Word-of-mouth among blood service employees who also donate blood: a qualitative investigation of advantages and challenges for dual-role donors.

BACKGROUND: Despite word-of-mouth (WOM) and electronic WOM (eWOM) influencing people's willingness to donate blood, no research has explored this behavior among blood service employees who are also donors. This underexplored segment is highly important, as they are generally committed to both the organization and the cause and are likely more informed on the topic of blood donation than the average donor. METHODS: This study comprised six online focus groups with 26 Australian Red Cross Lifeblood employees who are also donors. Questions covered a range of blood donation and WOM topics, including when they became blood donors, if they had engaged in WOM about blood donation, what they had talked about and with whom, and what were audience reactions. Thematic analysis was then used to explore how responses related to the employees' motivations, opportunities, and abilities to engage in WOM and eWOM about blood donation. RESULTS: While most employee-donors saw alignment in their employee and donor roles, advocating for blood donation was not considered a necessary part of either role. Educating others about blood donation was a common goal of employee-donor WOM and eWOM, and almost all employees engaged in reactive WOM, triggered by events (e.g., recent donations) or questions about their work. Employee-donors in donor-facing roles (e.g., communications and collections staff) felt more aware of the importance of encouraging others to donate blood and were also more likely to be proactive in their WOM activity. Along with these perceived advantages of having a dual role, employee-donors also identified some disadvantages, such as unrealistic expertise expectations and negative audience responses that can be difficult to navigate. CONCLUSIONS: Being an employee-donor is a double-edged sword. For example, increased opportunities to talk about blood donation and access to more information can be offset by having to respond to more challenging questions/comments and expectations, while appropriately representing their employer. More research is needed among those in employee-donor roles within the healthcare and/or non-profit sectors, to determine whether these are issues faced more broadly, and how those in dual roles can be most effectively supported to engage in positive WOM and eWOM.

Migration-related Factors and Settlement Service Literacy: Findings from the Multi-site Migrants' Settlement Study.

Migrants' access and effective utilisation of settlement services depend on their level of settlement service literacy (SSL). However, SSL is multi-dimensional in nature and has many facets that are influenced by demographic and migration-related factors. Identifying factors that drive various components of SSL, and thus allowing for more focused development of specific dimensions, is critical. The aim of this study was to examine the relationship between components of SSL and migration-related and migrants' demographic factors. Using a snowball sampling approach, trained multilingual research assistants collected data on 653 participants. Data were collected using face-to-face or online (phone and via video platforms such as Zoom and Skype) surveys. Our findings suggest that demographic and migration-related factors explained 32% of the variance in overall SSL; and 17%, 23%, 44%, 8%, 10% of the variance in knowledge, empowerment, competence, community influence, and political components of SSL respectively. SSL was positively associated with pre-migration and post-migration educational attainment, being employed in Australia, being a refugee, coming from the sub-Saharan region but negatively associated with age and coming from the East Asia and Pacific region. Across SSL dimensions, post-migration education was the only factor positively associated with the overall SSL and all SSL dimensions (except the political dimension). Employment status in Australia was also positively associated with competency and empowerment, but not other dimensions. Affiliating with a religion other than Christianity or Islam was negatively associated with knowledge and empowerment whilst being a refugee was positively associated with knowledge. Age was negatively associated with the empowerment and competency dimensions. The study provides evidence of the importance of some pre- and post-migration factors that can assist in developing targeted initiatives to enhance migrants' SSL. Identifying factors that drive various components of SSL will allow for more focused development of specific dimensions and therefore is critical.

The importance of information acquisition to settlement services literacy for humanitarian migrants in Australia.

BACKGROUND: Due to the diversity and range of services provided to humanitarian migrants during the settlement phase of migration, acquiring information across multiple service domains is intrinsic to the effective utilisation of settlement services. There are research gaps investigating how humanitarian migrants experience and navigate unfamiliar, multiple, and often complex information and service systems of host countries. This study seeks to understand the impediments to humanitarian migrants' effective utilisation of information about settlement services and to identify strategies that can be implemented to overcome these barriers. METHODS: Service providers were purposively recruited from organisations funded by the Australian Government to deliver settlement programs. The study applied an inductive thematic analysis approach to identify key themes that emerged from the data. RESULTS: From the perspective of service providers, the themed findings identified how humanitarian migrants gain knowledge about services, their information needs, information seeking practices and skills, and information specific to service domains. The findings illustrate the importance of acquiring information, knowledge, and skills across multiple information platforms and service domains as being integral to the effective utilisation of settlement services for humanitarian migrants. The study identifies systemic barriers to information and service access and suggests different strategies and approaches to improve access to context specific key information. The study identifies factors that inhibit the effectiveness of the Australian settlement service provision model and emphasises the need for targeted training of mainstream referral services. The study highlights the important role that settlement service providers play as mediators of information, adept at tailoring information to humanitarian migrants' individual and community information needs. CONCLUSION: The findings provide important insights that highlight the different roles that policymakers, researchers, and service providers can play to inform new approaches that improve the effectiveness of information and settlement service provision, as part of contributing to optimum settlement outcomes for humanitarian migrants.

Establishing the psychometric properties of constructs from the conceptual 'Settlement Services Literacy' framework and their relationship with migrants' acculturative stress in Australia.

BACKGROUND: Effective migration often requires supports for new arrivals, referred to as settlement services. Settlement services literacy (SSL) is key to ensuring new migrants have the capability to access and utilise the information and services designed to support the resettlement process and achieve positive settlement outcomes. To date, however, no research has sought to empirically validate measures of SSL or to assess individual migrants' levels of SSL. The aim of this study was to establish the psychometric properties of constructs from the conceptual SSL framework. DESIGN: Using a snowball sampling approach, trained multilingual research assistants collected data on 653 participants. The total sample was randomly divided into two split-half samples: one for the exploratory factor analysis (EFA; N = 324) and the other for the confirmatory factor analysis (CFA; N = 329) and scale validation. The final SSL scale included 30 questions. The full data set was used to test the nomological validity of the scale regarding whether the components of SSL impact on migrants' level of acculturative stress. RESULTS: The EFA yielded five factors: knowledge (eight items, α = 0.88), empowerment (five items, α = 0.89), competence (four items, α = 0.86), community influence (four items, α = 0.82), and political (two items, α = 0.81). In the CFA, the initial model demonstrated a poor to marginal fit model. Its re-specification by examining modification indices resulted in a good model fit: CMIN/DF = 3.07, comparative fit index = 0.92, root mean square error of approximation = 0.08 and standardised root mean square residual = 0.07, which are consistent with recommendations. All the path coefficients between the second-order construct (SSL) and its five dimensions (knowledge, empowerment, competence, community influence and political) were significant at an α = .05 level, giving evidence for the validity of different SSL dimensions. We found that SSL is significantly related to migrants' acculturative stress (ß = - 0.39, p < 0.05) in the nomological model. CONCLUSIONS: The study provides evidence of the construct validity and reliability of the SSL tool. It provides the basis for integrating the measures of SSL into evaluation of settlement services. This will allow for more effective decision-making in designing and implementing settlement services as well as funding and service agreements to address any deficiencies.

Australian lessons for developing and testing a culturally inclusive health promotion campaign.

The purpose of the study was to develop and test culturally appropriate health promotion materials that were seen to be socially inclusive in regard to blood donation within the Australian-African community. Materials were produced in multiple languages (English, Arabic, Swahili and Kirundi) and were initially developed based on previous pilot data, with feedback from the project partner (Australian Red Cross Blood Service) and the African community. Seven formative focus groups with 62 participants were then conducted to ensure the materials would be effective, credible and culturally acceptable to the target audience, including preferred messages, taglines and images. The response confirmed that quotes and images from community members (as opposed to actors) were critical to ensure messages were engaging and believable, and had meaningful taglines that were perceived to be authentic. The refined materials were then used in a community intervention study. The evaluation included an assessment of respondents' views of the messages post-intervention. Of the 281 African migrants who saw the campaign materials during the intervention period, the majority (75.8%) strongly agreed that the materials made them feel part of the wider Australian community. These results suggest that engagement in developmental activities with targeted communities is important for creating positively viewed culturally targeted public health campaigns. A six-step process is suggested that could be used by other organizations to ensure that messages are acceptable to targeted migrant communities.

Interventions to Increase Blood Donation among Ethnic/Racial Minorities: A Systematic Review.

Ethnic/racial minorities are under-represented in blood donor populations in most developed countries. This is of particular concern where minorities differ from a country's majority population in terms of blood or tissue typing, especially where type matching is required for effective management of rare disorders such as sickle-cell disease that require multiple transfusions. This systematic review assessed the effectiveness of interventions to increase blood donation among ethnic/racial minority populations in developed countries. We searched MEDLINE, EMBASE, CINAHL, and ProQuest on 20 March 2017 with no date restrictions and supplemented this with searches on Google Scholar, blood collection agency websites, reference lists of included studies, and a forward search of citations of included studies. We included intervention studies designed to increase recruitment and/or retention of adult, ethnic/racial minority blood donors in developed countries. The review identified eight studies reported in nine publications. Six were conducted in the USA with African Americans. Four studies reported on multifaceted, community-based interventions; three reported on one-off information and educational video interventions, presented face-to-face, or delivered via post or e-mail. The level of evidence for efficacy was low, and the majority of studies were assessed as having some risk of bias related to one or more methodological issues. All eight studies reported positive outcomes in blood donation and/or intention to donate. Seven trials found that the intervention increased presentation for donation, and three found an increase in the percentage of new donors from the ethnic minority targeted. The review findings demonstrate that it is possible to design and implement effective interventions to motivate individuals from ethnic/racial minority groups to donate blood. One-off interventions may be as effective as multifaceted, community-based interventions. There was insufficient evidence to recommend particular interventions, and future research should empirically assess alternative interventions using robust study designs.

Exploring Factors Influencing Childhood Obesity Prevention Among Migrant Communities in Victoria, Australia: A Qualitative Study.

Despite the availability of numerous obesity prevention initiatives in developed countries including Australia, rising childhood obesity levels have been found among migrant communities which contribute to widening obesity-related disparities in these countries. We sought to understand the factors influencing the participation of migrant communities in childhood obesity prevention initiatives. We conducted a qualitative study using semi-structured interviews among 48 migrant parents from African, Middle Eastern, Indian and Vietnamese origins living in disadvantaged areas of Victoria, Australia to explore their views on childhood obesity and its prevention. Thematic analysis showed low obesity literacy among migrant communities, cultural influences negatively impacting their healthy lifestyle behaviours and cultural, family-level and community-level barriers impacting their participation in childhood obesity prevention initiatives. There is an urgent need to improve obesity literacy among migrant communities using bicultural workers in order to improve their responsiveness to childhood obesity prevention initiatives. Health interventionists are urged to incorporate culturally-mediated influences in the design of obesity prevention programs to achieve energy balance and maintain healthy weight among migrants. Such culturally appropriate approaches have the potential of reducing the widening ethnic-related obesity disparities in Australia.

The effects of a culturally-tailored campaign to increase blood donation knowledge, attitudes and intentions among African migrants in two Australian States: Victoria and South Australia.

Research suggests that African migrants are often positively predisposed towards blood donation, but are under-represented in participation. A culturally-tailored intervention targeting the African migrant community in Australia was developed and implemented, to enhance knowledge about blood donation, improve attitudes towards donating, increase intentions to donate blood, and increase the number of new African donors in Australia. Four weeks after a targeted campaign, a survey evaluation process commenced, administered face-to-face by bilingual interviewers from the African community in Melbourne and Adelaide, Australia (community survey). The questionnaires covered demographics, campaign awareness, blood donation knowledge and intentions, medical mistrust and perceived discrimination, and were analysed to evaluate changes in knowledge and intention. Sixty-two percent of survey participants (n = 454) reported being aware of the campaign. With increasing campaign awareness, there was a 0.28 increase in knowledge score (p = .005); previous blood donation was also associated with an increased blood donation knowledge score. Blood donation intention scores were not associated with campaign awareness (p = 0.272), but were associated with previous blood donation behaviour and a positive blood donation attitude score. More positive scores on the blood donation attitude measure were associated with increasing blood donation intentions, self-efficacy and campaign awareness (score increases of 0.27, 0.30 and 0.04, respectively, all p<0.05). Data were collected on the ethnicity of new blood donors in six blood collection centres before and after the intervention, and independent of the intervention evaluation survey. These data were also used to assess behavioural changes and the proportions of donors from different countries before and after the survey. There was no difference in the number of new African migrant donors, before and after the intervention. The culturally-relevant marketing campaign was associated with improved blood donation knowledge and attitudes, but there was no short-term change in blood donation intentions or the number of African donors.

Barriers and facilitators to childhood obesity prevention among culturally and linguistically diverse (CALD) communities in Victoria, Australia.

OBJECTIVE: Childhood obesity is rising among culturally and linguistically diverse (CALD) groups who show poor engagement in obesity prevention initiatives. We examined the barriers and facilitators to the engagement of CALD communities in obesity prevention initiatives. METHODS: We used the nominal group technique to collect data from 39 participants from Vietnamese, Burmese, African, Afghani and Indian origins living in disadvantaged areas of Victoria, Australia. Data analysis revealed ranked priorities for barriers and facilitators for CALD community engagement in obesity prevention initiatives. RESULTS: CALD parents identified key barriers as being: competing priorities in the post-migration settlement phase; language, cultural and program accessibility barriers; low levels of food and health literacy; junk food advertisement targeting children; and lack of mandatory weight checks for schoolchildren. Key facilitators emerged as: bicultural playgroup leaders; ethnic community groups; and school-based healthy lunch box initiatives. CONCLUSION: This study has identified several policy recommendations including: the implementation of robust food taxation policies; consistent control of food advertising targeting children; improving CALD health literacy using bicultural workers; and matching health promotional materials with CALD community literacy levels. Implications for Public Health: These recommendations can directly influence public health policy to improve the engagement of CALD communities in obesity prevention services and ultimately reduce the widening obesity disparities in Australia.

Readiness of communities to engage with childhood obesity prevention initiatives in disadvantaged areas of Victoria, Australia.

Objective Disadvantaged communities bear a disproportionate burden of childhood obesity and show low participation in childhood obesity prevention initiatives. This study aims to examine the level of readiness of disadvantaged communities to engage with childhood obesity prevention initiatives. Methods Using the community readiness model, 95 semi-structured interviews were conducted among communities in four disadvantaged areas of Victoria, Australia. Community readiness analysis and paired t-tests were performed to assess the readiness levels of disadvantaged communities to engage with childhood obesity prevention initiatives. Results The results showed that disadvantaged communities demonstrated low levels of readiness (readiness score=4/9, 44%) to engage with the existing childhood obesity prevention initiatives, lacked knowledge of childhood obesity and its prevention, and reported facing challenges in initiating and sustaining participation in obesity prevention initiatives. Conclusion This study highlights the need to improve community readiness by addressing low obesity-related literacy levels among disadvantaged communities and by facilitating the capacity-building of bicultural workers to deliver obesity prevention messages to these communities. Integrating these needs into existing Australian health policy and practice is of paramount importance for reducing obesity-related disparities currently prevailing in Australia. What is known about the topic? Childhood obesity prevalence is plateauing in developed countries including Australia; however, obesity-related inequalities continue to exist in Australia especially among communities living in disadvantaged areas, which experience poor engagement in childhood obesity prevention initiatives. Studies in the USA have found that assessing disadvantaged communities' readiness to participate in health programs is a critical initial step in reducing the disproportionate obesity burden among these communities. However, no studies in Australia have assessed disadvantaged communities' readiness to engage in obesity prevention initiatives. What does this paper add? This paper addresses the current gap in the knowledge of disadvantaged communities' level of readiness to engage in childhood obesity prevention initiatives in Australia. The study also identified the key factors responsible for low readiness of disadvantaged communities to participate in current childhood obesity prevention services. By using the Community Readiness model this study shows the readiness levels specific to the various dimensions of the model; Understanding dimension-specific readiness allows us to identify strategies that are tailored to each dimension, as guided by the model. What are the implications for practitioners? With the increasing burden of childhood obesity on disadvantaged communities, policymakers and health practitioners are facing a crisis in obesity prevention and management. Almost every year, new interventions are being planned and implemented. However if the target communities are not ready to participate in the available interventions these efforts are futile. This study exposes the key factors responsible for low readiness to participate in current obesity prevention services by disadvantaged communities. Addressing these key factors and improving readiness before designing new interventions will improve the participation of disadvantaged communities in those interventions. The study findings ultimately have the potential of reducing obesity-related disparities in Australia.

Addressing migration-related social and health inequalities in Australia: call for research funding priorities to recognise the needs of migrant populations.

OBJECTIVE: Migrants constitute 26% of the total Australian population and, although disproportionately affected by chronic diseases, they are under-represented in health research. The aim of the present study was to describe trends in Australian Research Council (ARC)- and National Health and Medical Research Council (NHMRC)-funded initiatives from 2002 to 2011 with a key focus on migration-related research funding. METHODS: Data on all NHMRC- and ARC-funded initiatives between 2002 and 2011 were collected from the research funding statistics and national competitive grants program data systems, respectively. The research funding expenditures within these two schemes were categorised into two major groups: (1) people focused (migrant-related and mainstream-related); and (2) basic science focused. Descriptive statistics were used to summarise the data and report the trends in NHMRC and ARC funding over the 10-year period. RESULTS: Over 10 years, the ARC funded 15 354 initiatives worth A$5.5 billion, with 897 (5.8%) people-focused projects funded, worth A$254.4 million. Migrant-related research constituted 7.8% of all people-focused research. The NHMRC funded 12399 initiatives worth A$5.6 billion, with 447 (3.6%) people-focused projects funded, worth A$207.2 million. Migrant-related research accounted for 6.2% of all people-focused initiatives. CONCLUSIONS: Although migrant groups are disproportionately affected by social and health inequalities, the findings of the present study show that migrant-related research is inadequately funded compared with mainstream-related research. Unless equitable research funding is achieved, it will be impossible to build a strong evidence base for planning effective measures to reduce these inequalities among migrants.

Should blood donors be routinely screened for glucose-6-phosphate dehydrogenase deficiency? A systematic review of clinical studies focusing on patients transfused with glucose-6-phosphate dehydrogenase-deficient red cells.

The risk factors associated with the use of glucose-6-phosphate dehydrogenase (G6PD)-deficient blood in transfusion have not yet been well established. Therefore, the aim of this review was to evaluate whether whole blood from healthy G6PD-deficient donors is safe to use for transfusion. The study undertook a systematic review of English articles indexed in COCHRANE, MEDLINE, EMBASE, and CINHAL, with no date restriction up to March 2013, as well as those included in articles' reference lists and those included in Google Scholar. Inclusion criteria required that studies be randomized controlled trials, case controls, case reports, or prospective clinical series. Data were extracted following the Preferred Reporting Items for Systematic Reviews using a previously piloted form, which included fields for study design, population under study, sample size, study results, limitations, conclusions, and recommendations. The initial search identified 663 potentially relevant articles, of which only 13 studies met the inclusion criteria. The reported effects of G6PD-deficient transfused blood on neonates and children appear to be more deleterious than effects reported on adult patients. In most cases, the rise of total serum bilirubin was abnormal in infants transfused with G6PD-deficient blood from 6 hours up to 60 hours after transfusion. All studies on neonates and children, except one, recommended a routine screening for G6PD deficiency for this at-risk subpopulation because their immature hepatic function potentially makes them less able to handle any excess bilirubin load. It is difficult to make firm clinical conclusions and recommendations given the equivocal results, the lack of standardized evaluation methods to categorize red blood cell units as G6PD deficient (some of which are questionable), and the limited methodological quality and low quality of evidence. Notwithstanding these limitations, based on our review of the available literature, there is little to suggest that G6PD-deficient individuals should be excluded from donating red blood cells, although transfusions of such blood may potentially have negative impacts on premature neonates or patients who need repeated transfusions, and thus, for this group, screening for G6PD deficiency may be appropriate.

The influence of acculturation, medical mistrust, and perceived discrimination on knowledge about blood donation and blood donation status.

AIM: The aim of this research was to assess whether perceived discrimination, the level of acculturation, and medical mistrust are associated with knowledge about blood donation processes and blood donation status. METHODS: This cross-sectional study involved 425 African migrants recruited in Melbourne and Adelaide, Australia. Participants were surveyed face-to-face using bilingual workers to maximize the inclusion across different levels of literacy in the community. RESULTS: In the adjusted model, the scores for knowledge about blood donation were positively associated with a longer stay in Australia (ß = 0.12, p = 0.001), significantly higher among those with a tertiary education (ß = 0.75; p = 0.049), those who came from rural areas (ß = 1.54, p = 0.015), and Christians (ß = 1.83, p < 0.01) but significantly lower among those from the western African region (ß = -1.10, p = 0.032). Scores for knowledge about blood donation were lower among those who were marginalized (ß = -1.01, p = 0.026). Medical mistrust and perceived discrimination were not associated with knowledge about blood donation. Participants who were traditionally orientated were 69% less likely to have ever given blood than those who were bicultural or integrated (odds ratio [OR]: 0.31, p = 0.044), whereas the effects of perceived discrimination and medical mistrust were not significant. We also examined whether to restrict the analysis to those who had given blood in Australia postmigration and found that the level of acculturation and medical mistrust were not significant but that perceived discrimination, especially personal discrimination, mattered (OR = 0.63, p = 0.005). CONCLUSION: Efforts to increase blood donation among African migrants need to address the issues related to perceived personal discrimination as an important intervention target.

Demographic and socio-cultural correlates of medical mistrust in two Australian States: Victoria and South Australia.

Studies on medical mistrust have mainly focused on depicting the association between medical mistrust and access/utilization of healthcare services. The effect of broader socio-demographic and psycho-social factors on medical mistrust remains poorly documented. The study examined the effect of broader socio-demographic factors, acculturation, and discrimination on medical mistrust among 425 African migrants living in Victoria and South Australia, Australia. After adjusting for socio-demographic factors, low medical mistrust scores (i.e., more trusting of the system) were associated with refugee (ß=-4.27, p<0.01) and family reunion (ß=-4.01, p<0.01) migration statuses, being Christian (ß=-2.21, p<0.001), and living in rural or village areas prior to migration (ß=-2.09, p<0.05). Medical mistrust did not vary by the type of acculturation, but was positively related to perceived personal (ß=0.43, p<0.001) and societal (ß=0.38, p<0.001) discrimination. In order to reduce inequalities in healthcare access and utilisation and health outcomes, programs to enhance trust in the medical system among African migrants and to address discrimination within the community are needed.

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.