Practices Aimed at the Blood Donors Recruitment and Retention in St. Petersburg

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Practices Aimed at the Blood Donors Recruitment and Retention in St. Petersburg

Introduction

donation donor blood

Donation is one of the topics which is discussed in many countries. Researchers have been studying this pro-social activity from different angles. They study the motivation of donors, their barriers, behavior, attitude to donation. These topics are studied through psychology, sociology, anthropology, economy, and medicine. Moreover, there are works about strategies of recruiting and retaining donors. Despite this fact, a universal successful method of recruitment and retaining has not yet been invented.

This research is about blood donation. In spite, the fact that there are many blood donors and statistics show that, undoubtedly, the number of donors is growing (World Health Organization, 2019), the amount of donated blood is still not enough. This problem is caused not only because of the little number of donors. Blood donation should be permanent, regular activity. Constancy is one of the most important components of donation. In other words, donors must donate blood on a regular basis to be effective for blood donation. World Health Organization (2010) confirms the above and cites data that shows that first-time donors (those who donate once) are not effective. This is because regular donors make screening more than 2 times a year, which makes them tested and reliable because their blood is more likely to be suitable than the blood of newcomers (first-time). Thus, regular donations help to stabilize and increase blood supply (WHO, 2010).

Significant changes took place in the Russian specifics of blood donation in 2013, when the blood donation became officially free. The law on the donation of blood includes canceling remuneration thereby blood donation in Russia has become non-remunerated. Orloveckaja (2017) in her work cited data from the surveys of Russian Public Opinion Research Center (VTsIOM) and Public Opinion Foundation, in which the majority of respondents answered that they donate blood not because of material benefits or rewards. However, after the Law on Blood Donation and its Components in 2013 has been entered into force, the number of donors has significantly decreased. Therefore, it is possible that there is a misunderstanding between donors and people, who develop practices for recruiting and retaining, what donation and the donor should be (Orloveckaja, 2017). This phenomenon is considered in the example of the Russian metropolis of St. Petersburg.

In December 2017, a VTsIOM-Sputnik telephone survey was conducted, which showed that 40 percent of respondents did not have information about the location of the blood donation centers. Moreover, the survey determined that residents of St. Petersburg and Moscow are less likely to visit these blood donation centers. Thus, it can be noted that the population, potential donors are not properly informed about the possibility of donating blood.

Thus, that is the evidence that studying the practices of attracting and retaining blood donors plays a crucial role in the blood donation process. In other words, in addition to donors and their perceptions, attention should be paid to stakeholders responsible for the organization of blood donation and donors' recruitment process as well. So far, however, there has been little discussion about comparing views on existing practices of recruiting and retaining blood donors between donors and organizers of these practices. That is why the research question of this work is how are stakeholders responsible for the organization of blood donation and donors 'recruitment process attracting and retaining blood donors in Saint-Petersburg?

The object of the study is the organizers of donation events and donors. The subject of the study is the techniques and practices of blood donors' recruitment and retention, which are carried out in St. Petersburg. Moreover, in this empirical study, a comparison regarding the perceptions of retention and recruitment practices among donors and stakeholders is made.

The purpose of the research is to describe the practices of recruiting and retaining donors, their formation and reproducing.

Thus, the tasks of this study should be highlighted:

1. To identify current practices of recruiting and retaining blood donors implemented by different stakeholders;

2. To learn the ways stakeholders create those practices and evaluate their effectiveness;

3. To identify how donors experience and evaluate those practices

The overall structure of the study takes the form of six chapters, including introduction. Chapter Two begins by laying out the theoretical dimensions of the research. The third chapter is concerned with the methodology used for this study. The fourth section presents the findings of the research, focusing on the four key themes that are the formation of retention and recruitment practices, existing practices, the attitude of donors and organizers to existing practices, and the improvement of the system.

The method of qualitative research is a semi-structured interview with organizers and blood donors. Interviews with blood donors are the secondary data, which was collected for the other project “Prosocial behavior in the field of health: donation of biomaterials”. The samples of both types of respondents are purposive and snowball.

To begin with, I am operationalizing some concepts that will be used later in the article. The first thing to understand is what theoretical framework is used and what is meant by practice in this study.

1. Literature review

1.1 Theoretical framework: Social action and practice

The concept of "practice" is understood as the way of actions to solve certain practical problems in many empirical studies. In such cases, researchers usually observe how people manage to maintain the existence of different social institutions (Volkov &Harhordin, 2008).

There are different practices of attracting and retaining blood donors, and all of them are the ways of committing social action according to Max Weber (2016). In his scientific articles, he says that social action is an action that is focused on the behavior of other people and is related to it. Speaking of this in a situation of blood donation, social action can be defined as a process of attracting and retaining donors - this process is correlated with the behavior of potential donors and is focused on it. Social actors are event organizers. At the same time donation of blood is social action as well, so social actors will be blood donors. As can be seen there are several types of social action. They are Rational-purposeful Action, Value-rational Action, Affective Action и Traditional Action. For instance, the first example refers to the first type, action which is based on logic and scientific aspects. The value-rational action is about the norms and values of the actor, thereby he or she commits an action based on their values and beliefs. The affective action contains no reasoning about goals, means and consequences, this is a pure surge of emotions. The fourth type of social action is traditional. It is committed in repeated conditions and according to a specific model.

In this study, the main objective is to determine practices of retention and recruiting blood donors to such pro-social activities as blood donation. In other words, how the actors [organizers and administration] of various donor funds, donor days, etc., make sure that new donors come, and experienced donors continue to donate. Thus, practice in this paper is understood as a method aimed at committing a social action that contribute to the maintenance of donor activity in St. Petersburg.

1.2 Blood donation in other countries

Undoubtedly, it is important to understand what is happening in other countries in the field of blood donation, what problems they face, how they solve them and how they recruit and retain donors. Orlovetskaya (2016) wrote a review on the book “Giving blood: an institutional making of altruism” written by Charbonneau and Smith (2015), which describes the institutional aspects of blood donation practices in other countries. The main topics for discussion were devoted to the formation of blood donation under the influence of political, institutional and sociocultural factors, the transition to a decentralized collection of blood banks in hospitals, where the majority of donors are patients' relatives or friends, the importance of adapting practices to local realities, and the influence of the state on donation blood and donor activity. In order to demonstrate the importance of all practices and factors, this fragment will tell about historical facts and events that have affected blood donation.

There are many examples that show a “clash” of donor practices with accepted practices in society, such as traditions. The donation is considered harmful to humans in China, this opinion is traditional, therefore there are not many blood donors. However, since blood is needed in medicine, the government decided to introduce quotas for work collectives. In other words, a person on behalf of the whole team became a donor. Thus, the donor sacrificed himself/herself for the sake of others and for his actions received gratitude in the form of a sum of money and a week of vacation. For example, racial segregation of blood donors has been abolished in the United States. This was due to the fact that new technologies appeared that made it possible to conduct an indirect blood transfusion, as well as the fact that after the war, a donation was considered an act of patriotism, which means that it should be available to everyone. The sad experience with the donation of blood and its components was in France in the 1980s, then many recipients received AIDS-infected blood and plasma. This situation occurred due to the fact that donors were considered responsible people, heroes, that is why they did not undergo a proper examination. These examples show how the attitude towards donors and the practice of blood donation affects people's behavior, their actions and perceptions. It can be assumed, for example, that a person, knowing that donors are treated like heroes, decided to become a donor only in order to feel like a hero. In other words, it turns out that the usual ideas for that society motivated a person to donate blood. The actions of the Chinese government, which supported donors, with the help of material compensation and a weekend, contributed to an increase in the number of blood donors in their country. All these actions are practices of recruiting and retaining blood donors. Moreover, to attract and retain blood donors, they use such methods as strengthening social ties: establishing blood banks on school grounds, rewarding donors. All actions are aimed at ensuring that blood donation is not treated as an extreme procedure. This goal was set in Canada (Charbonneau & Smith, 2015). Such practices have been in countries in different historical periods.

Consider the current situation in different parts of the world. Around 117.4 million blood donations have been made worldwide per year, 42% of them are collected in high-income countries, where only 16% of the world's population lives (World Health Organization, 2019). Despite this, in developed countries, there is a shortage of donated blood. According to the data from the Red Cross, every 2 minutes someone needs donated blood in the United States. In addition, it is mentioned that less than 38 percent of the US population has the opportunity to become blood donors. The Red Cross in the United States provides about 40% of the blood and its components, owing to voluntary donors. But supply cannot always satisfy demand because only about 3% of eligible people donate blood every year (American Red Cross, 2020). Only 3 percent of residents in Australia donate blood every year, while the Red Cross reports that they need 29,000 donations per week (Australian Red Cross Lifeblood, 2020). In Europe, according to WHO (2011), there is a deficit donated blood as well: 90% of potential donors do not donate blood. Due to an aging population and a lack of donor blood, the requirements for blood intake and for donors are reduced. For example, in some regions of Europe, the allowable age for blood donations has dropped to 15 years.

.A decrease in the number of donors is due to several factors: population aging (Moog, 2009); an increase in the group of donors who did not fit for medical reasons; a low percentage of returning first-time donors, strict donor deferral criteria, and the limited shelf life of blood products (Drackley et al., 2012; Riley, Schwei & McCullough, 2007).

To sum up, there are problems around the world with a shortage of blood donors, how they are struggling with this, and what they are doing for this, is indicated below.

1.3 Studying the practices of recruitment and retention of blood donors

Currently, there are many foreign studies dedicated to attracting, recruiting blood donors. They are divided into works devoted to the study of the population, that is, their awareness, involvement in the donor process (active donor, first-time, non-donor), attitudes towards donation, and research that study organizational processes as well, how organizations, blood banks affect donors, how they are involved in the donation process. Since both types are combined in this study, it is necessary to talk about how each of them is studied.

In order to improve the situation, researchers began to study portraits of non-donors, check the awareness of citizens of their countries, etc. For example, researchers from Spain divided non-donor into segments to increase recruitment efficiency. These clusters were formed on the basis of motives and barriers to donating blood from non-donors (Martэn-Santana, Beerli-Palacio & Romero-Domэnguez, 2020). Using the survey, they identified a list of motives and barriers that more affect the decision of non-donor citizens to donate blood. Six clusters were identified. The first cluster, the largest, consists of the most selfless people, it is dedicated to `impure altruists'. The second cluster is called `I want to, but make it easy for me'. It includes people who have a high level of impure altruism, health benefits and high sensitivity to marketing stimuli. This group has the motivation to donate blood, but there is no way to do this due to lack of resources (for example, time and information). The third cluster is `free ? riders', these are people who have no motivation to donate and have strong barriers to donation. The fourth cluster is called `reciprocal altruists'. It is non-donors who have motivation to donate, the highest level of impure altruism, who are very sensitive to marketing stimuli, to health benefits and to appreciation. They are people who will donate blood because of both altruistic and personnel motives. The next cluster is about `I can't because I'm scared', this group will not become a donor because their level of motivation is smallest and they have a lot of fear and aversion to donate. The last cluster determine as `I want to, but I can't', these non-donors have a lot of barriers which neutralize their high level of motivation. As a result, Martэn-Santana, Beerli-Palacio and Romero-Domэnguez (2020) said that non-donors from 1 cluster are the most attractive whereas 3 and 5 clusters are the least. To attract representatives from the 4th cluster blood transfusion centers are needed to design promotion campaigns and to provide incentives to reciprocal altruists. Non-donors from `impure altruists', `I want to, but make it easy for me', `reciprocal altruists' and `I want to, but I can't' clusters are the target group for recruitment. As can be seen there are different obstacles for each of these clusters. That is why, various strategies and practices are necessary for recruiting and retaining representatives of the groups.

All this information is collected for the state organizations to have an idea of what is happening and take certain actions. Studies that are mentioned above are aimed at reducing blood deficiency by identifying motives, barriers, knowledge, and attitudes of potential donors. Studies focusing on donor shortages are mostly focused on the individual characteristics of donors, ignoring the importance of the influence of the social context (Smith, Matthews, & Fiddler, 2013). The social context is not only the rules of the society in which the donor is located but the state as well, its attitude to donation, the way the state shows this attitude.

That is interested how recruitment and retention practices were studied when the respondents included organizers of events, projects, and actions dedicated to blood donation. It is worth starting with why the organization of blood collection funds has paramount importance.

The role of organizations in the formation of donation and a donor career is important because providers (organizers) create "reasons" for which blood should be donated. Moreover, it is those who decide who should be recruited, therefore, the promotion campaign is focused specifically on this category of citizens. For example, the Red Cross focuses on people with social and religious values, which certainly affects the human perception of donation (Healy K, 2010).

Smith, Matthews and Fiddler (2013) studied the role of the organization in recruitment and retainment of blood donors. They conducted 156 in-depth interviews with employees of blood services, donors, and non-donors in 25 organizations. In addition to interviews, researchers used a qualitative research method, it is observation, with which they monitored how employees communicate with donors. In the course of data analysis, 3 main topics were identified: “leveraging social networks, embedding the clinic in the community, and donating blood and social reciprocity” (Smith, Matthews & Fiddler, 2013). The first topic describes the strong interpersonal ties as one of the most effective motives for first-time donors to donate at first time. Research shows that company where coworkers were cohesive, the rate of first-time donors was the highest. At the same time, if there is an active donor in the company, he or she can influence their colleagues by social pressure. They emphasized that the employees of organizations are cohesive and the behavior of donors depends on their actions. The second topic talks about the fact that the territorial location of the blood transfusion center or rather convenience and accessibility is important for potential donors. In addition, this block noted that an important fact for attracting to donation is the involvement of employees in other volunteer activities. Moreover, the cohesion among both medical staff and donors cause retention of the donors. The block about social reciprocity shows that repeat donors associate their donations with reciprocity toward their community. In this work, interviews with donors and service employees who influence donor behavior were conducted.

Another study by the same authors (Smith, Matthews & Fiddler, 2011), which was conducted in Canada and which studied The Canadian Blood System, is devoted to the study of the influence of social capital. The research methods were interviews with employees of organizations, donors and non-donors, and ethnographic observation. The author agrees with Healy (2000, 2010), who says that the internal altruism that organizations try to evoke among potential donors in order to attract them to this pro-social activity is ineffective. As a result, the hypothesis of Smith et al. (2011) that the decision to donate blood or not depends more on the community in which the person is located, was confirmed.

Researcher Healy (2000) questioned the work of his colleagues (Piliavin & Callero, 1991), who wrote about altruism, he suggested that blood donors feel “elusive altruism”. This hypothesis is associated with the fact that there are many different organizations that collect blood. Each organization has its own idea of a “suitable donor”. Thus, these organizations form people's opinions and ideas about donation, developing practices of attracting donors. Healy (2000) believes that it is worth paying attention not to individual characteristics, but rather to the institutional component. Organizations recruiting donors, collecting blood, advertising can exclude any group from potential donors by their actions. In his study, he compares several countries of the European Union and their practices. Moreover, some of the institutional elements for blood collection are volunteer organizations and blood banks. Both of them have their own practices of recruitment and retention of donors. The results showed that the collection regimen significantly affects donor activity. So, for example, it turned out that the practice of attracting the Red Cross organization does not particularly attract donors, perhaps this is due to the donor's portrait they presented to people.

This study has a different way of testing and evaluating recruitment and retaining practices: the donors and the organizers of blood donations were studied, they are people who are involved in the process of donors' recruitment. The scientific problem of this study is that there are not so many studies (where respondents are organizers and donors) which are suitable for solving this problem in contradiction to those that study exclusively donors, non-donors or only influences of organization.

1.4 Motivations of blood donors

In order to trace the connection of the practices used to attract and retain donors with the ideas and needs of active and potential donors, it is necessary to identify the motivations of donors. Studies that research donor motivation often use Theory of Planned behavior (TPB) of Icek Ajzen (2011) ((e.g. Bednall, Bove, Cheetham, & Murray, 2013; Bailey, Tomson, Risdale, & Ben-Shlomo, 2014; Piersma, Bekkers, Klinkenberg, de Kort, &Merz, 2017; Carver, Chell, Davison, &Masser, 2018 ) ). This theory allows the most widely explained behavior and motives that cause this behavior. It means that the behavior depends on the intention to commit it. The intention is influenced by attitude, subjective norm, and control. These factors are moderated by beliefs: behavioral beliefs, normative and control beliefs. The theory of planned behavior demonstrates the ability to predict intent and behavior in relation to blood donation (France et al., 2015). Based on the results of a study by France et al. (2015), the attitude to blood donation is formed on the basis of evaluative judgments about this pro-social activity, while subjective norms are social pressure exerted on blood donors.

Donor motivation is the main feature by which the practices of recruiting and retaining them should be formed.Since there are different types of donors, for example, first-time and experienced donors as well as those who do not have any experience in blood donation (non-donors), respectively, their motivation to start donating blood or to continue may differ . Altruism and collectivism are major donor motivations based on reviews by Carver, Chell, Davison & Masser (2017) and Bednall & Bove (2011). Motivators such as a sense of duty (moral obligation / personal moral norm), a positive attitude towards donation, non-monetary incentives (free screening, additional leave, gifts), reciprocity (surrenders because he/she was once helped), indirect reciprocity ( donates blood, if it is useful in the future), the influence of the environment, a positive effect on well-being, satisfaction of curiosity (significant for donors for the first time). It is worth noting that the motivations of men and women can differ from each other, for example, altruism is more often characteristic of women than men.

Now the motivations of first-time donors and return donors will be compared. According to the systematic review of Bagot, Murray & Masser (2016) the main motivators for first-time donors are personal moral norms, subjective norms, enjoyment for helping others, collectivistic motivations, and personal benefits. Based on the study, donor return depends on a positive attitude towards donation, the presence of confidence that donation is under personal control, and the influence of subjective norms. Self-efficacy and self-identity also strongly influence the decision of the donor to return (Bagot, Murray & Masser, 2016).

Thus, we can summarize that in the formation of a certain practice of recruiting or retaining a blood donor, it is necessary to pay attention to the fact that motivations of people can be different. Perhaps it is necessary to separate strategies regarding the respondent's gender, social status, and other factors that may be characteristic of different social groups of the population. It is social institutions that contribute to the formation of the appearance of the donor and the motivation of donors for blood donation, therefore, depending on how they represent the blood donor, what they understand as the donor wants, the number of blood donors changes.

1.5 Voluntary blood donation

Voluntary non-remunerated blood donations (VNBD) considered the best type of donation (WHO, 2013) . World Health Organization claims that this type of donation is the safest for the recipient. Many countries, adhering to this point of view, have made blood donation non-remunerated, including the Russian Federation. As mentioned above, the new Law on Blood Donation and its Components came into force in 2013 . In this regard, new questions arose regarding blood donation. The fact is that blood donors receive monetary recompense, which is given to them as compensation for food (the blood donation center should provide free food to donors, but not everyone has the opportunity to do this, that is the reason why they give money), which is necessary after donation. This compensation is due to everyone according to the law, regardless of which region of the country the donor lives in (the difference is only in the amount of money that is given to donors), but despite the fact that compensation is given to everyone and is not considered as payment, not all donors are regarded non-remunerated. This kind of donors can be paid if he / she has a rare phenotype. At the same time, donations with the receipt of social support measures in the form of monetary rewards are not taken into account in the total number of donations for awarding with the badges "Honorary Donor of Russia" (Tsentr krovi imeni O.K. Gavrilova DZM, 2018). Thus, the donation can be non-remunerated and the donor receives 5 percent of the living wage for it or donation can be paid, if a donor has a rare phenotype, but then he/she refuses rewards and privileges but receives a payment much higher than 5% of the living wage.

Despite the fact that with the concepts of “non remunerated donor” and “paid donor” it has become increasingly clear, it is worth considering the definitions that are used throughout the world. Follea (2016) in his work showed what voluntary non remunerated donation is and what is its difference from paid donation. It is important to consider and understand this topic, as for some donors this material compensation matters: sometimes it is an incentive to donate blood, and sometimes vice versa. Follea (2016) provides definitions for concepts such as “voluntary and non remunerated donation” and “payment”. These definitions were formulated and supported by the Nuffield Council on Bioethics (NCB), the European Blood Alliance (EBA), the Plasma Protein Therapeutics Association (PPTA) and the EC. Voluntary gratuitous donation, according to Council of Europe (1990) is:

«Donation is considered voluntary and non remunerated if the person who gives blood, plasma or cellular components of his/her own free will and receives no payment for it, either in the form of cash or in kind which could be considered a substitute for money. This would include time off work other than that reasonably needed for the donation and travel. Small tokens, refreshments and reimbursements of direct travel costs are compatible with voluntary, non remunerated donation».

According to this definition and the explanation which Nuffield Council on Bioethics (2011) gave “payment” is all types of transactions that imply the issuance of a sum of money or goods with a monetary value. Payment includes recompense, reward, and purchases.

The Nuffield Council on Bioethics (2011) indicated in its report that altruism-based systems and remuneration-based systems can exist together, not mutually exclusive. The Bioethics Council has developed a six-step scheme that shows the relationship between altruism and remuneration. In other words, when the donation is considered an altruistic act, and when it is based only on the benefit of the donor.

According to the NCB, compensation is a reimbursement to donors for non-financial losses that they might have incurred due to donations. This scheme was created to protect donors and recipients from an ethical point of view. The ladder shows different forms of donor incentives: altruist-focused encouragement and non-altruistic-focused encouragement.

Now the situation with an unpaid donation is considered. We need to understand it in order to find out who is more influenced by the propagation of blood donation, to whom it is oriented.

Uyba, Eihler, Chechetkin, Danilchenko in their work “Voluntary unpaid blood and blood components donation in Russian Federation” (2017), based on statistical data, showed the dynamics of the development of VNRD in Russia from 2007 to 2015. The results showed that the development of this type of blood donation is positive, and the percentage of blood donors is growing. It is worth noting that, based on the data cited by the researchers, the share of non-remunerable blood donors and its components in the structure of donors in 2015 amounted to 97.5%. Thus, we can say that in Russia the donation of blood and its components is a voluntary share of non-remunerable donation. In other words, 97.5% of donors belong to the 1-4 stage of the intervention ladder.

1.6 Current Practices and Methods for determining their effectiveness

There are various practices focused on attracting and retaining donors. These practices have methodological and theoretical foundations. The methodological basis is social marketing, which is used for high-quality and adapted to the target audience implementation of theoretically sound practices.

An article “Rekruting donorov krovi (v pomoshch' organizatoram donorskogo dvizheniya)” (2011) was published on the activities of organizations promoting the donor movement. It describes the forms and methods of recruiting blood donors. The authors of the article called PR and social marketing the main methods (promotion of ideas and familiarization of different sections of the population with them). For example, potential donors were attracted through various events, social advertising, flyers, etc. Another important strategy is communication, the main purpose of it to describe the process of donation for donors, to explain that it is easy and safe (Carter, Wilson, Redpath, Hayes & Mitchell, 2011).

Ferguson (2015) proposed a new approach to the creation of practices for attracting and retaining donors based on altruism. The theoretical discussion is called Mechanism of Altruism (MOA). Its main components are “warm-glow messages, voluntary reciprocal altruism, charitable incentives, guilt primes”. The researcher compared the effects of pure altruism and warm-glow interventions. Participants in the experiment were sent various messages about the appeal to donate blood. Pure altruism messages contained a text saying that the participant's blood could help others, and warm-glow messages were about positive effect and feelings after donation. As a result, messages with a warm-glow context were more effective. Charitable incentives have a great influence on warm-glow altruists because the donor can feel proud of themselves, including donating compensation for donating blood for a good cause, for helping those in need. Voluntary reciprocal altruism is based on justice, where self-interest is an incentive for a fair outcome. In other words, when a potential donor begins to donate blood because he/she suggests that they may need a blood transfusion. Guilt primes are caused by hostility to inequality. This study helps to understand what practice is based on. For example, what content social advertisement should have to be successful.

Based on the statistics presented at the beginning of this work, it can be assumed that there are not enough blood donors. That is why it is necessary to understand not only what practices are used in the region, but how institutions evaluate their effectiveness as well. To do this it is should be started by understanding how researchers of these practices determine effectiveness.

The first practice is personalized message and calls to potential blood donor about the importance of his or her blood, how it can help others. A study by Chamla and co (2006) tested the effectiveness of this strategy. Researchers used the method of randomized clinical trial to identify control and experimental groups. The first group was sent a letter with general information about blood donation, and the second was sent a letter that contained information about the respondent's blood group and the number of people who have the same blood type. Researchers wanted to check if respondents would donate blood over the next one month. The study showed that participants in the experimental group were 43 percent more likely to return their pro-social activity (Chamla, Leland & Walsh, 2006). Another study (Ou-Yang, He, Rong & Bei, 2017) tested the effectiveness of phone calls and SMS messages to inactive donors, those who stopped to donate blood for some reason. They tested efficacy by the same method as Chamla and co (2006). Respondents were randomly divided into three groups, one was got the telephone calls, the other got SMS messages, the control group was without intervention. The results of the study are similar to the previous one. Attention, reminders have a positive effect on donor activity (Ou-Yang, He, Rong & Bei, 2017).

The next practice is about peer recruitment and regular reminders. In 2013, another work about the attraction of new donors among students was conducted. Researchers selected the most active students to promote the activities of blood donation. Students were attracted through regular Facebook posts, SMS notifications, and media alerts. Sneћana Jovanoviж Srzentiж, Ivana Rodiж and Mirjana Kneћeviж (2013) compared the number of people who donated blood in 2012 and in 2013. As a result, the percentage of students who donated in 2013 was 21 percent higher.

Thus, it concludes that when the donor is given attention, when he or she gets the information about the importance of their donation, and has regular reminders and social approval, the percentage that these donors will come to donate blood again increases. Since the main goal in this study is to find out what practices are used to attract and how they are formed, you need to understand how their effectiveness is evaluated. To do this, during the interview, the actors were asked about how to assess the effectiveness of practices, and what practice is the most successful in their opinion.

2. Methodology

2.1 Data collection

The main method of this qualitative research is semi-structured interview. The experience of respondents in participation and organization of events about blood donation is explored by asking open-ended questions. Qualitative method can be more useful for identifying and characterizing the process of recruiting and retaining blood donors.

Two different groups of respondents were interviewed. Organizers and donors are groups who are responsible for the situation with blood donation and from whom it directly depends. Organizers are actors whose task is to attract new donors and retain first-time and experienced ones. They are engaged in informing the public, developing practices that contribute to improving indicators related to donation. Donors are people who could be influenced by established practices. Accordingly, it is important to compare the opinions of both social groups about existing practices.

2.2 Sub-group: organizers of donor activity

Qualitative method was used to explore personal experience of the respondents (Semenova, 1998). Some organizers work in institutions focused on recruiting and retaining blood donors (organizers in non-profit/non-government organizations) whereas others realize Donor Day as a part of social responsibility. The last one are local organizations at the university level and organizations of events in the companies. That is the reason why practices of recruiting and retaining of organizations can vary depending on their tasks. That is why, in order to obtain relevant and detailed results, it was decided to conduct semi-structured interviews.

The main group for this study is the organizers of events related to blood donation. They are divided into two groups: organizers in non-profit organizations and organizers in universities and companies. The following topics were discussed during the interview: respondents' experience in organizing events; practices that are used and the ways they are designed and modified; interaction with actors involved in the organization of events; an ideal system of practices for attracting and retaining blood donors (Appendix 4).

The guide for respondents was conducted by the researcher with the participation of the project group. Most of the questions for the organizers used according to the work of the researcher Healy (2000). He wrote that organizations involved in attracting and retaining blood donors adhere to a specific portrait of a donor, thereby attracting only them and losing others. Owing to his assumptions, questions were about such topics as a description of the characteristics of a “typical donor”, the process of creating practices for attracting and retaining, suggestions about why people participate/do not participate in such events. All these aspects answer the research question.

The main sample was purposive and complemented by a snowball sample. The purposive sampling is used to find respondents with particular characteristics (Tong, Sainsbur & Craig, 2007). Organizers respondents were recruited that way: they were sent messages through social networks or by e-mail, where all information about the study was described. Information about which organizations host Donor Day was obtained using Internet resources, for example, the web-source of Blood Service. Only for the recruitment of the two organizers of Donor Day at universities, a snowball sample was applied. One respondent from the non-profit organization and one informant at a university were recruited by a research team at a blood donor event. Among the 10 organizers (Appendix 2), two were representatives from non-profit organizations specializing in blood donation, and eight respondents are donor day organizers in their institutions. The interview collection stopped due to data saturation: methods of attraction, strategies began to be repeated. As a result, 10 interviews with the organizers for the initial analysis were collected, 8 of which were conducted by the researcher. Eight interviews with organizers were on Skype, Zoom, and WhatsApp because of the coronavirus and quarantine pandemic. The remaining two were collected before the virus appeared. The average duration of the interviews is 54 minutes. Each interviewee felt comfortable, was positive and open-minded. It is worth noting that no one refused to answer questions, everyone expressed a desire to continue to participate in the study, said that they should be contacted if any questions arise.

Some difficulties in recruiting appeared during the search for respondent organizers. Since the organizers, for the most part, were sent invitations to participate in the study by email, many of the messages were ignored and were not answered. Because of this, the main difficulty was to find Donor Day organizers in companies. Messages were sent to more than ten organizations, but only four responded and agreed to be interviewed. There were no problems with the search for organizers of Donor Day at universities, as news about holding promotions at universities are regularly posted in the Donor Fund group on the VKontakte social network. In addition, university communities, which were dedicated to donating blood, were found by searching for groups on VKontakte. These communities posted news and events about Donor Day, as well as contacts from event organizers. Two organizers rejected the invitation to being an interviewee because of the high workload and the lack of time.

2.3 Sub-group: blood donors

An additional group is blood donors. Interviews with them were collected for the study in the framework of the project “Prosocial behavior in the field of health: donation of biomaterials” led by Ksenia Yeritsyan. In this work, interviews with donors are secondary data. The list of questions asked to blood donors is mostly about the respondent's donor career, his / her motivations, and barriers (Appendix 5). These topics can show the attitude of donors to various practices and donation in general. In addition, the attitude to donation helps to identify the target groups who are attracted to the current propaganda, what donors are guided by, and what they pay attention to. Donor respondents shared their opinions about the current situation with blood donation and their attitude to the system.

The design of the interview guide with this group was based on reading and studying literature. The list of questions for blood donors was created by members of the project team with researchers' participation.

The sample was the same as for recruiting organizers: main sample was purposive and additional was a snowball sample. The participants were recruited from the surveys which were conducted at two universities: the Higher School of Economics and Herzen University. The study group of the project which was mentioned above conducted a survey on donor motivations. Participants of the Donor Day were asked to provide their contacts for further interaction at the end of the survey, those who agreed to give their contacts (mobile phone number, email address, or a link to a page on a social network), and we later contacted them. Thus, respondents were found for interviews, then they gave to the interviewers the contacts of their acquaintances who are also blood donors. It is worth noting that donors were interviewed, regardless of the frequency of blood donations and regardless of their donor career, its success. Just over half the sample (60%) is first-time donors, others are experienced. As a result, 45% of donor respondents were recruited using the snowball method (Appendix 3). Thus, there are 20 interviews with donors for the secondary analysis, 10 of which were collected by the author.

Interviews with donors were mainly conducted in face-to-face meetings (17/20), they could be in a cafe, in a park and only a few interviews conducted online in skype or zoom. The average duration of the interviews is approximately 40 minutes.

2.4 Ethical considerations

Prior to the interview, oral informed consent was obtained from all respondents. Respondents were asked permission to record dialogue. They were apprised about how this audio recording will be used in the future - translated into text. All interviews are deciphered and anonymized, any personal information, such as the name or name of the organization, has been removed. The type of transcription is verbatim.

2.5 Data analysis

Data analysis was carried out on the basis of qualitative content analysis (Schreier, 2012). This analysis allows focusing on those topics that answer the research question. The coding was made in the MAXQDA program.

As a result of coding, the main topics were identified: the formation of retention and recruitment practices, existing practices, the attitude of donors and organizers to existing practices, and the improvement of the system.

3. Empirical Base

This section is devoted to the description of the data obtained. It is divided into several main parts that answer the research question and correspond to the tasks set at the beginning of the study. Thus, the first topic discussed concerns the formation of practices for attracting and retaining blood donors

3.1 Process and tactics of designing recruiting and retaining practices

The first part of the analysis consists of a description of the ways and methods that the actors (organizers) are guided in order to create a relevant practice or scheme for attracting and retaining blood donors.

To begin with, it is necessary to consider the fact that various types of organizations are involved in the study: those who specialize in attracting and are included in the controlling of the process of blood donation and those who are partially included in this process for manifesting social responsibility or for other reasons but not as a main activity. The last type can be divided into two categories according to the type of organization level, that is, who initiates the events and ways of attracting donors to them - the administration or employees/students.

“... we just have a boss, he's a donor, I don't know is he an honorary donor or not, but I know that he is very interested in it, and as far as I understand, everything really comes from the motivation that he wants to attract employees of their company…” - (5 respondent, commercial organization)

“... it turned out that among the employees there are already donors who donate for many years, someone donated several times, and the employees themselves asked if it was possible to organize this in our office” - (8 respondent, commercial organization)

Thus, actors, who are professionals in the field of blood donation, and direct their activities exclusively to donors and to support and develop this system, pay more attention to the process of creating practices. The proof of this thesis can be traced further.

One of the ways to form practice is to communicate with the target audience. Some organizers, in order to create a practice or evaluate the success of their ideas, turn to blood donors, being interested in their opinions and impressions:

“ We communicate constantly and very actively with blood donors”

(2 respondent, non-profit organization)

In addition, studies are organized:

“We had a goal to make a portrait of a donor of St. Petersburg, so we had questionnaires.” - (10 respondent, non-profit organization)

After the organizers of non-governmental institutions find out the information they need, they form a new practice of recruiting or retaining based on the preferences and answers of donors. For example, an organization in which respondent work has created a partnership action with a large company. It provides donors with its services free of charge in order to motivate them to continue donating blood in the situation of a coronavirus pandemic:

“ we started with # Partner #, promotional codes in 22 cities of Russia for blood donors so that they can safely leave and arrive now” (2 respondent, non-profit organization)

To attract potential and experienced donors, the organizers use different informational channels and types of notifications, presentation of information, relying on the target audience and representation of the organizers about it

“ So, of course, for Moscow, well, Moscow, St. Petersburg and the regions are very different. And the messages should be different. <...> ... we have an audience of more than 25-34, that is, we need our own approaches to people” - (2 respondent, non-profit organization)

“... we also have employees, so we still use posters, because employees can already be adults, they can skip information from VK, not notice and not respond” - (4 respondent, university)

“ VKontakte is youth, Instagram is assembled from our colleagues.” - (10 respondent, non-profit organization)

“… the target audience is students, we mainly conduct a campaign through social networks associated with the university ” - (6 respondent, university)

The main difference between the practices is considered the age of the potential donor, for whom this practice is designed. This approach is typical of the majority of respondents. The actors who organize Donor Day in commercial companies do not make any separation, all their practices are the same for all employees.

“no, the same message is sent to everyone” (7 respondent, commercial organization )

However, the actors from the funds focus their attention on the population as a whole, on their social activity during creating practices:

“In St. Petersburg, people are more active on their own, in principle, it is easier to pull them out of the house and they have more civil responsibility. It seems to me. Because they are, in principle, more active in all aspects. Not only in blood donation” (2 respondent, non-profit organization)

This difference is due to the fact that organizations have different levels. Nonprofit organizations have an impact on the whole city, and others on the staff and students of their institution.

The next way to form practice is to focus on foreign practices. Despite the fact that there is no single international system of practices for attracting and retaining blood donors (Charbonneau & Smith, 2015), sometimes actors use foreign ideas to adapt them to Russian society. For example, they can read the research or analyze social advertising: