Participants

The data collection was completed as a non-probability sampling in cooperation with the Hungarian Red Cross. Two criteria were defined for including participants: one for the respondent to be of the legal age of 18 and one for the active whole blood donor status. The final sample size was 418 (31.6% were male and 68.4% were female) and heterogeneous both in terms of demographic background (18 counties) and age (18–68 years, M = 41.91; SD = 10.61), with the total number of donations (range = 1–163, M = 20.57) and the number of donations during COVID-19 (range = 0–9, M = 2.89). By type of residence, 17.9% of the participants lived in a capital city, 29.9% in a regional centre or larger town, 29.4% in a smaller town, and 22.7% in a village. Nearly half of the respondents were married and a quarter of them were currently in a relationship, 17.9% were single and 6.7% were divorced or separated. The majority (60.9%) of the sample had a tertiary and roughly a third of them had a secondary education level. 42.6% of the sample reported being religious. The descriptive data can be seen in Supplement 2.

Procedure and Measures

Before the data collection, the authors of this study obtained the approval of the Ethics Review Committee for Research at Eszterházy Károly Catholic University (RK/995/2021). In the first wave of data collection (August-November 2021), the paper-and-pencil survey was administered to a random sample of blood donors in each of the Hungarian regions allowing for a broad sample of age and demographic characteristics to be included. The data collection was conducted with the help of volunteer coordinators of the Hungarian Red Cross regional centres. In the meantime, an on-line version of the survey was also available. In this phase, a total number of 219 donors participated. The second wave of data collection was carried out online via the National Blood Service's newsletter, website and Facebook page between March and April 2022 (N = 199). The on-line data was collected through the UNIPOLL system in both phases. Before completion, prospective participants were provided with written information highlighting that their participation in the study was voluntary and anonymous and that the data obtained from the survey would be treated confidentially. Afterwards, the participants gave their informed consent to participate in the research.

The preliminary analyses were conducted using SPSS Version 26, and the path modelling analysis was conducted with JASP Version 0.19.0 [29]. We used Pearson’s correlation analysis to investigate the association between motivational and COVID-related factors, and intention to donate in the next 6 months. Path model analysis was conducted by the maximum likelihood estimation using the bootstrapping method. We evaluated the fit of the model with the following indices: χ2, RMSEA, SRMR, and CFI.

The survey contained the following parts:

Blood Donation History

The questions were selected on the basis of previous similar studies [30]. Respondents were asked if they had given whole blood before and, if so, how many times. The number of donations since the start of the COVID-19 pandemic were evaluated (11 March 2020), and the total number of their donations so far (See Supplement 3).

COVID-19-Related Concerns and Perceived Barriers

The questionnaire was designed in the present research using similar studies [3] and advice from experts working in the blood transfusion service. In this scale, eight items were used to examine the extent to which COVID-19 was associated with barriers like fear and safety (e.g., "I was afraid of contracting COVID at the blood donation site";”I did not feel safe to donate blood”), changed life circumstances and perceived inconveniences (e.g., “confinement was a barrier to blood donation”, “I have suffered personal losses'', “My general stress level increased”, My general activity level decreased”, “I experienced more side effects from donating blood than before the pandemic”; “It was harder to find a suitable blood donation venue than before the pandemic”). As the next step, a cumulative scale was created. The scale has a good reliability index (α = 0.869).

Hungarian Blood Donor Motivation Scale

The validated questionnaire [31] measures the motivational background of blood donors with twenty items across four factors. The first factor (Self-growth) contains eight items that are linked to the " personal gains" associated with donating blood, in particular, good feelings (sense of importance), overcoming personal problems, making new relationships, and health-related aspects (e.g. "Donating blood helps to overcome my problems"). The second factor (Habit and Identity) contains three items that highlight the habit- and identity-forming nature of blood donation (e.g. “It has become a habit for me to give blood, so I don't think about the reasons for it”). The third factor (Altruism and Prosocial Behavior) contains four items, which refer to the importance of helping others, compassion, caring, and prosocial values (e.g. "I donate blood because I feel compassion for those needing blood products"). The fourth factor is Social Reference, which contains five items with the positive influence of close contacts on blood donation, for example, whether the friends-acquaintances would like the person to donate blood (e.g. “People close to me want me to give blood”). The scale has a good reliability index (α = 0.826).

Blood Donation Self-Efficacy Scale

The four self-efficacy items (edited by the authors in this study) assessed an individual’s belief of their confidence and perceived ability to donate blood successfully (For example; “I believe in my capability to donate blood”; “I consider myself as able to be a blood donor as long as my health allows it”) on a five-point Likert scale. The scale achieved good internal consistency validity with a high Cronbach’s α of 0.82 in this study. The factor structure indicated good model fit during the confirmatory factor analysis (χ2 (2) = 3.26, p = 0.20, χ2/df = 1.63, RMSEA = 0.05, SRMR = 0.02, CFI = 0.99, TLI = 0.99).

Intention to Give Blood in the Next Six Months

The return of intention to donate blood was measured with a three-item scale. It assesses the willingness of the respondents to donate blood within the next 6 months. The scale measures the extent to which individuals intend to donate blood again within the next six months. It consisted of three items (“I plan to donate blood within the next 6 months”; “I want to donate blood during the next 6 months”; and “I intend to donate blood within the next 6 months”) with a 5-point Likert scale. This scale achieved good internal consistency validity with a high Cronbach’s α of 0.96 in this study.