DISTRIBUTION OF READINESS TO BE AN ORGAN DONOR IN A REPRESENTATIVE SAMPLE

Abstract

91 Introduction. This paper describes the adaptation of the Transtheoretical Model of behavior change (TTM) to increasing the donation intention rate. A key TTM variable for the design of individual and public health interventions is Stage of Change, which employs past behavior and behavioral intention to characterize an individual's readiness to change. The Stages of Change are Precontemplation (not ready), Contemplation (considering change), Preparation (preparing for change), Action (recently changed) and Maintenance (maintaining change). To be in Action, individuals must document intent and inform family members of that decision. A representative sample is described which provides accurate estimates of the overall stage distribution in the population and comparisons on gender, age, race and educational level. Method. A random-digit dial methodology was employed. Participants were 604 residents of Louisiana age 18 and older who completed a telephone survey assessing awareness and attitudes about organ donation and transplantation. Stage of Change was assessed through a series of questions about wishes to donate organs after death. Those expressing a wish to donate were asked about documentation of that intent and whether they informed family members. Results. The stage distribution was 28% in Precontemplation, 18% in Contemplation, 20% in Preparation and 33% in Action/Maintenance (A/M, combined for further analyses). Educational level affected the stage distribution with the proportion of the sample in Precontemplation decreasing as the education level increased (χ2(6) = 41.3, p<.001). Race was also a significant factor as minority participants (93% Black) were twice as likely to be in Precontemplation while White participants were twice as likely to be in A/M (χ2(3) = 41.5, p<.001). Age and gender did not significantly affect the stage distribution. Discussion. This stage distribution has important implications for intervention design. Existing interventions to increase donation intentions are most appropriate for the Preparation stage, but the majority of the sample not yet in A/M were in the first two stages (70%). This results in mismatches between the readiness of the individual and the intervention. The stability of the distribution across age and gender suggests that interventions appropriately matched to stage can be applied across gender and all age groups. Differences found with respect to educational level and race can serve as a guide to the tailoring of intervention materials.