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Identity and motivation predict behavior and intention of organ donation.

Abstract: Because of the many improvements in medical and pharmaceutical technologies and the success of organ transplant procedures, there is a growing need for donated organs. The present study explored the relationships between identify and motivation as predictors of donor behavior and donor behavioral intentions. Results indicated that volunteer identify best predicted frequency of volunteering suggesting that strong volunteer identify may increase volunteer behaviors such as blood and organ donation. These findings may help organ donor campaigns target individuals who are more likely to volunteer time, energy, and potentially human organs.

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Organ transplantation gained recognition when the first successful human-to-human kidney transplant was performed in 1954 (Gibson, 1996). Thirteen years later, the first human-to-human heart transplant was performed (Freeman, Westphal, Davis, et al., 1995). Since that time, great improvements have been made in surgical procedures and pharmaceutical treatments to help the body resist rejection of newly implanted organs. As a result of these improvements transplantation has now become a standard medical procedure. However, despite the success and promise of medical transplantation, the primary problem now lies in the gap between organ supply and demand. More specifically, although roughly 45,000 people at any give time are on organ transplant waiting lists in the United States only approximately 5,000 of an estimated 25,000 people who could donate each year actually do so (Gibson, 1996; Shanteau, Harris, & VandenBos, 1992). Because of the lack of donors, one person dies every three hours waiting for a transplant (Gibson, 1996). One possible way to increase the number of organs available for transplant is to increase the number of people who sign organ donor cards and/or indicate their donation wishes on their driver's license. Thus, public awareness about this problem must be increased if the gap between supply and demand is to be reduced.

Research on those who typically complete organ donor cards suggests that volunteers are more highly educated, have higher incomes, and are more likely to be young, and female (Simmons, Fulton, & Fulton, 1972). Another interesting finding is that choosing to sign a donor card is somehow tied to individual religious beliefs and other attitudes that contribute to perspectives on perceptions of life and death. Specifically, those who sign donor cards often hold more liberal religious views, have a more favorable attitude toward science, are more likely to engage in novel experiences, are more active in charity work, and are more likely to have donated blood in the past. Further, these individuals are more internally directed, have a more definite body image, and accept their own mortality as compared to their non-donor counterparts (Cleveland, 1975).

One way to explain organ donation behavior is through the use of identity theory. The central proposition of this theory consists of the relationships between three components: commitment, identity salience, and role performance (Stryker, 1987). The more important a role is to an individual the more he/she will commit to it, the stronger this commitment, the more salient the role is to his/her identity, and the more salient the role is to his/her identity, the more he/ she will engage in behaviors consistent with the role. Identity theory stems from the concept of symbolic interactionism, which postulates that society influences individuals by responding to their behaviors (Hogg, Terry, & White, 1995). In other words, symbolic meanings are learned from the responses of others in society to one's actions; society responds to an individual's volunteer behavior by viewing that person as one who helps others. These symbolic meanings form the foundation of the different roles that one portrays and these roles then become part of that person's identity (Burke & Reitzes, 1981).

Stryker (1968) noted that there are three characteristics of an identity. First, identities are social products that are created and maintained through naming oneself relative to a social group, interacting with others in the group, and presenting oneself as a group member. Second, identities give meaning to the self and are organized hierarchically from the most salient to the least salient. Third, identities are symbolic and reflexive in character. Therefore, identities provide symbolic meanings about social interactions. These meanings reflect back to the person that he/she occupies a specific role in society, which enhances self-meaning of the role.

According to Charng, Piliavin, & Callero (1988), role identity salience is dependent upon three factors: the degree to which others identify the person with the role, the amount of social support one receives for occupying the role, and the size of one's social network that is linked to the role identity. Role identity salience can be measured through noting how likely a role is to be assumed in different situations (Stryker, 1987). This means that as an individual increasingly identifies with a role, others will more likely view that person in the role, which results in both increased role identity saliency and an increase in the behaviors associated with this role. For example, the more an individual identifies him/herself as a volunteer, the more others will see him/her as a volunteer, and thus the volunteer role becomes more salient to the person. Increasing the salience of the volunteer role also increases behaviors associated with maintaining the volunteer identity. Relative to the present study, the more an individual volunteers, the more likely he/she will sign donor cards because doing so is consistent with volunteer identity--volunteers must behave like volunteers.

Studies determining why individuals donate blood, organs, or time have shown that there are six basic functions that volunteering serves (Ridge, Snyder, French, et al., 1990). These functions or motives include values (personal feelings and beliefs about the importance of helping others), understanding (the desire to learn about those who are being helped), esteem enhancement (feeling better about oneself), protection (helping address inner conflicts or anxieties), career (making contacts or exploring career options), and social functions (fulfilling social norms).

Around the time of World War II, the process of blood preservation was discovered, making blood transfusions widely available. Donating blood is a similar act to both organ donation and volunteerism because it involves giving part of the self with nothing concrete in return, except for individual feelings that accompany performing altruistic acts. Therefore, the results of blood donor studies could be useful in guiding organ donation campaigns as well as in efforts to increase volunteerism. Results of studies linking blood donation behavior to identity theory have demonstrated that salience of the blood donor role, defining oneself as a blood donor, social relationships tied to blood donation, and others' expectations to donate were all found to predict both previous and future blood donation behaviors (Callero, 1985; Callero, Howard, & Piliavin, 1987). These studies suggest that people with high volunteer role-identity salience will be more likely to define themselves as regular volunteers, have a greater number of friendships linked to volunteering, perceive higher expectations from others to volunteer, and ultimately volunteer more often when given the opportunity to engage in helpful, caring and potentially life saving behaviors (such as organ donation).

Consequently, the purpose of the present study is to determine whether volunteers are a good population to target with regard to increasing organ donation. It is predicted that participants who have strong volunteer identities will be more receptive to organ donation information because it will provide an opportunity for them to act in accordance with their volunteer identities. Consequently, a strong volunteer identity will lead to signing an organ donor card. It is further believed that both volunteer identity and volunteer motivation will be correlated with and will predict organ donation intentions and organ donation behavior.

METHODS PARTICIPANTS

A total of 129 individuals served as participants ([n.bar]=98 female; [n.bar]=31 male). These subjects were drawn from classroom settings in the Philadelphia area and were enrolled in various psychology classes. All subjects completed and signed Informed Consent Forms consistent with the procedures approved by the Institutional Review Board for the Protection of Human Subjects in Research. Upon complete of the study all subjects were thoroughly debriefed.

MATERIALS

To assess the strength of his/her volunteer identity, each participant completed the Volunteer Behavior Questionnaire (VBQ) (Chamg, Piliavin, & Callero, 1988). The VBQ measures three facets of a volunteer's identity: subjective norms (the volunteers perception of the expectations of others), volunteer role-person merger (the degree to which the participant sees him/ herself as a volunteer), and social relations (the number of social ties related to volunteering). Previous research (Charng, Piliavin, & Callero, 1988) has demonstrated strong reliability and appropriate use for the current sample on the overall scale (Cronbach's alpha r=.81), volunteer role-person merger (Cronbach's apha r=.81), and the social relations measure (Cronbach's alpha r=.82). Because this scale was used to measure blood donor identity, wording was changed slightly in this study to assess volunteer identity of organ donation.

Measurers of organ donation intentions and demographic characteristics of the participants were also included at the time of the experiment. Organ donation intentions were measured by asking the following three questions: 1. Do you have an organ donor card signed or have you indicated your donation wishes on the back of your license? 2. Do you think that you would sign an organ donor card now? 3. Do you think that you would sign an organ donor card in the future? Organ donation behavior was measured by determining whether or not the participant took the organ donor brochure at the completion of the study, as described below. The demographic variables measured included the participant's frequency of volunteering each month, each year, and throughout his/ her lifetime, his/her concerns about donating organs, whether he/she knew anyone who benefited from an organ transplant, whether or not he/she had a signed donor card or indicated his/her donation wishes on their drivers license, whether he/she was religious, whether his/her religion supported donation, whether he/she believed that organ transplants should be performed, and his/her age and gender.

Volunteer motivations were measured using the Volunteer Function's Inventory (VFI) (Clary, Snyder, & Ridge, 1992). The 30-item questionnaire consists of six subscales including social (social norms), values (personal feelings about the importance of helping others), career (making contacts or explore career options), understanding (learning about those being helped), protective (addressing inner conflicts and anxieties), and esteem motivation (feeling better about oneself). Each subscale consists of five items and is evaluated on a seven-point Likert scale ranging from "not at all important/accurate for you" to "extremely important/accurate for you". The VFI has shown high internal reliability with alpha coefficients for all of the subscales greater than or equal to .80 and acceptable test-retest reliability greater than .60.

DESIGN AND PROCEDURE

After informed consent was sought, participants were first asked to complete the VBQ. Next, participants were directed to a room that contained organ donor pamphlets. These participants were then read passages from the organ donor brochure and were instructed to follow along in the brochures with the experimenter. The passages that were read emphasized the need for signed donor cards, the importance of discussing donation decisions within families, medical procedures for procurement, religion, and how many people one donor can help. The participants were then given five minutes to complete the behavioral intention and demographic questionnaires. Next, they were given five minutes to read the organ donor brochure on their own. At the completion of the five minutes, the experimenter instructed them to take the brochure with them at the end of the study if they thought they would like to complete the organ donor card inside the brochure, and to leave the brochure on the table if they were not interested in completing the organ donor card. Finally, the participants completed the VFI. After all data were collected, the participants were thoroughly debriefed as to the purpose of the study.

RESULTS

To determine the relationships between volunteer identity (VBQ) and frequency of volunteering, bi-variate correlations were calculated. Significant relationships between volunteer identity and how often participants volunteer each month ([r.bar] = .418, [p.bar]<.001), and each year ([r.bar] =.419, [p.bar]<-001) were found. Bi-variate correlations were also calculated between volunteer motivations (VFI) and volunteer identity (VBQ). Significant relationships between VBQ and motives of values ([r.bar] =.610, [p.bar]<.001), motives of understanding ([r.bar] =.480, [p.bar]<.001), motives of self-esteem ([r.bar] =.380,[p.bar]<.001), social motives ([r.bar] = .374, [p.bar]<.001), and protective motives ([r.bar] =.366,[p.bar]<.001) were noted.

Regression analyses were also conducted to predict frequency of volunteering, organ donation intentions, organ donation behavior, and strength of volunteer identity. For each of the four analysis, 15 variables were entered into the equation (whether the subject took the brochure, whether he/she would sign the organ donor card now, whether he/she would sign the donor card in the future, VBQscore, VFI scores, how many times the subject volunteered per month, how many times the subject volunteered per year, whether he/she had any concerns about donating, whether he/ she had known anyone who has benefited from a transplant, whether he/she had an organ donor card currently signed or had indicated donation wishes on the back of their license, whether his/her religion supported organ transplantation, how many times the subject had volunteered during his/her lifetime, whether or not he/she was religious, whether he/she believed that organ transplants should be performed, and the participant's age and gender. For each analysis, Pin values were set at .15 and Pout values were set at .20. Regression analyses conducted using the three subscales of the VBQ identified no significant relationships. Therefore, as in previous research (Charng, Piliavin, & Callero, 1988), the total VBQ score was used in each regression analysis.

To determine which variables best predict frequency of volunteering, two separate stepwise multiple regression analyses were conducted. In the first analysis, how many times participants volunteered each month was used as the outcome variable, and in the second analysis how many times participants volunteered each year was used as the outcome variable. For both analyses, volunteer identity was the main predictor of how many times participants volunteer each month (B=.421, [R.sup.2]=.177, t=3.218) and each year (B=.340, [R.sup.2].160, t=3.145).

Another set of regression analyses was conducted to determine which variables best predict an individual's organ donation behavior and his/her present and future organ donation intentions. Six variables best predicted whether a participant would take the organ donation brochure. The six variables, which accounted for 49.9% of the variance, included intent to sign a donor card in the future (B=.301, [R.sup.2]=.251, t=2.427), believing that transplants should be performed (B=.206, [R.sup.2]=.462, t= 1.906), volunteering to address inner conflicts or anxieties (B=.243, [R.sup.2]=.421, t=2.100), already having a signed donor card (B=.240, [R.sup.2]=.307, t=2.055), the participant's religion supporting organ transplants (B=.216, [R.sup.2]=.499, t=1.778), and volunteering because of personal values and beliefs (B =-.353, [R.sup.2]=.353, t=-2.912).

The variables best predicting the behavioral intention of whether or not participants intended to sign the donor card at the time of the experiment were having taken the brochure (B=.452, [R.sup.2]=.224, t=3.720) and having concerns about donating (B=-.281, [R.sup.2]=.303, t=-2.304, which accounted for 30.56% of the variance. Finally, the two variables best predicting the behavioral intention of whether the participant intended to sign the donor card some time in the future were having taken the brochure (B=.519, [R.sup.2]=.252, t=4.017) and being motivated to volunteer to address inner conflicts or anxieties (B=-.206, [R.sup.2]=.294, t=-1.672), which accounted for 29.36% of the variance.

The final regression analyses were conducted to determine which variables predict strength of volunteer identity (VBQ). Being motivated to volunteer because of personal values and beliefs (B=.493, [R.sup.2]=.309, t=4.372), how many times participants volunteered each month (B=.280, [R.sup.2]=.402, t=2.463), age (B=-.163, [R.sup.2]=.436, t=-1.741), and if participants had any concerns about donating (B=-. 191, [R.sup.2]=.461, t=-4.623) best predicted how much one identifies with being a volunteer, and these accounted for 46.14% of the variance.

DISCUSSION

The purpose of this study was to determine whether volunteer identity or specific motivations behind volunteering are related to, and can predict, organ donation behavior. The volunteer motivations of values, understanding, self-esteem, social, and protective were all found to correlate significantly with strength of volunteer identity. Consistent with similar studies (Brofee & Deaux, 1994), the results of this study demonstrate that participants volunteer because of their personal feelings and beliefs about the importance of helping others, to learn about those being helped, to feel better about oneself, to fulfill social norms, and to address inner conflicts and anxieties. This suggests that it is most important for volunteers to engage in volunteer activities because they are driven primarily by personal values and beliefs about the importance of helping others, and to gain an understanding of both themselves and those they help. Relationships between volunteer identity and frequency of volunteering were also found. These results are comparable with a similar study using a sample of blood donors suggesting that the stronger the participant's identity as a blood donor, the more often he/she donated blood (Callero, Howard, Piliavin, 1987). Consequently, measuring the salience of individual identities could aid in predicting the frequency of future behaviors associated with the identity.

Several other findings of this study were also noteworthy. First, participants who took the brochure at the completion of the experiment were more likely to sign a donor card in the future.

Second, for participants who were religious, if their religion supported organ donation they were more likely to take the donor brochure. Because all major Judeo-Christian religions generally support donation, perhaps certain religions can be successfully targeted to increase the number of signed donor cards (Horton & Horton, 1991).

Relative to the importance of using identity theory to predict organ donor behavior and intentions to donate, this theory states that being strongly committed to a role reinforces identity with the role, which tends to reinforce behaviors associated with the role. However, the results of the study failed to conclusively support the theory that strong volunteer identity reinforces organ donation behavior and intentions. Simply stated, strongly identifying with being a volunteer does not necessarily mean that a participant will engage in organ donation behavior when given the opportunity. One possible explanation for this is that deciding to sign an organ donor card is a major decision while deciding to give blood or volunteer to help others is a temporary decision. Further, this decision does not only involve individual beliefs about life and death but also what family members believe as well. Signing a donor card is only the first step to having donation wishes granted. The final step typically involves consent of the family members. Therefore, the prospective organ donor must discuss donation wishes with his/her family prior to making a final decision about organ donation.

Of the 37 participants who expressed concerns about donating organs, 54.1% reported they did not think every effort would be made to save their lives if they were involved in a tragic accident and had a signed donor card. In addition, 18.9% of the concerned participants were afraid that an open casket funeral would not be possible if organs were donated. These findings suggest that many people have misconceptions regarding organ donation. Perhaps educating the public about misconceptions such as these would lead to an increased number of signed organ donor cards. Future studies should further explore these issues and should attempt to replicate these exploratory findings with more diverse samples.

REFERENCES

Brofee, B., & Deaux, K. (1994). Integrating motivational and identity theories of volunteerism. Poster presented at the American Psychological Society. Washington, D. C.

Burke, P.J., & Reitzes, D. C. (1981). The link between identity and role performance. Social Psychology Quarterly, 44 (2), 83-92.

Callero, P. L. (1985). Role-identity salience. Social Psychology Quarterly, 48 (3), 203-215.

Callero, P. L., Howard, J. A., & Piliavin, J.A. (1987). Helping behavior as role behavior: Disclosing social structure and history in the analysis of prosocial action. Social Psychology Quarterly, 50 (3), 247-256.

Charng, H. W., Piliavin, J. A., & Callero, P. L. (1988). Role identity and reasoned action in the prediction of repeated behavior. Social Psychology Quarterly, 51 (4), 303-317.

Clary, E. G., Snyder, M., & Ridge, R. (1992). Volunteers' motivations: A functional strategy for the recruitment, placement, and retention of volunteers. Nonprofit Management and Leadership, 2, 333-350.

Cleveland, S. E. (1975). Personality characteristics, body image and social attitudes of organ transplant donors versus non-donors. Psychosomatic Medicine, 37 (4), 313-319.

Freeman, A. M., III, Westphal, J. R., Davis, L. L., & Libb, W. (1995). The future of organ transplant psychiatry. Psychosomatics, 36(5), 429-437.

Gibson, V. (1996). The factors influencing organ donation: A review of the research. Journal of Advanced Nursing, 23, 353-356.

Hogg, M. A., Terry, D. J., & White, K. M. (1995). A tale of two theories: A critical comparison of identity theory with social identity theory. Social Psychology Quarterly, 58 (4), 255-269.

Horton, R. L., & Horton, P.J. (1991). A model of willingness to become a potential organ donor. Social Science & Medicine, 33 (9), 1037-1051.

Ridge, R., Snyder, M., French, S., Pederson, J. H., Meine, P., Copeland, J., & Clary, E. G. (1990). The volunteer functions inventory: Towards an understanding of the motivations to volunteer. Paper presented at the annual meeting of APA, Boston.

Shanteau, J., Harris, R. J., & VandenBos, G. R. (1992). Psychological and behavioral factors in organ donation. Hospital and Community Psychiatry, 43 (3), 211-212.

Simmons, R. G., Fulton, J., & Fulton, R. (1972). The prospective organ transplant donor. Omega Journal of Death and Dying, 3 (4), 319-339.

Stryker, S. (1968). Identity salience and role performance: The relevance of symbolic interaction theory for family research. Journal of Marriage and the Family, 30, 558-564.

Stryker, S. (1987). Identity theory: Developments and extensions. In K. Yardley &T. Honess (Eds.), Self and Identity: Psychosocial Perspectives (pp. 89-103). John Wiley & Sons Ltd.

Gary Gargano, Ph.D.

Amy M. Nagy, M.S.

M. Michelle Rowe, Ph.D.

Gary Gargano, Ph.D. is an Instructor of Psychology at Merced College. Amy N. Nagy, M.S. is affiliated with Saint Joseph's University. M. Michelle Rowe, Ph.D. is an Associate Professor and Chair of the Department of Health Services at Saint Joseph's University. Address all correspondence to M. Michelle Rowe, Ph.D., Associate Professor and Chair, Department of Health Services, Saint Joseph's University, 5600 City Avenue, Philadelphia, PA 19131, PHONE: 610.660.1576, FAX: 610.660.3359, E-MAIL: mrowe@sju.edu
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Author:Rowe, M. Michelle
Publication:American Journal of Health Studies
Geographic Code:1USA
Date:Sep 22, 2004
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