All stages of the research were carried out at the Regional Hemotherapy Center of Franca, a city of approximately 300,000 inhabitants, located in the southern state of São Paulo. In 2017, 12,814 blood donations were made by donors who had visited this facility.

This study on the development of a self-reporting questionnaire was performed in three stages. The first stage was the development of a preliminary version of the instrument in which the items of a questionnaire, introduced by Borges et al.,9 were updated, based on the perceptions of blood donors participating in focus groups. A preliminary version of the new instrument was then elaborated and, in the second stage, submitted to content validity. Subsequently, the instrument was updated again before being submitted to a pre-test (i.e., third stage) by using a sample of blood donors. The study protocol was approved by the Human Research Ethical Committee of the Ribeirão Preto Medical School at the University of Sao Paulo, under the protocol number 1.845.298.

This stage used blood donor focus groups to search for new items that could be associated with blood donation, subsequently using them to revise the questionnaire proposed by Borges et al.9 Thirty participants were randomly invited through telephone contact and the meetings were held with groups of 10 donors each in a comfortable room. Illiterate and visually impaired donors were not selected to participate, as the questionnaire was intended to be self-administered. The meetings began with the explanation that the participants could speak freely and that the expression of opinion would not affect their frequenting of the blood bank. The following questions were discussed sequentially: "Why do you donate blood?"; "When you come here to donate your blood, what do you expect?"; "What makes a donor satisfied?"; "What makes a donor unsatisfied?"; "Have you ever donated blood elsewhere?”, and; “How was the experience?". Thematic content analysis was applied for data analysis, comprising three phases: ordering, classification and final analysis. From the participant reports, the items of the proposed questionnaire on blood donor satisfaction were distributed into three categories, as proposed by Borges et al.,7 namely, accessibility and convenience, technical aspects and interpersonal aspects. For the purpose of this study, accessibility was defined as the ability of donors to get quick access to the facility and convenience, as the donor perception of time and effort required to donate blood. Technical aspects involved the perceptions of the physical structure of the facility and professional competence of the staff. Interpersonal aspects included the relationship between the donor and professionals involved in the blood donation process. The items of the proposed questionnaire were not structured as affirmative statements, as in the questionnaire developed by Borges et al.7 Instead, the items were structured based on satisfaction attributes which were assessed by the donors according to their degree of satisfaction on a five-point scale ranging from “completely dissatisfied” to “completely satisfied”.

The content validity describes the degree to which the elements of an assessment instrument are relevant and representative of the construct to be measured.12 In the present study, the content validity referred to the assessment of the clarity and relevance of the instrument items by a panel of experts, in order to determine a set of items representing the blood donor satisfaction.13,14 Thus, the instrument proposed in the previous stage was evaluated by a group of 12 raters, that is, hemotherapists, physicians, and nurses with at least one year of experience in blood donor service. The raters were not informed about which domain each item was associated with.

Content validity comprises four criteria15:

• (a)

  Relevance of the items. Experts were asked to classify each item as essential, useful but not essential and not necessary. For each item, the content validity ratio (CVR) was is given by the formula CVR = (E – n/2)/(n/2), where “n” is the total of raters and “E” is the total number of raters who indicated the item as essential. The CVR ranges from -1 to +1, being negative when less than half of the raters assessed an item as essential. According to Table 2 of the article by Wilson et al.,16 for an item to be retained, an item CVR must be more than 0.566 for a sample of 12 raters.

• (b)

  Clarity. With regard to the wording itself, each item of the instrument was classified by the raters according to three possible answers: "It is very clear", "A small revision is necessary" or "A substantial revision is necessary". If necessary, the experts could write suggestions to improve the wording of each item.

• (c)

  Domain structure. The experts classified each item of the instrument according to its domain: accessibility/convenience, technical aspects and interpersonal aspects. In addition, the raters were allowed to classify an item as belonging to any of these domains. The factorial validity index (FVI)13 determines the degree to which the raters correctly associate each item to its respective domain. The FVI of each item is given by the number of raters who correctly associated the item to its domain, divided by the total number of raters.

• (d)

  Comprehensiveness. The comprehensiveness of the satisfaction measurement is indicated by the raters, who suggested items to be excluded from, or included in, the questionnaire. In this manner, the raters were asked to answer two questions: "What items do you recommend to be excluded from the questionnaire on blood donor satisfaction?" and "What other items do you suggest that should be included in the questionnaire on blood donor satisfaction?"

A revised version of the questionnaire was self-administered to a convenience sample of blood donors after they signed a free consent form. All donors who visited the facility and completed the whole process of blood donation in a defined period of three days were invited to participate. An alternative option was included in each item in this version of the questionnaire, asking the donor whether he or she had clearly understood the statement. The questionnaire was anonymously filled out by the donors in the blood center cafeteria after the blood collection process was over. The cafeteria is a quiet and cozy environment where the donors were allowed enough time to complete the questionnaire, which was performed at the end of their stay. At this moment, it was presumed that the donors were able to evaluate their satisfaction with the whole process of blood donation.

Among the thirty blood donors invited to participate in the focus groups, 19 were present at the scheduled time (7 women and 12 men; mean age of 39.4 years; age range of 19–63 years). The thematic content analysis allowed for an appreciation of the interpersonal aspects, such as the service provided by the blood bank staff. Based on the donor perception of what he or she reported to be most important to his or her satisfaction, a new 25-item instrument was thus developed. These items are listed in the first column of Table 1. Items 1, 4, 8, 17, 21 and 23 were designed to be appropriate for the domain “accessibility/convenience”, items 6, 7, 10, 12, 14, 15, 18 and 19, for the domain “technical aspects” and items 2, 3, 5, 9, 11, 13, 16, 20, 22, 24 and 25, for the domain “interpersonal aspects”.

The level of overall satisfaction was assessed by the following question: “In general, how satisfied were you with the services provided in the blood bank?” This question was included in the questionnaire to avoid a possible response bias resulting from a stimulus caused by the content of these items.

The questionnaire elaborated in the previous stage was evaluated by a group of 12 raters. Table 1 shows the CVR, FVI, suggestions (if any) for changes and exclusions, and conclusion on content validity. Items 4, 6, 17, 18, 20, 21, 22 and 24 presented the CVR values less than 0.566, that is, their validity is questionable according to the raters. Items 18, 22 and 24 were classified as "not necessary" by one rater, whereas item 19 was also classified as "not necessary" by two raters. Meanwhile, we have decided to keep these items in the instrument to describe important aspects regarding the welcoming reception. Table 1 also shows the FVI for each item. One can observe that items 4, 6, 14 and 21 have FVI values less than 0.5, and only four items (5, 9, 11 and 24) presented FVI values higher than 0.8, suggesting that the instrument may have an unclear factorial structure.

As for the clarity of the items, the raters considered items 1–6, 8–11, 13, 16–19, and 21 not clear enough and thus, in need of revision (Table 1). In these cases, the raters presented suggestions to improve the wording of the items. Based on these suggestions and on the CVR and FVI values, the last column of Table 1 describes the measures taken in relation to possible modifications in the instrument.

When asked to suggest items that could be included in the instrument, some raters suggested addressing aspects such as entertainment options in the waiting room, Wi-Fi access, car parking, donor communication after donation, efficient campaigns and appointment scheduling service. Although these items are important, we believe they do not meet the needs of all blood donors in general and thus, they can be further assessed by specific studies. One rater suggested inserting blank lines after each item so that the donors could write the reasons for possible dissatisfaction with it. In these cases, however, we believe that the donor should be motivated to use the suggestion box, as the satisfaction questionnaire does not replace other quality management procedures adopted by blood banks.

Of the 142 invited blood donors, 28 (19.7 %) refused to participate in this stage. The final sample included 114 blood donors, 50 women and 63 men, aged 18–61 years (mean age of 33 years; standard deviation of 9.7 years). Only one donor reported misunderstanding items 1 and 4 of the instrument. Five donors reported being "completely dissatisfied" in all 25 items of the instrument and five other donors reported being "completely dissatisfied" in almost all items. After completing the instrument, these donors reported not paying attention to the option scale, as they thought they were answering "completely satisfied", while indicating "completely dissatisfied". To avoid this problem in the future application of the instrument, it was decided to add emoticons to the choice scale representing satisfaction categories. Emoticons were also added to the general satisfaction scale. Considering these improvements, Figs. 1 and 2 in the Appendix show the final version of the Blood Donor Satisfaction Questionnaire (BDSQ) written in Brazilian Portuguese (front and back respectively).

Fig. 1.

The blood donor satisfaction questionnaire (BDSQ) in Brazilian Portuguese (front).

(0.55MB).

Fig. 2.

The blood donor satisfaction questionnaire (BDSQ) in Brazilian Portuguese (back).

(0.59MB).