title: Donor anxiety, needle pain, and syncopal reactions combine to determine retention: a path analysis of two-year donor return data.
abstract: BACKGROUND
  Efforts to expand the donor pool by recruiting younger donors have resulted in higher numbers of initial donations, but retention of young donors continues to be challenging.
  
  
  METHODS
  Path analysis was used to examine the simultaneous relationships among syncopal reactions, donation anxiety, needle pain, donor satisfaction, and donation intention in predicting repeat donation. Participants included 421 first- and second-time donors recruited for a study comparing the effects of predonation water loading with and without the use of applied muscle tension during donation (52% female, 60.8% first-time donor, mean age 20.3 years). For this longitudinal follow-up study, donor database records were accessed 2 years after the index donation to assess repeat donation.
  
  
  RESULTS
  Results of a series of path analyses demonstrated the influential role of donor anxiety in shaping donor retention (final model χ(2) = 35.75, root mean square error of approximation 0.03, comparative fit index 0.98, weighted root mean square residual 0.74). First, anxiety exerted a direct negative influence on donation intention, the proximal and sole direct predictor of repeat donation. Second, anxiety increased the likelihood of donor-reported needle pain, adversely affecting donation satisfaction and, subsequently, donation intention. Finally, anxiety was associated with donor ratings of syncopal reactions through its impact on needle pain, which also contributed to decreased donation intention.
  
  
  CONCLUSIONS
  These results provide novel evidence that donation anxiety plays a central role in shaping future donation behavior. Individual differences in anxiety must be considered when developing and testing strategies to enhance blood donor retention.
authors.affiliation: Ohio University, Athens, Ohio; American Red Cross, Blood Services, Central Ohio Region, Columbus, Ohio; McGill University, Montreal, Quebec, Canada.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: France
authors.forename: Janis L
authors.initials: JL
authors.lastname: France
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Wissel
authors.forename: Blaine
authors.initials: B
authors.lastname: Ditto
authors.forename: Tara
authors.initials: T
authors.lastname: Dickert
authors.forename: Lina K
authors.initials: LK
authors.lastname: Himawan
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000453:epidemiology* / Q000209:etiology; D001782:Blood Donors / Q000523:psychology* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D009339:Needles / Q000009:adverse effects*; D010146:Pain / Q000453:epidemiology* / Q000209:etiology; D013575:Syncope / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult