Barriers to engaging in blood donation during the COVID-19 pandemic among nondonors and lapsed donors in a Chinese community : a critical medical anthropology perspective

Abstract

Background: The COVID-19 pandemic has presented a major challenge to maintaining a stable blood supply. In Hong Kong, the percentage of eligible donors who donated blood dropped from 2.7% before the pandemic to 2.34% and 2% during the pandemic. Objective: This study explored barriers to blood donation among nondonors and lapsed donors during the COVID-19 pandemic. Methods: A critical medical anthropology framework and a qualitative descriptive design were used. In-depth semi-structured interviews were conducted individually between February and July 2021 in Hong Kong with 80 adults aged 19–65 years who were nondonors or who had previously donated blood but had lapsed from doing so. Results: The participants who did not donate blood during the pandemic reported multiple reasons that arose during the pandemic and before it. The decision to not donate is sometimes the outcome of a social process established before the pandemic. Although institutional infection control and quarantine policies were most relevant for nondonation during the pandemic, policy and structural factors intertwined and created new social and cultural ideals that demotivated participants from donating blood. The difficult relationship between mainland China and Hong Kong as well as participants' unpleasant experiences with personnel in donor centres served as underlying barriers before the pandemic. Discussion: The decision not to donate during the pandemic cannot be explained by pandemic factors alone. Although the participants' sense of being a ‘good citizen’ arising from the new social norms developed in the pandemic at the intermediate level (quarantine policy) and the macro-level social structure (collective responsibility) had affected their micro-level perceptions (blood donation as unnecessary and risky and healthcare personnel as dangerous), their experiences at different social levels preceded the pandemic had played an important embedding role in reinforcing their nondonation during the pandemic. Conclusion: To enhance the motivation to donate blood among nondonors and lapsed donors, merely addressing the barriers arising from the pandemic is inadequate. Prepandemic factors should also be addressed. Patient or Public Contribution: The participants shared their experiences in the interviews. All participants had read and confirmed the content of their transcripts and referred more participants for this study.