1. Recruitment and Retention of Migrant Blood Donors in the Netherlands
An Intervention Mapping Based Development
Elisabeth F. Klinkenberg a,b, Elisabeth M. J. Huis in ’t Veld a,c, Wim L. A. M. de Kort a,b, Julia C. M. van Weert d, Mirjam P. Fransen b
a Department of Donor Studies, Sanquin Research, Amsterdam, The Netherlands
b Department of Public Health, Academic Medical Center, Amsterdam Public Health research institute, University of Amsterdam, Amsterdam, The Netherlands
c Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
d Amsterdam School of Communication Research/ASCoR, Department of Communication Science, University of Amsterdam, Amsterdam, The Netherlands
09 November 2018

2. The story of Emilia
1,000 – 1,500 patients with sickle-cell anaemia in the Netherlands.
Chronic blood transfusions.
More prevalent among people with Sub-Saharan African roots.
Due to underrepresentation of African donors, the stock is limited
More African donors need to be recruited and retained as blood donors.
Emilia is one of the 1500 patients with sickle-cell anaemia
Due to shape of the blood cells, oxygen transport is limited and the cells can clot in vessels.
Not necessarily speaking of ABO and Rhesus-D blood groups, but extended blood types that do not occur in people of Western/European descent.
To prevent alloimmunisation and transfusion reactions
Different blood types compared to people of Western/European descent (e.g. FY(a-b-) or U-).
Need of extensively typed and matched blood.
09 November 2018

3. Systematic intervention development
Step 1
Needs Assessment
Step 2
Logic Model of Change
Step 3
Program Design
Step 4
Program Production
Step 5
Implementation Plan
Step 6
Evaluation plan
Systematic intervention development
Based of a foundation of theoretical, empirical and practical information
Iterative and cumulative process, preventing inadequate decisions
Intervention Mapping protocol for effective decision making.3
Extensive analyses of donation barriers and motivators.
Intervention development with planning groups
(pilot) implementation and evaluation.
09 November 2018

4. Step 1: Needs-assessment
4. Quantitative surveys target group
1. Systematic literature review
2. Qualitative interviews target group
5. Intervention development
3. Organisation analysis blood bank
-In step 1 multiple phases as well
09 November 2018

5. Qualitative interviews target group
“I do know the Red Cross. But the name you just said; I have never heard about it.”
N=16
“In Ghana…individually people don’t go. But when the organisations are asking to come and donate the blood, they go.”
N=20
In the qualitative interviews we interviewed 16 people from Ghana and 20 people from Surinam currently living in the NL.
One main outcome is that the Dutch blood bank orgnisation was not known of  only four out of 36 recognized the name or logo. Participants knew more of blood donation in their country of birth.
Also, there were different expectations from country of origin. While the blood bank in the NL is quite individualistic and ‘the donor comes to us’, especially in Ghana the participants perceived donating blood more as a community-activety and the ‘bank goes to the donor’
09 November 2018

6. 3. Organisational analysis blood supply chain
Regular recruitment
Registration
Pre-donation screening
Blood collection
Post-donation
screening
Specialised strategies
Discovery rare donor
“If the donor physician has the first conversation, he might decide that it is not possible for the potential donor to become a blood donor and will not take the first samples. Then we do not find out that this person has a very interesting blood type.”
Main obstacles  no extensive blood typing during pre-donation deferral. Strict guidelines
09 November 2018

7. Quantitative surveys target group
09 November 2018

8. Intervention development
6 performance objectives (POs)
PO.1
Become aware of the need of blood
PO.2
Contemplate a blood donor career
PO.3
Decide to become a blood donor
PO.4
Register as a blood donor
PO.5
Come to first appointment/donor check
PO.6
Donate at least once every 12 months
Recruitment
Retention
09 November 2018

9. Intervention development
Planning groups:
Rating 22 change objectives and 8 practical applications on relevancy and achievability.
Bloodmatch
team
Research
group
Donor recruitment dept.
Intervention experts
Target group
09 November 2018

10. Intervention development; preliminary outcomes
Knowledge
Attitude
Subjective norm/support
Self-efficacy
Intervention development; preliminary outcomes
“The target group should recognize there is a need of specific blood donations”
Other important change objectives: “The target group should express positive feelings towards starting a donor career” and “The target group should express confidence in continuing being a blood donor”.
Applications should consist of consciousness raising activities:
Other methods: arguments, mass media role-modeling & public commitment
- Make aware of possible consequences of a shortage of (specific) blood types  via the webpage or ambassadors who needed a blood transfusion in the past.
09 November 2018

11. Thank you for your attention!
Elisabeth F. Klinkenberga,b
a Department of Donor Studies, Sanquin Research, Amsterdam, The Netherlands
b Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands

12. References
(1) Jaarverslag Sanquin (2016).
(2) Reid, M.E., Lomas-Francis, C. and Olsson, M.L. (2012) The blood group antigen facts book. 3rd ed.
(3) Bartholomew, L. K., Markham, C. M., Ruiter, R. A., Kok, G., & Parcel, G. S. (2016). Planning health promotion programs: an intervention mapping approach. John Wiley & Sons.
(4) Klinkenberg, E. F., Huis in't Veld, E. M. J., de Wit, P. D., van Dongen, A., Daams, J. G., de Kort, W. L. A. M., & Fransen, M. P. (2018). Blood donation barriers and facilitators of Sub‐Saharan African migrants and minorities in Western high‐income countries: a systematic review of the literature. Transfusion Medicine.
09 November 2018

13. Performance objectives: migrant
Determinants
Performance objectives: migrant
Knowledge
Attitude
Social norm/support
Self-efficacy
Skills
Recruitment
PO.1 Become aware of the need of blood donors
KN.1 Recognize there is a need for specific blood donations
SI.1 Recognize that friends/family members are also aware of the need of blood donors
PO.2 Contemplate a blood donor career
KN.2 Recognize advantages and disadvantages of donating blood
AT.2 Express positive feelings towards contemplating about a blood donor career
SI.2 Recognize that friends/family members support thinking seriously about starting a donor career
SE.2 Express confidence in dealing with disadvantages of being a blood donor
SK.2 Demonstrate the ability to search information about the advantages and disadvantages of donating blood
PO.3 Decide to become a blood donor.
KN.3 Explain what it entails to become a blood donor
AT.3 Express positive feelings towards starting a blood donor career
SI3. Recognize that friends/family members support the decision to become a blood donor
SE.3 Express confidence in becoming a blood donor
PO.4 Register as a blood donor.
KN.4 Explain how the registration process works
AT.4 Express positive feelings about registering as a blood donor
SE.4 Express confidence in registering as a blood donor
SK.4 Demonstrate the ability to register as a blood donor via the website
Retention
PO.5 Come to first appointment/donor check.
KN.5 List the place and time for the appointment
SK.5 Demonstrate the ability to plan and come to an appointment
PO.6 Donate at least once in the 12 months.
KN.6 State the importance of donating regularly
AT.6 Express positive feelings about donating regularly
SI.6 Recognize that friends/family members support regular donations
SE.6 Express confidence in continuing being a blood donor
SK.6 Demonstrate the ability to donate at least once a year

14. Performance objectives: migrant
Determinants
Performance objectives: migrant
Knowledge
Attitude
Social norm/support
Self-efficacy
Skills
Recruitment
PO.1 Become aware of the need of blood donors
KN.1 Recognize there is a need for specific blood donations
SI.1 Recognize that friends/family members are also aware of the need of blood donors
PO.2 Contemplate a blood donor career
KN.2 Recognize advantages and disadvantages of donating blood
AT.2 Express positive feelings towards contemplating about a blood donor career
SI.2 Recognize that friends/family members support thinking seriously about starting a donor career
SE.2 Express confidence in dealing with disadvantages of being a blood donor
SK.2 Demonstrate the ability to search information about the advantages and disadvantages of donating blood
PO.3 Decide to become a blood donor.
KN.3 Explain what it entails to become a blood donor
AT.3 Express positive feelings towards starting a blood donor career
SI3. Recognize that friends/family members support the decision to become a blood donor
SE.3 Express confidence in becoming a blood donor
PO.4 Register as a blood donor.
KN.4 Explain how the registration process works
AT.4 Express positive feelings about registering as a blood donor
SE.4 Express confidence in registering as a blood donor
SK.4 Demonstrate the ability to register as a blood donor via the website
Retention
PO.5 Come to first appointment/donor check.
KN.5 List the place and time for the appointment
SK.5 Demonstrate the ability to plan and come to an appointment
PO.6 Donate at least once in the 12 months.
KN.6 State the importance of donating regularly
AT.6 Express positive feelings about donating regularly
SI.6 Recognize that friends/family members support regular donations
SE.6 Express confidence in continuing being a blood donor
SK.6 Demonstrate the ability to donate at least once a year
Relevant
Achievable
Designated by few
Designated by many

15. Practical application
Determinant
Method
Theory 
Practical application
Knowledge
Consciousness raising
Health Belief Model
Precaution-Adoption Process Model
Trans-Theoretical Model
Raise awareness of potential consequences of specific blood shortages via internet and during meetings with ambassadors.
Framing
- Protection Motivation Theory
Positive or negative framed messages (dependent on outcome of message framing experiment), such as: ‘(Not) Donating blood today may cause a friend to live (die) tomorrow.’
Attitude
Arguments
Communication-Persuasion Matrix
Elaboration Likelihood Model
Focused arguments on the benefits of donating blood for the target group, such as benefits for people of the same ethnic background and own health benefits of autologous donations.
Cultural similarity
- Communication-Persuasion Matrix
Blood bank ambassadors of the same ethnic or cultural background as the target group.
Subjective norm/support
Mobilizing social networks
- Theories of Social Networks and Social Support
Target group is coached to make their positive views on blood donation clear to other community members, also when they are not eligible to donate themselves.
Mass media role-modeling
Diffusion of Innovations Theory
Social Cognitive Theory
Promote short movies with ethnic minorities who donate blood and why they decided to become a donor.
Self-efficacy
Public commitment
Theories of Automatic, Impulsive, and Habitual Behavior
Encourage the target group to publically announce that they donate blood.
Skills
Planning coping respones
Attribution Theory
Relapse Prevention Theory
In a small group session, name potential barriers for donating blood and discuss how these barriers can be alleviated.

16. Practical application
Determinant
Method
Theory 
Practical application
Knowledge
Consciousness raising
Health Belief Model
Precaution-Adoption Process Model
Trans-Theoretical Model
Raise awareness of potential consequences of specific blood shortages via internet and during meetings with ambassadors.
Framing
- Protection Motivation Theory
Positive or negative framed messages (dependent on outcome of message framing experiment), such as: ‘(Not) Donating blood today may cause a friend to live (die) tomorrow.’
Attitude
Arguments
Communication-Persuasion Matrix
Elaboration Likelihood Model
Focused arguments on the benefits of donating blood for the target group, such as benefits for people of the same ethnic background and own health benefits of autologous donations.
Cultural similarity
- Communication-Persuasion Matrix
Blood bank ambassadors of the same ethnic or cultural background as the target group.
Subjective norm/support
Mobilizing social networks
- Theories of Social Networks and Social Support
Target group is coached to make their positive views on blood donation clear to other community members, also when they are not eligible to donate themselves.
Mass media role-modeling
Diffusion of Innovations Theory
Social Cognitive Theory
Promote short movies with ethnic minorities who donate blood and why they decided to become a donor.
Self-efficacy
Public commitment
Theories of Automatic, Impulsive, and Habitual Behavior
Encourage the target group to publically announce that they donate blood.
Skills
Planning coping respones
Attribution Theory
Relapse Prevention Theory
In a small group session, name potential barriers for donating blood and discuss how these barriers can be alleviated.
Relevant
Achievable
Designated by few
Designated by many

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