The fear associated with blood and organ

donation: an explication of fright and anxiety

Context—Fear inhibits potential donors’ willingness to engage in behaviors. Thomas Richard Wagner,
Theoretically, fright and anxiety are differentially associated with blood and organ PhD, Chris Manolis, PhD
donation, respectively. Fright is the experience of an immediate harm, whereas anxiety Xavier University, Cincinnati, Ohio
is a fear of the unknown.
Objective—To compare the fear-related concepts of fright and anxiety in relation Corresponding author: Thomas Richard
to blood donation and signing an organ donor card. Wagner, PhD, Department of Communica-
Design—Scales were created to separate the 2 fear types that were consistent in tion Arts, Xavier University, 3800 Victory
theme and addressed the same dependent variables fright and anxiety. Parkway, Cincinnati, OH 45207-3214
Setting and Participants—Participants were 509 college students at a large mid- (e-mail: wagnert@xavier.edu)
western university.
Results—Survey responses from 509 participants supported the theoretical expli-
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confirmatory factor analysis supported that fright and anxiety were differentially 101 Columbia, Aliso Viejo, CA 92656
associated with the contexts of blood and organ donation. Phone (800) 899-1712 (ext 532) or
Conclusions—The results supported the theoretical proposal that fright and anxiety (949) 448-7370 (ext 532)
are differentially related. The ability to measure such emotions will help future Fax (949) 362-2049
researchers create models that are more accurate for predicting potential donors E-mail reprints@aacn.org
and create messages to assuage fears. A greater understanding of fear will lead to
more effective messages. (Progress in Transplantation. 2012;22:200-206)

©2012 NATCO, The Organization for Transplant Professionals

doi: http://dx.doi.org/10.7182/pit2012467

I n this study, we explored the differences between

the fear types of anxiety and fright in blood and
organ donation settings. Previous research has shown
that fear of engaging in health-related behavior affects
attitudes, intentions, and behaviors toward engaging in
the act itself.1-4 However, this research has not exam-
ined the differences between the types of fears associ-
ated with various health-related acts. The present study
attempts to create measures that differentially assess the
fear types, fright and anxiety, in blood and organ dona-
tion contexts, respectively.
Lazarus’s5 theoretical conception of fear seems use-
ful in distinguishing measures in these 2 donation con-
texts because he separates fear into 2 types: anxiety and
fright. Lazarus theorized that related but distinct forms of
fear arise from known and unknown dangers. Anxiety
arises when an individual’s existential meaning is dis-
rupted. Lazarus5 posited that anxiety is unique from other
types of fear because the threats associated with the neg-
ative affect of anxiety are threats of the unknown.
According to Lazarus, existential anxiety reminds people
of their mortality. Another distinguishing feature of anx-
iety is that the threat is abstract rather than concrete.
Anxiety is fear of the unknown, lacking immediate phys-
ical harm. Lazarus and Lazarus6 explained that people
have an underlying fear of death that is not in our
immediate conscience. We usually don’t think of death
on a regular basis but, for many people, experiences
related to this fear produce the emotion of anxiety.
Activities that remind people of their own mortality,
such as any activity related to the idea of organ dona-
tion, produce feelings of uncertainty and anxiety.
Lazarus5 defined fright as fear that involves immi-
nent physical harm. People can pinpoint and accu-
rately identify the harm. For example, understanding
the pain associated with being burned can produce the
emotion of fright when faced with the possibility of
being burned by fire. People who are experiencing
fright are able to describe what they are afraid of,
whereas people experiencing anxiety may not be able
to specifically describe their concern. Lazarus described
the differences between anxiety and fright:

200 Progress in Transplantation, Vol 22, No. 2, June 2012 www.progressintransplantation.org


As with anxiety, uncertainty or ambiguity is
always a feature of fright because the harm is
always in the future. However, since the dan-
ger is concrete and sudden and there is little
time to reflect, uncertainty is not always as
prominent in fright as it is in anxiety, where
the threat is symbolic, existential, and
ephemeral.5(p235)
Lazarus conceptually distinguishes fright and anx-
iety as fear of the known and unknown, respectively.
Fright and anxiety provoke the action tendencies of
escape and avoidance, respectively. Because the harm
is understood in fright, the avoidance impulse is direct.
With anxiety, the source of the threat is not fully under-
stood because of its existential nature and, therefore,
neither is the action tendency and thus avoidance.
Lazarus and Lazarus6(p54) described the differences
in how people experience the emotions of anxiety and
fright. Anxiety is an uncertain threat, often experi-
enced as “low or moderate intensity, a state of distress
that remains chronic or recurrent.” Anxiety makes peo-
ple uneasy about an existential concern: often fear of
death. Fright is an immediate prospect of injury or
pain. The experience of fright is higher in intensity than
anxiety. Still, Lazarus and Lazarus6(p50) describe the 2
fear types as “close cousins,” thus, the 2 constructs are
theoretically related.
Lazarus’s conceptualization of anxiety is pertinent
to organ donation as research has shown that fear of
death and anxiety is associated with organ donation.
Amir and Haskell7 found a positive correlation between
participants who had not signed an organ donor card
and fear of death. In addition, Smith et al8 created mes-
sages to reduce anxiety associated with signing an organ
donor card but did not measure anxiety directly. Lester9
found a positive relationship between scores on a fear
of death scale and an unwillingness to donate organs.
People have described their feelings associated
with signing an organ donor card as uncomfortable.10
In their directions for future research, Morgan et al11
emphasized the importance of studying the relation-
ship between existential anxiety and organ donation
directly. The researchers explained that they had not
included the measurement of anxiety in their current
study “because of difficulties involved in the opera-
tionalization in the face of little extant research and a
dearth of reliable, valid, measures.”11(p655) Furthermore,
the researchers stressed the need to study anxiety stat-
ing “although this is rarely mentioned directly, exis-
tential anxiety almost surely plays a role in personal
reactions to organ donation.”11(p655) Subsequent research
included 2 questions to measure the anxiety associated
with the lack of information about family members’
donation beliefs.12 Still, the anxiety experienced in
relation to the decision to sign an organ donor card has
www.progressintransplantation.org
The fear associated with blood and organ donation
not been directly measured and compared with the
type of fear experienced with other health-related dona-
tion gifts. The type of fear experienced when signing
an organ donor card relates to Lazarus’s explanation
of anxiety.
On the other hand, in blood donation, the fears that
individuals experience are consistent with Lazarus’s
explication of fright. These fears are concrete threats
of immediate physical harm. Mathew et al13 and Sojka
and Sojka14 explored the specific deterrents associated
with blood donation, including fear of needles, pain,
and fear of contracting or finding out about a disease.
Researchers have found that the fears experienced with
blood donation are associated with immediate physi-
cal harm, and this emotional experience fits Lazarus’s
definition of fright.1,15,16
The purpose of the current study was to test
Lazarus’s theoretical explanation of fear types of fright
and anxiety in the contexts of blood and organ dona-
tion and to understand further how the fear types are
distinct.5 Specifically, we set out to create and test an
empirically valid measure of the emotions associated
with giving blood and signing an organ donor card.
Methods and Results
Phase 1: Item Generation
The initial phase of the scale development was
item generation. Two 5-item questionnaires were gen-
erated to measure fright and anxiety in the context of
blood and organ donation acts (signing an organ donor
card). The items from these questionnaires can be
viewed in Table 1, but the actual measures did not con-
tain labels. Two emotion researchers created the items
based on Lazuras’s5 theoretical explanation of the 2
fear types, and the items were further scrutinized by a
doctoral level research methods class at a large Mid-
western University as part of an in-class activity. For
each questionnaire, 2 of the items were stated from a
positive perspective (eg, “Needles are not a problem
for me.”) to reduce the potentially biasing effect of
responding to all negative statements. Also, positive and
negative items were randomly interspersed in each scale.
Fear measures include pain associated with donating,
concern about disease/infection and lowered immune
resistance, and general anxiety/nervousness. Seven-point
(strongly agree to strongly disagree) scales were used.
Phase 2: Initial Data Collection
The item-generation phase of the study resulted in
a 10-item scale, 5 items meant to measure fear of giv-
ing blood and 5 items measuring anxiety associated
with being an organ donor. Although we expect the 2
factors to correlate positively and significantly with
each other, we also posit that the 2 factors will demon-
strate a clear distinctiveness when compared with
each other.
Progress in Transplantation, Vol 22, No. 2, June 2012 201
Wagner and Manolis
Table 1 Items from questionnaires about fear of blood donation and anxiety about signing an organ donor carda
The following items are to assess your feelings about blood donation and signing an organ donor card. Your answers will be used
only for research purposes. Please answer the items honestly, in terms of how you really feel, not how you would like to be.
Strongly disagree
1 2 3 4
Blood donation: fright
1. Donating blood would involve too much pain for me.
2. I am generally not frightened to donate blood.
3. Needles are not a problem for me.
*4. I can pinpoint my fears toward donating blood.
*5. I feel that real harm will result from my involvement in blood donation.
Signing an organ donor card: anxiety
*6. I am not sure why I feel uncomfortable with the idea of donating organs.
7. The idea of donating organs makes me anxious.
8. The idea of donating organs makes me nervous.
9. I feel uneasy about donating organs.
10. The thought of donating organs gives me an uneasy feeling of what might happen in the future.
a Items with an asterisk were removed because of poor fit of the statistical model.
To test the different types of fear in the contexts
of blood and organ donation, 509 undergraduate stu-
dents from a large Midwestern university voluntarily
agreed to participate in the study. The university’s
institutional review board approved the study. Partici-
pants were recruited from introductory communica-
tion classes, and research participation was voluntary.
All participants were handed measures with an informed
consent sheet as the top page and asked to fill them out
anonymously. Students reviewed the informed con-
sent sheet and elected whether or not to participate.
Those who chose to participate filled out the measure
(see Table 1) and returned their responses to a research
assistant. To protect anonymity, all informed consent
documents and measures were disassembled before
data entry.
This student population is desired because healthy
young adults are ideal donors for both blood and sign-
ing an organ donor card. This population is more often
engaged in more reckless behavior than other seg-
ments of the population, making them ideal candidates
for donation of healthy organs. Also, previous research17
has shown that college students account for a large
percentage of the blood donor population. Participants
in this study were 61.6% female, predominantly white,
and ranged in age from 18 to 27 years old.
In the initial data analysis, we tested the scale with
a sample of all 314 female participants taken from the
total 509 participants in the study. Initial analyses con-
sisted of both exploratory factor analysis (principal
components analysis) and reliability estimates (Cron-
bach α) and revealed a more parsimonious scale.
Although a 2-factor solution adhering to a priori expec-
tations (a fear of giving blood factor and an anxiety
associated with being an organ donor factor) explained
the data, 3 items were deemed inappropriate because
202 Progress in Transplantation, Vol 22, No. 2, June 2012
Strongly agree
5 6 7
of poor factor loadings and low reliability estimates.
Specifically, 2 items from the fear of giving blood fac-
tor and 1 item from the anxiety associated with being
an organ donor factor were omitted (Table 1). The
reliability coefficient for the fear of giving blood fac-
tor was 0.826, and the reliability coefficient for anxiety
associated with being an organ donor factor was 0.832.
At this point, we subjected these data to a confir-
matory factor analysis (CFA) in order to verify statis-
tically the structure of the reduced, 7-item instrument
and the accompanying factors. The test of a measure-
ment model with the 2 hypothesized latent variables
produced a very good fit, χ 13 2 = 11.0, P < .61, compar-
ative fit index [CFI] = 1.0, incremental fit index [IFI]
= 1.0, and root-mean-square error of approximation
[RMSEA] = 0.0 (the χ 21 2 for the null model was 946).
In addition to the nonsignificant χ 2 estimate, all
parameter estimates loaded significantly onto their
respective factors, P values < .001) with an average
loading of 0.76 (ranging from 0.56 to 0.93). As
expected, the 2 factors—fear of giving blood and anx-
iety associated with being an organ donor—were pos-
itively and significantly correlated (r = 0.28, P = .01),
but at the same time, demonstrated a fair degree of
distinctiveness.
The dimension variance of each scale item was
also computed. These components of variance provide
additional evidence of the reliability of scores on indi-
vidual items. A widely accepted critical value, 0.50,
specifies that at least 50% of the variance in an item is
due to the hypothesized dimension.18,19 The remainder
of variance is systematic nondimension-related and
random error. Approximately 71% of the individual
item reliabilities (5 of 7) either met or exceeded the
critical value of 0.50 with an average variance of 0.60
(range, 0.31-0.86). The dimension-related indices of
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Table 2 Two-group comparisons
Hypothesis χ2 df Comparative fit index
Baseline 1352.9 42
1 36.1 26 0.99
2 57.0 31 0.98
3 59.8 32 0.97
average variance extracted are considered additional
indicators of reliability. Because each of the 2 factors
explained at least 50% of the variance (0.62 and 0.58
for fear of giving blood and anxiety associated with
being an organ donor, respectively) in the average
item, the items were deemed satisfactory.
Phase 3: A Second Data Analysis Effort
In a second data analysis effort, we tested the
scale with all 195 male participants from a total sam-
ple of 509 participants. We chose males such that we
could subsequently compare both male and female
samples on the newly devised scale as we have no rea-
son to believe that the 2 sexes should differ according
to their fear or anxiety levels associated with giving
blood and being an organ donor, respectively. In this
way, the scale can be compared directly across 2 sim-
ilar yet independent samples for structural invariance.
For the scale to be generally applicable, it should have
similar structural properties across comparable yet
independent samples. If a scale is not nearly equiva-
lent across similar yet independent samples, then the
relation of fear and/or anxiety levels to other variables
can be confounded by scaling differences, and the
comparison of standings on the scale across samples
becomes superfluous. It was determined a priori to not
only test statistically the structure of the scale with the
newly collected data (eg, conduct a CFA with the sam-
ple of males), but also to compare statistically the struc-
ture of the scale across the 2 samples (the female and
male samples) by using a structural equation, multiple-
group modeling approach (ie, simultaneously estimat-
ing a measurement model across 2 independent groups
or samples).
The results of the CFA for the male data revealed
a well-fitting model estimating the same 2 hypothe-
sized latent variables measured with the male data,
2 = 25.05, P = .02, CFI = 0.97, IFI = 0.97, RMSEA =
χ 13
0.07 (the χ 221 for the null model was 407.11).
Although the χ2 was significant in this model at P<.05,
the remaining fit indices suggest a fairly well-fitting
model. For instance, RMSEA values up to 0.08 usu-
ally signal acceptable model fit.20 The reliability
coefficients for the fear of giving blood and anxiety
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The fear associated with blood and organ donation
Root-mean-square
Incremental fit index error of approximation
0.99 0.04
0.98 0.06
0.98 0.06
associated with being an organ donor factors were
0.69 and 0.82, respectively. All parameter estimates
loaded significantly on to their respective factors (P
values < .001) with an average loading of 0.70 (rang-
ing from 0.51 to 0.86). The 2 factors were again posi-
tively and significantly correlated (r = 0.21, P = .05)
yet conceptually distinct.
The dimension variance of each scale item indi-
cated that approximately 57% of the individual item
reliabilities (4 of 7) either met or exceeded the critical
value of 0.50 with an average variance of 0.50 (rang-
ing from 0.26 to 0.74). Further, each factor explained
or came very close to explaining at least 50% of the
variance in the average item (0.44 and 0.55 for fear of
giving blood and anxiety associated with being an
organ donor, respectively), and, as before, the items
were deemed satisfactory. Next, we conducted the
multisample analysis.
Phase 4: A Multisample Analysis
As alluded to earlier, it was predicted that the
structure of the “blood-fear, organ-anxiety” scale would
be similar for the 2 sexes (samples). In this case, we
estimate simultaneously a measurement model for each
independent sample. As a rule, multisample models
have large χ2 values and can be difficult to estimate.21
Further, it is unrealistic to expect a multisample analy-
sis to produce a better fitting model than any single-
sample model, given that the lack of fit in 1 sample
leads to lack of fit in the multiple-group model, and
the lack of fit in any 1 sample contributes to the over-
all χ2 test.
Three specific hypotheses were tested in a multi-
sample analysis (Table 2). Overall, the hypotheses eval-
uate the extent to which the item responses are similar
across the 2 samples (ie, invariance). The test for each
hypothesis imposes increasingly more stringent con-
straints, forcing the 2 models to be more and more sim-
ilar. The extent to which these constraints are shown
to be statistically appropriate further validates the
invariant nature of the scale.
First, a test of form (H1) in the present context is
whether the model for the 2 samples (corresponding to
the female and male samples) has the same number of
Progress in Transplantation, Vol 22, No. 2, June 2012 203
Wagner and Manolis
Table 3 Items from questionnaire about anxiety about blood donation and fear of organ donation
The following items are to assess your feelings about blood donation and signing an organ donor card. Your answers will be used
only for research purposes. Please answer the items honestly, in terms of how you really feel, not how you would like to be.
Strongly disagree
1 2 3 4
Blood donation: anxiety
1. The idea of donating blood makes me anxious.
2. The idea of donating blood makes me nervous.
3. I feel uneasy about donating blood.
4. The thought of donating blood gives me an uneasy feeling of what might happen in the future.
Signing an organ donor card: fright
5. Donating organs would involve too much pain for me.
6. I am generally not frightened to donate organs.
7. I believe that signing an organ donor card would not affect the care I receive at a hospital.
latent variables (factors) with the same indicators, and
the same specification of fixed and free parameters.
Table 2 presents the χ2 estimates and summary fit indices
generated by this test of form. The insignificant χ2
value (36.1, df = 26, P = .09) and high values for the fit
indices lead to the conclusion that the model form holds
similarly for the 2 samples. Thus, H1 is supported.
Having received support for this initial test of
invariance, we conducted 2 subsequent tests of invari-
ance in a hierarchical fashion. The hypothesis that the
factor coefficients were equal for the 2 groups (H2)
was tested next. This hypothesis restricted the regres-
sion of the items on the factors (ie, slopes relating the
measures to the latent variables) to be equal for the 2
samples. Although the χ2 estimate of 57.0 with 31
degrees of freedom was statistically significant (P =
.003), the relatively high goodness-of-fit measures
accompanying this test (CFI = 0.98, IFI = 0.98,
RMSEA = 0.06) provided evidence that the factor struc-
ture is largely invariant across the 2 groups. The χ2
difference (Δχ2) between H2 and H1 is 20.9 with 5
degrees of freedom. When compared with a cutoff
critical χ2 value of 20.5 (P < .001), this test suggests
caution in accepting the added restriction (ie, equal
slopes). The individual parameter estimates for the 2
samples (models), however, indicate that the 2 sets of
factor coefficients are in fact highly similar. The aver-
age difference in standardized factor coefficients across
the 2 samples, for instance, is 0.077 with the single
largest difference equal to 0.172. This result suggests
that the Δχ2 test is very sensitive.22
The final test of invariance added the restriction
that the covariance matrix for the 3 empirically derived
factors was invariant across the 2 samples (H3). This
implies that the factor covariances (or interfactor cor-
relations) are equal in the 2 samples. Table 2 shows
that H3 had a χ2 estimate of 59.8 with 32 degrees of
freedom (P = .002) and fit indices that were very high
(CFI=0.98, IFI=0.98, RMSEA=0.059), thus providing
204 Progress in Transplantation, Vol 22, No. 2, June 2012
Strongly agree
5 6 7
continued support for the invariance prediction. An
examination of interfactor correlations revealed simi-
lar values across the samples, and the Δχ2 of H3 and
H2 (2.8 with 1 degree of freedom) is not significant (P
= .05). In the end, ample evidence suggests that the
factor intercorrelations are equivalent across the 2 inde-
pendent groups or samples, and H3 is supported.
Overall, the multisample analyses corroborate the
consistency of the empirically derived models across
the 2 independent samples of male and female respon-
dents. Such findings give us the confidence that the
factors derived from the present inventory are valid,
reliable, and robust. Next, we estimate an alternative
model for comparison purposes.
Phase Five: An Alternative Model
In a final attempt to verify the current “blood-
fear, organ-anxiety” scale, we estimated an alternative
model. Specifically, we derived a blood-anxiety, organ-
fear scale and compared its measurement model to the
current blood-fear, organ-anxiety measurement model.
We created the new scale by replacing the words “donat-
ing blood” with the words “donating organs” across the
entire 7-item scale (Table 3). Thus, the scales were con-
sistent in theme and addressed the same dependent vari-
ables. We then had the same group of male and female
respondents reply to the newly devised inventory.
Having found consistent evidence that the male and
female samples were largely invariant with respect to
the structure of the blood-fear, organ-anxiety scale, we
combined the 2 samples (males and females) for this
phase of the research. Thus, we endeavor to compare the
original blood-fear, organ-anxiety measurement model
(Table 1) by using a combined male-female sample with
a blood-anxiety, organ-fear measurement model (Table
3) that uses the same combined sample. We assume the
latter model will evidence a worse fit with the data
according to extant theory (see earlier portions of this
article). Because the 2 scales are not equivalent, we do
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not conduct a multisample analysis here and instead
compare the 2 models according to model χ2 estimates.
As expected, the results of the original blood-fear,
organ-anxiety measurement model with the combined
data set suggest a very well-fitting model, χ 132 = 18.48,
P = .14, CFI = 1.0, IFI = 1.0, RMSEA = 0.03 (the χ 212 for
the null model was 1309.37). The results of the alter-
ative, blood-anxiety, organ-fear measurement model, on
the other hand, suggest a relatively poor fitting model,
χ 13
2 = 64.1, P < .001, CFI = 0.95, IFI = 0.95, RMSEA =
0.09 (the χ 21
2 for the null model was 1225.4).
The results of testing the alternative model serve
to further validate the blood-fear, organ-anxiety scale.
In addition to being a theoretically sound inventory,
the blood-fear, organ-anxiety scale also demonstrates
sound psychometric properties. Specifically, the measure-
ment models pertaining to the 2 independent samples
(males and females) indicated a sound, valid, reliable
scale and the multisample analyses further corrobo-
rated this conclusion.
Discussion
The purpose of this study was to test Lazarus’s5
theoretical explanation of fright and anxiety in the
context of blood and organ donation. The hypotheses
in this study suggested that the 2 types of fear would
be differentially associated with the contexts of blood
and organ donation. According to Lazarus, anxiety is
fear of the unknown, death, and a fear that is not con-
crete, whereas, when people experience fright, their
fear is clear and immediate.
To test the theoretical differences in fright and
anxiety, we created a measure that asked participants
to rate their feelings of the fear types. Based on the
findings from previous research, we proposed that fright
and anxiety would factor load in blood and organ
donation contexts, respectively. Our findings supported
this proposed hypothesis.1,7,8,13
There may be other equivalent models that fit the
data equally well if not better than the CFA models
proposed and tested in this study. CFA does not report
that a model is theoretically acceptable or unaccept-
able, but only that it is a good fit. Future research should
explore more indicators that might better capture the
constructs of fright and anxiety in blood and organ dona-
tion contexts.
In retrospect, although all of the exogenous items
that were thought to be indicators of the endogenous
variables were theoretically derived, they may not
have been either interpreted well by the participants or
they may have been poorly worded. Three items were
removed because of weak loadings. The removal of
these items in future revisions to this scale may be a
prudent act of model trimming. The removal of an
item should be based on both theory and data.
www.progressintransplantation.org
The fear associated with blood and organ donation
Conclusion
Our measure is the first step toward helping those
working in blood and organ donation campaigns
understand the differentially related emotions inhibit-
ing giving blood and signing an organ donor card. The
ability to understand and measure such emotions will
help future researchers create models that are more
accurate for predicting potential donors and create
messages to assuage fears. A greater understanding of
fear will lead to more effective messages.
Although our instrument revealed sufficient relia-
bility and validity, and was invariant across 2 inde-
pendent samples, the measurement of the scale should
be tested with additional samples in various contexts.
Results of this study support several good indicators
of fright and anxiety in blood and organ donation con-
texts. These items can be used to develop future ver-
sions of fright and anxiety measures.
Financial Disclosures
None reported.
References
1. Ferrari JR, Leippe MR. Noncompliance with persuasive
appeals for a prosocial, altruistic act: blood donating. J Appl
Soc Psychol. 1992;22(2):83-101.
2. Kopfman JE, Smith SW. Understanding the audiences of a
health communication campaign: a discriminate analysis of
potential organ donors based on intent to donate. J Appl Com-
mun Res. 1996;24(1):33-49.
3. Nijkamp MD, Hollestelle ML, Zeegers MP, van den Borne B,
Reubsaet A. To be(come) or not to be(come) an organ donor,
that’s the question: a meta-analysis of determinant and inter-
vention studies. Health Psychol Rev. 2008;2(1):20-40.
4. Oswalt R, Gordon J. Blood donor motivation: a survey of minor-
ity college students. Psychol Rep. 1993;72(93 pt 1):785-786.
5. Lazarus RS. Emotion and Adaptation. New York, NY: Oxford
University Press; 1991.
6. Lazarus RS, Lazarus BN. Passion and Reason: Making Sense of
Our Emotions. New York, NY: Oxford University Press; 1994.
7. Amir M, Haskell E. Organ donation: who is not willing to
commit? Psychological factors influencing the individual’s
decision to commit to organ donation after death. Int J Behav
Med. 1997;4(3):215-229.
8. Smith SW, Kopfman JE, Lindsey LL, Yoo J, Morrison K.
Encouraging family discussion on the decision to donate organs:
the role of the willingness to communicate scale. Health Com-
mun. 2004;16(3):333-346.
9. Lester D. Organ donation and the fear of death. Psychol Rep.
2005;96(3 pt 1):769-770.
10. Albright CL, Wong LL, Dela Cruz MR, Sagayadoro T.
Choosing to be a designated organ donor on their first driver’s
license: actions, opinions, intentions, and barriers of Asian
American and Pacific Islander adolescents in Hawaii. Prog
Transplant. 2010;20(4):392-400.
11. Morgan SE, Stephenson MT, Harrison TR, Afifi WA, Long
SD. Facts versus ‘feelings’: how rational is the decision to
become an organ donor. J Health Psychol. 2008;13(5):644-658.
12. Morse CR, Afifi WA, Morgan SE, et al. Religiosity, anxiety,
and discussions about organ donation: understanding a complex
system of associations. Health Commun. 2009;24(2):156-164.
13. Mathew SM, King MR, Glynn SA, Dietz SK, Caswell SL,
Schreiber GB. Opinions about donating blood among those
who never gave and those who stopped: a focus group assess-
ment. Transfusion. 2007;47(4):729-735.
Progress in Transplantation, Vol 22, No. 2, June 2012 205
Wagner and Manolis
14. Sojka BN, Sojka P. The blood donation experience: self-reported
motives and obstacles for donating blood. Vox Sanguinis.
2008;94(1):56-63.
15. Duboz P, Cunéo B. How barriers to blood donation differ
between lapsed donors and non-donors in France. Transfusion
Med. 2010;20(4):227-236.
16. France CR, Montalva R, France JL, Trost Z. Enhancing atti-
tudes and intentions in prospective blood donors: evaluation
of a new donor recruitment brochure. Transfusion. 2008;
48(3):526-530.
17. Nonis SA, Ford CW, Logan L. College students’ blood dona-
tion behavior: relationships to demographics, perceived risk,
and incentives. Health Marketing Q. 1996;13(4):33-46.
18. Bagozzi RP. Further thoughts on the validity of measures of
206 Progress in Transplantation, Vol 22, No. 2, June 2012
elation, gladness, and joy. J Personality Soc Psychol. 1991;
61(1):98-104.
19. Fornell C, Larcker DF. Structural equation models with unob-
servable variables and measurement error. J Marketing Res.
1981;18(3):382-388.
20. Browne MW, Cudeck R. Alternative ways of assessing model
fit. In: Bollen KA, Long JS, eds. Testing Structural Equation
Models. Newbury Park, CA: Sage; 1993:136-166.
21. Bentler PM, Bonett DG. Significance tests and goodness of fit
in the analysis of covariance structures. Psychol Bull.
1980;88(3):588-606.
22. Hair JF, Anderson RE, Tatham RL, Black WC. Multivariate
Data Analysis. 5th ed. Upper Saddle River, NJ: Prentice-
Hall; 1998.
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