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The Impact of Social, Cognitive and Attitudinal Dimensions on College Students’ Support for Organ Donation

2011; Elsevier BV; Volume: 12; Issue: 1 Linguagem: Inglês

10.1111/j.1600-6143.2011.03783.x

1600-6143

Anthony M. D’Alessandro, James W. Peltier, Andrew J. Dahl,

Blood donation and transfusion practices

American Journal of TransplantationVolume 12, Issue 1 p. 152-161 Free Access The Impact of Social, Cognitive and Attitudinal Dimensions on College Students' Support for Organ Donation A. M. D'Alessandro, A. M. D'Alessandro Department of Liver Transplantation, UW Organ Procurement Organization, University of Wisconsin, Madison, WI UWHC Organ Procurement Organization, University of Wisconsin, Madison, WISearch for more papers by this authorJ. W. Peltier, Corresponding Author J. W. Peltier Department of Marketing, University of Wisconsin, Whitewater, WICorresponding author:James W. Peltier, peltierj@uww.eduSearch for more papers by this authorA. J. Dahl, A. J. Dahl Department of Marketing, University of Wisconsin, Whitewater, WISearch for more papers by this author A. M. D'Alessandro, A. M. D'Alessandro Department of Liver Transplantation, UW Organ Procurement Organization, University of Wisconsin, Madison, WI UWHC Organ Procurement Organization, University of Wisconsin, Madison, WISearch for more papers by this authorJ. W. Peltier, Corresponding Author J. W. Peltier Department of Marketing, University of Wisconsin, Whitewater, WICorresponding author:James W. Peltier, peltierj@uww.eduSearch for more papers by this authorA. J. Dahl, A. J. Dahl Department of Marketing, University of Wisconsin, Whitewater, WISearch for more papers by this author First published: 12 October 2011 https://doi.org/10.1111/j.1600-6143.2011.03783.xCitations: 37AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Abstract This study investigates how college students can be social support catalysts for organ donation and how social, cognitive and attitudinal dimensions impact organ donor registration. A total of 317 people participated in the exploratory portion of the project and a total of 1800 responses were obtained from an online survey to members of a national student organization. The findings show that perceptions of the benefits of organ donation and altruistic motives had the greatest impact on the support for organ donation while respondents' knowledge about how to register to be an organ donor was the dominant dimension for donor registration status. Social-based communications had the next greatest impact for both support and donor registration. Based on the findings, an 18-month social media campaign was launched with the student organization that had 20 421 website visitors, 4473 Facebook members, 1189 YouTube video submissions with 164 000 views, motivated 19 623 people to go to a state's organ donor registration page, and had 9000 documented organ donor registrations. Within the student organization, organ donor registration increased by 28%. On the basis of these project results, Donate Life America and other sponsors have provided funding for two additional years. Abbreviations: CAMA Collegiate American Marketing Association H hypothesis ns not significant Std standardized Introduction Recently, the strategic shift by health care professionals and researchers toward the application of social marketing principles has placed greater emphasis on finding ways to involve community members in promoting organ donation registration by university students (1). Unfortunately, college-age students have underparticipated in organ donor registration, a surprising fact given that college students tend to support social causes they believe in (2, 3). Despite this underparticipation, communication initiatives targeting college students have a strong likelihood of success for motivating them to register to be an organ donor and to serve as opinion leaders (4-9). Although literature investigating college students' awareness, perceptions, beliefs and behaviors is sparse, research evidence exists that multimedia and peer-to-peer communication campaigns may increase the engagement levels of this large and important age group (8, 9). This interest is motivated in part by an increased focus by consumers to participate in the "cocreation" of health services enabled by new information and communication technologies such as online health communities, blogs, social media networks and Web 2.0 (10). College students have been especially active in the use of interpersonal media and have a greater likelihood of using social media such as online videos, text-messaging, instant messaging and other user-generated content to communicate with members of their social communities (11). Although this emergent area of inquiry has added to our knowledge, little research has examined comprehensive frameworks that investigate the joint impact that social and personal communication-based factors have on the support for organ donor registration by college students. Even less is understood about whether the variables that impact support for organ donation are similar or dissimilar to those that explain students' actual organ donor registration. Donor research targeting college students that increases our understanding of important determinant variables from awareness through registration is thus, warranted (3, 12, 13). This study, which was funded by a 2-year grant from the US Department of Health and Human Services Administration, addresses this void through insight into how college students in student organizations may serve as social media catalysts for communications designed to motivate others to learn about the need of organ donation and to become organ donors. The results from this study were used to develop an 18-month US-wide social media and interpersonal communication project in conjunction with a large student organization to raise awareness and support for organ donor registration. We thus attempt to answer the following research questions: What psychosocial factors, including interpersonal, social and personal communications, (1) most impact the support for organ donation by college students, (2) most distinguish organ donor registrants from nonregistrants and (3) whether the relative impact of these psychosocial factors are the same for organ donation support and actual registration behavior? Our model and hypotheses that we test are presented in Figure 1. Figure 1Open in figure viewerPowerPoint Organ donation support and registration behavior framework. Materials and Methods Sample The Collegiate American Marketing Association (CAMA) agreed to participate in the 2-year grant project, including a qualitative research stage, a quantitative research stage and an organ donor registration campaign. The CAMA is a professional marketing association with approximately 10 000 members and 300+ chapters in the United States, Canada and Puerto Rico. The CAMA offered researchers access to its member base and agreed to participate in the organ donor registration campaign upon completion of the research stage of the project. Questionnaire design An exploratory research stage and a review of the literature were used to construct the questionnaire to test the stated hypotheses. The exploratory research initiated with 150 key informant interviews with CAMA students to uncover potential barriers to organ donor registration, how social and interpersonal media may hinder/assist the information dissemination process, and other questions relevant to the research project and organ donor registration campaign. Upon completion of these interviews, focus groups with 96 participants were conducted with CAMA leaders at the University of Wisconsin-Whitewater, University of Nevada-Las Vegas, University of Pennsylvania Wharton School and Texas State-San Marcos. All of the focus groups were moderated by experienced research professionals indentified in the grant proposal. Based on these interviews and focus groups, the final questionnaire contained a variety of questions that fell into seven cognitive, attitudinal and social dimensions relevant to explaining organ donation support and registration: (1) Awareness/knowledge about organ donation, (2) acknowledgement of an organ and tissue demand-supply gap, (3) concerns/fears with organ donation, (4) altruism and benefits, (5) social support, (6) social relevance/impact and (7) viral support of social causes. Except for viral support of social causes, the statements used within each dimension used a five-point Likert scale ranging from 1 = strongly disagree to 5 = strongly agree. Two measures were used to identify respondent's likelihood of engaging in viral support of social causes (1 = very unlikely to 5 = very likely). The questionnaire was approved by the University of Wisconsin institutional review board (IRB) and staff at the CAMA headquarters. As shown in Figure 1, these seven dimensions were then used as independent variables in two separate regression models. The dependent variables in the regression models are (1) overall support for organ donation (I support organ donation, five-point agreement scale) and (2) registered to be an organ donor (0 = no, 1 = yes). Approximately 8500 current CAMA members with an email address were sent an online survey link via email asking for participation in the study. After three waves, a total of 1802 student organization members responded to the survey. The average open rate was 30%, resulting in a 70.6% response rate for those who read the email message (1802/2550). The overall response rate regardless of open rate was 21.2% (1802/8500). These response rates compare favorably for a national online survey of college students (14). The profile of respondents is provided in Table 1. The gender, age and class standing findings match the overall demographic profile from the CAMA's annual conference membership survey. As with many professional student organizations, most members are juniors and seniors. Table 1. Profile of respondents Profile (%) Gender Female 69 Male 31 Age 18 4.6 19 8.4 20 19.7 21 27.4 22 15.6 23 6.7 24 1.9 25 2.3 26+ 13.4 Class standing Freshman 6.7 Sophomore 8.7 Junior 28.0 Senior 44.4 Graduate student 6.7 Other 5.1 Length as organization member 1 semester or less 55.2 2 semesters 15.1 3 semesters 13.9 4 semesters 6.7 5+ semesters 9.1 Major Marketing 76.6 Business (nonmarketing) 17.0 Nonbusiness 6.4 Campaign development An organ donor registration campaign was implemented that used the CAMA as the initiator of a viral communication process designed to spread the word about organ donation, motivate others to participate in the social spreading of information and importantly, to get organization members, other university students, friends and family to become organ donors. A project website was developed that (1) presented videos to introduce the program and to provide testimonials, (2) contained organ donation statistics, (3) conveyed step-by-step instructions for implementing effective communication campaigns, (4) spotlighted what chapters were doing, (5) provided a direct means of registering by state and (6) offered varied social media opportunities including Facebook, Twitter, project blog and YouTube. Results Scale dimensionality and reliability Initially, the items representing the seven theoretical constructs were subjected to an exploratory principle component factor analysis to assess dimensionality and scale reliability. Items with low and/or multiple factor correlations were dropped from the assessment. Items of each construct were carefully examined to make sure that all items were loaded based on theory. Next, the remaining items were subjected to an item to total correlation analysis. Items with low item to total correlations were eliminated. The coefficient alpha for each of the measures was computed to estimate the reliability. As shown in Table 2, the cognitive, attitudinal and social dimensions loaded as expected. Except for social relevance/impact, all of the dimensions had acceptable coefficient alpha reliability scores for exploratory research. The coefficient alpha score for the social relevance/impact dimension is low for two reasons. First, unlike the other statements that used a five-point Likert scale, this dimension used a two-point know/did not know scale (0 = no, 1 = yes). Second, only 25.1% of the respondents indicated that they know someone who died and had their organs donated to others, 18.3% have had a friend who needed a transplant, 18.1% have a family member who needed a transplant and 6.9% knew someone who died while on a transplant waiting list. These low yes frequencies contributed to the lower coefficient alpha score as well. We, thus allowed this dimension to remain in the test of organ donor support and registration. Table 2. Factor analysis Fears/ Benefits/ Social Viral Social Concerns Altruism support Knowledge support Need impact Wealthy patients are moved up the waiting list faster than lower income patients 0.669 Donated organs often go to undeserving people 0.669 Minorities have a lower chance of being selected to receive a donated organ 0.654 The family of the organ donor ends up paying extra medical bills 0.653 Doctors do not try as hard to save someone's life if they know they are an organ donor 0.631 Many people on the waiting list are there because they did not take care of themselves 0.613 The system for allocating organs to wait list patients is unfair 0.587 Elderly people cannot become an organ donor because of their age 0.553 An organ donor cannot have a regular funeral/an open casket because of the surgery 0.509 College students are too young to think about dying and organ donation 0.491 Signing up to become an organ donor is the right thing to do 0.739 After someone dies, it makes sense to let others use their organs 0.710 Getting more people to sign up to be an organ donor will save countless lives 0.697 Signing up to become an organ donor is an easy way to help others in need 0.684 Organ donation gives purpose to one's death 0.647 More people would sign up to be an organ donor if they knew more about it 0.552 Most people have family members or friends who will need an organ transplant 0.458 My friends are supportive of organ donation 0.699 If asked by a friend, a person is likely to sign up to become an organ donor 0.679 If asked by their son/daughter, parents are likely to sign up to be an organ donor 0.656 My fellow university students are supportive of organ donation 0.645 My family is supportive of organ donation 0.563 I have had discussions with others about being an organ donor 0.437 I am familiar with how to sign up to be an organ donor 0.858 My family is familiar with how to sign up to be an organ donor 0.855 My friends are familiar with how to sign up to be an organ donor 0.805 I have read/viewed/listened to information on how to be an organ donor 0.607 Become a fan/friend/follower of a "Cause" you support 0.883 Send an invite to someone to become a fan/friend/follower of a "Cause" you support 0.872 Many people on the transplant waiting list die while waiting for an organ 0.728 Only a small percent of the US population is a registered organ donor 0.668 The demand for organ transplants far exceeds the available supply of organs 0.659 I knew someone who died while on the transplant waiting list 0.681 I have friends who have needed an organ transplant 0.680 I have family (parents, aunts, uncles, etc.) who have needed an organ transplant 0.646 I knew someone who died and had their organs donated to others 0.418 Total variance explained = 52.09% 11.08 9.67 9.18 8.06 4.87 4.68 4.55 Coefficient alphas 0.81 0.80 0.77 0.85 0.82 0.64 0.49 Statistical methods Independent sample t-tests were used to compare responses for organ donor registrants and nondonor registrants. Multiple regression was used to assess the impact of each dimension on the support for organ donation registration. Binary logistic regression was used for evaluating the impact of the dimensions on organ donor registration status. Descriptive findings Although women outnumber men in the organization, few meaningful and significant differences were found across gender and suggest that our findings can be generalized to men and women. A cross tabulation of responses comparing the first and the second 50% of respondents uncovered few meaningful differences, thus reducing nonresponse bias. A summary of key findings is shown in Table 3. Table 3. Descriptive findings Dimension Statement % Agree % Neutral % Disagree Fears and concerns Wealthy patients are often moved up the waiting list faster than lower income patients 34.8 31.1 34.0 The system for allocating organs to wait list patients is unfair 17.7 56.9 25.4 Elderly people cannot become an organ donor because of their age 16.7 35.9 47.4 Minorities have a lower chance of being selected to receive a donated organ 15.8 34.6 49.6 The family of the organ donor ends up paying extra medical bills 9.2 46.7 44.1 Doctors do not try as hard to save someone's life if they know they are an organ donor 17.7 20.6 61.8 Many people on the waiting list are there because they did not take care of themselves 13.8 20.5 65.8 Donated organs often go to undeserving people 8.9 27.2 63.9 An organ donor cannot have a regular funeral/an open casket because of the surgery 9.8 22.0 68.3 College students are too young to think about dying and organ donation 14.6 11.0 74.5 Donation benefits/altruism Getting more people to sign up to become an organ donor will save countless lives 92.9 5.7 1.4 Signing up to become an organ donor is an easy way to help others in need 87.7 8.2 4.1 After someone dies, it makes sense to let others use their organs 82.6 13.5 3.9 Signing up to become an organ donor is the right thing to do 76.9 20.1 3.1 More people would sign up to be an organ donor if they knew more about it 79.7 13.6 6.7 Organ donation gives purpose to one's death 60.6 21.2 18.2 Most people have family members or friends who will need an organ transplant 57.2 30.9 11.8 Social interactions/support My family is supportive of organ donation 70.0 22.4 7.6 My friends are supportive of organ donation 58.7 37.8 3.4 If asked by their son or daughter, parents are likely to sign up to become an organ donor 64.3 27.2 8.5 If asked by a friend, a person is likely to sign up to become an organ donor 56.1 31.7 12.2 I have had discussions with others about being an organ donor 60.1 15.1 24.7 My fellow university students are supportive of organ donation 42.6 54.2 3.2 Awareness and knowledge about organ donation I am familiar with how to sign up to be an organ donor 70.0 8.7 21.4 My family is familiar with how to sign up to be an organ donor 65.9 14.5 19.6 I have read/viewed/listened to information on how to be an organ donor 53.2 17.5 29.2 My friends are familiar with how to sign up to be an organ donor 48.2 26.6 25.2 Viral support of social causes Become a fan/friend/follower of a "cause" you support (likely/neutral/unlikely%) 79.6 11.3 9.1 Send an invite to someone to become a fan/friend/follower of a "cause" you support (likely/neutral/unlikely%) 57.1 21.1 21.8 Need acknowledgement The demand for organ transplants far exceeds the available supply of organs 93.0 5.9 1.1 Many people on the transplant waiting list die while waiting for an available organ 88.0 10.2 1.9 Only a small percent of the US population is a registered organ donor 70.5 21.1 8.4 Social relevance/impact I knew someone who died and had their organs donated to others (yes%) (25.1%) – – I have friends who have needed an organ transplant (yes%) (18.3%) – – I have family who have needed an organ transplant (yes%) (18.1%) – – I knew someone who died while on the transplant waiting list (yes%) (6.9%) – – Scale ranged from 1 = strongly disagree to 5 = strongly agree; except for viral support of social causes (1 = very unlikely to 5 = very likely) and social relevance/impact (yes/no). Organ donors versus nondonors Just over one-half (52.9%) are registered as an organ donor. A comparison of respondents using cross tabulations shows that students who are registered organ donors generally are (1) more knowledgeable about the need for organ donation and the registration process, (2) more likely to have positive attitudes and perceptions of the impact organ donation has on others' lives, (3) more knowledgeable that many of the common myths about organ donation are incorrect and (4) more likely to agree that they and others in their contact network are supportive of organ donation (Table 4). Table 4. Comparisons of registered donor versus nondonor on agree versus neutral/disagree % Agree Registered donor Nondonor Pearson Dimension Statement (n = 953) (n = 849) chi-square Fears and oncerns Doctors don't try as hard to save someone's life if they know they are an organ donor 11.2 24.3 .001 An organ donor can't have a regular funeral/an open casket because of the surgery 6.8 12.6 .01 The family of the organ donor ends up paying extra medical bills 6.5 11.5 0.01 Elderly people can't become an organ donor because of their age 13.3 20.7 0.01 Wealthy patients are often moved up the waiting list faster than lower income patients 29.3 40.9 0.001 Minorities have a lower chance of being selected to receive a donated organ 14.4 17.0 ns Donated organs often go to undeserving people 8.4 9.1 ns The system for allocating organs to wait list patients is unfair 13.7 21.3 0.01 Many people on the waiting list are there because they did not take care of themselves 13.3 14.1 ns College students are too young to think about dying and organ donation 12.0 17.6 0.05 Donation benefits/altruism Signing up to become an organ donor is an easy way to help others in need 95.1 80.0 0.001 Organ donation gives purpose to one's death 68.4 52.2 0.001 Signing up to become an organ donor is the right thing to do 90.9 62.2 0.001 Getting more people to sign up to become an organ donor will save countless lives 95.8 89.6 0.001 More people would sign up to be an organ donor if they knew more about it 84.6 75.2 0.001 Most people have family members or friends who will need an organ transplant 61.4 54.1 0.05 After someone dies, it makes sense to let others use their organs 92.4 73.3 0.001 Social interaction/support My family is supportive of organ donation 86.5 51.1 0.001 My friends are supportive of organ donation 72.4 43.0 0.001 If asked by their son or daughter, parents are likely to sign up to become an organ donor 72.4 55.0 0.001 I have had discussions with others about being an organ donor 72.4 46.1 0.001 If asked by a friend, a person is likely to sign up to become an organ donor 66.7 43.9 0.001 My fellow university students are supportive of organ donation 51.1 32.8 0.001 Knowledge about need for organ donation I am familiar with how to sign up to be an organ donor 89.9 49.1 0.001 My family is familiar with how to sign up to be an organ donor 83.1 46.1 0.001 My friends are familiar with how to sign up to be an organ donor 59.7 33.5 0.001 I have read/viewed/listened to information on how to be an organ donor 71.5 32.4 0.001 Viral support of causes Become a fan/friend/follower of a "Cause" you support (likely%) 79.5 79.7 ns Send an invite to someone to become a fan/friend/follower of a "Cause" you support (likely%) 55.3 59.2 ns Need acknowledgement Only a small percent of the US population is a registered organ donor 69.0 73.7 ns The demand for organ transplants far exceeds the available supply of organs 95.1 92.2 ns Many people on the transplant waiting list die while waiting for an organ 92.8 86.1 0.001 Experience and support issues I have family who have needed an organ transplant (yes%) 19.0 17.0 ns I have friends who have needed an organ transplant (yes%) 21.3 14.8 0.01 I knew someone who died while on the transplant waiting list (yes%) 8.6 5.0 0.05 I knew someone who died and had their organs donated to others (yes%) 32.5 16.5 0.001 Scale ranged from 1 = strongly disagree to 5 = strongly agree; except for viral support of social causes (1 = very unlikely to 5 = very likely) and social relevance/impact (yes/no). An extensive range of other intergroup analyses were run including gender, personal experiences with organ donation, age, class standing and major. Few significant differences surfaced except for those noted for donor registrant versus nonregistrants. Hypothesis testing findings Overall support for organ donor registration Multiple regression was used to assess the relative impact each of the seven dimensions had on respondents' overall support for organ donation. Factor scores were used as the independent variables and respondent gender and class standing were used as control variables. As Table 5 shows, all seven of the cognitive, attitudinal and social variables had a significant impact and in the hypothesized direction (R2= 0.495, F = 106, p < 0.001). Neither gender nor class standing had a significant impact on college students' support for organ donation. In terms of their relative impact, donation benefits and altruism had the greatest influence on support for organ donation, followed by social interactions/support, fears and concerns, knowledge about organ donation, social relevance/impact, need cknowledgement and participation in viral social causes. Table 5. Overall support for organ donation Organ donation support dimensions Std Beta t-value p-Value Donation benefits/altruism 0.510 22.45 0.001 Social interactions/support 0.392 17.27 0.001 Fears and concerns −0.243 −10.69 0.001 Awareness and knowledge about organ donation 0.111 4.89 0.001 Social relevance/impact 0.070 3.08 0.01 Need acknowledgement 0.068 2.98 0.01 Viral social causes support 0.060 2.65 0.01 R2= 0.495, F = 106, p < 0.001. Donor registration status Binary logistic regression was used to assess the impact each of the dimensions had on predicting donor registration status. As for organ donation support, the factor scores for each of the seven dimensions were used as independent variables and gender and class standing were used as control variables (Table 6). Six of the seven cognitive, attitudinal and social variables had a significant impact predicting donor registration status and explain a high percent of the variation in responses (Nagelkerke R2= 0.488, χ2= 138, p < 0.001). Neither gender nor class standing had a significant impact. Regarding their relative influence on predicting donor status, knowledge about organ donation had the greatest impact, followed by social interactions/support, donation benefits and altruism, fears and concerns, participation in viral social causes and social relevance/impact. Table 6. Donor registration status Organ donation support dimensions Beta Wald Sig Awareness and knowledge about organ donation 1.235 160.79 0.001 Social interactions/support 0.811 83.60 0.001 Donation benefits/altruism 0.773 79.75 0.001 Fears and concerns −0.514 −36.97 0.001 Viral social causes support 0.367 18.54 0.001 Social relevance/impact 2.33 8.08 0.010 Need acknowledgement −0.034 0.083 ns Nagelkerke R2= 0.488, χ2= 138, p < 0.001. Comparison of organ donation support and registration status A primary objective of this research was to indentify the cognitive, attitudinal and social dimensions on both the support of organ donation and actual registration behavior. The acceptable coefficient alpha levels for all but one dimension and the high variance explained provide support for scale reliability and validity. We were also interested in determining whether the relative importance of these dimensions varied depending on whether support or behavior was evaluated. In Table 7 we present test statistics for organ donation support (t-test) and donor registration status (Wald statistic), along with the rank ordering of importance of the independent variables. Table 7 shows that the most critical element for generating support for organ donor registration differs dramatically when compared to increasing the likelihood of actually registering to be an organ donor. Specifically, perceptions of the benefits of organ donation and altruistic motives had the greatest impact on the support for organ donation while respondents' knowledge about how to register to be an organ donor was the dominant dimension for donor registration status. Second and important given the greater opportunity to generate social-based communications in personal and electronic forms, Social Interactions/Support had the next greatest impact for both support and donor registration. Third, except for need acknowledgement, there is a relatively high level of consistency across the two regressions on the remaining dimensions. Table 7.