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This is the author’s version of a work that was submitted/accepted for publication in the following source: Hyde, Melissa K., Mclaren, Patrick J., & White, Katherine M. (2014) Identifying belief targets to increase bone marrow registry participation among students who have never donated blood. Psychology, Health & Medicine, 19(1), pp. 115-125. This file was downloaded from: http://eprints.qut.edu.au/65602/

c Copyright 2013 Taylor & Frances (Routledge)

This is an Author’s Accepted Manuscript of an article published in [include the complete citation information for the final version of the article as published in the Psychology, Health & Medicine, 19(1), 2014 [copyright Taylor & Francis], available online at: http://www.tandfonline.com/10.1080/13548506.2013.775467.

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BELIEFS ABOUT JOINING A BONE MARROW REGISTRY

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Running head: Beliefs about joining a bone marrow registry

Identifying belief targets to increase bone marrow registry participation among students who have never donated blood

Melissa K. Hyde, 1, 2 Patrick J. Mclaren, 2 and Katherine M. White.2 1

Behavioural Basis of Health, Griffith Health Institute, Griffith University

2

School of Psychology and Counselling, Queensland University of Technology and Institute

of Health and Biomedical Innovation

Address correspondence to: Dr Melissa Hyde, Behavioural Basis of Health, Griffith Health Institute, Griffith University, 176 Messines Ridge Road, Mt Gravatt, Queensland, 4122, Australia. Email: [email protected]

Word count: 126 (Abstract) 2995 (Main text only)

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Abstract New members on bone marrow registries worldwide are needed to allow sufficient diversity in the donor pool to meet patient needs. We used the theory of planned behaviour belief-basis and surveyed students who had not donated blood previously (i.e. non-donors) (N = 150) about the behavioural, normative, and control beliefs informing their intentions to join the Australian Bone Marrow Donor Registry. Key beliefs predicting non-donors’ intentions included: viewing bone marrow donation as an invasion of the body (β = -.35), normative support from parents (β = .40), anticipating pain/side effects from giving blood (β = -.27), and lack of knowledge about how to register (β = -.30). Few non-donors endorsed these beliefs, suggesting they are ideal targets for change in strategies encouraging bone marrow donor registration.

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Introduction Each year thousands of people, in Australian alone, are diagnosed with fatal blood disorders such as Leukaemia and Hodgkin’s lymphoma (The Leukaemia Foundation, 2008a). One viable treatment that may save or improve quality of life is a bone marrow (BM) transplant (including Hematopoietic Stem Cells) from a compatible donor. While 30% of people find a donor match within their family, the vast majority rely on national BM donor registries, such as the Australian BM Donor Registry (ABMDR), to find a suitable match (Australian Bone Marrow Donor Registry [ABMDR], 2010a). As of December 2009, 173,257 donors were registered on the ABMDR (ABMDR, 2010b). Potential donors aged 1840 years are recruited for the register and donors are retired from the ABMDR at 60 years of age. It is critical to maintain the balance of donors on the registry and to recruit a larger pool of donors to ensure sufficient diversity is available to meet the needs of patients (ABMDR, 2010). Currently there is an insufficient pool of BM donors to meet demand (Glasgow & Bello, 2007). Understanding people’s motivations to register as a BM donor is important to increase the pool of potential donors and offer life-saving or improving treatment. Joining the BM donor registry likely involves contemplating risks associated with donation including anticipating pain and side-effects related to the BM/stem cell donation (Glasgow & Bello, 2007), as well as the potential to be called upon to donate once registered. Also, joining the ABMDR requires a blood sample for tissue typing. For new or novice donors, giving a blood sample involves overcoming a fear of needles and blood (Armitage & Conner, 2001; Giles, McClenahan, Cairns, & Mallet, 2004), anticipated side-effects (fainting or other vasovagal reactions, France, Ditto, France, & Himawan, 2008; Sauer & France, 1999) and potentially discovering an illness or disorder (Sojka & Sojka, 2008). Therefore, people’s motivations to join a BM registry may be informed by beliefs related to three aspects: blood donation, BM donation, and registration.

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Despite the need to increase the donor pool (Glasgow & Bello, 2007) and the discrepancy between donation willingness and actually joining a BM registry (Onitilo et al., 2004), the majority of research has focused on the process of donating BM (Bagozzi, Lee, & Van Loo, 2001; Glasgow & Bello, 2007; Switzer et al., 2003) rather than decisions to join a BM registry. One exception is Norvilitis and Riley (2001) who compared donors and nondonors on variables including personality, self-competency, life satisfaction, and fear of medical procedures. They found that busy schedules, fear, and lack of education were common reasons preventing non-donors from registering, and fear of needles and pain were deterrents. Normative support (or lack thereof) from friends and family may also inform BM donation and registration decision-making (Norvilitis & Riley 2001; Studts, Ruberg, McGuffin, & Roetzer, 2010; Stukas, Dew, Switzer, & Simmons, 1999). Acknowledging the importance of beliefs, Glasgow and Bello (2007) used the Theory of Planned Behaviour (TPB; Ajzen, 1991) belief-basis as a framework to explore African Americans’ BM donation intentions. The three most commonly identified beliefs in the qualitative phase of this study were “painful experience for the donor” (41%), “health concerns for the donor” (38%), and “family’s approval” (26%) (p. 373). Consistent with Glasgow and Bello and donation studies in other contexts (Armitage & Conner, 2001; Hyde & White, 2007) we adopted the TPB belief-basis for our study. Using the TPB to identify key belief targets for future interventions The TPB belief framework refers to advantages and disadvantages (behavioural beliefs), perceived referents approving or disapproving (normative beliefs), and barriers preventing or motivators facilitating (control beliefs) behaviour. These beliefs relate to a person’s intentions and subsequent behaviour (Ajzen, 1991). Traditionally, beliefs were assessed using a multiplicative combination of a belief and evaluative item (behavioural beliefs x outcome evaluations; normative beliefs x motivation to comply, and control beliefs

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x perceived power). However, these evaluative items are not essential for belief measurement (Ajzen, 1991) and have not been included in our study (Hamilton & White, 2011; Hyde & White, 2009a). Several researchers (e.g., Fishbein & Yzer, 2003; Francis et al., 2004) note these behavioural, normative, and control beliefs can inform interventions to encourage/discourage behaviour. Hornik and Woolf (1999) outline three criteria to select target beliefs for behaviour-change (see Fishbein, von Haeften, & Appleyard, 2001; Fishbein & Yzer, 2003; Hamilton & White, 2011). First, for the population investigated, there should be a strong relationship (significant correlation or predictive relationship) between the belief and outcome measure (intention or behaviour). Second, the number of people who hold the belief should not be substantial so that a large proportion of the population could be encouraged to change their belief. Third, the researcher must evaluate whether a realistic argument and evidence can be provided to encourage the target population to change their belief. The Current Study Deciding to join a BM registry likely involves many of the beliefs that inform decisions for a first-time blood donor; however, our study offers insight beyond the blood donor experience. BM donation is perceived by the general population as a more invasive and painful procedure. Donating blood is a volitional choice made at a time and place convenient to the donor whereas joining a BM registry means that a person could be called upon to donate at a future point that is not of their choosing (and possibly more than once). Accordingly, the decision to join a BM registry may include beliefs related to blood donation as well as to other aspects of BM donation and registering. Furthermore, joining a BM registry involves giving a blood sample and the beliefs of first-time blood donors are likely to differ from experienced donors (Masser, White, Hyde & Terry, 2008). To avoid any potential confound of prior donation experience on beliefs we focussed on people who have never

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donated blood (i.e. non-donors). Our aims were two-fold. First, we explored people’s behavioural, normative, and control beliefs and intentions for joining a BM registry. Second, we used Hornik and Woolf’s (1999) criteria to identify target beliefs that could encourage non-donors to join the ABMDR. Method Participants Participants were predominantly female (67%) university students (N = 150) who had not previously donated blood. Participants were aged 18-40 years (Mage = 21.4; SD = 4.6) and in good health making them ideal candidates for donation. Design and Procedure As part of a larger experimental study on risk and BM registration decisions (Mclaren, Hyde, & White, 2012), students from a large university in Queensland, Australia were approached in lectures or on campus and invited to complete either an online (via a link provided on a recruitment flyer) or paper version of a questionnaire. Students were informed that participation was voluntary, anonymous and confidential and received either research participation credit or a chocolate for their participation. Measures Target behaviour. The target behaviour was joining the ABMDR in the next 6 months. Participants received a definition outlining the steps required to join the ABMDR: (1) making an appointment with the Australian Red Cross Blood Service to donate blood, (2) completing a consent form to join the registry, and (3) donating blood for testing and tissue typing. We did not measure actual registration behaviour; instead, we used intentions as a proxy measure of behaviour (Ajzen, 1991). Intention. Four items measured intention to join the ABMDR on 7-point Likert scales scored 1 (strongly disagree) to 7 (strongly agree) and formed a reliable scale (α = .93). The

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four items were: “I intend to”, “I would be willing to”, “I plan to”, and “I will make an effort to” join the ABMDR in the next 6 months”. Beliefs. Consistent with TPB specifications (Ajzen, 1991), an elicitation study was conducted initially with 20 university students (16 female) who were in good health and aged 18-40 years (Mage = 26.0, SD = 5.4) to identify salient behavioural, normative, and control beliefs about joining the ABMDR. We used content analysis to identify behavioural, normative, and control beliefs commonly reported by 25% of the sample or more for use in the main study questionnaire (Table 1). Participants rated the likelihood that nine behavioural beliefs (three advantages and six disadvantages), eight normative beliefs, and 16 control beliefs (10 barriers and six motivators) would occur if they joined the ABMDR in the next 6 months. Beliefs were measured using 7-point Likert-type scales scored 1 (extremely unlikely) to 7 (extremely likely). Belief scales were not created and internal consistency measures are not reported because belief scales are not expected to be internally consistent. A degree of ambivalence about beliefs is likely to exist because people may value some beliefs positively and others negatively and these beliefs are not expected to correlate highly with each other (Ajzen, 2006). In our study, individual beliefs are of interest to identify targets for change. Demographics. Sex (male, female), age in years, and self-reported BM donation knowledge (“Overall, how would you rate your knowledge of the topic of BM donation?” 1 very poor to 7 excellent) were included. Data Analysis Strategy Descriptive analyses determined the distribution of the sample by age, sex, and selfreported BM donation knowledge. Correlations between belief items and intentions were examined (Table 1). In line with Hornik and Woolf’s (1999) first criteria, we conducted a series of multiple regressions with each belief set (behavioural, normative, control barrier,

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and control motivator beliefs) regressed onto intention to test the strength of the relationship between the belief and outcome measure (Table 2). Initially, we controlled for any effects of the unsuccessful experimental manipulation from the larger study by entering the condition (risk information vs. none) variable in the first step of analyses. Condition was not a significant predictor of intention and is not included in the analyses presented here. In line with Hornik and Woolf’s second criteria, the percentage of non-donors who fully or strongly endorsed a belief that was a significant predictor of intention was examined for the possibility of belief-change (Table 2). For Hornik and Woolf’s third criteria, we then considered whether beliefs which met the two previous criteria could be changed by giving evidence or information to strengthen or discount a belief. Results Descriptive Analyses Prior knowledge of BM donation was very low (M = 2.6, SD = 1.3) with 79.1% of participants self-reporting a score of 3 or below on the 7-point scale. Participants had slightly weak intentions to join the ABMDR (M = 3.32, SD = 1.38). Most behavioural, normative, and control beliefs were correlated significantly with non-donors’ intentions to join the registry. Multiple Regression Analyses Predicting Non-Donors’ Intentions to Join the ABMDR Behavioural beliefs. The linear combination of behavioural beliefs explained 22% of non-donors’ intentions to join the ABMDR (Table 2 displays F and beta statistics). Only one behavioural belief was significant and endorsed partially or fully by 63.1%; the more nondonors thought BM donation was an invasion of their body and a likely consequence of joining the registry, the less they intended to join (36.9% did not hold this belief strongly). Normative Beliefs. Normative beliefs explained 27% of non-donors’ intentions with partner and parents as the two significant normative influences. Less than a quarter of non-

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donors fully or strongly endorsed partner (9.5%) or parents (14.1%) as informing their intentions. Control Barrier Beliefs. Control barrier beliefs explained 27% of variance in nondonors’ registering intentions. The less non-donors anticipated pain or side effects from giving blood, lacked knowledge about BM registration, or believed effort was required to register, the stronger their intentions to register. A small proportion fully or strongly endorsed these beliefs (Table 2). Control Motivator Beliefs. Control motivator beliefs explained 29% of variance in non-donors’ intentions to join the ABMDR. One belief, ‘information about how to register’, was a significant and positive predictor of intentions and was fully or strongly supported by 23.7% of non-donors. Discussion New members on the BM registry are needed to allow sufficient diversity to meet patient needs (ABMDR, 2010b). We examined non-blood donors’ intentions to join the ABMDR and their associated behavioural, normative, and control beliefs. Using Hornik and Woolf’s (1999) criteria, and consistent with prior BM donation research (e.g., Glasgow & Bello, 2007; Norvilitis & Riley, 2001), we identified key behavioural (bone marrow donation as an invasion of the body), normative (support from parents), control barrier (pain/side effects), and motivator (knowledge about how to register) target beliefs significantly associated with non-donors’ registering intentions (criteria 1). These beliefs were not endorsed by a substantial proportion of non-donors (criteria 2), suggesting the potential to introduce information or evidence encouraging belief change (criteria 3). Based on our findings several strategies can be offered for intervention. Strategies for intervention

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Just over a third of non-donors disagreed with the behavioural belief that BM donation is an invasion of their body. Increasing non-donors’ knowledge about less invasive methods of BM donation may be useful such as leukapheresis (blood is extracted through a vein in the arm to allow separation of stem cells from other blood components, for transplant) (ABMDR, 2010a) compared to the more well-known form of BM donation (requiring general anaesthetic for blood stem cell extraction from marrow in the pelvic bone cavity which occurs via needle and syringe) (ABMDR, 2010a). Only a small proportion of non-donors believed their partner and parents would support their decision to join the registry. While it is unclear whether this perceived disapproval is due to concern for donor wellbeing or potential risks associated with BM donation, it suggests the need to increase perceived approval from important others (Glasgow & Bello, 2007) potentially by encouraging parental or partner involvement in the decision or asking a parent or partner along to the blood donation collection facility for moral/emotional support (Sojka & Sojka, 2008). Sharing the experiences of family members of BM donors who were concerned for their loved one’s wellbeing but ultimately supported their decision may also help to increase perceptions of family approval for joining the registry (Hyde & White, 2009b). Our findings suggest that information or interventions to overcome anticipated fears about blood donation may also be needed. Only a small proportion of non-donors did not believe anticipating pain or side effects from giving blood would stop them from joining the registry, suggesting that a much larger proportion of non-donors fear the process (Ditto, France, & Holly, 2010; Harrington et al., 2007; Masser et al., 2008); a finding that is consistent with prior research showing that non-donors who anticipate more anxiety about donating blood are less inclined to donate (Robinson, Masser, White, Hyde, & Terry, 2008). Offering non-donors strategies to overcome the anticipated negative experience of blood

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donation may be worthwhile (Ditto et al., 2010; France, France, Kowalsky, & Cornett, 2010; France, Montalva, France, & Trost, 2008; Masser & France, 2010). For example, Masser and France (2010) found a modified blood donation coping brochure incorporating a narrative for first-time donors was more successful than the standard blood service and control (exercise) brochures in increasing efficacy for donation and reducing anticipated vasovagal reactions. There is potential for such coping brochures to be applied in the BM context and distributed at the time an appointment is made to give a blood donation or as a resource on the BM registry website. Few non-donors believed the amount of effort required and lack of knowledge about how to register would not prevent them from registering. In other words, these barriers would stop many non-donors from joining the registry. These beliefs are amenable to change through the provision of new information or evidence; a quarter of non-donors would be motivated to register if information about how to join was provided. Testimonies from nondonors who have joined the registry could highlight registering as a straightforward process that can be time effective if planned in advance and to reduce fear or apprehension about the blood donation and registration process (Hyde & White, 2009b; Robinson et al., 2008). Limitations and Future Directions Despite its strengths, the results of the study should be interpreted with caution. Our focus on intentions to join the registry rather than registering behaviour was not ideal; however, intentions have a strong relationship with behaviour in donation contexts (e.g., Schlumpf et al., 2008). Furthermore, joining a BM registry is a behaviour that people will likely only perform once which reduces the chances that prior behaviour is inflating the relationship between beliefs and intentions (Weinstein, 2007). The sample comprised nondonors who were predominantly female and university students; future research should address these limitations.

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Beliefs for non-donors and experienced donors may differ (Masser et al., 2008). Experienced donors may find the required blood sample to be less challenging than first-time donors and future research should compare the beliefs of these two groups. Qualitative methods could be used to better understand normative support in this context since few nondonors perceived approval from important others for joining the BM registry. It is possible that the wishes of significant others may be unknown or may potentially be more supportive than might be perceived by non-donors. Another essential avenue for future research is to consider beliefs related to each step of the BM registration process. In the current study, we considered all three steps simultaneously (an approach used in other donation contexts; Hyde & White, 2007; 2009a) which precluded a separate examination of beliefs that could offer further insight into the motivations underlying registration decisions. Finally, overcoming barriers to joining the BM registry is a critical avenue for future research which could involve piloting a donation coping brochure as well as the standard BM registry brochure to alleviate anticipated fear about donating blood; an essential step in registering. Overall, this study has identified a range of beliefs that could serve as useful targets to increase intentions to register as a BM donor among people who have never donated blood. Appropriate measures to overcome the barriers to joining the registry may increase nondonors’ intentions to join and potentially increase the chances that a positive donor match will be found via donor registries for those individuals needing a BM transplant to save or improve their quality of life.

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References Australian Bone Marrow Donor Registry. (2010a). Joining the bone marrow registry. Retrieved 25th July, 2012. Available: http://www.abmdr.org.au/pdf/dynamic_pages/3/ 82514915_ donorbrochure_08.pdf (Brochure updated October 2012. Available: http://www.abmdr.org.au/pdf/dynamic_pages/3/92447657_N1177%20ABMDR%20D L%208pp%20October%202012%20LR.pdf) Australian Bone Marrow Donor Registry. (2010b). Australian Bone Marrow Donor Registry Annual Report 2009. Retrieved 14th June, 2012. Available: http://www.abmdr.org.au/dwnload/ABMDR_2009_AReport_Nov10_MR.pdf Ajzen, I. (1991). Theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179-211. doi: 10.1016/0749-5978(91)90020-T Armitage, C. J., & Conner, M. (2001). Social cognitive determinants of blood donation. Journal of Applied Social Psychology, 31, 1431-1457. doi: 10.1111/j.15591816.2001.tb02681.x Bagozzi, R. P., Lee, K-H., & Van Loo, M. F. (2001). Decisions to donate bone marrow: The role of attitudes and subjective norms across cultures. Psychology and Health, 16, 2956. doi: 10.1080/08870440108405488 Ditto, B., France, C. R., & Holly, C. (2010). Applied tension may help retain donors who are ambivalent about needles. Vox Sanguinis, 98, e225-e230. doi: 10.1111/j.14230410.2009.01273.x Fishbein, M., von Haeften, I., & Appleyard, J. (2001). The role of theory in developing effective interventions: Implications from Project SAFER. Psychology, Health & Medicine, 6, 223-238. doi: 10.1080/13548500123176 Fishbein, M., & Yzer, M. C. (2003). Using theory to design effective health behavior

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interventions. Communication Theory, 13, 164 -183. doi: 10.1111/j.14682885.2003.tb00287.x France, C. R., Ditto, B., France, J. L., & Himawan, L. K. (2008). Psychometric properties of the Blood Donation Reactions Inventory: a subjective measure of presyncopal reactions to blood donation. Transfusion, 48, 1820-1826. doi: 10.1111/j.15372995.2008.01831.x France, C. R., France, J. L., Kowalsky, J. M., & Cornett, T. L. (2010). Education in donation coping strategies encourages individuals to give blood: Further evaluation of a donor recruitment brochure. Transfusion, 50, 85-91. doi: 10.1111/j.1537-2995.2009.02381.x France, C. R., Montalva, R., France, J. L., & Trost, Z. (2008). Enhancing attitudes and intentions in prospective blood donors: Evaluation of a new donor recruitment brochure. Transfusion, 48, 526-530. doi: 10.1111/j.1537-2995.2007.01565.x Francis, J. J., Eccles, M. P., Johnston, M., Walker, A., Grimshaw, J., Foy, R., et al. (2004). Constructing questionnaires based on the Theory of Planned Behaviour: A manual for health services researchers. United Kingdom: New Castle: Centre for Health Services Research. Giles, M., McClenahan, C., Cairns, E., & Mallet, J. (2004). An application of the Theory of Planned Behaviour to blood donation: the importance of self-efficacy. Health Education Research, 19, 380-391. doi: 10.1093/her/cyg063 Glasgow, M. E. S., & Bello, G. (2007). Bone marrow donation: Factors influencing intentions in African Americans. Oncology Nursing Forum, 34, 369-377.doi: 10.1188/07.ONF.369-377 Hamilton, K., & White, K. M. (2011). Identifying key belief-based targets for promoting regular physical activity among mothers and fathers with young children. Journal of Science and Medicine in Sport, 14, 135-142. doi:10.1016/j.jsams.2010.07.004

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Harrington, M., Sweeney, M. R., Bailie, K., Morris, K., Kennedy, A., Boilson, A., et al. (2007). What would encourage blood donation in Ireland? Vox Sanguinis, 92, 361– 367. doi: 10.1111/j.1423-0410.2007.00893.x Hornik, R., & Woolf, K. D. (1999). Using cross-sectional surveys to plan message strategies. Social Marketing Quarterly, 5, 34 – 41. doi: 10.1080/15245004.1999.9961044 Hyde, M. K., & White, K. M. (2007). Young Australian adults’ knowledge and beliefs about organ donation. Progress in Transplantation, 17, 220-227. Hyde, M. K., & White, K. M. (2009a). Communication prompts donation: Exploring the beliefs underlying registration and discussion of the organ donation decision. British Journal of Health Psychology, 14(3), 423-435. doi: 10.1348/135910708X339542 Hyde, M. K., & White, K. M. (2009b). Knowing a donor and identifying as one: Determinants of people’s willingness for related and anonymous living donation. Psychology, Health & Medicine, 14 (5), 524-535. doi: 10.1080/13548500903012855 Masser, B. M., White, K. M., Hyde, M. K., & Terry, D. J. (2008). The psychology of blood donation: Current research and future directions. Transfusion Medicine Reviews, 22, 215-233. doi: 10.1016/j.tmrv.2008.02.005 Mclaren, P. J., Hyde, M. K., & White, K. M. (2012). Exploring the role of gender and risk perceptions in people’s decisions to register as a bone marrow donor. Health Education Research, 27(3), 513-522. doi:10.1093/her/cyr112 Norvilitis, J. M., & Riley, T. M. (2001). Exploring the motivations of bone marrow typing donors. Journal of Psychosocial Oncology, 19, 49-62. doi: 10.1300/J077v19n01_04 Onitilo, A. A., Lin, Y. H., Okonofua, E. C., Afrin, L. B., Ariail, J., & Tilley, B. C. (2004). Race, education, and knowledge of bone marrow registry: Indicators of willingness to donate bone marrow among African Americans and Caucasians. Transplantation Proceedings, 36, 3212-3219. doi: 10.1016/j.transproceed.2004.10.019

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Robinson, N. G., Masser, B. M., White, K. M., Hyde, M. K., & Terry, D. J. (2008). Predicting intentions to donate blood among nondonors in Australia: An extended theory of planned behavior. Transfusion, 48, 2559-2567. doi: 10.1111/j.15372995.2008.01904.x Sauer, L. A., & France, C. R. (1999). Caffeine attenuates vasovagal reactions in female firsttime blood donors. Health Psychology, 18, 403 - 409. doi: 10.1037/02786133.18.4.403 Schlumpf, K. S., Glynn, S. A., Schreiber, G. B., Wright, D. J., Steele, W. R., Tu, Y., et al. (2008). Factors influencing donor return. Transfusion, 48, 264-272. doi: 10.1111/j.1537-2995.2007.01519.x. Schreiber, G. B., Schlumpf, K. S., Glynn, S. A., Wright, D. J., Tu, Y., King, M. R., et al. (2006). Convenience, the bane of our existence, and other barriers to donating. Transfusion, 46, 545–553. doi: 10.1111/j.1537-2995.2006.00757.x Sojka, B. N., & Sojka, P. (2008). The blood donation experience: self-reported motives and obstacles for donating blood. Vox Sanguinis, 94, 56–63. doi: 10.1111/j.14230410.2007.00990.x Studts, J. L., Ruberg, J. L., McGuffin, S. A., & Roetzer, L. M. (2010). Decisions to register for the National Marrow Donor Program: rational vs emotional appeals. Bone Marrow Transplantation, 45, 422-428. doi: 10.1038/bmt.2009.174 Stukas, A. A., Dew, M. A., Switzer, G. E., & Simmons, R. G. (1999). Potential bonemarrow donors and their spouses: The effects of volunteerism on distress levels. Journal of Applied Social Psychology, 29, 1-22. doi: 10.1111/j.15591816.1999.tb01372.x

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Switzer, G. E., Myaskovsky, L., Goycoolea, J. M., Dew, M. A., Confer, D. L., & King, R. (2003). Factors associated with ambivalence about bone marrow donation among newly recruited unrelated potential donors. Transplantation, 75, 1517-1523. doi: 10.1097/01.tp.0000060251.40758.98 The Leukaemia Foundation (2008). Leukaemias. Retrieved 25th July, 2012, from http://www.leukaemia.org.au/web/aboutdiseases/leukaemias_index.php Weinstein, N. D. (2007). Misleading tests of health behavior theories. Annals of Behavioral Medicine, 33, 1-10. doi: 10.1207/s15324796abm3301_1

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Table 1 Means, Standard Deviations and Correlations for Non-Donors’ (N = 150) Belief Items and Intention to Join the Australian Bone Marrow Donor Registry among Non-Donors Belief-item

M

SD

Correlation (r) with Intention

Behavioural beliefs Saving or improving the lives of other people

5.79

1.22

.12

Being unable to change my decision once I have registered

3.58

1.67

-.12

Having to undergo surgical procedures if I am a donor match

4.79

1.65

-.01

Enabling efficient procedures to find a donor match

4.87

1.30

.06

Experiencing health risks or complications as a result of donating BM

3.81

1.62

-.20*

Knowing someone will donate to me if I need it

4.59

1.36

.07

Thinking BM donation is an invasion of my body

3.43

1.82

-.43***

Experiencing pain as a result of donating BM

5.08

1.84

-.21**

Experiencing pain or side effects as a result of giving blood

4.52

1.84

-.21**

BELIEFS ABOUT JOINING A BONE MARROW REGISTRY Normative beliefs Family

3.65

1.64

.43***

Partner

3.62

1.50

.45***

Parents

3.64

1.67

.45***

People who need or have received a BM transplant

6.00

1.44

.20*

Friends

3.79

1.40

.40***

Doctors and other medical professionals

4.99

1.61

.26***

Church and religious group members

4.91

1.90

.16*

Australian BM Donor Registry

4.97

1.80

.03

Anticipating pain as a result of donating BM

5.19

1.89

-.37***

Thinking I am ineligible to donate blood or BM

3.84

1.68

-.05

Lack of knowledge about the BM donation process in general

4.93

1.70

-.08

Anticipating pain or side effects as a result of giving blood

4.81

1.94

-.41***

Amount of effort required

4.78

1.49

-.27***

Lack of knowledge about how to register

4.65

1.63

.08

Control barrier beliefs

19

BELIEFS ABOUT JOINING A BONE MARROW REGISTRY Fear of seeing blood

3.26

2.08

-.25**

Having too many constraints on my time

4.89

1.67

-.17*

Feeling fearful about needles or blood (e.g., phobia)

4.21

2.22

-.30***

Being unaware of where a blood collection centre is located

4.14

1.75

.01

Hearing about people who have benefitted from a transplant

5.48

1.22

.39***

Knowing someone who needs a transplant

6.31

1.04

.25**

Information about how to register

4.69

1.34

.49***

Knowing more information about the donation process and the risks involved

5.04

1.35

.39***

Having friends/family who would join the registry with me

5.02

1.50

.20*

Personally knowing the transplant recipient

5.92

1.52

.05

Control motivator beliefs

* p < .05. ** p < .01. *** p < .001.

20

BELIEFS ABOUT JOINING A BONE MARROW REGISTRY

21

Table 2 Summary of Key Beliefs Identified in Multiple Regression Analyses Informing Non-Donors’ (N =150) Intentions to Join the Australian Bone Marrow Donor Registry β

R2

.22

Behavioural beliefs

Df

9,136

F

% full

% strong

Total %

beliefb

beliefc

believe

4.37***

Saving or improving the lives of other people

.05

-

-

-

Being unable to change my decision once I have registered a

-.06

-

-

-

Having to undergo surgical procedures if I am a donor match a

.14

-

-

-

Enabling efficient procedures to find a donor match

.07

-

-

-

Experiencing health risks or complications as a result of donating BM a

-.11

-

-

-

Knowing someone will donate to me if I need it

.07

-

-

-

Thinking BM donation is an invasion of my body a

-.35***

18.8%

18.1%

36.9%

Experiencing pain as a result of donating BM a

-.12

-

-

-

Experiencing pain or side effects as a result of giving blood a

-.07

-

-

-

Normative beliefs

.27

8,137

6.23***

BELIEFS ABOUT JOINING A BONE MARROW REGISTRY

22

Family

-.22

-

-

-

Partner

.27*

1.4%

8.1%

9.5%

Parents

.40*

2.0%

12.1%

14.1%

People who need or have received a BM transplant

.10

-

-

-

Friends

.06

-

-

-

Doctors and other medical professionals

.18

-

-

-

Church and religious group members

-.14

-

-

-

Australian BM Donor Registry

-.15

-

-

-

.27

Control barrier beliefs

10,13

4.91***

Anticipating pain as a result of donating BM a

-.05

-

-

-

Thinking I am ineligible to donate blood or BM a

-.05

-

-

-

Lack of knowledge about the BM donation process in general a

-.04

-

-

-

Anticipating pain or side effects as a result of giving blood a

-.27*

6.0%

11.4%

17.4%

Amount of effort required a

-.22*

3.4%

2.7%

6.1%

Lack of knowledge about how to register a

-.30**

4.7%

9.4%

14.1%

Fear of seeing blood a

-.09

-

-

-

BELIEFS ABOUT JOINING A BONE MARROW REGISTRY Having too many constraints on my time a

-.11

-

-

-

Feeling fearful about needles or blood (e.g., phobia) a

-.03

-

-

-

Being unaware of where a blood collection centre is located a

.06

-

-

-

.29

Control motivator beliefs

6,139

23

9.59***

Hearing about people who have benefitted from a transplant

.12

-

-

-

Knowing someone who needs a transplant

.14

-

-

-

Information about how to register

.38***

8.8%

14.9%

23.7%

Knowing more information about the donation process and the risks

.17

-

-

-

Having friends/family who would join the registry with me

-.17

-

-

-

Personally knowing the transplant recipient

-.14

-

-

-

involved

Note. a Negatively worded item (i.e., reversed item). b Items measured on a 7-point Likert scale. A score of 7 represents full acceptance of a belief item, with the exception of reverse scored items where a score of 1 represents full acceptance of a belief.

c

Items measured on a 7-point

Likert scale. A score of 6 represents strong acceptance of a belief item, with the exception of reverse scored items where a score of 2 represents strong acceptance of a belief. * p < .05. ** p < .01. *** p < .001.