ability to cope with donation (i.e., self-efficacy) as crucial determinants of donation intention. Therefore, recruitment materials that specifically address these constructs have the potential to outperform traditional educational brochures. STUDY DESIGN AND METHODS: Participants were randomly assigned to read one of three brochures: 1) a new brochure addressing common donor concerns and suggesting specific coping strategies, 2) a standard blood center brochure, or 3) a control brochure on healthy eating and exercise. Standardized questionnaires were completed before and after the brochures to assess change in blood donation anxiety, attitude, self-efficacy, and intention. RESULTS: Although no significant changes were noted for the control brochure, after reading the new brochure participants reported significant improvements in attitude, anxiety, self-efficacy, and donation intention. The standard donation brochure had an intermediate effect. CONCLUSION: Efforts to address common donor fears and to provide useful coping suggestions may improve the effectiveness of blood donation recruitment materials.

BACKGROUND: The need for blood products is constant and unremitting, yet only a small percentage of eligible individuals answer the appeal to donate. Further, most new donors never return to provide a repeat donation. The ongoing need to attract and retain new donors has led to the examination of psychosocial factors that may predict the likelihood of blood donation behavior. By use of regression techniques, prior studies have established that elements of the Theory of Planned Behavior (e.g., attitude, subjective norm, personal moral norm, and perceived control or self-efficacy) can predict intention to donate among nondonors. STUDY DESIGN AND METHODS: Path analysis was used to further examine the utility of the Theory of Planned Behavior in predicting donation intention in a sample of 227 experienced donors who completed an online survey. Experiential measures relating to previous donations, including the experience of vasovagal reactions and overall donor satisfaction, were added to the model. RESULTS: The final model, which provided an excellent fit to the data, characterized 1) three direct pathways from attitude, subjective norm, and self-efficacy to donation intention and 2) four indirect pathways, wherein self-efficacy, personal moral norm, vasovagal reactions, and overall donor satisfaction influence donation intention through attitude. In total, 65 percent of the variance in donation intention and 50 percent of the variance in attitude is accounted for in this model. CONCLUSION: The Theory of Planned Behavior can be used to predict donation intentions among experienced donors. Further, the model's predictive utility is improved by considering the influence of previous donation experiences on donor attitudes.

First-time blood donors are essential to the US donor pool, providing nearly a third of all donations. Unfortunately, there are a wide variety of obstacles to repeat donation and new donors are extremely difficult to retain. Because each donor experiences a unique set of deterrents, we developed a post-donation interview based on motivational interview principles in order to flexibly address individual barriers. The primary aim of this randomized clinical trial is to examine retention of first-time, group O blood donors who are randomly assigned to receive either a telephone-delivered interview with motivational and action planning components or a standard-of-care control call approximately six weeks after their donation. Measures of donation attitude, perceived behavioral control, intention, and motivational autonomy will be measured before and after the telephone contact using online surveys, and donation attempts will be tracked for one year using blood center donor databases. We hypothesize that, compared to controls, donors who receive the telephone interview will be more likely to make a donation attempt over the following year. In addition, we will examine possible mechanisms of action of the interview using key predictors of donation behavior as described by Self Determination Theory (i.e., motivational autonomy) and the Theory of Planned Behavior (i.e., attitude, perceived behavioral control, and intention). Results of this intervention may help to support a novel strategy to enhance retention of selected blood donors in an effort to better meet the nation's blood supply needs.

Fear of blood draws is a predictor of vasovagal reaction risk among whole blood donors, and this relationship is particularly evident among less experienced donors. This study examines the combined effect of donor fear and total blood draw time on vasovagal reactions.After successfully completing the blood donor health screening, 2730 whole blood donors attending high school drives were asked about their fear of having blood drawn. Donor reports of fear versus no fear were combined with total blood draw time to predict phlebotomist ratings of donor vasovagal reactions.Both fear and draw time were significant predictors of vasovagal reactions, with observed reaction rates of 31.2% for fearful donors whose blood draw lasted 10 minutes or more versus 5.0% for nonfearful donors whose draw lasted less than 6 minutes. Binomial regression analyses revealed that fear remained a significant predictor of reaction rates across all blood draw intervals examined (odds ratio, 2.8-4.1; all p 0.001) and that these effects were maintained after controlling for donor sex, weight, estimated blood volume, pulse rate, and donation status.This report shows that both fear and blood draw time increase vasovagal reaction rates, and the two are additive. These findings suggest that fearful donors should be the focus of special attention to reduce their distress before donation as well as careful observation throughout the draw.

The nociceptive flexion reflex (NFR) is a polysynaptic withdrawal reflex that occurs in response to painful stimulation. In human studies, NFR responsiveness has been used as a direct measure of nociception as well as an indirect measure of supraspinal modulation of nociceptive transmission. Previous studies have suggested that anxiety may influence NFR responding, and therefore it has been recommended that anxiety be reduced by familiarizing participants with assessment methodology prior to formal NFR assessment. The present study was designed to assess the influence of anxiety on NFR threshold. Using a repeated measures design, 40 men and women completed an NFR threshold assessment twice within session one, and twice again during a second session conducted 24 h later. Within each assessment session, state anxiety was measured at the beginning of the session and immediately following each NFR threshold assessment. Results indicated that although anxiety increased in response to NFR threshold assessment and was positively related to subjective pain reports, anxiety was not related to observed NFR threshold levels. These findings suggest that individual differences in anxiety do not significantly affect NFR threshold level determinations under standard testing conditions.

A growing body of evidence suggests that episodes of fainting can deter volunteer blood donors from returning to donate in the future. In contrast, relatively little is known about the effect of significantly more common mild reactions (e.g., faintness, dizziness, lightheadedness) on donor retention. In the present study, 1052 volunteer blood donors completed a standardized measure of subjective physiological reactions immediately after blood donation (Blood Donation Reactions Inventory), and individual scores were used to predict repeat donation behavior during a one-year follow-up. Results of a logistic regression analysis indicated that higher scores on the Blood Donation Reactions Inventory were associated with a significantly lower likelihood of repeat donation, and that novice donors who scored highest on the scale were less than half as likely to have returned to donate in the following year. These findings suggest that the Blood Donation Reactions Inventory is an effective method of assessing reactions that predict donor non-return, and therefore may be a useful addition to future studies aimed at enhancing donor satisfaction and retention.

Catastrophizing is reliably associated with increased reports of clinical and experimental pain. To test the hypothesis that catastrophizing may heighten pain experience by increasing nociceptive transmission through spinal gating mechanisms, the present study examined catastrophizing as a predictor of pain ratings and nociceptive flexion reflex (NFR) thresholds in 88 young adult men (n = 47) and women (n = 41). The NFR threshold was defined as the intensity of electrocutaneous sural nerve stimulation required to elicit a withdrawal response from the biceps femoris muscle of the ipsilateral leg. Participants completed an assessment of their NFR threshold and then provided pain ratings using both a numerical rating scale (NRS) and the short-form McGill pain questionnaire (SF-MPQ). Pain catastrophizing was assessed using the catastrophizing subscale of the coping strategies questionnaire (CSQ). Although catastrophizing was positively related to both NRS and SF-MPQ pain ratings, catastrophizing was not significantly related to NFR threshold. These findings suggest that differential modulation of spinal nociceptive input may not account for the relationship between catastrophizing and increased pain.

Therapeutic mechanisms hypothesized to underlie improvements in tension headache activity achieved with combined relaxation and electromyographic (EMG) biofeedback therapy were examined. These therapeutic mechanisms included (1) changes in EMG activity in frontal and trapezii muscles, (2) changes in central pain modulation as indexed by the duration of the second exteroceptive silent period (ES2), and (3) changes in headache locus of control and self-efficacy. Forty-four young adults with chronic tension-type headaches were assigned either to six sessions of relaxation and EMG biofeedback training (N = 30) or to an assessment only control group (N = 14) that required three assessment sessions. Measures of self-efficacy and locus of control were collected at pre- and posttreatment, and ES2 was evaluated at the beginning and end of the first, third, and last session. EMG was monitored before, during, and following training trials. Relaxation/EMG biofeedback training effectively reduced headache activity: 51.7% of subjects who received relaxation/biofeedback therapy recorded at least a 50% reduction in headache activity following treatment, while controls failed to improve on any measure. Improvements in headache activity in treated subjects were correlated with increases in self-efficacy induced by biofeedback training but not with changes in EMG activity or in ES2 durations. These results provide additional support for the hypothesis that cognitive changes underlie the effectiveness of relaxation and biofeedback therapies, at least in young adult tension-type headache sufferers.

Blood is a valuable resource, but most people do not donate. One deterrent to blood donation is the anticipation of vasovagal symptoms (e.g., dizziness, nausea, and fainting), despite the fact that such symptoms typically affect a small proportion of donors. The current research examined norm perceptions regarding vasovagal symptom experiences and used a message-framing paradigm to communicate accurate norm information and increase future donation intentions.Three studies were conducted using young adult samples. In Study 1, donors and nondonors estimated the percentage of people who experience vasovagal symptoms. In Studies 2 and 3, nondonors and donors (respectively) were provided with accurate, positively framed, or negatively framed norm messages and indicated their intentions to donate.In Study 1 we found that participants vastly overestimated how normative it was to experience vasovagal symptoms and this overestimation was stronger among nondonors. In Studies 2 and 3, we showed that positively framed normative messages ("90% of donors do not experience vasovagal symptoms") were generally more influential than negatively framed messages ("10% of donors do experience vasovagal symptoms"), except among past donors who had unfavorable donation experiences.These findings suggest that targeting and correcting norm perception may be a critical step toward improving blood donation rates.