In Brazil, blood donation has not been remunerated in any way since 1980.1 The implementation of an altruistic donation model brought the need for strategies to encourage the population to donate blood voluntarily and regularly. It has been suggested that an understanding of the characteristics of donor groups provides information for the development of effective recruitment and retention strategies.2,3 While about 5% of people in the United States donate blood each year,3 less than 2% of the Brazilian population do it regularly.4 In Brazil, it is estimated that only 40% of people return within one year after the first donation and 53% within two years.5 In addition, it is estimated that 30% never return to donate after the first donation.

Information about opinions, motivation and feelings of blood donors is important for the organization and administration of blood centers6 as well as to establish a profile of these individuals. This information can serve as a basis for the elaboration of projects that aim to educate, mobilize, attract and retain regular voluntary donors.

Published articles on the motivation and recruitment of blood donors have described that altruism/humanitarianism, sense of solidarity or duty, social pressure, replacement and reward, and possible personal or family benefits are the main reasons for donation.7–9 In addition, the study by Gonçalez et al.10 showed that altruism is the main motivator for blood donation in Brazil, although Oliveira et al.11 warned that many of the Brazilian blood donors could be motivated for reasons that are not exclusively altruistic, such as seeking tests. Pessi12 showed that attitudes and acts of altruism are indeed linked to religiosity. If people with religious ties contribute more actively to charitable practices, it is expected that there is some relationship between religiosity and attitudes concerning blood donation. In fact, Abohghasemi et al.13 showed that after altruism, religious beliefs are the most common positive motivation for blood donation among Iranians. In a Canadian study,14 it was found that 7.6% of the respondents reported that religious convictions motivated them to start donating blood. However, in the report on religiousness and blood donation in a large and nationally representative sample of young adults published by Gillum and Masters,15 religiousness was not associated with a history of blood donation in men, with the exception of higher donation rates among Catholic men aged 35–44 years old. In addition, a North American study,16 on investigating the relationship of sociodemographic and attitudinal factors with a history of blood donation among the general public, did not find a significant association between religious and spiritual salience and prior history of donation.

Thus, in order to bring more light on this issue, the purpose of the present study was to examine the association between religiousness and blood donation among Brazilian postgraduate students. The attitudes of postgraduate students of health-related areas toward blood donation can be of great importance as they are potentially ‘opinion leaders’ on social and public health topics, considering that their future activities will be focused on education and healthcare.

Seventy-two percent of the subjects who participated in the study were women with a mean age of 29.0 years (range: 22–52 years old) and twenty-eight percent were men with a mean age of 30.3 years (range: 23–55 years old). Table 2 shows the characteristics of the participants. The most common religious affiliations were Catholicism (54.4%), and Kardecist Spiritism (21.2%). Kardecist Spiritism is a religion with aspects of science and philosophy that originated in France in the 18th century and was popularized in Brazil in the mid-20th century. An inspection of the data in Table 2 suggests that women are more likely to have religious affiliations, considering that the frequency of atheists and agnostics is higher among men than among women (14.1% versus 2.4%, respectively).

All study participants had completed undergraduate courses in health-related areas. Table 2 shows that the most common professions were nurses (19.0%), followed by physicians, nutritionists, physiotherapists, pharmaceuticals, biologists, biophysicians, physical educators, and other professionals with frequencies of less than 10 representatives. A total of 21.6% of the women who participated in the study were regular blood donors, in comparison with 28.1% of the men.

Table 3 shows the students’ blood donation attitudes with regard to social standards. The regular donors participating in the study had a higher frequency of people in their homes who also donated blood (64% versus 40% of the students who intended to become donors and 32% in the non-donor group). The results in Table 3 also suggest that the frequency of close friends disapproving of people who refused to donate blood is higher among blood donors compared with students intending to become a donor. In addition, the presence of close friends who donated blood was more common among regular donors than among non-donors and students who intended to become a donor.

Table 4 lists the means and standard deviations for the ORA, NORA and IR dimensions of the P-DUREL, according to gender, age, religion, and attitude toward blood donation.

Table 5 shows the results of the beta-binomial regression analyses, including ORA, NORA and IR scores as dependent variables and gender, age group and blood donation attitude as independent variables. The coefficients shown in this table are measures of the effect of each covariate on the mean values of the dependent variable in a logit scale.25 Coefficients higher than zero are suggestive of a positive association, whereas coefficients of less than zero are suggestive of a negative association. Ninety-five percent credible intervals different from zero suggest significant associations. The intercept is a constant value, that is, the value of the link function when all the independent variables are equal to zero. Thus, the regression analysis suggests that women tend to have higher mean ORA, NORA and IR scores than men. Regular donors tend to have higher mean ORA scores than non-donors, and regular donors tend to have higher mean IR scores than students who donated only once and intend to return. In addition, students older than 40 years tend to have higher mean IR scores.

While many authors have postulated that religiosity correlates strongly with participating in charitable actions, Otto and Bolle29 suggested that overall altruism is related to charity giving, but not to blood donation behavior. Thus, it is possible that the various aspects of altruism link differently to specific behaviors, and consequently, attitudinal factors toward blood donation involve a complex set of values, satisfaction with services, trust, fear and feelings. Although religiousness is an important feature of human behavior, there are few studies in the literature directly dealing with the possible relationship between religiousness and blood donation. Gillum and Masters15 state that they conducted the first report on religiousness and blood donation in a large, nationally representative sample of young adults. However, these authors did not find any direct connection between religiousness and history of blood donation. Unlike this important report, the present study finds that, in a specific group of university students, religiousness can be a factor that potentially influences the decision to donate blood.

The major limitation of the present study lies in the characteristics of the subjects. The analyses were performed in a restricted population of individuals who had graduated in courses in health-related areas and they thus tend to be knowledgeable of the importance of blood donation. In addition, they were mostly women. All these factors complicate the extrapolation of the results to broader populations. Contact with the university environment, where the practice of blood donation is highly regarded is, per se, a factor that influences the decision to donate blood. In fact, the results in Table 2 show that 23.5% of the participants are regular donors, whereas less than 2% of the Brazilian population donates blood regularly.4 Despite these limitations, the results of the present study are potentially important for the following reasons. Firstly, there is a lack of studies of possible associations between religiousness and attitudes toward blood donation, mainly using validated instruments. Even the study by Gillum and Master,15 which highlighted the relationship between religiousness and blood donation, did not use a validated instrument to assess religiousness. In this aspect, the present study is thus innovative although the results are restricted to a group of people with particular characteristics. Secondly, the results show that religiousness is inserted in this context as an example of dimension that can stimulate blood donation among these individuals, even though they receive other stimuli from the environment in which they live. It is hoped that the future professional activities of these students will be directed to community healthcare and teaching to promote health. Thus, these subjects may play an important role in spreading the importance of donating blood in the community. Thus, the results of this article are useful to understand this process. Thirdly, the results of this study can encourage further investigations about the role of religiousness in the blood donation decision-making process in respect to other specific populations of interest or a broader population. Hence, these studies can help to develop effective interventions to improve the retention and recruitment of new blood donors. Another possible limitation of this study is that the statistical regression model did not include socioeconomic variables to minimize possible confounding effects. However, the study used a sample in which all subjects had completed a university degree and it is thus assumed that there is not great heterogeneity among them in terms of socioeconomic factors. This would reduce a possible confounding effect in relation to these variables.

Statistical analysis shows that regular donors have higher religiosity scores than non-donors, suggesting that this may be a predictor of attitudes about blood donation. The participation in religious organizations can encourage relationships with people who have values and attitudes that encourage blood donation, and the results in Table 3 suggest that regular donors have contact with people, socially or within their families, who also donate blood. This result is corroborated by Healy,30 who hypothesized that people involved in religious organizations are more likely to donate blood. Considering that participants in the present study have good access to health information, it is clear that knowledge is not sufficient to influence the attitude of the individual toward blood donation. In accordance with Renaud and Bouchard,31 individuals just assume a given behavior when they are inserted in a social network that encourages such a behavior. Thus, social networks and active participation within religious circles would be a remarkable aspect of the association between blood donation and organizational religiousness, an issue that deserves to be explored in more detail in further studies.

Non-organizational religiousness, expressed by private religious activities such as prayer, meditation, and reading of religious books, has been related to poorer physical health.32 However, this should not apply to the participants in this study because they are health professionals and have good access to information and health services. The present study shows that female students have higher non-organizational religiousness than male students, but this finding does not allow us to state that non-organizational religiousness is associated with blood donation. Sample means for NORA scores are higher for regular donors than for non-donors (Table 4), but there is no evidence that this may be extrapolated to a broad population (the corresponding credible intervals contain zero; Table 5). However, further studies using larger samples should be encouraged in order to verify whether this absence of evidence is a consequence of a possible low power for hypothesis testing.

The present study also evidenced a relationship between intrinsic religiousness (IR) and attitudes toward blood donation. In addition to the studies that reckoned that positive aspects of religiousness are conducive to maintaining mental health in medically ill patients,33 the findings of the present study reinforce the condition that religiousness is also intertwined with altruistic acts potentially beneficial to the health of the community. New studies should be encouraged to bring new insights in the understanding of the role played by the different dimensions of religiosity in the intention to donate blood, return for further donations, and to practice altruistic attitudes concerning the promotion of health.

The authors declare no conflicts of interest.