African culturally and linguistically diverse communities' blood donation intentions in Australia: integrating knowledge into the theory of planned behavior.

BACKGROUND: The Theory of Planned Behavior (TPB) has been extensively used to examine donation intentions in the general community. This research seeks to examine whether TPB applies to one culturally and linguistically diverse (CALD) community in Australia and also incorporates blood donation knowledge as an antecedent in the model, given that the TPB assumes people make informed decisions regarding blood donation. STUDY DESIGN AND METHODS: A cross-section of 425 members of African CALD communities was surveyed face to face using bilingual workers, ensuring inclusion across literacy levels within the CALD community. Constructs used within the survey were drawn from the TPB blood donation literature (i.e., attitudes, social norms, and self-efficacy). A new measure of blood donation knowledge was included. RESULTS: Structural equation modeling found that the Basic TPB model did not hold for African CALD communities in Australia. The Basic TPB model was modified and within this Adapted TPB model attitudes were found not to impact intentions directly, but had a mediating effect through self-efficacy. An Extended TPB model including overall knowledge was then tested and improved the model fit statistics, explaining 59.8% variation in intentions. Overall knowledge was found to indirectly impact intentions, through self-efficacy, social norms, and attitudes. CONCLUSION: The TPB applies differently when examining African CALD communities' blood donation intentions in Australia. Knowledge is an important mediating component of the Extended TPB model rather than directly affecting intentions. Addressing CALD communities' psychographic characteristics may assist blood services in developing targeted strategies to increase donations within these communities.

"They don't want our blood": social inclusion and blood donation among African migrants in Australia.

The current study examines how feelings of social inclusion influence migrant communities' predisposition to donate blood, focusing specifically on Sub-Saharan African communities in Australia. We begin by explicating the theoretical links between social inclusion, citizenship and blood donation before discussing local and international perspectives of blood donation among African migrant communities. Using qualitative methods comprising nine focus group discussions, held between March and April 2010, we argue that blood donation intentions are mediated by whether or not individuals feel included in their new host society. Real and perceived discrimination experienced by African migrants in their everyday social interactions or in institutional settings can act as a barrier to blood donation. We conclude that removing such barriers, thereby increasing rates of donation in migrant communities, will help to build social capital and inclusion. Strategies for how this can be achieved are outlined.

Barriers to blood donation in African communities in Australia: the role of home and host country culture and experience.

BACKGROUND: An influx of African migrants and refugees can strain a host country's blood services, because often migrants have unique blood needs that cannot be sourced from local donors. To increase blood donation by the new migrants, host country blood services need to understand how blood and blood donations are viewed by immigrant communities, because recruitment models that are not culturally adapted may have limited success. STUDY DESIGN AND METHODS: Nine focus groups representing a cross-section of Australian-based African communities were conducted in multiple languages, facilitated by bilingual workers. The qualitative protocol was guided by the literature on blood donation by African migrants and communities in Africa. Thematic analysis identified the relevance of issues previously included in the literature and whether other issues facilitated or prohibited blood donation. RESULTS: Home country cultural issues were not generally raised as barriers to donation, and respondents were positively disposed toward donation. Home country experiences shaped respondents' views in Australia. Participants focused on assisting "individuals in need," rather than giving to a blood service that many viewed with suspicion because of issues in their home country. There was a lack of knowledge about the donation process in Australia. More importantly, respondents perceived that their blood would not be wanted, based on a perception of host country mistrust and discrimination. CONCLUSION: Developing an intervention that encourages migrants to donate blood needs to be culturally focused. It appears that addressing perceptions based on home country experiences is essential. Overcoming a general perception of discrimination is beyond any blood service, but there can be an attempt to ensure that blood donation is seen as an inclusive process-blood from everyone, for everyone.

'You can spend your life dying or you can spend your life living': identity transition in people who are HIV-positive.

This article examines, through the lenses of HIV-positive people, the unique phenomenon of identity transition. This research proposes that life-changing illnesses, such as HIV, are an undesired 'possession' that people accept to varying degrees, which we refer to as 'ownership'. While illnesses, such as HIV compel individuals to undergo a transformation process that usually begins with a deep feeling of detachment, and then proceeds to acceptance of their illness, and to feeling empowered and in control of their HIV status and lives, this process is very complex and non-linear as it involves many iterative progressions in identity transition. These transitions are highly individualistic; however, the underlying theme is that the more positive trajectories were those of people who focus on their new lives, living with HIV (i.e. taking ownership of their illness), rather than focusing on what they have lost when they became HIV-positive. The findings demonstrate that identity transition is a result of the ways that individuals rework, negotiate and transform their roles, actions and behaviours through their active engagement with support mechanisms. This study suggests that it is vital to promote positive interactions with support mechanisms to ensure that those with HIV view themselves positively.