Merav Ben Natan, PhD, RN, Keren Grinberg, M.Med.Sc, RN, Sharon Galula, BA, RN, and Michal Biton, BA, RN

Factors Affecting Israeli Women’s Decision Whether to Donate

Abstract Purpose: To examine whether Israeli mothers’ intention to donate cord blood can be predicted using the Theory of Planned Behavior (TPB). Study Design and Methods: A descriptive correlation study, employing the TPB. A questionnaire constructed based on a literature review of research on cord blood donation and on the TPB was administered to 207 Israeli women of childbearing age. Results: Behavioral attitudes (women’s total appraisal of cord blood donation), subjective norms (women’s perception of the opinion of significant others regarding the specific behavior), and perceived behavioral control (women’s total appraisal of their control of the behavior and perceived ease or difficulty of cord blood donation) were found to predict women’s intention to donate cord blood. Clinical Implications: Since behavioral attitudes, subjective norms, and behavioral control can predict cord blood donations, it is important for the medical and nursing staff to understand and use these concepts if they hope to obtain women’s cooperation concerning cord blood donation. Nurses should receive education on the subject of cord blood donation, increasing their awareness. It is possible that this could lead to a rise in such donations in the future. Both mothers and fathers should be consulted about the option of donating cord blood. Key words: Cord blood donation; Israel; Theory of Planned Behavior; Umbilical cord blood banking.

96

volume 39 |

number 2

Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

James Davies / Alamy

Cord Blood

March/April 2014

C

B. Boissonnet / BSIP SA / Alamy

ord blood is the blood that remains in the Although a debate exists whether cord blood donation placenta and the umbilical cord after birth. is useful, for example, some claim that in most cases alThis blood is an accessible source of stem logeneic bone marrow transplantation may be used (Shircells (Armson et al., 2005). Stem cells are Raz, 2011), cord blood has the potential to save lives, “superior cells” capable of replenishing various tissues in and ongoing research shows promising results (Abdullah, the human body (Dinç & Sahin, 2009). Stem cells origi2011). Due to the considerable shortage of cord blood nating from cord blood are currently used to treat 80 donations, it is necessary to investigate the behavioral indifferent diseases: thalassemia, aplastic anemia, replententions motivating women to donate cord blood in orishment of the blood cells of cancer patients treated with der to develop strategies to promote cord blood donaradiation or chemotherapy, and tions nationwide. To date, no others (Rimmer, 2008; Sirota, study has examined women’s 2010;). Stem cells from cord decision making regarding cord blood are collected immediately blood donation based on a Theafter birth by midwives, obstetriory of Planned Behavior (TPB). cians, and nurses who have undergone appropriate training Theoretical (Dinç & Sahin, 2009). In Israel, Framework donations of cord blood may be We selected the TPB (Ajzen, banked at either a public bank or 1991) as a theoretical setting for a private bank. Storing cord the current study, since it is one blood for the general public/unof the most frequently applied related individuals in need of models for predicting health and stem cells in a public bank is social behaviors (Armitage & done on a volunteer basis, and Conner, 2001). According to the its truly altruistic advantage is to model, the most crucial factor society as a whole. In a public influencing actual behavior is bank that cord blood could pothe individual’s intentions. In adtentially be used by any person dition, human behavior is guidin need. The greatest disadvaned by behavioral beliefs, attitude tage to public banking is that the toward the behavior, normative cord blood is not guaranteed beliefs, subjective norms, and available for use by the donor or perceived behavioral control. his or her family (Abdullah, Behavioral beliefs are an indi2011). vidual’s assumption that a cerIn 2012, there were 10,069 Cord blood is an tain behavior will lead to certain cord blood units in Israeli cord results. Normative beliefs reflect blood banks, placing Israel in accessible source of the individual’s subjective evalufourth position worldwide, with ation (i.e., belief) of how “sig12.6 cord blood units per 10,000 stem cells that is used nificant others” would wish him inhabitants. For comparison, to treat 80 different to act in order to perform or Switzerland is positioned tenth, avoid a specific behavior. An inwith 4.8 cord blood units per diseases. dividual’s intention to act in a 10,000 inhabitants (Bone Marcertain manner is affected by row Donors Worldwide, 2013). two main factors: his attitude However, despite Israel’s high toward the behavior—a personranking in the world with regard al component; and subjective norms—which reflect soto the number of donations, its ethnic diversity is a barrier cial leverage. to locating matching donations, and therefore there is still Behavioral attitudes stem from the individual’s judga significant shortage of cord blood in Israel (Shir-Raz, ment of whether performing the behavior would be 2011). “good” or “bad” for him. Thus, attitudes are a function Research conducted to date has proposed several facof the individual’s beliefs concerning the personal results tors that affect women’s decision whether to donate cord expected to follow from realization of his intentions. blood to public banks. Some of the factors uncovered in This subjective norm is the individual’s personal percepthe research are availability, willingness, and financial astion of the positive or negative social pressures exerted pects. Several studies have shown that there is a high deon him to perform or avoid a certain behavior. Thus, the gree of willingness to donate cord blood; however, desubjective norm applies pressure facilitating performance spite this willingness, actual donations are very scarce or avoidance of the behavior. Perceived behavioral con(Armson et al., 2005; Katz et al., 2011; Manegold et al., trol is defined by the individual’s belief regarding how 2010; Rucinski et al., 2010). MCN

March/April 2014

Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

97

There is a significant shortage of cord blood in Israel.

easy or difficult it is for him to perform a certain behavior (Ajzen, 2006). Godin et al. (2005) investigated factors that motivate people to donate blood. They found a strong sense of personal commitment to donate blood, both among those who donated in the past and among those who expressed an intention of donating in the future. In addition, past blood donations and the time that elapsed since the last donation were found to predict a high intention to donate in the near future. The shorter the duration since the last donation, the higher the intention is to donate blood in the future. Lemmens et al. (2005) found that some behavioral beliefs predict more positive attitudes toward blood donation; for example, the more donors believe that the process of donation is less painful and that the process does not take long, the more positive their attitudes to blood donation, and it predicts their intention to donate. Ben Natan and Gorkov (2011) explored whether the TPB adds significantly to the prediction of intended and actual blood donation among the general Israeli population, and found that Israelis’ perceived behavioral control of blood donation, their subjective norms, and their attitude toward blood donation predicted their intention to donate blood.

Aim of the Study In the present study, we examined whether the model based on the TPB succeeds in predicting mothers’ intention to donate cord blood to a public bank.

Methods Study Design

We used a quantitative correlational study with a convenience sample of women of childbearing age who attended a series of lectures on women’s health at local community centers in central Israel. A total of 221 questionnaires were distributed, and 207 questionnaires were returned, for a response rate of 93%. Measures and Instruments

We developed a questionnaire based on the theoretical foundation of the TPB. The content validity of the ques98

volume 39 |

tionnaire was established by reviewing and editing its general reliability by three nursing administrators and three nursing educators in this field. The questionnaire consisted of 51 items, 14 of which were demographic information, although the remaining 37 items were: 3 on behavioral beliefs regarding cord blood donation (Cronbach’s α = 0.8), 5 on behavioral attitudes toward cord blood donation (Cronbach’s α = 0.84), 4 on normative beliefs on the issue of cord blood donation (Cronbach’s α = 0.9), 8 on subjective norms regarding blood donation (Cronbach’s α = 0.84), and 3 items related to subjects’ perceived control of the act of donating blood (Cronbach’s α = 0.8). Three items were on awareness of the issue (Cronbach’s α = 0.91) and four on behavioral intention (Cronbach’s α = 0.94). In addition, seven questions were asked concerning knowledge on the topic of cord blood donation. All items on the questionnaire except sociodemographic items and items concerning knowledge were ranked on a Likert scale from 1 “strongly disagree” to 6 “strongly agree.” The knowledge questions were given 1 point for each correct answer; the maximum grade was 7 points. Research Procedure

The study was approved by the Ethics Committee of the Pat Matthews Academic School of Nursing and was conducted from March to May 2012 among women of childbearing age. Respondents were assured that the questionnaire was anonymous and would be used for research purposes only. Data Analysis

Data analysis was performed with the Statistical Package for Social Sciences (SPSS-PC, Version 19, SPSS Inc., Chicago, IL, USA). Descriptive statistics were used to describe the demographic characteristics of the sample and responses to the TPB and its subscales. Means and standard deviations (SD) of the responses were calculated. Pearson correlation and linear regression were used to determine the relationship between the variables of the TPB model.

Results The sample consisted of 207 women of childbearing age, aged 18–50, with a mean age of 31 (SD = 8.1). Table 1 shows that most of the participants (69.6%) were married. Of all respondents, 6.2% had given birth once or more, although some 90% of respondents were not pregnant when completing the questionnaire and some 10% of respondents were pregnant when completing the questionnaire. Of the pregnant women, 42.1% were in the second trimester, 36.8% were in the third trimester, and 21.1% were in the first trimester. About three quarters of respondents had an academic degree and 79.2% were born in Israel. Some 80% of respondents were employed; however, 72% defined their income as below average. Eighty five percent of respondents were Jewish. About half the respondents defined themselves as secular or traditional (33% and 22.2%, respectively), some 40% define themselves as religious, and 5% defined themselves as ultra-Orthodox.

number 2

Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

March/April 2014

Women’s Intention to Donate Cord Blood

Normative Beliefs and Subjective Norms

Most of the respondents (71%) would be willing to donate cord blood for the purpose of treating the ill, although 50% of respondents would not be willing to donate cord blood for research purposes. Fifty percent of respondents would make all efforts to donate cord blood, and some 62% of respondents intend to donate cord blood in the future. The mean of women’s behavioral intention to donate cord blood was moderate, M = 3.68 (SD = 1.49).

Respondents claimed that the most significant figure whose opinion affected their intention to donate cord blood was their husband (75%), closely followed by their doctor (61%) and their family (57%). A positive moderate correlation was found between women’s normative beliefs and subjective norms, that is, the more positive women’s normative beliefs on donation of cord blood to a public bank, the more positive their subjective norms are (r = 0.24, p < .01). Moreover, the more positive women’s subjective norms on donating cord blood to a public bank, the more positive their behavioral intention (r = 0.20, p < .01) (Table 2).

Knowledge About Cord Blood Donation

In regard to knowledge, most participants knew that there are public banks in Israel to which cord blood can be donated (72.9%); however, only 46.4% knew that cord blood can be used to treat a large number of illnesses, and only 32.9% knew that donating cord blood to a public bank is free of charge. Namely, most participants were aware in general of the concept of cord blood and of the existence of public banks, but they had no details of the uses of cord blood and of how to make a donation. The average knowledge of the participants on blood cord donations is M = 3.5 (SD = 1.6), that is, medium. There was a positive correlation between the level of knowledge and intention of donating blood (r = 0.36, p < .01).

Perceived Control of Donating Cord Blood

The mean of women’s perceived control of donating cord blood was high, M = 5.2 (SD = 1.1), and the more positive women’s control over the subject of donating cord

Table 1. Respondents Sociodemographic Data Variable

Age

Behavioral Beliefs and Attitudes Toward Cord Blood Donation

Most participants believed that donating cord blood poses no danger to the baby. Additionally, they believed that the donation is neither painful for the mother (69.6%) nor for the baby (75.8%). The more positive women’s behavioral belief concerning the donation of cord blood to a public bank, the more positive their behavioral attitude is. A moderate significant correlation was found (r = 0.32, p < .01). Most respondents perceived cord blood as important, and an absolute majority claimed that they attribute a great deal of significance to helping others in general (93%). A highly significant correlation was found between women’s behavioral attitude to cord blood donation and their behavioral intention, that is, the more positive women’s behavioral attitude to the issue of donating cord blood to a public bank, the more positive their behavioral intention was to do so (r = 0.58, p < .01) (Table 2). Awareness About Cord Blood Donation

Most of the respondents (87%) claimed that if they had had enough information about donating cord blood while pregnant, it would have helped them decide to donate. A moderate positive correlation was found between awareness and intention to donate cord blood (r = 0.35, p < .01) (Table 2). Respondents were interested in receiving information on the subject at an early stage of their pregnancy, and receiving the information from their obstetrician would have made it easier for them to make the decision. Most said that information on the lack of health risks to the mother and newborn would have made it easier for them to decide to donate cord blood (85%).

Marital status

Categories

n

%

25–18

64

31

35–26

89

43

50–36

54

26

Single

56

27

Married

144

70

Divorced

7

3

Widow Country of birth

Schooling

Employment

0

0

Israel

164

79

Other

43

21

Less than 12 years

2

1

12 years

35

17

Post secondary

10

5

Academic

160

77

Unemployed

37

18

Employee

166

80

Self-employed

Religious affiliation

Religiosity

Average wages

3

1

Jewish

176

85

Muslim

19

9

Christian

8

4

Other

4

2

Secular

69

33

Traditional

46

22

Religious

82

40

Ultra-orthodox

10

5

Below average

150

73

Average

36

17

Over average

21

10

MCN

March/April 2014

Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

99

Table 2. Associations Between Intention to Donate Cord Blood and Components of the TPB Intention

Behavioral Beliefs

Behavioral Attitudes

Normative Beliefs

Subjective Norms

Awareness

Perceived Control

Intention Behavioral beliefs

−0.33*

Behavioral attitudes

0.58*

−0.32*

Normative beliefs

0.65*

0.31*

0.59*

Subjective norms

0.20*

0.79

0.21*

0.24*

Awareness

0.35*

−0.11

0.32*

0.32*

0.22*

Perceived control

0.32*

−0.8

0.19*

0.19*

−0.82

0.44*

*p < .01.

blood to a public bank, the more positive their behavioral intention (r = 0.32, p < .01) (Table 2). Respondents tended to rank their control as high, and most (86.5%) believed that they had full control over the decision whether to donate cord blood and over their ability to receive information. An examination of the variables of the research model using linear regression in the enter technique showed that all model variables affect the intention to donate cord blood and the theoretical prediction ability is 52% (R2 = 52).

Discussion The research results show that the willingness (behavioral intention) of respondents to donate cord blood was high, and that they were willing to donate to treat the ill. Over half the respondents intended to donate cord blood in the future. In contrast, half the respondents would not be willing to donate cord blood for research purposes. This is compatible with Rucinski et al. (2010) who showed that women preferred to donate cord blood only for transplant purposes, to save lives, and not for research purposes. This fact is at odds with Katz et al. (2011) who showed that the large majority of women interested in donating cord blood are willing to donate cord blood for research purposes. This may be explained by women’s behavioral attitudes. The research findings show a strong correlation between behavioral attitudes and behavioral intention. Most respondents tended to see the contribution of cord blood as an ethical norm. Moreover, most agree that donating cord blood is beneficial and important, but in contrast to these findings, only half the respondents see the donation as having the importance of a national assign100

volume 39 |

ment, and thus they do not think that the donation should be used for research purposes. Similar to studies conducted by Shin, Yoon, Lee, Kim, and Roh (2011) and Armson et al. (2005), women’s consent to donate cord blood to a public bank is high and one of the conspicuous reasons for this donation is the wish to help others and save lives, that is, altruism—an act without self-centered motives. Women in this study believed that the donation of cord blood does not harbor any risks for their newborn. They also believed that the donation is not painful either for the mother or for the baby. Indeed, Rucinski et al. (2010) found that women claimed they would like to receive information about the procedure of how the blood is harvested. They wanted to know if it is painful or causes discomfort to the mother and the baby. They mentioned their fear of having a needle inserted in the umbilical cord right after birth. The research here showed that the most significant person involved in making a decision about cord blood donation is the husband/spouse. This is compatible with the findings of Katz et al. (2011) and of Dinç and Sahin (2009). In contrast, Salvaterra et al. (2010) found that women spoke of their obstetrician and of the nursing staff as having a very significant role in the decision to donate. They said that the information and availability of the staff strongly affect the decision to donate. In this study, the obstetrician emerged as an important figure for raising awareness, although not for the decision to donate in practice. The results of the current study show that the mean of women’s perceived control over the donation of cord blood is moderately high. Respondents tended to rank their control as high, and most believed that they had full control over the decision whether to donate cord blood

number 2

Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

March/April 2014

• Nurses can teach pregnant women about the concept of cord blood collection and of the existence of cord banks.

Keren Grinberg is a Nurse Educator at Pat Matthews School of Nursing, Hillel Yaffe Medical Center, Hadera, Israel. Sharon Galula, Pat Matthews School of Nursing, Hillel Yaffe Medical Center, Hadera, Israel. Michal Biton, Pat Matthews School of Nursing, Hillel Yaffe Medical Center, Hadera, Israel. The authors declare no conflict of interest.

• Pregnant women might not have any details of the uses of cord blood and of how to make a donation.

DOI:10.1097/NMC.0000000000000014

Summary of Nursing Implications • Due to the considerable shortage of cord blood donations, we need more investigation of the behavioral intentions motivating women to donate cord blood.

• Spouses or significant others should also be educated about cord blood donation.

and over their ability to receive information. In addition, respondents believed that they are in full control of the decision whether to donate cord blood. This is compatible with Dinç and Sahin (2009) and Fernandez, Gordon, Van den Hop, Taweel, and Baylis (2003) who showed that women’s control over the decision whether to donate blood has a significant effect on their decision to donate blood. In conclusion, the theoretical model seems to predict the intention of Israeli women to donate cord blood.

Limitations The research was conducted with a convenience sample, which might have biased the research results. Another limitation is the fact that the study was based on subjects’ self-report of behavioral intention to donate cord blood, and these findings cannot be objectively confirmed.

Conclusions This study suggests that receiving information at an early stage of the pregnancy is essential in order to make a decision to donate cord blood and that respondents would rather receive this information from their healthcare providers. For this reason, it is important for the medical and nursing staff to cooperate and take part in workshops on the subject. Increasing the awareness of healthcare providers regarding the significance of consultations with women on donating cord blood may lead to a rise in such donations in the future. As revealed in this study, the TPB is a useful model for predicting factors influencing Israeli women’s decision whether to donate cord blood. Beliefs, attitudes, normative beliefs, subjective norms, awareness, and behavior control predict women’s intention to donate cord blood in Israel. Further research on the subject is needed in order to confirm the results of the current study and uncover additional factors that might affect women’s intention to donate cord blood. ✜ Merav Ben Natan is a Director of Pat Matthews School of Nursing, Hillel Yaffe Medical Center, Hadera, Israel; Department of Nursing, School of Health Professions, Tel Aviv University, Tel Aviv, Israel. She can be reached via e-mail at [email protected]

References Abdullah, Y. (2011). Cord blood banking: What nurses and healthcare providers should know. MCN, The American Journal of Maternal Child Nursing, 36(6), 344–350. doi:10.1097/NMC.0b013e31822db253 Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211. Ajzen, I. (2006). Constructing a Theory of Planned Behavior questionnaire. Retrieved from www.people.umass.edu/aizen/tpb.html Armitage, C. J., & Conner, M. (2001). Efficacy of the Theory of Planned Behaviour: A meta-analytic review. British Journal of Social Psychology, 40(4), 471–499. doi:10.1348/014466601164939 Armson, B. A., Maternal/Fetal Medicine Committee, Society of Obstetricians and Gynaecologists of Canada. (2005). Umbilical cord blood banking: Implications for perinatal care providers. Journal of Obstetrics and Gynaecology Canada, 27(3), 263–290. Ben Natan, M., & Gorkov, L. (2011). Investigating the factors affecting blood donation among Israelis. International Emergency Nursing, 19(1), 37–43. doi:10.1016/j.ienj.2010.01.003 Bone Marrow Donors Worldwide. (2013). Annual Report 2012. Retrieved from www.bmdw.org Dinç, H., & Sahin, N. H. (2009). Pregnant women’s knowledge and attitudes about stem cells and cord blood banking. International Nursing Review, 56(2), 250–256. doi:10.1111/j.1466-7657.2008.00689.x Fernandez, C. V., Gordon, K., Van den Hof, M., Taweel, S., & Baylis, F. (2003). Knowledge and attitudes of pregnant women with regard to collection, testing and banking of cord blood stem cells. Canadian Medical Association or its licensors, 168(6), 695–698. Godin, G., Sheeran, P., Conner, M., Germain, M., Blondeau, D., Gagné, C., ..., Naccache, H. (2005). Factors explaining the intention to give blood among the general population. Vox Sanguinis, 89(3), 140– 149. doi:10.1111/j.1423-0410.2005.00674.x Katz, G., Mills, A., Garcia, J., Hooper, K., McGuckin, C., Platz, A., ..., Torrabadella, M. (2011). Banking cord blood stem cells: Attitude and knowledge of pregnant women in five European countries. Transfusion, 51(3), 578–586. doi:10.1111/j.1537-2995.2010.02954.x Lemmens, K. P., Abraham, C., Hoekstra, T., Ruiter, R. A., De Kort, W. L., Brug, J., & Schaalma, H. P. (2005). Why don’t young people volunteer to give blood? An investigation of the correlates of donation intentions among young nondonors. Transfusion, 45(6), 945–955. doi:10.1111/j.1537-2995.2005.04379.x Manegold, G., Meyer-Monard, S., Tichelli, A., Granado, C., Hösli, I., & Troeger, C. (2010). Controversies in hybrid banking: Attitudes of Swiss public umbilical cord blood donors toward private and public banking. Archives Gynecology and Obstetrics, 284(1), 99–104. doi:10.1007/s00404-010-1607-x Rimmer, Y. (2008). Tipot hayim—hadam hataburi [Drops of life—cord blood]. Galileo, 116. Retrieved from http://galileo.allmag.co.il/page/9782 Rucinski, D., Jones, R., Reyes, B., Tidwell, L., Phillips, R., & Delves, D. (2010). Exploring opinions and beliefs about cord blood donation among Hispanic and non-Hispanic black women. Transfusion, 50(5), 1057–1063. doi:10.1111/j.1537-2995.2009.02548.x Salvaterra, E., Casati, S., Bottardi, S., Brizzolara, A., Calistri, D., Cofano, R., ..., Rebulla, P. (2010). An analysis of decision making in cord blood donation through a participatory approach. Transfusion and Apheresis Science, 42(3), 299–305. doi:10.1016/j.transci.2010.03.005 Shin, S., Yoon, J. H., Lee, H. R., Kim, B. J., & Roh, E. Y. (2011). Perspectives of potential donors on cord blood and cord blood cryopreservation: A survey of highly educated, pregnant Korean women receiving active prenatal care. Transfusion, 51(2), 277–283. doi:10.1111/j.15372995.2010.02866.x Shir-Raz, Y. (2011). Shimur dam taburi beemet matzil hayim? Tahkir [Does banking cord blood really saves lives? Inquiry]. Menta. Retrieved from www.ynet.co.il/articles/0,7340,L-4157661,00.html Sirota, K. (2010). Dam taburi: Havtaha im shahar [Cord blood: Promise with a meaning]. BioInform, 4, 26–29. MCN

March/April 2014

Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

101

Factors affecting Israeli women's decision whether to donate cord blood.

To examine whether Israeli mothers' intention to donate cord blood can be predicted using the Theory of Planned Behavior (TPB)...
301KB Sizes 6 Downloads 2 Views