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Background This study aims to assess the impact of an educational intervention based on the theory of planned behavior (TPB) on breastfeeding mothers’ knowledge, attitude, subjective norms, perceived behavioral control regarding donor human milk (DHM), intention to donate milk and milk donation behavior. Method This cluster randomized controlled trial (CRT) was performed on 67 breastfeeding mothers (intervention, n  = 33; control, n  = 34) in health centers affiliated to Tehran University of Medical Sciences (TUMS) from April 2023 to October 2023. Four weekly 60-min educational sessions were conducted based on the TPB through lectures, group discussions, psychodrama method, videos and pictures display for mothers in the intervention group, while the control group received only routine care. The data collection tool was a researcher-made questionnaire based on the TPB. It assessed breastfeeding mothers' knowledge, attitudes, subjective norms, perceived behavioral control regarding milk donation, intention to donate milk, and actual milk donation behavior. The questionnaire was completed by participants in both groups before, immediately and three months after the intervention. Results The findings indicated that both the intervention and control groups were similar in terms of demographic and obstetrics variables. Additionally, before the intervention, there were no significant differences between the two groups regarding knowledge ( P  = 0.552), attitude ( P  = 0.734), subjective norms ( P  = 0.813), perceived behavioral control ( P  = 0.453), intention to donate milk ( P =0.476) and actual milk donation behavior ( P  = 0.105). However, the intervention group showed significant improvements in the mean score of noted variables immediately and three months after the intervention ( P  < 0.05). Moreover, regarding the frequency of milk donations, three months after the intervention, eight mothers in the intervention group had donated milk, whereas none of the mothers in the control group had done so ( P  = 0.002). Conclusion Our findings showed that the TPB-based educational intervention significantly enhanced milk donation behavior among breastfeeding mothers. Given that donor mothers are crucial for the establishment and sustainability of human milk banks (HMBs), such programs should be implemented to increase milk donation rates and support the development of HMBs. Trial registration irct.ir (IRCT20230124057203N1) registered February 14, 2023.

Recent research suggests that affluent individuals adopt agentic self-concepts, striving to stand out from others and to master the environment on their own. The present study provides a road test of this idea, showing that this theorizing can be utilized to increase charitable giving among the affluent, when individuals do not realize that their behavior is being studied. In a naturalistic field experiment conducted as part of an annual fundraising campaign (N = 12,316), we randomly assigned individuals from an affluent sample to view messages focused on agency (vs. communion). Messages that focused on personal agency (vs. communion) increased the total amount of money that individuals in the sample donated by approximately 82%. These findings provide evidence for a simple, theoretically-grounded method of encouraging donations among those with the greatest capacity to give.

Background A shortage of organs available for transplantation is causing loss of life. Increasing the number of individuals on the National Health Service (NHS) Organ Donor Register (ODR) is one way to address the shortage of organs. In Great Britain, new drivers registering for their driving licence are invited to join the ODR. A further 17 million drivers renew their road tax online each year, presenting an additional opportunity to prompt drivers to join the ODR. This trial explores the effect of adding persuasive messages to a prompt to join the ODR at the end of road tax payment transactions. Methods In this pragmatic, parallel group, quasi-randomised controlled trial, drivers renewing their road tax or registering for a driving licence were alternately allocated, using a JavaScript randomisation code embedded in the GOV.UK website, to view a control prompt inviting sign-ups to the ODR or the same prompt plus one of seven theoretically informed persuasive messages; (i) social norms alone, (ii) social norms plus the NHS ODR logo, (iii) social norms plus an image, (iv) loss frame, (v) gain frame, (vi) reciprocity and (vii) cognitive dissonance. The trial took place over a 4-week period in June 2013. The primary outcome measure was participants completing the online registration form (sign-ups). Results Altogether, 1,085,322 website users were included in the study. Further, 1171 more sign-ups were completed under the most effective message (reciprocity) compared to the control prompt alone (reciprocity: n  = 4256, control: n  = 3085; odds ratio, OR 1.38, 95% confidence interval 1.32–1.45, p  < 0.001). The loss-framed message was as effective. All messages increased sign-ups compared to the control prompt apart from the social norms message plus image ( n  = 2879; OR 0.94, 95% confidence interval 0.89–0.99, p  < 0.05). Conclusions Short persuasive messages alongside a prompt can persuade more ODR sign-ups for individuals renewing their road tax than a prompt alone. The most effective message remains in place today. Since the trial in 2013, the same message has been implemented across 25 government end-of-transaction websites on GOV.UK, resulting in 529,000 new registrations to the ODR up to 31st October 2017.

In this study, we evaluate the effect of education and deliberation on the willingness of members of the public to donate tissue to biobank research and on their attitudes regarding various biobank consent policies. Participants were randomly assigned to a democratic deliberation (DD) group, an education group that received only written materials, and a control group. Participants completed a survey before the deliberation and two surveys post-deliberation: one on (or just after) the deliberation day, and one 4 weeks later. Subjects were asked to rate 5 biobank consent policies as acceptable (or not) and to identify the best and worst policies. Analyses compared acceptability of different policy options and changes in attitudes across the three groups. After deliberation, subjects in the DD group were less likely to find broad consent (defined here as consent for the use of donations in an unspecified range of future research studies, subject to content and process restrictions) and study-by-study consent acceptable. The DD group was also significantly less likely to endorse broad consent as the best policy (OR = 0.34), and more likely to prefer alternative consent options. These results raise ethical challenges to the current widespread reliance on broad consent in biobank research, but do not support study-by-study consent.

It is unclear how much information should be provided to families of potential organ donors about the benefits of organ donation. Whilst this information is material to the donation decision, it may also be perceived as coercive. Randomised, double blind, controlled trial in which community members watched one of two videos of a simulated organ donation conversation that differed only in the amount of information provided about the benefits of donation. Participants then completed a questionnaire about the adequacy of the information provided and the degree to which they felt the doctor was trying to convince the family member to say yes to donation. There was a wide variability in what participants considered was the \"right\" amount of information about organ donation. Those who watched the conversation that included information about the benefits of donation were more likely to feel that the information provided to the family was sufficient. They were more likely to report that the doctor was trying to convince the family member to say yes to donation, yet were no more likely to feel uncomfortable or to feel that the doctor was uncaring or cared more about transplant recipients than he did for the patient and their family. This study suggests that community members are comfortable with health care staff providing information to family members that may be influential in supporting them to give consent for donation.

BackgroundIn forming opinions about donor registration systems such as opt-in versus opt-out, the sociopolitical implications of these systems may be confounded with attitudes toward organ donation itself, causing people to talk at cross purposes. The goal of the present research was to examine the interactive effects of sociopolitical viewpoint, attitude toward donation (as evidenced by current registration status in study 1 and registration intention of unregistered individuals in study 2), and patients’ need for organs on people’s support for a particular system.MethodIn study 1, we randomly assigned registered donors, registered nondonors, and nonregistered individuals to one of three sociopolitically inspired solutions to reducing the organ shortage, distinguishing between solutions based on autonomy, coercion by the state, and reciprocity, respectively. In study 2, we concentrated specifically on young and unregistered people in order to examine how prior donation intentions or indecision with respect to donor registration affect responses to the three different sociopolitical viewpoints. In both studies, we also manipulated salience of patients’ need.ResultsRegistered donors in study 1 and unregistered individuals with donation intention in study 2 (high in sympathy, low in anxiety) were highly and equally supportive of a solution based on autonomy and coercion. In contrast, registered nondonors in study 1 and unregistered and undecided individuals in study 2 (lower in sympathy, higher in anxiety) were less supportive of a solution based on coercion than autonomy. Study 2 also found that, for undecided individuals, a more salient need state was associated with a drop in anxiety and stronger support for coercion. Results for a system based on reciprocity were more difficult to interpret.ConclusionIndividuals most concerned with the need of patients waiting for an organ are relatively indifferent with respect to the sociopolitical implications of a registration system, while those strongly objecting to a coercive role for the state express reservations against organ donation itself. In order to help people to form balanced opinions about organ donation systems, we recommend to make the prosocial and sociopolitical aspects equally salient and deserving of debate.

Background The gap between the supply and demand of organ donors is substantial, causing patients to suffer from long waiting times. Moreover, the lack of registrations places a burden on family members and medical professionals when an unregistered individual dies. This article describes a cluster randomized controlled trial (CRCT) study to assess the effectiveness and quality of implementation of a web-based program aimed at encouraging lower-educated adolescents to register a well-informed choice about organ donation, regardless of it being as a donor or not. Methods/design The program will be delivered by teachers at schools for Intermediate Vocational Education in the Netherlands. The effectiveness will be assessed in a CRCT design with post-test only using self-administered questionnaires for the primary outcome (i.e. intention to register). Classes will be matched to improve equivalence of groups. From each pair of matched classes, one class will be randomly assigned to the experimental condition, and the other assigned to the control condition. Students in the control groups will fill in the questionnaire before receiving the program, while the experimental groups will do this afterwards. A post-test design prevents the risk of testing bias. The required sample size is 14 schools, with 10 classes per school and 13 unregistered students per class. The questionnaire assesses demographics, behavioural determinants (attitude, self-efficacy, knowledge and social outcomes), intention to register (as a donor) and registration status. Six months after delivery, registration status will be assessed again. Additionally, a process evaluation will be conducted to evaluate the quality of implementation using both qualitative (i.e. semi-structured interviews) and quantitative (i.e. logbooks, questionnaires, Google Analytics to track user behaviour at the website) methods. Discussion Findings of the study can help to further improve the program and serve as a basis for a solid dissemination plan. Moreover, the study will provide insight into (change in) determinants of registration and donorship and the translation of research into practice of school-based health promotion interventions, which can serve as an example for others. Trial registration The Dutch Trial Register, NTR6771 . Registered on 24 October 2017. This is version 2 of the protocol (5 November 2017).

Eliciting different attitudes with survey questionnaires may impact on intention to donate organs. Previous research used varying numbers of questionnaire items, or different modes of intervention delivery, when comparing groups. We aimed to determine whether intention to donate organs differed among groups exposed to different theoretical content, but similar questionnaire length, in different countries. We tested the effect of excluding affective attitudinal items on intention to donate, using constant item numbers in two modes of intervention delivery. Study 1: A multi-country, interviewer-led, cross-sectional randomized trial recruited 1007 participants, who completed questionnaires as per group assignment: including all affective attitude items, affective attitude items replaced, negatively-worded affective attitude items replaced. Study 2 recruited a UK-representative, cross-sectional sample of 616 participants using an online methodology, randomly assigned to the same conditions. Multilevel models assessed effects of group membership on outcomes: intention to donate (primary), taking a donor card, following a web-link (secondary). In study 1, intention to donate did not differ among groups. Study 2 found a small, significantly higher intention to donate in the negatively-worded affective attitudes replaced group. Combining data yielded no group differences. No differences were seen for secondary outcomes. Ancillary analyses suggest significant interviewer effects. Contrary to previous research, theoretical content may be less relevant than number or valence of questionnaire items, or form of intervention delivery, for increasing intention to donate organs.

Background Throughout the world there is an insufficient supply of donor organs to meet the demand for organ transplantations. This paper presents a protocol for a randomised controlled trial, testing whether a simple, theory-based anticipated regret manipulation leads to a significant increase in posthumous organ donor registrations. Methods We will use a between-groups, prospective randomised controlled design. A random sample of 14,520 members of the adult Scottish general public will be contacted via post. These participants will be randomly allocated into 1 of the 4 conditions. The no questionnaire control (NQC) group will simply receive a letter and donor registration form. The questionnaire control (QC) arm will receive a questionnaire measuring their emotions and non-cognitive affective attitudes towards organ donation. The theory of planned behavior (TPB) group will complete the emotions and affective attitudes questionnaire plus additional items assessing their cognitive attitudes towards organ donation, perceived control over registration and how they think significant others view this action. Finally, the anticipated regret (AR) group will complete the same indices as the TPB group, plus two additional anticipated regret items. These items will assess the extent to which the participant anticipates regret for not registering as an organ donor in the near future. The outcome variable will be NHS Blood and Transplant verified registrations as an organ donor within 6 months of receiving our postal intervention. Discussion This study will assess whether simply asking people to reflect on the extent to which they may anticipate regret for not registering as an organ donor increases organ donor registration 6 months later. If successful, this simple and easy to administer theory-based intervention has the potential to save lives and money for the NHS by reducing the number of people receiving treatments such as dialysis. This intervention may also be incorporated into future organ donor campaigns. Trial registration number ISRCTN: ISRCTN92204897

This highly important book introduces the realm of organ donation, providing an overview of the current situation, highlighting the challenges, summarizing past research, and providing guidance for future research. The first book to bridge the gap between applied research and the social and behavioral issues surrounding organ donation An impressive collection of contributors from a range of both practitioners and scientists actively working in the field Provides a concrete example of how evidence-based research and theory can be applied with real-world value Explores future directions of organ donation and research including community-based health interventions, ethical considerations, and advancing donor registration The latest publication in the prestigious Claremont Applied Social Psychology Series.