w w w . r b h h . o r g
Revista
Brasileira
de
Hematologia
e
Hemoterapia
Brazilian
Journal
of
Hematology
and
Hemotherapy
Original
article
Perceptions
of
donors
and
recipients
regarding
blood
donation
Vander
Monteiro
da
Conceic¸ão
a,∗,
Jeferson
Santos
Araújo
a,
Rafaela
Azevedo
Abrantes
de
Oliveira
a,
Mary
Elizabeth
de
Santana
b,
Márcia
Maria
Fontão
Zago
aaUniversidadedeSãoPaulo(USP),RibeirãoPreto,SP,Brazil
bUniversidadedoEstadodoPará(UEPA),Belém,PA,Brazil
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Articlehistory:
Received31March2016 Accepted19May2016 Availableonline11June2016
Keywords: Blooddonor Bloodtransfusion Transfusionservice Hematology
DeliveryofHealthCare
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Objective:Theaimofthisstudywastoidentifytheperceptionsofblooddonorsand recipi-entsregardingtheactofdonatingblood.
Method:Thisdescriptive study witha survey designfocuses onsubjective andcultural aspects.Twentydonorsand20recipients inthebloodbank atthetime ofdata collec-tionparticipatedinthestudy.Interviewswereanalyzedaccordingtodeductivethematic analysis.
Results:Twothemesemerged–perceptionsofdonorsandperceptionsofrecipients.Both groupssawtheactofdonatingbloodassomethingpositive,thoughdonorsassociatedtheir reportswiththeexperiencesofpeopleclosetothemwhoneededbloodtransfusions,while therecipientsassociateddonationswiththemaintenanceoftheirlivesas,forthem,ablood transfusionwasanecessarymedicaltreatment.
Conclusions:Perceptionsregardingblooddonationsareculturallyconstructed,asthe partic-ipantsassociatedknowledgeacquiredinthesocialworldwithmoralissuesandtheirlife experiences.Hence,inadditiontohelpingothers,theseindividualsfeelsociallyandmorally rewarded.
©2016Associac¸ ˜aoBrasileiradeHematologia,HemoterapiaeTerapiaCelular.Published byElsevierEditoraLtda.ThisisanopenaccessarticleundertheCCBY-NC-NDlicense
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Introduction
InBrazil,blooddonationisavoluntaryandnon-remunerated act.For this reason,blood banks needstrategiesto attract donors in order to provide blood products to hematology
∗ Correspondingauthorat:Sala75,EscoladeEnfermagemdeRibeirãoPreto,UniversidadedeSãoPaulo,AvenidaBandeirantes,3900, 14040-902RibeirãoPreto,SP,Brazil.
E-mailaddress:vandermonteiro@usp.br(V.M.Conceic¸ão).
patients. News reports usually show the difficulties blood banksfaceinrecruitingdonors, whichresultsinareduced supplyofbloodproducts.
Withtheintenttochangethiscontext,researchersconduct studiestoverifytheprofileofdonorsandidentifythosewho aremostlikelytoagreetodonateblood.Astudyconducted
http://dx.doi.org/10.1016/j.bjhh.2016.05.006
inacityintheinteriorofParaná,Brazilidentified5700donor candidatesin2008.Mostwerewomen(3477)andregularblood donors(3079),whichrevealedthatalargenumberofdonors wereloyaltothefacility.1
Otherstudiesusingaqualitativemethodologyidentified possiblereasons forthe donationofblood,suchas solidar-ity,theneedtoreplacesupplies,thebenefitsofdonating,and curiosity.2Donatingisinherenttothelifeofhumansevenif
suchanactisnotalwaysperceived.Conversationsregarding bloodraisefeelingsinthesocialimaginarysuchasfear,pain, lifeanddeath,sufferingandjoy.3
Therefore,blooddonationisanactthatinvolvescultural elementsthatpermeatesociallife.Cultureisanassociation ofinformationthat characterizes an activity performed by an individual. Information cannot be described by biology butbymembersofasocialgroup,who assignmeaningsto attitudes,whichare theninterpretedbyresearchersto cor-roborateknowledgefromthesocialmilieu.4
Fromthisperspective,ahealthproblemisnotanindividual understanding,but aconsensualunderstanding,which has interpretativerelevanceinitssocialgroupoforiginandcan affectbehaviorandeventhewaypeoplerelatetoeachother whencopingwithaproblem.5
Healthprovidersspecializing intransfusion therapyand hematologyshouldbeattentivetothecontextinwhichthey are inserted, not only inrespect to the clinical or organi-zational aspects within a blood therapy center but, more importantly,tounderstandtheindividualstowhomcareis provided.Eveniftheseindividualsstayforlessthan30min intheservice, theyrepresentaculturalgroupthatreceives carefromahealthcarefacility,assigningmeaningsandhaving perceptionsregardingtheactofdonatingblood.
Notethathealthcaredeliveryshouldalsobebasedonthe perceptionsofpatientsregardingagivenphenomenon,beit ofabiological or psychosocialnature, asthis may directly influencethemaintenanceofdonationpractices.Hence,the objectiveofthisarticlewastoseekanunderstandingofthe perceptions of donors and recipients regarding the act of donatingblood.
Method
Thisdescriptivestudywithasurveydesignfocusedon sub-jectiveaspects,6highlightingculturalfeaturesthatemerged
inthe interviews ofthe participants. The Anthropology of Health7 was the theoretical framework used, based upon
which,cultureinvolvesthedimensionsthatdirectlyinfluence thebehaviorsofindividualsregardingtheirhealth,whether relatedtoself-careorcaredeliveredbyanother.Thecultural perceptionconcerningblooddonationofpeopleusingablood bankisthefocusofthisstudy.
Thisstudywasconductedinabloodbankinthestateof Pará,Brazil where40 participants were recruited:20 blood donorsand20recipientswhoattendedthefacilityfrom Jan-uarytoDecember2011.Eventhoughthedatawerecollectedin 2011,theauthorsbelievethattheperceptionspresentedhere representthecurrentcontextofdonorsandrecipientsfrom thefacilityunderstudy.Therefore,the publicationofthese
resultsinthecurrentcontextisjustifiedbasedonthescientific maturationoftheresearchers.
Donorswereinterviewedafterblooddonationand recip-ientswereapproachedduringbloodtransfusions.Notethat members ofbothgroupswere older than 18years old and signedinformedconsentformsbeforebeingincludedinthe study.
The interviews were held in a private room provided to the researchers in the facility’s premises. A question-naire addressing sociodemographic data and an interview scriptaddressingperceptionsregardingblooddonationwere applied,audiorecordedandlatertranscribedfordataanalysis. Themeetingslasted20minonaverage.
Sociodemographic data were analyzed according to descriptive statistics. Transcriptions were analyzed using deductivethematicanalysisandclassifiedintocommon cat-egoriesaccordingtotheirfrequencyandrelevanceandlater organizedintothematicunits.8
This study is in agreement with resolution 466/12 of the National Council of Health that provides “Regulatory Guidelines and Standards for Research Involving Human Subjects”.9 Theproject wassubmitted to and approvedby
the Institutional Review Board at HEMOPA (Blood Therapy and Hematology Foundation Center of Pará: Protocol No. 0541.0.000.324-11).Thestudy’sparticipantsareidentifiedby falsenameswheneverexcerptsoftheirreportsareincluded inthispaper.
Results
Characterizationofparticipants
Ofthe40participants,20weredonorsand20wereblood recip-ients.Amongthedonors,55%wereagedbetween20and29 yearsold,30%wereagedbetween30and39yearsold,and15% werebetween40and49yearsold.Inregardtogender,5%were menand 95% were women.Concerningreligion, 45%were Catholic,30%wereEvangelical,10%wereSpiritualistsand15% didnotreporttheirreligion.Halfthedonorsweresingle,40% were marriedand 5%were widowed. Themonthlyincome wasfrom twominimumwagesfor70%ofthe participants, tobetweenthreeandfivetimestheminimumwagefor20%; 5%hadamonthlyincome6to10timestheminimumwage, while5%didnotreporttheirincome.Intermsofeducation, 15%hadbachelor’sdegrees,15%attendedsomecollege,20% hadcompletedhighschool,20%hadincompletehighschool, 20%hadcompletedmiddleschool,20%hadincomplete mid-dleschool,while5%didnotstatetheirlevelofschooling.The reasonsthattheparticipantsprovidedastowhytheydonated bloodincludedvoluntarydonationsfor35%ofdonorsand65% wereaskedtodonateblood.
highschool,50%hadincompletemiddleschool,and5%had completedmiddleschool.Monthlyincomevariedfrom one minimumwagefor50% ofrecipients tothree tofivetimes theminimumwagefor30%;20%didnotreporttheirincome. Thereasonstheseparticipantsrequiredtransfusionsincluded hemophiliaAandBin10%oftherecipients, thrombocyto-peniain5%,hypoplasiain5%,irondeficiencyanemiain10%, sicklecellanemiain55%,anemiacausedbysuddenlossof bloodin10%,andanemiathatneededclarificationin5%.
Perceptionsofdonors
Donorsconsidered blooddonation tobelinkedtolife,that is,givingbloodmeansfosteringlife,mainlykeepinglifeand wardingoffdeath.Thereportsrevealperceptionsthatratify thesestatements,suchassavinglives,helpinglives, strength-eninglives,andavoidingdeath,whichcanbeobservedinthe excerptsexemplifyingtheperceptionsofthe sampleunder study.
“Donatingmeanscooperatingwithlife,withthefacility(blood bank),helpingothersandoneself,becausewehavetherightto examseverythreemonths,sohelpingothersnotexpecting any-thinginreturn;inadditiontohavingtherighttotakethedayoff, thoughIneverdo”(Lucas);
“Savingalife.Because,bloodisthemainorganoflife,soitis donatinglife.Ialso renew myblood,feel relievedand lighter, andIalsofeelhealthy.”(Luís);
“Helpingothers.PeopleneeditandonedayImayneedit,soI needtodomysharetoensureI’llhaveit.Ineedtohelpsomehow whoever is in need. I always had a desire to help, perhaps becauseofmyupbringing”(Marcos);
“Donatinglife,becausegivingbloodhelpspeoplelive,likewhen there’re accidents. As when my grandma got ill and needed severalbloodtransfusionsandithelpedhertostaylongerwith us,beforeshedied...Givingalittlebloodyouwon’tmiss,can savelives”(Felipe).
Perceptionsofrecipients
Blooddonationpermeatesthelivesofrecipientsbecausefor themthebloodtransfusionsareamedicaltreatmentandtheir reportsexpressperceptionsrelatedtosavinglives,solidarity, anactoflove,needforcare,inadditiontoamoralcomponent becausethedonationofbloodisseenasasociallyacclaimed action.
“Donatingisaneed,peopleshould donateto thosein need.I havehypoplasia,Ineedbloodtokeepgoingwithmylife. Donat-ingbloodisimportantbecauseweneedtohelptheillandalso learnaboutthediseaseswehavethroughtheresearchpeopledo” (Pedro);
“Donating is life because without blood, it’s difficult right? Nobody survives without blood. I get happy when someone donatestous.Anyonewhohastheopportunitytodonate,should donate.Therearealotofpeoplewhoneedit.Ialwayshadthe desiretodonate,howeverIhadhepatitiswhenIwasachildand youcannotgivebloodifyouhave hepatitisandthat’swhenI foundoutaboutmyproblem.Butthosewhocan,shoulddonate” (Letícia);
“Solidarity andlove because it’sasingle actthatsaves lives ofotherpeople.It’sutterlyimportantbecauseitsavedmylife” (Nayara);
“It’sanactofsolidaritybecauseIguessthatpeoplewhodonate aremorehumanethanthosewhoreceiveit.Iguessthatdonors areveryimportantforme.Iguesstheyshouldtakecareof them-selvesbecausetheysavelivesandbecauseofthemI’mheretoday; theyprolongedmylife”(Emanuele).
Discussion
Donorsandrecipientsholdsimilarperceptions,suchasthe perspective thatdonationsmaintainlife,relatetomorality, and controlthe body. We,however, understand that these perceptionsareculturallyconstructedindifferentways.The perceptionsofdonorsinvolvetheirexperienceswithsomeone whoneededtransfusions,suchastheirchildren,relativesor friends,whilerecipientsassociatedonationwiththeirhealth conditions,aspeoplewhohavebloodtransfusionsaspartof theirmedicaltreatment.
Experience is composed of elements such as history, culture and lifeand isexpressed through language; when analyzingexperiences, people givemeaningtophenomena theyexperienced.10Therefore,donorsandrecipientsassign
meaningtotheactofgivingblood basedontheirpersonal experiences.Webelievethatexperiencesaresymboliccultural manifestationssociallyconstructedandshowhowpeopleact intheworld.11
When talking about blood donation as anact that pro-longs life,donorsdesiretokeeprelatives,friends orpeople theydeemimportantclose.Recipients,however,whenthey talkaboutlife,talkabouttheirownlives,aboutthepossibility ofstayingaliveandcontinuingwiththeirplans,desiresand dreams.Inbothcases,whenthetermlifeisdescribed,itrefers tothemaintenanceofsocialrelationshipsestablishedbyan illindividual,and,implicitly,thedifficultrelationshipofthe participantswiththefiniteaspectoflife.
Inregardtotheconditionsthatleadtotheendoflife,itis commonforindividualstovaluedailypracticesthatexemplify happymoments,sotheyassignmeaningstostillbeingalive.12
Practicessuchasworking,takingcareofchildren,andhelping othersarepartofapositiveexperienceinlife12andstrengthen
themotivationtodonate.
TalkingaboutdeathisuncommoninWesternsociety;the subjectoftenleadstoaninvoluntarydefensemechanismof denialsopeopleavoidtalkingabouttheirowndeathorthatof thosewithwhomtheyhaveestablishedsomeaffectivebond. Itisessentialhowever,totalkaboutthissubjectasdeathisan unpredictablephenomenon.13
We also believe that the word life was included in the interviewsbecauseitisatermusedinblooddonation cam-paigns.Oneofthemostfamousslogansusedis“Donateblood, donatelife”.Hence,webelievethatovertheyears,theword lifebecameassociatedwiththecontextofbloodtherapyand cametobeculturallysharedbyindividualsinsertedinthis context.
strategytorecruitdonorswithoutofferingamaterialreward, so that donating blood would be a sociocultural act that wouldenableonetoplayhis/hersocialroleintheprocessof protectinglife.14
Amoral component is present in the participants’ per-ceptionsinwhichdonating blood isdescribed asanactof kindness,thatis,whenpeopledonate,theyshowtosociety howsupportivetheyarebecausetheyperformedanactoflove. Hence,individualsareseeninapositivelightamongmembers fromtheirsocialmilieusincedonatingbloodissomethingthat addsstatustothedonor’sidentity.
Donorcandidatesgothroughascreeningprocessandthey maydonatebloodonlyiftheyareapproved,afterwhichtheir blood bags are examined to verify whether there are any anomalies.Inthiscontext,weseethatthedonationofblood hasanother moralcomponent. Beingable to donateblood meansthatonehasahealthy lifestyle,that is,oncemore donorsprovetosocietythattheyhaveanormativesociallife, theyhavenobehaviorsordiseasesthatarestigmatizedinthe socialworld.Theseincludeacquiredimmunodeficiency syn-drome(AIDS),orhavinghadunprotectedsexualintercourse, useddrugs,oraremenwhohadsexualintercoursewithother menasshown inthe Brazilian legislationregulating blood therapyprocedures.15
Moralexperienceisrelatedtothevalorizationofwhatis consideredrightinasocialcontext.Individualsassumethe moralandsocialconsequencesinvolvedinagivenattitude sothatanindividualmovesclosertoorfurtherawayfrom culturallyconceivedstigmas.16Themoralworldisbasedon
thepreservationoffundamentalvaluesthatconstitutesocial life.17
Bothgroupshighlightedthattheexams providedbythe bloodbankareessentialtothedonorrolebecausetheprocess isseenasanexchange,astheydonatebloodtheyalsoreceive informationregardingtheirownhealth.Helpingothersgains aperspectiveoftakingcareofoneself,becausewhen individ-ualsdonatetheyalsolearnabouttheirownhealthandhave controlovertheirbodysothat,basedontheresultsofexams theycanmanagelife.
Associating the body with a disease means not only acknowledging its development within the body, but also understanding it asresulting from pastactions. Therefore, incorporatedhabitsdefinefutureprospects,evenifitisnot a causally determiningfactor.18 The body is an individual
agency,inwhichexperienceisembodied,itisthecenterofour actionsanddesires,whichweneverfullymaintainorcontrol bypersonaldecisions.19
Inthecontextunderstudy,theactofdonatingbloodis com-posedofknowledge,attitudes,andbehaviorsconstructedin thesocialworldandalsoconstitutedbyindividualexperience sothatblooddonationisperceivedasapositiveactionandthis perceptionisculturallysharedbyindividualswhoexperience thephenomenon.
Conclusions
Donorsandrecipientsperceiveblooddonationassomething positivewithindividualswhogivebloodbeingacknowledged assupportiveandkindindividualsconcernedwiththehealth
ofothers.Nonetheless,elements associatedwiththeactof donatingareculturallyconstructed.Theydependon individ-ual experience, as inthe case ofpeople withhematologic diseases who need blood transfusions to stay alive or in the case of individuals who want to keep someone, with whomtheyshareanaffectivebond,alive.Theseelementsalso dependonthesocialworldbecausedonationwastransformed intoaprocessinwhichdonorsarenotmateriallyrewarded; rathermoralvaluesarethereward.
Givingblood,therefore,istoenablesomeonetoliveandto haveplansandplayasocialrole.Italsomeansself-careand controloverone’sownbodyinadditiontowardoffdeath,a topicthatisperpetuatedassomethingnegativeand marginal-izedineverydaylife.
Consequently,the knowledgeprovidedherecansupport thedevelopmentofstrategiestorecruitdonorsfortheblood bankinvestigatedinthisstudyandotherbloodbanksinBrazil, becauseitpresentsthemoralelementsinvolvedinthe pro-cessofdonating bloodthat areessential topromotingand maintainingthisaction.
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
Acknowledgments
WethankthenursesAdrianaMirandaandLucialbaSilvafor cooperatingwiththisstudy.
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