Sexual behaviour-based screening questions: Understanding and mitigating donor discomfort
What is this research about?
Screening blood donors to determine their eligibility to donate is an important layer of safety within the blood system. To screen prospective donors, blood operators use a donor questionnaire (DQ) that asks questions about potential exposure to infections that could be transmitted via transfusion to recipients. With the current DQ used in Canada, men are deferred from donating blood for three months since the date of their last sexual contact with a man. This screening approach has been criticized for being discriminatory. Despite incremental changes in recent years, these time-based donor eligibility criteria still exclude many sexually active gay, bisexual and other men who have sex with men (gbMSM), including some trans, non-binary and other gender diverse people, and do not consider an individual donor’s risk of exposure to sexually transmitted infections, regardless of sexual orientation. In late 2021, Canadian Blood Services filed a proposal with its regulator, Health Canada, to use an alternative approach to screen donors. If approved, questions that ask about men having sex with men will be replaced with gender neutral, sexual behaviour-based screening questions asked of all donors. This study assessed the approach’s feasibility by exploring:
How donors understand proposed alternative sexual behaviour-based screening questions;
How acceptable they think the questions are; and
How comfortable they feel answering them.
Most donors are likely to find sexual behaviour-based screening questions understandable and acceptable and feel comfortable answering them. Still, blood operators can use mitigating strategies to enhance donors' understanding and comfort level.
What did the researchers do?
Recruitment emails were sent to randomly selected Canadian Blood Services donors meeting inclusion criteria. From these, forty whole blood and plasma donors were selected for semi-structured one-on-one interviews in which they were asked open-ended questions that explored their understanding of, and comfort with, three sexual behaviour-based screening questions:
In the last 3 months, have you had a new sexual partner?
In the last 3 months, have you and your sexual partner only had sex with each other?
In the last 3 months, have you had anal sex?
Researchers analyzed data to assess participants' understandings of the questions, examine their comfort/discomfort, and identify strategies to mitigate donor discomfort.
What did the researchers find?
While all participants reported understanding what the three sexual behaviour-based questions were asking, participants thought some terms (e.g., “sex,” “partner,” and “new”) would benefit from being clarified. All participants considered the questions acceptable, and most felt comfortable answering them. Participants’ comfort/discomfort was influenced by several factors such as their expectations of screening, the social norms they bring to donation, whether their answer felt like a personal disclosure, knowing why the questions were being asked, trusting the confidentiality of the process, their confidence in knowing their sexual partner's behaviour, and the potential for the question to be discriminatory. Based on the findings, the researchers suggest four mitigating strategies to enhance donors' comfort: forewarning donors that questions about sexual behaviours will be asked; providing an explanation for why questions are being asked; clarifying ambiguous words; and using a self-administered questionnaire (e.g., a web-based app).
How can you use this research?
Canadian Blood Services is committed to making blood donation as inclusive as possible while maintaining the safety of the blood supply. By addressing concerns about donor discomfort and potential impacts on the sufficiency of the blood supply related to this, these findings support Canadian Blood Services’ submission to Health Canada to change the DQ and ask sexual behaviour-based screening questions. The results suggest that donor loss resulting from donor discomfort is likely to be minimal – not one participant stated that they would stop donating due to discomfort. Some participants viewed sexual behaviour-based screening questions as less discriminatory than the current questions about men having sex with men. Most participants did not perceive the addition of these questions to be a significant change to their donation experience. That said, the study indicates that mitigating strategies to reduce potential discomfort among donors should be considered. These could include a short explanation added to the DQ before sexual behaviour-based questions; explanatory videos that could be made available online; and providing donors with information about terms/words used. The findings can also inform blood operators’ communication plans and staff training plans around implementing such a change.
About the research team
Dr. Jennie Haw is a Canadian Blood Services scientist and an Adjunct Research Professor, Department of Health Sciences, Carleton University. Dr. William Fisher is a distinguished professor emeritus and adjunct research professor - social and personality psychology at Western University. Dr. Taylor Kohut is an adjunct research professor in the Department of Psychology at Western University. Hyunjin Woo is a master's student at the Institute of Health Policy, Management and Evaluation, University of Toronto and is the author of this Research Unit.
This research unit is derived from the following publication(s)
Haw J, Woo H, Kohut T and Fisher W: Sexual risk behaviour questions: Understanding and mitigating donor discomfort. Transfusion 2022; 62(2):355-364. Doi: 10.1111/trf.16755.
Acknowledgements: This research was supported by the MSM Plasma Program, funded by the federal government (Health Canada). The research was also supported by Canadian Blood Services which is funded by the federal government (Health Canada) and the provincial and territorial ministries of health. The views herein do not necessarily reflect the views of the federal, provincial, or territorial governments of Canada. Canadian Blood Services is grateful to blood donors for making this research possible.