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Abstract

As the global population ages, addressing blood donation among middle-aged and older adults is increasingly vital for societal and medical systems. Past research has examined the effectiveness of social marketing campaigns in promoting blood donation. This study aims to determine if social marketing can enhance continuous blood donation intentions in this demographic. The study surveyed 440 participants (aged 40–65; 51.25% female) regarding attitudes, subjective norms, perceived behavioral control, and behavioral intention related to blood donation. Participants’ perceptions of the social marketing 4Ps (product, price, place, promotion) for blood donation were also assessed. Results reveal that product, place, and promotion aspects of social marketing positively influence blood donation plan behavior in middle-aged and older adults. Moreover, subjective norms and perceived behavioral control positively impact their donation intentions. As middle-aged and older adults play a significant role in blood donation, this study offers valuable insights for future researchers and practitioners.

Plain language summary

Promote middle-aged and older adults’ blood donation intention with social marketing

As the world’s population gets older, it’s becoming more important for society and healthcare systems to address blood donation among middle-aged and older adults. Previous research has looked at how well social marketing campaigns encourage people to donate blood. This study investigated if using social marketing can make middle-aged and older adults more likely to keep donating blood regularly. They surveyed 440 participants (aged 40–65; 51.25% female) to ask about their thoughts, what others think, how much control they feel they have, and how much they want to donate blood. They also asked participants what they thought about the different aspects of social marketing (product, price, place, promotion) for blood donation. The results showed that product, place, and promotion all make middle-aged and older adults more likely to plan to donate blood. Also, what others think and how much control they feel they have make them more likely to want to donate. This study is important because middle-aged and older adults make up a large percentage of the population who can donate blood, and it gives useful information for future researchers and people working in this field.

Keywords

behavior intention blood donation older adults social marketing

Background

As the global older population continues to grow, it has brought various impacts to society, including shifts in the age distribution of blood donors. Although previous studies have suggested that the number of older blood donors may increase in the future (Drackley et al., 2012), recent research has found that the majority of blood donors are still young individuals (Fung et al., 2022; Patel et al., 2019). In addition to the age distribution of blood donors, Fung et al. (2022) also highlighted an interesting finding that the frequency of blood donation is higher among older population. Furthermore, promoting stable blood donation among older population can help society address certain underlying issues. For instance, older adults may be the primary recipients of blood transfusions (Mortazavi et al., 2023), so the increase in the older population could lead to an increased demand for blood donations. The upper limit of blood donation age has been loosened in some countries around the world due to the improvement of medical standards and the improvement of the health status of older adults. Many developed countries (e.g., Canada, New Zealand, United Kingdom, and United States) no longer have age restrictions on donating blood (Goldman et al., 2019). In addition, research has indicated that most older blood donors agree that the upper age limit for blood donation should be raised (Quee et al., 2024). Therefore, besides focusing on how to encourage more people to engage in blood donation, it is equally important to explore ways to encourage regular and repeated blood donation behavior among donors.

Blood Donation Behavior and Social Marketing

Over the years, various successful publicity strategies have been employed to promote voluntary non-remunerated blood donation (Martín-Santana et al., 2018; Torrent-Sellens et al., 2021). Notably, the use of marketing concepts in non-profit endeavors has garnered increasing attention (Blery et al., 2010; Dolnicar & Lazarevski, 2009), and applying these concepts to recruit voluntary unpaid blood donors has emerged as a significant trend in medical resource management. One prominent approach in promoting public welfare through marketing is “social marketing.” Social marketing is an intervention strategy aimed at changing public behavior patterns (Kotler & Lee, 2008) and has found widespread application in public health initiatives (Grier & Bryant, 2005). Previous research has explored how social marketing can promote blood donation (Beerli-Palacio & Martín-Santana, 2009, 2015; Behnampour et al., 2022; Pesavento & Bégué, 2011). However, limited attention has been given to the effect of social marketing on promoting blood donation among middle-aged and older adults. Therefore, the present research aims to bridge this gap in line with the global trend of population aging.

When planning or evaluating a social marketing plan, the “theory of planned behavior (TPB)” (Ajzen, 1991) can be utilized to understand message content and strategy. TPB is a social psychology theory that explains how attitudes, subjective norms, and perceived behavioral control influence an individual’s behavior. It suggests that a person’s intention to engage in a behavior is the most important predictor of their actual behavior. The theory posits that an individual’s intention is influenced by their attitude towards the behavior, their perception of the social norms surrounding the behavior, and their perception of their ability to control the behavior (Ajzen, 2002; Armitage & Conner, 2001; Godin & Kok, 1996; Sheeran, 2002).

TPB provides a framework for understanding and changing behavior, with Ajzen (1985) proposing that behavior occurrence is regulated by the strength of people’s intentions. The stronger the intention, the more likely people are to act, while a lower intention decreases the likelihood of action. TPB not only offers a foundation for shaping or modifying behavior but also applies to behavioral decision-making and explaining people’s conduct. As a result, TPB is frequently utilized in advertising marketing, health behavior, public relations, and environmental protection research (Conner & Sparks, 2015). This study intends to explore how social marketing can influence the blood donation behavior intentions of middle-aged and older adults. Thus, based on the social marketing concept derived from Kotler and Lee (2008) and combined with Ajzen’s (1985) TPB model, we investigate the extent to which social marketing is associated with blood donation behavior among middle-aged and older adults.

Promoting Middle-Aged and Older Adults’ Blood Donation Intention by Social Marketing

Blood donation is a crucial element of public health, as it provides a steady supply of blood for essential medical treatments. Understanding the blood donation intentions of older adults is vital in promoting continuous blood donation within this demographic. To achieve this, the 4Ps of social marketing—Product, Price, Place, and Promotion—can be effectively employed to encourage middle-aged and older individuals to donate blood. Let’s explore how each of these 4Ps can be utilized in the context of blood donation:

Product: In the context of blood donation, the product refers to the concept of blood donation itself. By highlighting the benefits of blood donation, such as saving lives and contributing to the community, people can better identify with the importance of this act and thus increase their willingness to donate (J.-S. Lin & Lu, 2008). Additionally, dispelling common misconceptions and fears related to blood donation, such as fear of needles or fainting, through informative activities (Zucoloto et al., 2019) can also boost willingness to donate. Therefore, promoting these concepts can have a positive impact on enhancing people’s willingness to donate blood.

Price: Perceived costs associated with donating blood can be a barrier for middle-aged and older adults. Implementing campaigns that offer incentives or rewards for blood donation can effectively reduce these perceived costs and increase willingness to donate (Lacetera & Macis, 2012; Lacetera et al., 2012). Importantly, the costs related to the blood donation process, including time and expenses, need to align with what middle-aged and older donors consider reasonable in order to encourage blood donation behavior.

Place: The location of blood donation centers can also be a hindrance for middle-aged and older individuals, especially those facing mobility or transportation issues. Research has shown that campaigns promoting the accessibility and convenience of blood donation centers, such as emphasizing their proximity to community locations or providing transportation to and from the centers (Şahinyazan et al., 2015), or even introducing mobile applications for blood donation (Hummady, 2022), can effectively increase blood donation. Ensuring that channels, locations, or venues for blood donation services are convenient will also enhance willingness to donate blood.

Promotion: Social marketing campaigns utilizing various promotional strategies can effectively promote blood donation among middle-aged and older adults. Persuasive messages that emphasize the benefits of blood donation, such as nonmonetary incentives, have been shown to increase blood donation intention (Chmielewski et al., 2012). Additionally, offering small coupons (Lacetera & Macis, 2012), refreshments, or free health checks can also boost willingness to donate (Chmielewski et al., 2012). Utilizing social media can be particularly effective, as more people are turning to social media for health information and community connections (Alanzi & Alsaeed, 2019).

Research has demonstrated that social marketing campaigns incorporating the 4Ps can effectively promote blood donation (Beerli-Palacio & Martín-Santana, 2015). For instance, Healy and Murphy (2017) found that altruism played a significant role in predicting blood donation intentions. This suggests that social marketing advertisements emphasizing selfless giving can be effective in promoting blood donation. Furthermore, campaigns using persuasive messages and collaborating with community organizations (Smith et al., 2011) have also proven effective in promoting blood donation. This highlights the importance of a comprehensive social marketing approach that employs a variety of strategies to promote blood donation.

In conclusion, by employing the 4Ps of social marketing—Product, Price, Place, and Promotion—social marketing campaigns can encourage middle-aged and older individuals to donate blood. Emphasizing the benefits of blood donation, reducing perceived costs, ensuring accessible and convenient donation locations, and using diverse promotional strategies can all contribute to increased blood donation among middle-aged and older adults, ultimately bolstering the availability of blood supply for medical treatments.

Hypothetical Inferences from Current Research

In the context of blood donation, the TPB can be used to understand why individuals may or may not engage in this behavior. Attitudes (AB) refer to an individual’s positive or negative evaluation of the behavior. AB is influenced by behavioral beliefs. Behavioral beliefs are associated with the individual’s expectation of the outcomes resulting from their relevant behavior, indicating that behavioral beliefs represent the subjective probability of a certain outcome resulting from the behavior the individual is concerned about (Ajzen, 1991). In the case of blood donation, AB might include beliefs about the importance of blood donation, perceived health benefits of donation, and concerns or fears about the donation process. Emphasizing the benefits of “product” and “price” in social marketing may be able to promote the AB of middle-aged and older people towards blood donation. Therefore, the current study proposes the following hypothesis:

Hypothesis 1 (H1): The more positive the middle-aged and older people’s perception of products in social marketing, the more positive their attitude towards blood donation.

Hypothesis 2 (H2): The more positive the middle-aged and older people’s perception of price in social marketing, the more positive their attitude towards blood donation.

Perceived behavioral control (PBC) refers to an individual’s perceived ability to perform the behavior. PBC is influenced by control beliefs. Control beliefs primarily focus on identifying the factors that may facilitate or hinder individuals from engaging in a specific behavior. In other words, it reflects the extent to which individuals perceive factors that can facilitate or hinder their behavioral performance when engaging in a particular behavior (Ajzen, 1991). In the context of blood donation, PBC might include beliefs about the convenience of finding a blood donation center or blood donation service hours. The benefits of “place” in social marketing may be able to promote the PBC of middle-aged and older people towards blood donation. Therefore, the current study proposes the following hypothesis:

Hypothesis 3 (H3): The more positive the middle-aged and older people’s perception of place in social marketing, the more positive their perceived behavioral control towards blood donation.

Subjective norms (SN) refer to the perceived social pressure to engage or not engage in a behavior. SN is influenced by normative beliefs. Normative beliefs involve the significant reference of personal or group expectations towards an individual’s adoption of a certain behavior. In other words, it refers to an individual’s perception of the importance of personal or group expectations as a reference for whether they should or should not engage in a particular behavior (Ajzen, 1991). In the context of blood donation, SN might include the opinions of family, friends, or colleagues about blood donation, as well as the perceived societal expectations about blood donation. The “promotion” in social marketing could potentially enhance the SN around blood donation among middle-aged and older individuals. Because various channels in society (including news reports, physical advertisements, or social media promotions) promote blood donation, it may lead people to perceive this behavior as socially endorsed, thus strengthening their SN towards blood donation. Therefore, the current study proposes the following hypothesis:

Hypothesis 4 (H4): The more positive the middle-aged and older people’s perception of promotion in social marketing, the more positive their subjective norms towards blood donation.

In addition, research has consistently shown that attitudes towards blood donation are strongly associated with a higher likelihood of intending to donate blood and actually donating blood (Conner et al., 2013; Lownik et al., 2012). For example, a study conducted in Trinidad and Tobago found that people who had positive attitudes towards blood donation were more likely to have donated blood in the past and expressed stronger intentions to donate blood in the future (Sampath et al., 2007). Therefore, the current study proposes the following hypothesis:

Hypothesis 5 (H5): Positive attitudes towards blood donation can have a positive influence on middle-aged and older adult’s behavioral intention.

Research has also shown that subjective norms can be an important predictor of blood donation behavior (Clowes & Masser, 2012). For example, a study conducted in Sub-Saharan Africa found that pro-social motivation and the desire to have a positive effect on the community were significant predictor of blood donation behavior (Zanin et al., 2016). Therefore, the current study proposes the following hypothesis:

Hypothesis 6 (H6): Positive subjective norms towards blood donation can have a positive influence on middle-aged and older adult’s behavioral intention.

Finally, research has consistently shown that perceived behavioral control is a significant predictor of blood donation behavior (J. L. France et al., 2014). For example, Giles and Cairns (1995) indicated that perceived behavioral control was a significant predictor of intention to donate blood and actual donation behavior. Therefore, the current study proposes the following hypothesis:

Hypothesis 7 (H7): Positive perceived behavioral control towards blood donation can have a positive influence on middle-aged and older adult’s behavioral intention.

Method

In order to test the hypotheses proposed in the current study, the research methodology consists of two parts: (1) pilot test and (2) formal research investigation based on the pilot test. The purpose of the pilot test was to verify the reliability and validity of the questionnaire modified for blood donation behavior based on past research. Next, the purpose of a formal survey study is to test whether the hypotheses of the current study holds.

Pilot Test

For the pilot test, this study collected and integrated questionnaire items based on past literature. This study compiled topics for each dimension according to the research survey needs, then discussed the suitability between items and facets using exploratory factor analysis, followed by a reliability analysis. Based on the results of the exploratory factor analysis, this study removed certain items to create the final questionnaire. The questionnaire included three parts: the first part focused on the theory of planned behavior in blood donation, the second part addressed social marketing perceptions related to blood donation, and the third part gathered basic demographic information.

Measures

Theory of Planed Behavior

This part of the questionnaire covered attitudes, subjective norms, perceived behavioral control, and behavioral intentions regarding blood donation. It included a total of 24 items, compiled with reference to the studies by Chen et al. (2017) and Hsiao (2019). Additionally, the researchers adjusted the items to focus specifically on “blood donation behavior.” The scale used a 5-point Likert scale, where higher scores indicated a stronger intention to donate blood.

Social Marketing Cognition of Blood Donation

The questionnaire was compiled with reference to the questionnaire designed by Tsung (1995), M.-C. Lin (2001), and J.-S. Lin and Lu (2008), with a total of 15 items. To explore the relationship between the blood donation behavior of the middle-aged and older adults and the application of the 4Ps of social marketing. The scale used a 5-point Likert scale, where higher scores indicated more positive social marketing cognition of blood donation.

Participants of Pilot Test

The pilot test questionnaire used purposive sampling. The current study recruited people aged 41 to 65 (average age: 54.52) who had ever donated blood as pilot test participants. A total of 70 questionnaires were distributed, and 58 valid questionnaires (82.9%) were recovered.

Exploratory Factor Analysis

Reliability analysis and exploratory factor analysis were conducted as a foundation for the formal questionnaire. First, a sampling appropriateness test, including the KMO and Bartlett’s test of sphericity, was performed to assess suitability for factor analysis. The KMO value ranged from 0 to 1; the higher the value, the more common factors were present among variables, making the data more appropriate for factor analysis. In contrast, a KMO value below 0.5 indicated unsuitability for factor analysis. The KMO value was judged as follows: 0.8 ≤ KMO ≤ 0.9 indicated good (meritorious); 0.7 ≤ KMO ≤ 0.8 indicated medium (middling); 0.6 ≤ KMO ≤ 0.7 indicated mediocre; and 0.5 ≤ KMO ≤ 0.6 indicated not suitable (miserable) (Cureton & D’Agostino, 1993; Kaiser, 1970; Kaiser & Rice, 1974). Additionally, Bartlett’s test of sphericity, proposed by Bartlett (1951), was used to assess the correlation matrix of variables to determine if the data followed a multivariate normal distribution and if it was appropriate for factor analysis.

Results of Pilot Test

Table 1 showed that the KMO value of the variable and Bartlett’s sphericity test reached a significant level, indicating the presence of common factors among the variables, making them suitable for factor analysis. In the factor analysis of each dimension in this study, we used Principal Component Analysis (PCA) to obtain the factor loadings for five dimensions: attitude, subjective norm, perceived behavioral control, behavioral intention, and social marketing cognition. We deleted items with factor loadings less than .4 (Wang et al., 2019). This process resulted in a final questionnaire containing 35 items, including: 6 items on attitude, 5 on subjective norm, 5 on perceived behavioral control, 5 on behavioral intention, and 14 on social marketing cognition (2 on product, 2 on price, 4 on place, and 6 on promotion).

Table 1.

KMO and Bartlett Test of Sphericity Value.

Dimension	KMO	Bartlett test of sphericity	p
Attitude	0.855	421.386	<.001
Subjective norm	0.672	228.196	<.001
Perceived behavioral control	0.744	116.389	<.001
Behavioral intention	0.826	202.218	<.001
Social marketing cognition	0.830	609.214	<.001

Participants of the Current Research

This study uses purposive sampling. The locations where the questionnaire was distributed included blood donation locations in the northern and central districts of Taiwan. A total of 470 formal questionnaires were distributed, and 30 were invalid, with a valid sample rate of 93.62%. In addition, limited by the regulations of the research site (Taiwan), currently only adults under the age of 65 are allowed to donate blood, so the maximum age of the samples in the current study is only 65 years old. Additionally, we chosed to include participants starting from age 41 because, had Taiwan followed other countries in lifting the age restriction, individuals in this age group would likely have become the next potential donors. By understanding the attitudes and intentions of this age cohort, we aimed to gain insights into their potential behavior in a future context where age restrictions might have been relaxed. Therefore, the current study takes 440 participants as a valid sample, and Table 2 shows the statistical information of the basic information of all participants.

Table 2.

The Basic Information of All Participants.

N = 440	Group	N	%
Gender	Male	215	48.75
Gender	Female	225	51.25
Age	41–45	78	17.68
	46–50	133	30.15
	51–55	73	16.55
	56–60	48	10.88
	61–65	108	24.48
Education level	Junior high school (included) and below	7	1.58
	High school	84	19.04
	Colleges and universities	210	47.61
	Master’s degree or above	139	31.51
The number of blood donation (times)	1–3 time(s)	219	49.65
	4–6 times	63	14.28
	7–9 times	20	4.53
	Over 10 times	138	31.29

Data Analysis

In this study, SPSS 23.0 and SmartPLS 3.2.6 were used for statistical analysis and hypothesis verification. It includes descriptive statistical analysis, exploratory factor analysis, confirmatory factor analysis and partial least squares (PLS). Descriptive statistical analysis was used to present the basic information of the participants; exploratory factor analysis was used to develop the research instrument (i.e., questionnaire); confirmatory factor analysis was used to valid the reliability and validity analysis of the measurement model; PLS was used to check the fit of the research instrument and to test the research hypothesis. This study uses SmartPLS version 3.2.6 for data analysis (Ringle et al., 2015). PLS was used to estimate the reliability and validity of the measurement model and the path coefficient of the structural model, and the bootstrap method was used to repeatedly draw samples 5,000 times to verify the significance of all estimated parameters. Since the main function of PLS is to explore and explain more complex models, it maximizes the predictive ability, overcomes the problem of multicollinearity, and is not limited by data distribution (Hair et al., 2012). Furthermore, Hair et al. (2021) pointed out that PLS is a better choice if the variable relationship or construct measurement of the structural model is not very clear, or when the research focus is on exploration rather than verification. Therefore, PLS is very suitable for the data type of this study. The analysis and interpretation of the PLS model in this study is divided into two parts. The first part is to test the reliability and validity of the measurement model; the second part is to test the significance and predictive power of the path coefficient of the structural model.

Results

Reliability and Validity Analysis of the Measurement Model

The measurement model analysis includes three aspects: internal consistency reliability, convergent validity and discriminant validity. According to Hair et al.’s (2021) suggestion, the factor loadings of all observed variables should be higher than .50, and the combined reliability (CR) should also be higher than .70 to confirm that the measured variables achieve internal consistency. The average variance extracted (AVE) should be greater than .50 to confirm that the model has convergent validity. In this study, through the confirmatory factor analysis (CFA) in PLS, it was found that the measurement models of all facets were in line with Hair et al.’s (2021) recommended standard value, indicating that the measurement model of this study has good reliability and validity. The above results are shown in Table 3.

Table 3.

Reliability and Validity of Each Dimension.

Dimension	Item	Factor loading	Cronbach’s alpha (α)	CR	AVE
Product (P1)	P1-1	.88	.72	0.88	0.78
Product (P1)	P1-2	.89	.72	0.88	0.78
Price (P2)	P2-1	.95	.91	0.96	0.92
Price (P2)	P2-2	.97	.91	0.96	0.92
Place (P3)	P3-1	.57	.81	0.88	0.64
	P3-2	.91
	P3-3	.79
	P3-4	.89
Promotion (P4)	P4-1	.57	.91	0.93	0.71
	P4-2	.85
	P4-3	.92
	P4-4	.92
	P4-5	.87
	P4-6	.87
Attitude (AB)	AB-1	.82	.87	0.91	0.63
	AB-2	.84
	AB-3	.83
	AB-4	.86
	AB-5	.89
	AB-6	.46
Subjective norm (SN)	SN-1	.84	.86	0.90	0.65
	SN-2	.89
	SN-3	.90
	SN-4	.69
	SN-5	.68
Perceived behavioral control (PBC)	PBC-1	.66	.77	0.84	0.52
	PBC-2	.77
	PBC-3	.66
	PBC-4	.75
	PBC-5	.76
Behavioral intention (BI)	BI-1	.63	.88	0.92	0.69
	BI-2	.88
	BI-3	.80
	BI-4	.90
	BI-5	.91

Furthermore, Table 4 shows the values of the square root of AVE are greater than the correlation coefficients between the respective dimension and other dimensions, meeting the requirements of the Fornell–Larcker indicator (Hair et al., 2021).

Table 4.

The Correlation Analysis and Discriminate Validity of the Measurement Model.

Variable	M (SD)	Correlation analysis
	M (SD)	P1	P2	P3	P4	AB	SN	PBC	BI
Product (P1)	1.87 (0.66)	.88
Price (P2)	3.11 (1.07)	.43**	.96
Place (P3)	2.15 (0.71)	.44**	.39**	.80
Promotion (P4)	2.37 (0.86)	.42**	.32**	.53**	.84
Attitude (AB)	1.49 (0.49)	.53**	.19**	.43**	.31**	.80
Subjective norm (SN)	1.97 (0.68)	.58**	.33**	.45**	.52**	.59**	.80
Perceived behavioral control (PBC)	1.88 (0.65)	.40**	.15**	.40**	.50**	.45**	.44**	.72
Behavioral intention (BI)	2.30 (0.86)	.48**	.26**	.36**	.55**	.41**	.48**	.71**	.83

Note. Value on the diagonal with italics fonts is the square root of AVE and the value below the italics number of the diagonal is the correlation coefficient between the corresponding construct and other constructs.

p < .01.

Full Model Verification Results

First, the GOF value of the overall model is 0.47, which has a good degree of fit (Wetzels et al., 2009), and subsequent analysis can be carried out (Figure 1).

Figure 1.

Initial model and hypotheses.

The structural model analysis results are shown in Table 5. Product cognition of social marketing was positively and significantly correlated with attitude (β = .55***, t = 15.25), supporting Hypothesis 1. The R² value for attitude was .29, indicating that product cognition explained 29% of the variance in attitude. Price cognition of social marketing did not show a significant correlation with attitude (β = −.05, t = 1.17), so Hypothesis 2 was not supported. Place cognition of social marketing was positively and significantly correlated with perceived behavioral control (β = .40***, t = 8.55), supporting Hypothesis 3. The R² value for perceived behavioral control was .16, meaning that place cognition explained 16% of its variance. Promote cognition of social marketing showed a positive and significant correlation with subjective norm (β = .52***, t = 13.22), supporting Hypothesis 4. The R² for subjective norm was .27, indicating that promote cognition explained 27% of its variance. Attitude was not significantly correlated with behavioral intention (β = .02, t = 0.51), so Hypothesis 5 was not supported. Subjective norm showed a positive and significant correlation with behavioral intention (β = .19***, t = 4.24), supporting Hypothesis 6. The R² for behavioral intention was .56, indicating that subjective norm and perceived behavioral control together explained 56% of the variance in behavioral intention. Perceived behavioral control was also positively and significantly correlated with behavioral intention (β = .63***, t = 15.18), supporting Hypothesis 7. The results are shown in Figure 2.

Table 5.

Effects of the Full Model.

Hypothesis	Relationships of variables	Path coefficient	Standard deviation (SD)	t	p	Hypothesis testing
H1	P1 → AB	0.55	0.036	15.25	<.001	Supported
H2	P2 → AB	−0.05	0.040	1.17	.242	—
H3	P3 → PBC	0.40	0.047	8.55	<.001	Supported
H4	P4 → SN	0.52	0.039	13.22	<.001	Supported
H5	AB → BI	0.02	0.034	0.51	.611	—
H6	SN → BI	0.19	0.045	4.24	<.001	Supported
H7	PBC → BI	0.63	0.042	15.18	<.001	Supported

Figure 2.

Full model of PLS-SEM.

Discussion

Based on current research results, subjective norm and perceived behavioral control are two important factors that have a significant effect on middle-aged and older adults’ continuous blood donation behavioral intentions. These two factors can have a positive influence on our behavioral intentions by shaping our beliefs towards the behavior.

First, subjective norms can be a motivator for behavior change because people often look to others for guidance on what is socially acceptable or desirable. If we perceive that our friends, family, or colleagues support a particular behavior, we are more likely to adopt it ourselves (Cialdini & Goldstein, 2004). For example, a study found that students who believed their peers supported recycling had stronger intentions to recycle themselves (Schultz et al., 2007). Such a situation based on subjective norms also occurs in blood donation behavior intentions (Clowes & Masser, 2012; Zanin et al., 2016). The current research infers that middle-aged and older people may have a stronger sense of social responsibility as they get older, so the current research results show that subjective norms are significantly associated with blood donation behavior intentions.

Second, perceived behavioral control can also have a positive relationship with middle-aged and older adults’ blood donation behavioral intentions. If we feel that a behavior is too difficult or beyond our control, we may be less motivated to engage in it. This situation also occurs in the behavior of blood donation (Li et al., 2021). For example, individuals with higher self-efficacy towards blood donation have higher intentions to donate blood (Veldhuizen et al., 2011), and the same pattern was found during the COVID-19 pandemic (Masser et al., 2020). Therefore, blood donors’ confidence in their own situation may lead to more active blood donation behavior, and vice versa. In summary, based on the fact that over 50% of the current study participants had donated blood more than four times, we believe this may have led to the current study’s results showing a significant positive correlation between perceived behavioral control and blood donation intention.

Finally, in the current findings, attitudes did not have a positive or negative effect on behavioral intentions to donate blood. Therefore, the current study attempts to provide a plausible explanation. Several past studies have found that attitudes towards blood donation may not always be related to behavioral intentions to donate blood. For instance, while Abdel Gader et al. (2011) found that 92% of non-donors expressed a very positive attitude towards donating blood, Eshak et al.’s (2019) research indicates that positive attitudes increase the likelihood of giving is negligible. These findings suggest that attitudes towards blood donation may not always translate into actual behavior. One possible explanation for this discrepancy is that attitudes are often influenced by social norms and external pressures, which may not necessarily translate into a strong personal motivation to donate blood (Conner & Armitage, 1998). It can be seen that the above situation may also occur in middle-aged and older blood donors. In addition, some past research has suggested that education should be used as a means of promoting attitudes towards blood donation (Abderrahman & Saleh, 2014; C. R. France et al., 2010, 2011). Similar methods may need to be reconsidered when applied to middle-aged and older adults, because the results of this study reveal that attitudes may not be the main factor affecting blood donation behavior intentions in middle-aged and older people.

The Potential of the 4Ps in Promoting Blood Donation Behavior

Based on the current research results, we have three important findings regarding the 4Ps of social marketing for blood donation among middle-aged and older adults: (1) product cognition has a significant positive relationship with attitude, (2) place cognition has a significant positive relationship with perceived behavioral control, and (3) promotion cognition has a significant positive relationship with subjective norm.

First, in terms of product cognition of social marketing, this study evaluates the importance placed on the concept of blood donation, such as its potential to save lives and benefit the community. A study on blood donors in China found that 68.2% of participants cited helping patients as a motivation for donating blood, 65.5% noted the health benefits, and 43.8% valued the free blood type test and health checkup (Ou-Yang et al., 2017). Therefore, the current study suggests that social marketing campaigns emphasizing the positive aspects of blood donation may align with the motivations of Chinese blood donors and foster a more positive attitude toward blood donation behavior.

Secondly, regarding place cognition of social marketing, this study assesses participants’ perceptions of the convenience of blood donation, such as shuttle services between donation centers and communities and extended operating hours at donation stations. The findings indicate that perceived convenience is positively related to the perceived behavioral control of middle-aged and older adults regarding blood donation. For example, Şahinyazan et al. (2015) found that closer proximity to blood centers or the provision of transportation options can increase the willingness to donate. For middle-aged and older adults, long distances or complex travel arrangements may act as barriers (Chaudhury et al., 2012; Xie et al., 2018). Consequently, this study suggests that reducing these barriers could enhance perceived behavioral control over blood donation among middle-aged and older adults.

Third, in terms of promotion cognition of social marketing, this study examines participants’ perceptions of blood donation promotion efforts, such as social media campaigns and traditional media outreach. The results indicate that as middle-aged and older adults perceive these promotional messages more positively, their subjective norms regarding blood donation also improve. Past research has shown that social marketing on social media can successfully raise awareness and combat stigmatization (Sampogna et al., 2017). Research by Duh and Dabula (2021) suggests that social media can shape new reference groups, influencing the awareness of family members and peers. Therefore, we speculate that when middle-aged and older adults see blood donation messages widely disseminated online or in the community, they perceive it as a socially supported trend, which strengthens their subjective norms.

Lastly, this study found no significant relationship between the price cognition of social marketing and older adults’ attitudes toward blood donation. While previous studies have indicated that small or non-monetary incentives can increase blood donation (Lacetera & Macis, 2012; Lacetera et al., 2012), and past research suggests that incentive feedback is more influential among younger people than those aged 55 and over (Glynn et al., 2003). This difference may explain why the current study did not find a significant relationship between price perception and attitude among older adults.

Limitations

First and foremost, it is important to note that this study was conducted during the outbreak of the severe acute respiratory syndrome coronavirus, known as COVID-19, from April 2021 to May 2021. This major public health and safety event might have influenced the attention and participation of middle-aged and older individuals in blood donation, which could have impacted the research results. This limitation is considered a force majeure factor beyond the control of this study. In light of this, future studies are recommended to continuously update knowledge on blood donation behavior among middle-aged and older individuals to account for differences across various periods and regions.

Additionally, it is worth mentioning that the participants in the current study were all individuals who had previously donated blood. Therefore, the results of this study may not be easily applicable to middle-aged and older individuals who have never donated blood before. Moreover, it should be noted that the current participants tended to have higher education levels, with university and graduate education comprising 79.12% of the study participants. Therefore, caution should be exercised when interpreting the findings of this study. This study did not collect data on participants’ employment status or their access to blood donation centers, which could be important factors influencing blood donation behavior. Employment status may affect an individual’s availability and willingness to donate blood, as those with more flexible schedules might have greater opportunities to participate in donation activities. Similarly, proximity and ease of access to blood donation centers can significantly influence one’s likelihood to donate, as individuals with limited access may face logistical barriers. While our study primarily focused on the direct impact of social marketing factors on blood donation intentions, we recognize that these additional socioeconomic and logistical variables could further contextualize and enhance the understanding of blood donation behavior. Future research should consider incorporating these variables to capture a more comprehensive view of the factors influencing donation behavior, particularly among diverse demographic groups.

Lastly, the current study utilized a cross-sectional approach, making it challenging to capture the long-term blood donation behavior of middle-aged and older individuals. While this study provided valuable insights into the factors influencing the intention to donate blood among middle-aged and older adults, future research should aim to measure actual blood donation behavior. A potential approach would be to conduct longitudinal studies or follow-up surveys (e.g., Osei-Boakye et al., 2024) to observe whether participants who expressed a willingness to donate blood eventually acted on their intentions. Additionally, integrating data from blood donation centers on actual donation rates could offer a more comprehensive view of the gap between intention and behavior. Further research could also explore factors influencing this discrepancy, such as logistical challenges or situational changes that might prevent individuals from following through on their intentions. By examining these aspects, future studies can enhance our understanding of the behavioral mechanisms behind blood donation and improve the effectiveness of targeted social marketing interventions. This approach would provide a more complete picture of blood donation behavior, allowing for more practical recommendations and policies to encourage consistent and actual blood donation among targeted populations.

Conclusion and Implications

Given the fact that the global population is facing the reality of aging, social and medical systems should pay more attention to the blood donation situation of middle-aged and older adults. The current study aims to explore the potential of applying social marketing to promote blood donation behavior among middle-aged and older adults, and hopes to further expand the related research field. Based on the current research results, it is suggested that future social marketing activities aimed at promoting blood donation among middle-aged and older adults should focus more on eliminating barriers to their participation in blood donation behavior. For example, this study found that the place of blood donation may be one of the key factors in middle-aged and older adults’ perceived behavioral control of blood donation. In conclusion, in the future, whether as blood donors or recipients, middle-aged and older adults may account for a larger proportion of the population, so it is hoped that the findings of this study can provide some useful recommendations for future researchers and practitioners.

Footnotes

Authors’ Note

C.-C. Liu is an Assistant Professor, H.-C. Lin is a Professor, and J.-Y. Wang is a MEd. All three authors are from the same institution, and all agree to the submission and publication of this manuscript.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Chih-Chi Liu

Hung-Chou Lin

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. The data are not publicly available due to restrictions their containing information that could compromise the privacy of research participants.

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Promote Middle-Aged and Older Adults’ Blood Donation Intention with Concepts of Social Marketing and Theory of Planned Behavior: A Cross-Sectional Survey

Abstract

Plain language summary

Keywords

Background

Blood Donation Behavior and Social Marketing

Promoting Middle-Aged and Older Adults’ Blood Donation Intention by Social Marketing

Hypothetical Inferences from Current Research

Method

Pilot Test

Measures

Theory of Planed Behavior

Social Marketing Cognition of Blood Donation

Participants of Pilot Test

Exploratory Factor Analysis

Results of Pilot Test

Participants of the Current Research

Data Analysis

Results

Reliability and Validity Analysis of the Measurement Model

Full Model Verification Results

Discussion

The Potential of the 4Ps in Promoting Blood Donation Behavior

Limitations

Conclusion and Implications

Footnotes

Authors’ Note

Declaration of Conflicting Interests

Funding

ORCID iDs

Data Availability Statement

References