Study Examines Perceptions of Likeness to Prototypical Blood Donor

A paper published in Vox Sanguinis sought to characterize perceptions of likeness to the prototypical blood donor in the United Kingdom (UK) through the lens of multiple stakeholders, “(blood donors, [sexually active gay and bisexual men], recipients of blood, [and] people from ethnic minorities),” and identify the role homophily, defined as how individual blood donors “perceive themselves [in terms of likeness] to the prototypical [blood] donor.” The authors described perceptions of likeness to the prototypical blood donor, or homophily, as a barrier to blood donation. They explained that, “we explore the perceived prototypical blood donor, calculate homophily scores for people from different cultural, social, and health backgrounds to quantify their similarity to the prototypical donor and investigate whether those homophily scores predict decisions to donate.” This study highlights the importance of understanding the likeness of the prototypical blood donor in efforts to improve donation rates.

The homophily study recruited an, “initial gender-balanced UK adult sample [and a] second UK adult sample of non-heterosexual, non-asexual identifying [sexually active men who have sex with other men.] All individuals were paid £1.00 for participating in the survey and were asked, “whether they had ever donated blood in the UK (Yes/No/ I’m not sure/ Prefer not to say) and were coded as blood donors if they responded ‘Yes’. Blood donors were subsequently asked (i) when they last donated blood (within the last two months/ 2 to 12 months ago/12 months to 2 years ago/Longer than 2 years/I cannot remember/Prefer not to say). Non-donors are those who have never donated, lapsed donors have donated but not within the last two years, and current donors have donated in the last two years.” The researchers noted that, “[t]he total homophily scores, Η, range from 0 to 3, where 0 indicates that the respondent shares neither age group, gender, nor ethnicity with a prototype donor, and 3 indicates that the respondent shares all three.”

The final survey sample featured 785 respondents. The homophily study examining perceptions of likeness to the prototypical blood donor found that, “the prototypical UK donor is perceived to be 30–44 years old, White, educated to A level (high school) or [college] degree level, middle class, and left-wing. There is no clear perception that donors are more likely to be male or female.” Additionally, the authors noted that, “[c]urrent donors have the highest overall homophily score of 2.15 out of 3, significantly higher than non-donors but similar to lapsed donors. This is driven by the ethnicity homophily score, in which current and lapsed donors have a higher average ethnicity homophily score and are thus more likely to perceive the prototypical donor’s ethnicity as the same as their own ethnicity.” They further explained that blood recipients, “had the lowest homophily score of 1.22, which is significantly lower than non-[recipients] and, again, this is primarily related to ethnicity homophily. [Blood recipients] view themselves as less similar in ethnicity to their perception of the prototypical donor. [Sexually active gay and bisexual men] had a higher homophily score (2.04) than non-[sexually active gay and bisexual men], driven by the gender homophily. Thus, [sexually active gay and bisexual men] see their gender (men) as similar to their perception of the gender of the prototypical donor. Women have a higher homophily score than men, which is also driven by the gender homophily scores, with women perceiving themselves as more similar to the prototypical donor in terms of gender. Homophily also varied by ethnicity, with Asian, Black, mixed, and other ethnicities all having lower homophily scores than White participants.” Additionally, the researchers discovered that, “78 people said they would donate once, 72 were unsure, and two preferred not to say.” They determined that, “the results show that a homophily score of two or three predicts an active decision to make more than one donation, compared with feeling uncertain about donating.”

The authors of the homophily study concluded that, “[p]rior research has identified a wide set of barriers to blood donation including psychological concerns (anxiety, phobia of needles and blood), structural issues (inconvenience, location, and time), as well as issues specific to minorities, such as prejudice and differential deferral. We show that homophily should be added as a structural and specific barrier.” They noted that, “[c]urrent donors perceive themselves as being most similar to the prototype donor, followed by [sexually active gay and bisexual men], with blood recipients being the least similar. People from ethnic minorities also have low homophily scores. As greater homophily increases the probability of making an active decision to be a repeat donor [and perceptions] of prototypical donors are associated with the decision to donate via the homophily score, with smaller perceived differences between a person’s prototype and their own personal demography increasing their likelihood of donating.” The authors of the perceptions of likeness to the prototypical blood donor study added that, “[a] novel and interesting finding is the perception that the prototypical UK blood donor is left-wing [and this] ideology, compared with right-wing ideology, is associated with increased compassion for others, which taps into wider associations of compassion, altruism and helping those in need. Unfortunately, we do not know the current political ideology of UK blood donors. Without knowing this, it is difficult to propose effective strategies. However, having politicians from all ideologies jointly endorse blood donation as a compassionate act may encourage wider diversity of donors.”

Recommendations for blood centers from the homophily study include the, “need to change the perception of blood donation as an exclusively middle-aged activity, especially if they wish to recruit younger donors. One possible strategy is to normalize and represent blood donation as a positive, socially normative activity through social media (e.g., Instagram, TikTok, BeReal or Snapchat posts). Blood donation could be presented as an aspirational and community-building activity for young people and made relevant to them.” The researchers acknowledged that the study is descriptive, “and we make no claims of causality. [However,] the implications of these results underscore the importance of the blood donor prototype and homophily, which should now be considered in future work. [Study limitations included:] the sample was not representative by ethnicity and age; however, the consistency of the findings by age, gender and ethnicity supports the contention that this did not affect the results; the age categories were not uniform, which may have contributed to the prototypical age effect being middle age; we did not assess directly if people were completely unwilling to donate, and this should be explored in future studies. Finally, causality needs to be explored and the use of instrumental variable models, propensity score matching, and Directed Acyclic Graphs (DAG)s can all be considered.”

Citation: Ferguson, E., Bowen, S., Mills, R., et al. “The prototypical UK blood donor, homophily and blood donation: Blood donors are like you, not me.” Vox Sanguinis. 2024.