A virtual reality paradigm simulating blood donation serves as a platform to test interventions to promote donation.

Effective interventions that support blood donor retention are needed. Yet, integrating an intervention into the time-pressed and operationally sensitive context of a blood donation center requires justification for disruptions to an optimized process. This research provides evidence that virtual reality (VR) paradigms can serve as a research environment in which interventions can be tested prior to being delivered in blood donation centers. Study 1 (N = 48) demonstrated that 360°-video VR blood donation environments elicit a similar profile of emotional experience to a live donor center. Presence and immersion were high, and cybersickness symptoms low. Study 2 (N = 134) was an experiment deploying the 360°-video VR environments to test the impact of an intervention on emotional experience and intentions to donate. Participants in the intervention condition who engaged in a suite of tasks drawn from the process model of emotion regulation (including attentional deployment, positive reappraisal, and response modulation) reported more positive emotion than participants in a control condition, which in turn increased intentions to donate blood. By showing the promise for benefitting donor experience via a relatively low-cost and low-resource methodology, this research supports the use of VR paradigms to trial interventions prior to deployment in operationally-context field settings.

Researchers' views on and practices of knowledge translation: an international survey of transfusion medicine researchers.

BACKGROUND: Health research is often driven by the desire to improve the care and health of the community; however, the translation of research evidence into policy and practice is not guaranteed. Knowledge translation (KT) activities, such as dissemination and end-user engagement by researchers, are important to achieving this goal. This study examined researchers' views on and practices of KT in the field of transfusion medicine. METHODS: An anonymous, cross-sectional survey was distributed to transfusion medicine researchers in May 2022 by emailing corresponding authors of papers in four major blood journals, emailing grant recipients, posting on social media, and through international blood operator networks. Comparative analyses were conducted for career stage, work setting, research type, and KT training. RESULTS: The final sample included 117 researchers from 33 countries. Most participants reported that research translation was important (86%) and felt it was their responsibility (69%). Fewer than half felt they had the skills to translate their research (45%) or knew which strategies to employ (45%). When examining how research findings are shared, most reported using diffusion activities (86%), including publishing in peer-reviewed journals (74%), or presenting at academic conferences (72%). Fewer used dissemination methods (60%), such as developing educational materials (29%) or writing plain language summaries (30%). Greater use of tailored dissemination strategies was seen among researchers with KT training, whilst traditional diffusion strategies were used more by those working in an academic setting. Most participants had engaged end-users in their research (72%), primarily to consult on a research component (47%) or to involve them in the research process (45%). End-user engagement was greater among researchers with established careers, working in both academic and applied settings, and with KT training. CONCLUSIONS: Whilst participating researchers acknowledged the importance of KT, they typically focused on traditional diffusion strategies. This is despite well-established knowledge of the limited impact of these strategies in achieving KT. Those with KT training were more likely to use tailored dissemination strategies and engage end-users in their research. This demonstrates the value of sharing knowledge from the KT field with health researchers to facilitate KT.

Warming up cool cooperators.

Explaining why someone repeats high-cost cooperation towards non-reciprocating strangers is difficult. Warm glow offers an explanation. We argue that warm glow, as a mechanism to sustain long-term cooperation, cools off over time but can be warmed up with a simple intervention message. We tested our predictions in the context of repeat voluntary blood donation (high-cost helping of a non-reciprocating stranger) across 6 studies: a field-based experiment (n = 5,821) comparing warm-glow and impure-altruism messages; an implementation study comparing a 3-yr pre-implementation period among all first-time donors in Australia (N = 270,353) with a 2-yr post-implementation period (N = 170, 317); and 4 studies (n = 716, 1,124, 932, 1,592) exploring mechanisms. We show that there are relatively warm and cool cooperators, not cooling cooperators. Cooperation among cool cooperators is enhanced by a warm-glow-plus-identity message. Furthermore, the behavioural facilitation of future cooperation, by booking an appointment, is associated with being a warm cooperator. Societal implications are discussed.

A randomized controlled trial of post-donation communication materials to increase donor return following a vasovagal reaction.

BACKGROUND: Vasovagal reactions (VVRs) are one of the primary reasons for people to stop donating blood. The aim of this study was to evaluate the impact of newly developed online communications on the rate of return of whole-blood (WB) and plasma donors who experienced a VVR. STUDY DESIGN AND METHODS: First-time and experienced WB and plasma donors who had a VVR without a loss of consciousness in the previous 3 days were randomly allocated to receive (a) an SMS sent 1-4 days post-VVR (n = 2303), (b) an email sent 6-10 days post-VVR (n = 2360), (c) both the SMS and the email (n = 2248), or (d) business-as-usual donor retention communications (control; n = 2557). Donation data were extracted to determine subsequent donation attempts. RESULTS: For return within 3 months, WB donors in the Email Only condition had significantly increased odds of returning (OR: 1.26, 95%CI: 1.01-1.56). Subgroup analysis within WB donors showed increased odds of return for women sent the SMS and Email (OR: 1.50, 95%CI: 1.14-1.96) or the Email Only (OR: 1.44, 95%CI: 1.10-1.89), and for first-time donors sent the Email Only (OR: 1.48, 95%CI: 1.07-2.05). At 6 months, only first-time WB donors in the Email Only condition had significantly increased odds of returning (OR: 1.30, 95%CI: 1.01-1.69). No significant effects of the intervention were found for immediate or intermediate return for plasma donors. DISCUSSION: Sending an email addressing common donor concerns regarding VVRs increases WB donor retention, but additional strategies are needed for the effects to last and to retain plasma donors.

Experiences of knowledge translation among researchers in transfusion medicine: Findings from an international survey study.

BACKGROUND: Translation of research knowledge is critical to ensure transfusion medicine policies and practices reflect current evidence and so effectively support the health of blood donors and recipients, as well as ensuring ongoing blood supply. The aim of this study was to investigate the barriers and facilitators of knowledge translation (KT) among transfusion medicine researchers and determine what KT supports are needed. STUDY DESIGN AND METHODS: An anonymous, cross-sectional survey was distributed by emailing corresponding authors of papers in four major blood journals, emailing grant recipients in the area of transfusion medicine, posting on social media, and through an international blood operator network. RESULTS: The final sample included 105 researchers. Participants had a positive orientation toward KT, with few perceiving KT as not relevant to their research or beneficial for their careers. However, many reported facing difficulties practicing KT due to time constraints, competing priorities, or lack of funds or resources. Fostering relationships with stakeholders was seen as a key facilitator of KT but a number of researchers expressed difficulties engaging and communicating with them. Collaboration opportunities, protected time for KT, and access to KT resources were some of the supports researchers felt were required to help their KT efforts. CONCLUSION: To minimize the knowledge to practice gap in transfusion medicine and ensure findings from research lead to improved outcomes, organizations need to support researchers in their KT efforts and facilitate interactions between researchers and research end-users.

Beyond fear: A longitudinal investigation of emotions and risk of a vasovagal reaction in first-time whole-blood donors.

BACKGROUND: Fear is a recognized predictor of vasovagal reactions (VVRs) in blood donors. However, less is known about the role of other emotions, including positive emotions, that donors might experience. The aim of this study was to identify the emotions experienced in center that predict onsite VVRs, and to determine at what point during the donation appointment, the experience of these emotions is most influential. STUDY DESIGN AND METHODS: A sample of 442 first-time whole-blood donors (57.7% female; mean ± SD age 30.7 ± 11.7 years) completed a survey in the waiting area and before venepuncture in the donation chair to assess their current emotional experience. The survey data were matched with routinely-collected demographic, donation, and donor adverse event information. A generalized estimating equations model was used to identify emotions associated with the occurrence of a VVR. RESULTS: A total of 56 (12.7%) participants experienced a VVR. The occurrence of a VVR was significantly associated with lower love/closeness/trust (OR: 0.53, 95%CI: 0.34-0.82) and higher scared/fearful/afraid (OR: 1.96, 95%CI: 1.18-3.25) states. Significant interaction effects suggested that the effect of scared/fearful/afraid decreased while stressed/nervous/overwhelmed increased from the waiting area to before venepuncture on the likelihood of a VVR. DISCUSSION: To effectively reduce donor VVR risk, blood collection agencies need to address a broader range of emotions at different points during the donation process.

Using the Health Action Process Approach to predict blood donation intentions and return behavior following a vasovagal reaction for whole blood and plasma donors.

BACKGROUND: To inform the development of interventions to retain donors following a vasovagal reaction (VVR), the aim of this study is to use the Health Action Process Approach (HAPA) to identify predictors of intentions to re-donate and actual return behavior among whole blood (WB) and plasma donors who experienced a VVR. STUDY DESIGN AND METHODS: A total of 1136 WB donors (Mage  = 32.4 ± 12.5 years; 73.4% female) and 1141 plasma donors (Mage  = 36.5 ± 14.4 years; 73.3% female) completed an online survey after experiencing a VVR. Two hierarchical regression analyses were conducted for each donation type. In the first analysis, donation intentions were regressed onto the motivational HAPA constructs and social support. In the second analysis, donor return within 6 months was regressed onto social support, intentions, and the volitional HAPA constructs. RESULTS: The motivational and social support variables accounted for 47.2% of the variance in intentions to return in WB donors and 15.7% in plasma donors. For both groups, task self-efficacy, positive and negative outcome expectancies, and social support were significant predictors of intentions to return. Intentions and action planning were significant predictors of donor return in both groups, and recovery self-efficacy was significant for plasma only. CONCLUSION: The HAPA model can provide guidance to blood collection agencies to design phase-specific and individually-focused interventions to retain WB and plasma donors following a VVR.

Improving donor retention following a temporary deferral: A cluster randomized controlled trial of deferral educational materials.

BACKGROUND: Providing educational materials to deferred donors has been shown to increase their understanding about their deferral and knowledge about their return. The aim of this study was to determine the effectiveness of educational materials in increasing the retention of deferred donors. STUDY DESIGN AND METHODS: A three-arm cluster randomized controlled trial was conducted, with the following conditions: (a) Incenter Brochure plus Email; (b) Email Only; (c) Control. The Incenter Brochure plus Email condition also included a guided conversation led by staff at the point of deferral. Donors were followed up for 3 months after their deferral had ended to determine if they had attempted to donate. RESULTS: Compared with the Control condition, donors in the Incenter Brochure plus Email condition had increased odds of return at 3 months after their deferral ended (OR: 1.16; 95% CI 1.00-1.33). Subgroup analysis highlighted that novice (OR: 1.38; 95% CI 1.04-1.83) and established donors (OR: 1.36; 95% CI 1.13-1.64) had increased odds of return if they received the incenter materials. Donors who were deferred to maintain their well-being (OR: 1.28; 95% CI 1.03-1.60) and donors with a prior deferral history (OR: 1.55; 95% CI 1.15-1.55) had increased odds of return if they received the incenter materials. No significant differences were found between the Email Only and Control conditions. DISCUSSION: This trial demonstrates the benefits of providing onsite educational materials to donors at the point of deferral. This is a simple, effective strategy to increase the return behavior of donors within 3 months of their deferral ending.

Notifying donors when their deferral is ending: An effective donor retention strategy.

BACKGROUND: The application of a temporary deferral often leads to donor lapse. Contributing factors may be donors not knowing when their deferral ends or not being contacted and asked to return. The aim of this study was to determine the effectiveness of a reminder message notifying donors that their deferral is coming to an end in increasing donors' postdeferral return rates. We evaluated the optimal time, content, and mode of delivery of the reminder message. STUDY DESIGN AND METHODS: Two studies were conducted with deferred donors. Study 1: donors (n = 1676) were randomized to be sent a reminder message at one of three time points (4 weeks before, 1 week before, and 1 week after their deferral ended) or to a no contact control condition. Study 2: donors (n = 1973) were randomized to three message type conditions (emotive email, nonemotive email, nonemotive SMS). Attempted return behavior was extracted (appointments, attendances) at 1 month. RESULTS: In Study 1, being sent the reminder message increased odds of donors attempting to return within 3 months compared with the control group (OR:2.01). Sending the reminder 1 week before the deferral ended was the most effective time point. In Study 2, the nonemotive message increased the odds of attempting to return compared with the emotive message (OR:1.38). No differences were found between email and SMS messages. DISCUSSION: Sending a reminder message to donors when their deferral is coming to an end is a simple, effective, and cost-effective method to retain donors.

The vasovagal reaction experience among blood donors: A qualitative study of factors that affect donor return.

RATIONALE: Blood collection agencies face ongoing challenges in retaining voluntary donors to meet the demand for blood and blood-related products by healthcare services. A known deterrent to continued blood donation is the experience of a vasovagal reaction (VVR). However, there has been little research into donors' experiences of these reactions and the factors that influence their decision to return, which is essential information to inform strategies to improve donor return. OBJECTIVE: The aim of this paper was to explore blood donor views and experiences of a VVR, with a particular interest in how the reaction influenced their return behaviour, using the Transactional Model of Stress and Coping. METHODS: We conducted 34 semi-structured in-depth interviews between February and April 2018 with a sample of Australian donors who had experienced a VVR in the last seven days. Transcripts were analysed using the Framework Method. RESULTS: The VVR elicited various emotional responses, which appeared to be influenced by social support, being aware of the possibility of experiencing a VVR, or the donation outcome. In turn, the VVR experience affected intentions to return, with those who reported more positive experiences expressing stronger intentions. Further, donors felt more likely to return if they perceived their risk of a recurrent event as low and if they were able to identify appropriate problem and emotion-focused coping strategies. CONCLUSION: This article provides novel insights into possible ways to encourage blood donor return following a VVR.

Examining knowledge translation in blood donor research: A review of vasovagal reaction literature.

BACKGROUND: Knowledge translation focuses on the transfer of research findings into policy and practice. To provide insight into the state of knowledge translation in blood donor research, we undertook a rapid review of a key research area in the field with high potential for translation, vasovagal reactions (VVRs). We examined the number and nature of VVR-related studies to determine the availability of research evidence, and mapped the included articles along the research-to-practice trajectory using the Knowledge to Action framework. STUDY DESIGN AND METHODS: PubMed, PsycINFO, CINAHL, and EMBASE were searched for peer-reviewed journal articles from inception to October 2019 using the terms blood don* AND vasovagal OR faint* OR syncope. RESULTS: A total of 176 articles met our inclusion criteria. Studies relating to VVRs increased substantially from 1942 to 2019, with 84% published in the last 20 years. Articles were predominately observation (non-intervention) studies (117; 66%), followed by intervention (knowledge inquiry) studies (31; 18%) and review (knowledge synthesis) studies (20; 11%). The evidence from intervention research was limited, with 14 strategies tested in 31 studies and often by the same research groups. Only 5 (3%) implementation and evaluation studies were found; all focused on evaluating the effects of a newly introduced intervention on VVR rates through uncontrolled or cross-sectional study designs. DISCUSSION: VVR research is in the early stages of knowledge translation. More intervention research is needed to provide a robust evidence base as well as more published implementation research to share knowledge of translating research into policy and practice.

Improving the donation experience and reducing venipuncture pain by addressing fears among whole-blood and plasma donors.

BACKGROUND: Fear of blood donation is implicated in vasovagal reactions, donor recruitment, and retention. This study examined the extent to which fear among donors is associated with various donor outcomes in an Australian sample, and whether fear can be addressed on-site to reduce adverse reactions and improve the donation experience. STUDY DESIGN AND METHODS: Six hundred and sixty-four donors (age M = 33.4, SD = 12.7; 55% female) participated in a two-center, pragmatic, parallel group, individually randomized controlled trial. Following donor registration and consent, whole-blood (n = 539) and plasma (n = 125) donors were assigned to one of four Conditions: control; fear assessment; fear assessment + brochure; fear assessment + brochure + tailored conversation focused on any self-reported fear and coping strategies. Post-donation questionnaires assessed the donors' experience including positive support, donor self-efficacy, anxiety, fear, venipuncture pain, and vasovagal reactions. RESULTS: Fear among donors predicted higher venipuncture pain, post-donation anxiety, and vasovagal reactions and remained significant after controlling for other established predictors (i.e., total estimated blood volume, age, sex, and donation experience). Mediational analyses showed that exposure to brochures (with or without the tailored conversation) was associated with less pain, with this effect mediated by donor perceptions of more positive support. Venipuncture pain was also associated with vasovagal reactions, reduced likelihood of return within 6 months, and less satisfaction with the donation experience. CONCLUSION: The current results underline the importance of interventions to address fear among both whole-blood and plasma donors to secure the safety and well-being of donors and the blood supply.

Educating donors about deferrals through the provision of tailored materials: Findings from a survey of deferred donors.

BACKGROUND: Receiving a temporary deferral has been shown to negatively affect donor retention. One contributing factor for low donor return may be poor understanding of why the deferral has occurred. The aim of this study was to determine whether new educational materials-a brochure, guided conversation, and follow-up email-increased deferred donors' knowledge about their donation eligibility, satisfaction with the deferral process, intention to return, and odds of rebooking another appointment. STUDY DESIGN AND METHODS: A three-arm cluster randomised controlled trial was conducted to evaluate the impact of the educational materials compared to business as usual deferral procedures: (a) In-center brochure and follow-up email; (b) Email only; (c) Control. A survey was administered to a random sample of trial participants (n = 847). RESULTS: Compared with the control condition, donors in the in-center brochure and email condition were more knowledgeable about the end date of their deferral, and reported higher satisfaction with the deferral information provided, and had fewer questions and/or concerns about the deferral. Similar findings were observed when comparing the email only condition to the in-center brochure and email condition. No differences were found in intention to return. Donors in the in-center brochure plus email condition had increased odds (OR:1.385) of rebooking their next appointment compared to the combined email only and control conditions. CONCLUSIONS: The application of a deferral is often misunderstood by donors. Providing educational materials to donors can increase their understanding and may lead to increased retention of donors through rebooking of subsequent donations.

The Impact of Temporal Trajectories of Emotional Experience on Blood Donor Return.

BACKGROUND: Despite recognition that blood donation is an affectively poignant process, many aspects of donors' emotional experiences and their consequences remain unexamined. PURPOSE: This study tracked the donor's experience of several positive and negative emotions live as they arose during the donation process and tracked the impact of that experience on donor return. METHODS: New whole blood donors (N = 414) reported their experience of 10 positive and 10 negative discrete emotions before, during, and after donation. Return behavior of these donors and a business-as-usual control group was tracked over the next 6 months. RESULTS: In total, 46.4% of participants and 43.2% of the control group returned to donate within 6 months. On the basis of established relevance to blood donation and statistical considerations, group-based latent trajectories of three emotions (joy, calm, and stress) were modeled over time, revealing five classes of emotion trajectories. A trajectory of low/increasing joy and calm and high/decreasing stress was associated with significantly lower probability of return (preturn = .28, 95% confidence interval [CI] = 0.20, 0.38) relative to all but one other trajectory group and the control group. A trajectory of medium-high/increasing joy, high calm, and low/decreasing stress was associated with a significantly greater probability of return (preturn = .59, 95% CI = 0.49, 0.69) relative to two other trajectory classes and the control group. CONCLUSIONS: By identifying blood donors' emotion trajectories over time and the impact of those trajectories on return behavior, this research paves the way for the development of effective emotion-focused interventions to boost retention.

Offering new and returned donors the option to give plasma: implications for donor retention and donor adverse events.

BACKGROUND AND OBJECTIVES: In 2018, Australian Red Cross Lifeblood changed its plasmapheresis eligibility criteria to allow donors to donate plasma without the requirement of a prior successful whole blood donation. This study evaluated the impact of this policy change on donor retention and donor safety. MATERIALS AND METHODS: All donors who had attempted to give their first plasma or whole blood donation from January to June 2018 were included in this retrospective cohort study. Donor characteristics and adverse events were analysed for this index donation, and the cohort was followed for 18 months to analyse time to return, subsequent donation frequency and predictors of return. RESULTS: Male and younger donors provided a significantly greater proportion of first donation plasma than females and older donors. New donors who gave plasma had the highest rate of donor adverse events, including vasovagal reactions and phlebotomy injuries. Nevertheless, donor retention was not affected, with more new donors returning and at a greater subsequent donation frequency after a plasma donation compared to new donors donating whole blood. First-time plasma donors who had previously donated whole blood, however, had greater and quicker rates of return, and more subsequent donations. CONCLUSION: Offering new donors the option to give plasma had a positive effect on donor return and subsequent donation frequency. Removing the requirement of a prior whole blood donation is a viable way to increase plasma collections although the combined effect of new donor status and plasmapheresis procedure on adverse event risk needs to be considered.

Reduced risk of vasovagal reactions in Australian whole blood donors after national implementation of applied muscle tension and water loading.

BACKGROUND: A new national donor safety initiative was introduced in Australia in 2018, which aimed to encourage all whole blood donors to water load and to use applied muscle tension. This study evaluated the effect of this initiative on the rate of vasovagal reactions (VVR). STUDY DESIGN AND METHODS: Routinely collected data were used to identify whole blood donations and any associated VVRs before (n = 167,056 donations) and after implementation (n = 215,572 donations). Multivariate logistic regression analyses were performed to evaluate the differences in VVR rates. RESULTS: The total rate of VVRs declined from 22.5 per 1000 donations to 20.6 per 1000 donations after implementation, a reduction of 8% (p < 0.001). The rate of presyncopal reactions decreased by 8% in new donors and 12% in repeat donors. No impact was observed on the rate of syncope in any of the groups. The multivariate logistic regression analysis demonstrated the odds of experiencing a presyncopal reaction was reduced by 13% following implementation, with no significant effects on syncope. CONCLUSION: The findings of this study support the use of water loading and applied muscle tension in routine whole blood collection to reduce the incidence of VVRs.

Trends in return behavior after an adverse event in Australian whole blood and plasma donors.

BACKGROUND: This study examined the impact of donor adverse events (DAEs) on plasma donor return and compared these against trends in whole blood (WB) donors. STUDY DESIGN AND METHODS: Using a retrospective cohort design, donors who attempted to give plasma or WB in 2014-2015 were categorized by DAE and followed for 2 years. Analyses of return rate, time to return, subsequent donation frequency, and recurrent risk were performed. Donor characteristics associated with return were also assessed. RESULTS: For both plasma and WB donors, vasovagal reactions (VVRs) were the strongest deterrent to return, with a lower proportion returning, taking longer to return, and making fewer subsequent donations than those with uncomplicated donations. Despite a higher likelihood of a recurrent event among those who experienced a DAE, the majority had an uncomplicated subsequent donation. Donor characteristics associated with return varied by phlebotomy and DAE type. For donors experiencing a VVR, differences were observed by donor experience, age, sex, and site type between plasma and WB. For phlebotomy-injured donors, differences were observed by sex, blood type, donor experience, and donation outcome between the two groups. No factors associated with return after a citrate reaction were found. CONCLUSION: This study highlights the detrimental effects of DAEs on plasma return, in particular VVRs, and the differences in factors associated with return compared to WB donors. Further research is required to understand the mechanisms underlying the decision to return following a DAE.

Completeness and accuracy of self-reported history of blood donation: results from a cohort of older adults in Australia.

BACKGROUND: The validity of studies relying on self-report of blood donation may be severely threatened by systematic errors. STUDY DESIGN AND METHODS: We linked the Sax Institute's 45 and Up Study data, which asked self-report of blood and plasma donation including the date of most recent donation to the blood donor database at the Australian Red Cross Blood Service. We used the linked data to validate the accuracy of self-reported blood donation history including the completeness and accuracy of reported date of most recent donation. RESULTS: Of the total 142,503 participants, 47.8 and 5.1% reported ever donating blood and plasma, respectively. Of those self-reporting blood donation (n = 23,113) and plasma donation (n = 4,451) within the last 10 years of survey, 6262 (27.1%) and 1444 (33.0%) had no record of donation within that period, respectively. Among those who had a record of blood and plasma donation within 10 years before the survey, 97.6 and 93.0% correctly self-reported ever donating blood and plasma, respectively. Donors consistently reported a donation date more recent than the actual recorded date, and the median discrepancy and variability increased as the length of time from the survey date to the actual date of donation increased. CONCLUSIONS: Almost 98% of donors donating blood within a decade of survey completion date can correctly self-report their history of donation as ever donating blood, whereas 27% of participants self-reporting donation within a decade may not have actually donated blood. Further, self-reported date of blood donation is not a reliable measure of actual date of donation.

Does using applied muscle tension at strategic time points during donation reduce phlebotomist- and donor-reported vasovagal reaction rates? A three-armed randomized controlled trial.

BACKGROUND: Vasovagal reactions (VVRs) have a negative impact on donor safety and return. Applied muscle tension (AMT) increases blood pressure temporarily and has been suggested as a way to reduce donors' risk of VVRs. This study evaluated whether using AMT at three different time points during the donation procedure reduces the VVR symptoms reported by donors and the VVR reactions recorded by phlebotomists. STUDY DESIGN AND METHODS: A three-arm, multicenter, open-label randomized controlled trial was used to compare VVR symptoms and reaction rates between those practicing AMT during the entire donation (n = 244) to practicing AMT at VVR high-risk time points (n = 250) to a standard blood donation control group (n = 240). All participants were asked to drink 500 mL of water in the waiting area, and an even distribution of new and repeat donors was sought across conditions. RESULTS: Across all conditions, donors reported few VVR symptoms and the rate of reporting did not differ significantly across conditions. However, donors who practiced AMT at strategic time points had a significantly lower number of phlebotomist-registered VVRs in comparison to the other two study groups, with these rates not varying by sex or donor status. Greater compliance by donors with AMT instructions was observed in those asked to practice AMT at strategic time points compared to those asked to practice AMT during the entire donation. CONCLUSION: Practicing AMT at VVR high-risk time points reduces the number of phlebotomist-registered VVRs.