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FEDERAL STATE AUTONOMOUS EDUCATIONAL INSTITUTION

FOR HIGHER PROFESSIONAL EDUCATION

NATIONAL RESEARCH UNIVERSITY HIGHER SCHOOL OF ECONOMICS

St. Petersburg School of Social Sciences and Area Studies

BACHELOR'S PROJECT

Field of study: 39.03.01 Sociology

Degree programme: Sociology and Social Informatics

BLOOD DONATION IN RUSSIA: THE SELF AND THE BODY IN THE DONATION PRACTICES

Anna Evgenevna Shcherbakova

Supervisor: Senior Lecturer, Department of Management

A.Y. Meylakhs

Saint Petersburg 2020



Table of contents

Introduction

1. Literature review

1.1 General description of the field

1.2 Theoretical framework

1.2.1 Blood as resource

1.2.2 Blood as part of self

2. Methods

2.1 Description of research method

2.2 Sample

2.3 Participation in a collective project

2.4 Description of interview guide

2.5 Data collection procedure

2.6 Method of analysis

3. Results

3.1 Informants

3.2 General description of donation experience

3.3 Perception of blood

3.3.1 Preparation to the procedure

3.3.2 Visiting of the donation centers

3.3.3 Recovery after the procedure

3.3.4 Influence of blood donation on life

3.3.5 Attitude to blood

3.4 Motives to blood donation

3.4.1 Motivation

3.4.2 Description of the self

3.4.3 Hierarchy of biomaterials

Conclusion

Limitations

Future research agenda

Acknowledgements

References

Appendix A



Introduction

Theoretical relevance

In present time, blood donation is a rapidly developing sphere. This activity is vitally important for saving lives, because the demand for blood is annually rising by several times (White et al., 2017). The gradual increase requires attraction of more numbers of donors. That situation is a reason for a thorough investigation of a modern state of this problem.

A significant number of contemporary studies discuss blood donation from sociological point of view. For instance, some research focus on social-demographic (Wittock et al., 2017) or psychological (Merz et al., 2018) characteristics of blood donors, different motives for giving blood (Smith et al., 2011; Niza et al., 2013; Ferguson & Lawrence, 2016), while the other argue about strategies for recruitment of these people (Merz et al., 2018; Allain, 2019). Among these studies, there are two theoretical directions, which are not paid enough attention to in the framework of blood donation. One of which is interconnection between blood and body, while another is the link between self and blood.

Despite the fact that the topic of corporeality has been actively studying for many years, the relationship between body and its particles in blood donation sphere is started investigating relatively recently. A big share of research, following this theory, state that blood, being a body part, can be used as a resource for getting some benefits (Lipworth et al., 2011; Shaw, 2014; Ferguson et al., 2019). In addition, blood is considered to be less important, in comparison with other bio-particles, what induce people giving this biomaterial for personal interest (Lynch & Cohn, 2018).

The almost polar idea is perception of blood as self manifestation. According to this approach, blood donation activity is the way of self formation (Thorpe et al., 2019). To make it clear, a person creates his or her identity by giving this part of self. Furthermore, being previously a body part, donated blood contains self-image out of the body, what contributes to the desire of giving this biomaterial for personal representation in society (Koo & Fishbach, 2016).

Although the two mentioned approaches are different, there is some ambiguity in their understanding (Zeiler, 2014). It is not clear in which case blood is perceived only as body particle and when its link with self is generated. Thus, both ideas require a closer investigation. The present study is aimed to examine what theory can better describe empirical data, and is focused on filling the theoretical framework through studying Russian case.

Empirical relevance

As for Russia, blood donation have rapidly developed for the last years here. According to statistics (WCIOM, 2019), the number of blood donors has risen by ten percent for ten years. Nowadays, about half of Russian citizens take part in this activity (WCIOM, 2019). Although Russian blood donation is a good ground for investigation, the existing studies devoted to this topic are limited in several aspects. In particular, the biggest share of Russian research about blood donation are medical. To make it clear, a great amount of contemporary research describe donor's physical state, blood composition, donors' diseases and the blood donation system functioning. That causes the situation that Russian donors' activity is poorly studied from sociological point of view.

The previous attempt (Shcherbakova, 2019) of examining this problem was devoted to motivation of different age groups. According to the results of the term paper, comparatively to people older than 30, the younger once are more prone to give blood because of material incentives such as money or compensatory holiday, what may lead to decline of their activity in future (Shcherbakova, 2019). However, the chosen approaches, one of which is about influential factors to planned behavior, while another reflects altruistic behavior, revealed the difference between two age groups, but did not describe the prerequisites for such a difference. For that reason, the present paper is focused on modern theoretical direction of body and self in blood donation practices. The both theories are used, because it is not clear which one will be more appropriate for Russian case and can better describe the sample.

Research question and study description

This study is an exploratory in nature, which should give understanding whether other future research is necessary. There are two research questions of the present investigation. The first one: do blood donors perceive their blood as body particle, which may be used for getting benefit, or do they observe blood, more philosophically, as a part of self? The second question looks like this: is a particular attitude to blood can be a motive to blood donation in Russia? The study is based on qualitative approach, because the chosen theory requires deep examination and description of individual attitudes, perceptions and beliefs. The research is conducted in the form of semi-structured interviews. For the primary examining, it is supposed to recruit sixteen blood donors.

The study, in general, will be useful for understanding the full picture of people's motives to give blood, and may help in elaboration of measures to improve the situation, in particular improve the recruitment strategies of blood donation centers.



1. Literature review

1.1 General description of the field

There is a large volume of published studies describing blood donation from different points of view. It is necessary to point out that much of the current literature argues about the idea of motivation for giving blood. For instance, blood donation activity is widely discussed from two perspectives, which are theory of planned behavior (TPB) and mechanisms of altruism (MOA). Using TPB approach, the researchers primarily describe the process of giving blood through the influence of personal attitudes to this behavior, social approval and perceived control of committing the action (Bednall et al., 2013). All these aspects may increase or, on the contrary, decline the intention to donate blood.

In contrast to theory of planned behavior, a great deal of studies into blood donation focused on mechanisms of altruism approach. According to Ferguson and Lawrence (2016), people who donate blood do not follow the desire to help others without getting something in answer. Instead of these altruistic intentions, blood donors are guided by mechanisms of altruism, which are reluctant altruism, or committing actions because of others non-participation, reciprocity, or answering to previously got help, helping to relatives, building reputation, and warm-glow, in other words, desire of getting some benefit (Ferguson & Lawrence, 2016). As noted by Ferguson et al. (2019), people who donate blood are primarily motivated by warm-glow, or positive emotions and good health after helping others. In addition to this, some authors also emphasized that one of the significant factors contributing to starting the activity is the improvement of status because of helping others, what presents identity formation, as consequence (Wevers et al., 2014).

Both approaches have been used in the previous research (Shcherbakova, 2019). They revealed the difference between two age groups, but gave no idea of the reasons for such a difference. Thus, it is necessary to turn to another area of research, which is self and body in blood donation practices. The combination of the two concepts into one approach will give basis for deeper investigation of blood donation phenomenon in Russia.

1.2 Theoretical framework

In recent years, there has been an increasing amount of literature on blood perception, which is mainly supposed to facilitate or deteriorate the desire to give blood (Pat, 2016). The studies, devoted to this topic, focus on interconnectedness between blood and corporeality. Within this perspective, two approaches are defined, which are relationship between blood and body, and perception of blood as a part of self.

1.2.1 Blood as resource

In these approaches, some fundamental works are used as basis for blood donation studying. An early example of research into blood donation perception is reflected in Titmuss' work (Titmuss, 1970). According to this study (Titmuss, 1970), blood is considered to be a gift in the situation of economic relationships in the donation activity. Thus, blood is perceived as a resource for generating social interactions. In this framework, one meta-analysis (Niza et al., 2013) suggested that perception of blood as gift to the world increases the desire to voluntary give this biomaterial and, consequently, improves donors' participation. Similarly, several studies argued that the donors use their blood as an object for serving others, in other words, help society (Lipworth et al., 2011; Shaw, 2014; Lynch & Cohn, 2018). Despite the fact that Titmuss' theory is actively used in the discussion of blood importance, this approach is seriously criticized because of non-existence in modern reality (Niza et al., 2013). That gives some ground for examining this idea within Russian case, because of knowledge gap of blood donors' participation in this country.

Using Titmuss' approach, a big share of current papers on blood donation observe blood as a bio particle belonging to body, which is used as a resource in the donation activity. This idea is argued by several studies that establish that body tissues are independent of a person and, consequently, can be easily donated (Kent & Farrell, 2014; Lynch & Cohn, 2018; Kent et al., 2019). Blood is also situated in this row. Furthermore, this biomaterial is used as a resource for getting benefit (Lynch & Cohn, 2018). For example, giving blood, donors get money and compensatory leave in answer, or get sense of euphoria and improve blood quality (Ferguson et al., 2019). Lynch and Cohn (2017) supported this idea by examining how people changed behavior and attitudes to own body, because of blood perception. To put it more simply, the donors try to follow healthy life style; for instance, do more exercises, exclude fried foods from the diet, when they feel a bad quality of their blood. Thus, the blood resource is improved to facilitate the donation process. Following the “gift” approach, in qualitative study of different tissue donors, Shaw and Webb (2014) discussed instrumental intentions of those people who donated biomaterials. Correspondingly, such donors commit “body work”, since they get some benefit through the donorship of any part of own body (Shaw, 2014). In addition to this, the biomaterial can cause appearance of reciprocal benefit, or situation when both sides, a recipient and a donor, get some advantage (Shaw, 2008). The donors use their blood as a resource for which they get some compensation, while the recipients get a vitally necessary biomaterial. Similar to this study, systematic literature review by Lipworth et al. (2011) concluded blood as a body element, which helps getting some benefit, what makes this biomaterial to be a gift. To be more precise, people's desire to donate blood is generated by social requirement, that is why the biomaterial is considered to be an offering to society. In the same vein, Busby et al. (2014) discussed given blood as common good, because it is gifted to society.

A more philosophical view on this topic, presented by some research, is studying blood in the framework of body wholeness. For instance, Hawkins and Gillett (2014) argued that all biomaterials construct body as a whole. In this point of view, given blood, which is one of the body's particles, is considered to be an external element, not belonging to an individual. To make it more precise, something, removed out of body, is not perceived as a part of a person any more (Hawkins & Gillett, 2014). In addition, it should be pointed out that body is considered to be an element of identity in this case. According to this idea, giving blood demolishes the wholeness of body, what destroys an individual's identity (Hawkins & Gillett, 2014). The evidence presented in this section suggests that blood may be observed from both points of view, as a vital body part and as an element of self-formation, what requires to take a closer look on this problem not only from the perspective of blood as resource, but from another vector.

Overall, taking into consideration Titmuss' approach and different directions, developed from this theory, blood can be observed as a resource, which causes the desire of getting some benefit through using this biological particle as a tool in economic and social relationships. This idea is used as a base for the interview guide elaboration and as the theory for further analysis of empirical data in the present research.

1.2.2 Blood as part of self

On the other hand, there is many studies describing blood in the framework of interconnectedness of body and self. It is necessary to point out that the topic of self-formation was discussed in detail by Goffman (2002). According to this theory, through different activities, people create their self (Goffman, 2002). Furthermore, at the process of social interactions, individuals commit some actions, what generate their self-image, perceived by others. It is necessary to point out that there is also a similar approach, social identity theory, which is widely used in investigations of blood donation. In short, the theory states for the supposition that the self of a person consists of different identities, which are created in the process of social interactions (Terry et al., 1999). Following this concept, people create an identity of a blood donor through belonging to the group of these individuals. Despite the fact that the two theories are similar to each other, it was supposed to use the idea of Goffman's self approach integrated in blood donation perspective, what gives some ground for usage of modifications of this theory in the study of blood donation sphere.

One of the followers of Goffman's idea is experimental study by Koo and Fishbach (2016), which showed that the act of giving any part of body reflects self of an individual to more extent, in comparison with giving material attributes such money or clothes. In this case, giving some elements of body, blood donors create their self through the association with this behavior (Koo & Fishbach, 2016). Likewise, one more research discussed process of blood giving in the framework of hierarchy of self (Pat, 2016). As noted by Pat (2016), blood is an element, which reflects self less, in comparison with other body parts, for example, organs or face. Such a position of blood in the hierarchy is the reason for more frequent donations, comparatively to other biomaterials, because donors perceive blood as a less crucial body particle and, consequently, less significant for their self. Additionally, despite the fact that blood is less important within body, it is more significant out of it, what also contributes to the creation of self-image, or “donor-self” (Pat, 2016). Supporting this idea, a qualitative research by Thorpe et al. (2019) assumed blood as a mechanism of self-formation, since donors are perceived as altruistic people.

Looking at this topic through another vector, Waldby et al. (2004) mentioned that self is limited to the boundaries of body. According to this theory, blood can be perceived as self's element up to the moment of donation. In contrast to this, Hornik and Diesendruck (2017) emphasized subjectivity of the notion of self, what causes the situation that different people, depending on their experience, may consider, or not, donated blood to be a part of self.

Despite the fact that there is a vivid division in approaches of blood perception, some ambiguity in understanding of donation behavior is still generated by interrelation between self and body (Zeiler, 2014). In meta-analysis, Zelier (2014) claimed that some misunderstanding of perception of biomaterials exists. On the one hand, body cannot be separated from self (Zeiler, 2014), and, consequently, blood cannot lose link to self after donation. On the other hand, following the idea of embodiment, all the elements, extracted out of body, do not belong to the person any more (Zeiler, 2014). Thus, this confrontation of different researchers in relation to interconnectedness of self and blood, gives some basis for more investigation of this problem in further studies.

To sum up, the Goffman's idea gave the basis for development of the notion of self within examination of blood donation. The present study uses variations of Goffman's approach, adjusted to blood donation. In particular, the idea of hierarchy of self and the link between self and blood within and out of body are useful as basis for the research.

In summary, two previously discussed approaches cause some ambiguity in blood status. Some studies maintain the idea that blood should be perceived as a body part, used as a resource for getting benefit. However, a growing body of literature suggests the idea of investigating blood in relation to self-perception. This misunderstanding is a reason for examining both ideas within one research that will give possibility to find out the most relevant approach for the particular case and what theory describes motives to blood giving better.



2. Methods

2.1 Description of research method

The present study is an exploratory research, due to the fact that small amount of information about blood donors' attitudes to corporeality and self in Russia is presented. In addition, the paper is focused on the concepts of self and body, what requires a deeper approach in its investigation, because it is necessary to find out what beliefs the donors ascribe to the phenomena. These facts are the reason for choosing qualitative approach. The benefit of this method is an effective way of understanding, how inner motives of the donors are connected with their attitudes to blood (Kovalev & Shtejnberg, 1999).

Semi-structured interviews are used as the main method of information collection, what gives possibility to find out new topics and special vision for donor's experience. This type of interview supposes that the interviewer has the list of questions, but the researcher can ask additional questions that appear during the conversation (Bryman, 2016). Thus, this type of interview provides some flexibility for the interviewer and allows the informants to express their thoughts freely during the conversation (Bryman, 2016). The supposed number of interviews is sixteen because of several reasons. First of all, the study is exploratory in nature. To be more precise, the quantity of interviews is due to the lack of information about blood donors' attitudes in this country (Kovalev & Shtejnberg, 1999). Thus, it will give some information whether a scale research is necessary for investigation of the problem. In addition, it is stated than no less than fifteen interviews should be taken for exploratory research (Bryman, 2016), thus, sixteen interviews can be an appropriate quantity. Secondly, the study is descriptive in its nature, consequently, sixteen is an optimal number for deep analysis of each case.



2.2 Sample

There are several criteria for selecting the participants. The first one is age. The target group is donors older than eighteen and under twenty six. To make it clear, the results of the term paper (Shcherbakova, 2019) showed a poor participation of young people in the donation sphere, in comparison with donors older than thirty. Thus, the study is mainly focused on people younger than twenty six, what gives a good ground for the investigation of youth's participation in blood donation. Likewise, several people under thirty are also recruited, what will allow examining whether the beliefs about blood are generated because of age or whether other influential factors are hidden here. As for the age of the participants, one informant was nineteen years old, one was twenty years old, four were twenty-one years old, five were twenty-two years old, one was twenty-five years old, three were twenty-six years old. Only one participant in the survey was twenty-seven years old, but due to a small age difference, the informant was recruited.

The second criterion is donation quantity. For the sample, people with more than two donations were chosen. It is supposed that the more the times a person has given blood the more extensive the experience he or she has, what gives grounds for better behavior reflection. As for donations quantity, three participants donated blood twice, one participant gave blood three times, one more individual donated the biomaterial fourfold and the other informants gave blood more than six times. The maximum number of donations, which is about thirty, was reported by male who has been giving blood for seven years with the quantity of five donations per year. In addition, the sample includes eight males and eight females, what will help to prevent from offset in answers. To sum up, the sample consists of people before thirty, in particular older than eighteen and under twenty six, with more than two number of donations.

Since there are several criteria, the sample is formed through purposeful sampling, what enables to recruit participants due to the goal (Bryman, 2016). The informants were recruited at Donor Day and through publications in social media. It should be pointed out that five informants were recruited in the framework of collective project.

2.3 Participation in a collective project

As it has already been mentioned the whole work was individual. However, five interviews were taken during the work at collective project “Prosocial behavior in health: biomaterial donation” “Prosocial behavior in health: biomaterial donation” is HSE collective project. The supervisor of the project is Ksenia Eritsyan, docent of the Sociology Department. The main goal of the project was to study blood donation in Russia, in particular, motivation of donors, barriers, social environment relations, assessment of the quality of medical services. The project took place within the framework of HSE. All the informants were recruited at the Donor Day, which was held at the HSE in February. The writer of the present paper performed several tasks on this project. First of all, factor analysis of the results of the survey was performed. Secondly, it was taken part in the development of the expert interview guide. Thirdly, the interviews were conducted with donors from the HSE.. The project was conducted as a part of the educational process under the guidance of docent of the Sociology Department Ksenia Eritsyan. Since the topic of the project and the topic of the present bachelor thesis are similar, the project supervisor allowed to use the interviews collected in the framework of the study project. The interviews were conducted by the writer of the present paper individually. In the study, these interviews are indicated as #10, #13, #14, #15, #16. It is necessary to point out that the present research is focused on the idea of self and body in blood donation, while the project studies motivation of blood donors and their attitudes to the donation system in Russia. Therefore, five interviews were conducted with participants of HSE Donor Day, adding questions from the interview guide of the research.

There is no conflict of interests. The five interviews taken as part of the project are used only for the present study.



2.4 Description of interview guide

As for the interview guide, different topics are touched there (See Appendix A). To be more precise, the participants were asked general questions about their donor's career such as donor's debut, length of the donation activity, motivation. The guide also includes questions about attitudes to body; for instance, preparation for the procedure, wellbeing after a donation, relationship between blood and body. Additionally, the interview guide covers questions about self. In other words, the participants had to describe their understanding of self, representation of self in blood donation and interrelation between blood, body and self. The combining of both topics, body and self, will help to understand the general picture of the donors' attitudes, and find out the most relevant approach for describing the Russian case.

In general, the guide consists of six blocks, which are “experience”, “motivation”, “corporeality”, “identity/self”, “self and body”, “general information”. The first block “experience” focused on the information about number of donations, the donation period and the frequency of the donations. The block “motivation” was taken from the previous research (Shcherbakova, 2019), which was informative in this topic. This block was added because of the idea that some motives may describe a particular attitude to blood. This section included questions about the motives, which caused the desire to give blood, and the knowledge of the donation system. As for the third block, which is “corporeality”, it was focused on the information about preparation for the procedure, the process of blood giving, feelings during and after the donation and the consequences after the procedure. The fourth block is “identity/self”, which had questions about the perception of blood as a part of self, attitudes to other types of donation and comparison of different biomaterials with blood. The block “self and body” specified information how informants represent themselves as donors, relationship to body, link between self and body. The final block, which is “general information”, contained questions about age, field of activity and marital status.



2.5 Data collection procedure

Sixteen interviews were collected. All the narratives were recorded on a voice recorder. The duration of the interviews varied from thirty minutes to two hours. The records were transcribed by the researcher. This person also analyzed all the results.

2.6 Method of analysis

The interviews were coded with the help of MAXQDA (VERBI GmbH, 2020). The narratives were studied through qualitative content analysis that gave possibility to dip into content of the narratives (Mayring, 2014). All the interviews were investigated through semantic content analysis, which helped to find latent meanings embedded in a text. To make it clear, this type of qualitative content analysis identifies hidden values, which are embedded in a statement (Mayring, 2014).

First of all, before the analysis, a special codebook was created, which was used in the process of assigning codes. The codebook was elaborated on the basis of the questions from the interview guide. Four blocks were created. Each block had sub-blocks and codes. The first block was "socio-demographic characteristics", which included codes about age, occupation, and marital status. The second block was "motivation to donate", where the codes with different types of motivation, reasons for a certain frequency of blood donations, as well as the level of awareness about blood donation were highlighted. The third block, "blood donation practices", included codes about preparation for the donation procedure, the process of visiting the blood transfusion station, well-being, and emotions. The fourth block, called "identity/self/wholeness" consisted of codes that described blood as a part of body, as a part of self, the connection of blood with the self and the body, and the representation of the “donor-self”.

The analysis process consisted of reading each transcript and assigning codes to a specific phrase or paragraph. In other words, if a topic was mentioned in the text, the text was assigned a code that was appropriate to meaning. Each code related to a specific theme block had its own color. Therefore, during the encoding, the text immediately traced the thematic parts. Each interview was analyzed twice to avoid errors and omissions of information. Then the program generated resume with all the codes and quotes. This summary was used for an analytical description of the results.



3. Results

As it has already been mentioned, to understand donors' attitudes to blood, sixteen interviews were conducted. No issues were identified during the research process. All the chosen participants agreed to take part in the study. In addition, there were no topics avoided by the informants. Then the interviews were thematically analyzed through content analysis, what helped to reveal thematic parts for further conclusions.

3.1 Informants

As the results showed, most participants studied at university. Four informants combined study with work. Six interviewees worked. As for the fields of activity, they were different. Several informants studied at sociological sphere. Two participants reported PR as the field of their activity. Three individuals mentioned marketing. The other fields, which were reported, are jurisprudence, medicine, economy, journalism, geology, construction.

As for marital status, only one participant was married, and one was divorced. The other were single or had a partner.

3.2 General description of donation experience

According to the results, different periods of donation career were reported. The shortest period is two years. The most common length of donor career is four years. That result is stipulated by the fact that most of the informants studied in the fourth year of the university and began giving blood since the first course.

The often quantity of donations is once per year. Some participants gave blood twice a year. Some males reported four blood giving per year, while females mentioned three donations as the maximum annual number. One informant mentioned the highest number of donations, which is one per two months. It should be pointed out that the individual donated plasma, what gave possibility to donate blood every two months.

Different reasons to particular donations quantity were described. The most common reason to poor number of blood giving per year is health. Some informants mentioned that they considered frequent donations to deteriorate their state of health. For instance, one of the interviewees mentioned a poor eyesight as a reason to a rare quantity of donations. As she said:

My vision is not good. The nurses do not like it either. They have advised to check my eyesight with an ophthalmologist and come back in a case of good analysis. That is why I do not come so often to calm my conscience. (female, 21 y.o.,#6) У меня не все хорошо со зрением. Медсестры тоже неодобрительно к этому относятся. Говорят, идите проверьте зрение у офтальмолога. Если все будет хорошо, приходите. Вот поэтому я сама, чтобы успокоить свою совесть, прихожу не так часто. (женщина, 21 год,#6)

Similarly, other participant described her number of donations in the framework of health. Particularly, she stated others opinion about negative consequences after donations as the reason to poor visits to blood donation centers. As she commented:

I often hear information from my mother, who has never given blood. She said that I can't give blood often, once per six months, once a year. That is not good. (female, 21 y.o., #15) Я очень часто слышу информацию от мамы, которая никогда не сдавала. Она говорила, что мне часто сдавать кровь нельзя, раз в полгода, один раз в год. В этом нет ничего хорошего. (женщина, 21 год, #15)

Some interviewees described the number of donations by the demand of their organism. One informant outlined a withdrawal, which indicated the requirement of body in blood donation. The person reported:

There is a slight withdrawal sometimes. Indeed, the body sometimes wants to get rid of it [of the blood]. (male, 26 y.o., #11) Есть небольшая ломка иногда. Действительно, организм иногда хочет избавиться от этого [от крови]. (мужчина, 26 лет., #11)

That reports give some ground for the idea that the donors observe their donation experience inseparably with their well-being and state of organism.

What should be mentioned is that some informants stated that they must give blood a particular number of times because of their “donor” status. For example, one interviewee linked the frequency of donations with the rarity of his blood. In his mind, he had to give blood as much as possible because of a rare status of it. As the individual said:

It [blood] is rare in itself. It is fourth positive. So I don't even have a choice but to donate it. I should help the same people <...> with the same blood type. (male, 21 y.o., № #3) Она [кровь] редкая сама по себе- четвертая положительная. Так что у меня даже выбора нет, кроме как сдавать ее. Помогать таким же людям <…> с такой же группой крови. (мужчина, 21 год, № #3)

Another participant explained the quantity of blood giving through the desire to preserve the status of “active donor”. In other words, more rare number of donations would be a reason to transition to the status of “primary donor”. As the interviewee reported:

For the purpose to constantly update blood database. If you do not donate blood for six months, you are forcibly asked to come. If you don't come, your blood type is frozen. Then you are reclassified as a primary donor. (female, 21 y.o., #1) Чтобы база крови всегда обновлялась. Потому что потом, если ты полгода не сдаешь, тебя либо просят насильно прийти, а если ты не приходишь, то группа крови твоя замораживается. И пять ты должен стать первичным донором. (женщина, 21 год, #1)

Thus, some donors observed their donation experience through the idea to follow a particular donor status.

One more common reason of donations quantity is time. A big share of informants stated lack of time as the prerequisite to their rare visits of blood centers. For instance, one participant mentioned a break in his donation career, which was caused by lack of time. As he said:

I had a break in the donations for 3 or 4 months, because I had to pass a medical examination and get a medical certificate for the therapist. I could not do it because of lack of time and a big amount of work. (male, 26 y.o., #5) Но я потом пропускал, где-то месяца 3-4 не сдавал. Из-за того, что мне для терапевта нужно было получить заключение, пройти медосмотр. И я не мог зайти ввиду отсутствия времени, и работы было много. (мужчина, 26 лет, #5)

In addition, with the time factor, many informants mentioned ban on donor centers due to excess of their blood type. One interviewee explained the reason of one donation per year, which was absence of demand in his blood type. As he commented:

I wanted to start donating blood regularly, but there were some barriers. For example, blood transfusion stations had no demand in my blood type. (male, 22 y.o., #10) Как-то всё хотел начать регулярно, но что-то как-то всё не складывалось. Например, не нужна была моя группа крови. (мужчина, 22 года, #10)

To sum up, the periods of donation career reported by the participants varied from two years to seven years. The mentioned number of donations was also different, which is from one per year to every two months. As for the reasons to the donation quantity, the interviewees described common prerequisites such as time, ban by a donor organization, state of health, maintaining the donor status. Thus, the informants analyzed their experience from several points of view such as body state, in particular, health, donor self, or the desire to follow a particular image, and external factors. For that reason, it is necessary to observe the results from several vectors. To make it clear, the present research has two aims that is why a further analysis is divided into two parts, perception of blood and motives to blood giving.

3.3 Perception of blood

First of all, it is necessary to investigate the results from attitudes to blood vector. A particular perception blood, which is manifested through routine practices such as preparation to the procedure, visiting donation centers, blood giving and recovery after the process, may help to describe a particular type of behavior and possible reasons to blood giving.

3.3.1 Preparation to the procedure

Preparation for the donation is a significant part of the donation process. All the informants highlighted the preparation practices as an important stage of blood giving. The interviewees put a significant attention to their bad habits such as smoking or drinking alcohol. Practically all the participants tried to follow this instruction a few days before the procedure. Several individuals reported their complying with the requirement during one or two months before the visit of a donation center. For instance, one interviewee told about quitting smoking just before the donation. As he put it:

I completely stop smoking a week before the donation. I usually smoke, but I stop smoking a week before the blood giving. (male, 21 y.o., #3) За неделю до сдачи крови я прекращаю совершенно курить. То есть так обычно я курю, но за неделю до сдачи я прекращаю курить. (мужчина, 21 год, #3)

One more participants described her preparation before the procedure, which is reflected through abstinence from alcohol. She described her story in this way:

I am not drinking alcohol for the period. Last year, when I was waiting for the call for thrombocyte donation, I did not drink alcohol for six months. I was constantly waiting for the call. (female, 20 y.o., #2) Я не пью алкоголь какое-то время. Вот в прошлом году, когда я ждала, что позовут на тромбоциты, я не пила полгода алкоголь, ждала постоянно, что позвонят. (женщина, 20 лет, #2)

Another instruction followed by all the informants was a proper nutrition. The participants described the same diet, which consisted of eating the boiled, vegetables, fruits, light food. Additionally, a hearty breakfast was also mentioned as an important element of the diet. All the informants told about the need to refuse from eating fat and fried food. For example, one interviewee reported:

As for food, you cannot eat the fat in twelve hours. In the morning, you must have a hearty breakfast, which consists of porridge, fruits, sweet tea. (male, 22 y.o., #9) По еде, там еще нельзя есть жирное за 12 часов. Сутра нужно обязательно позавтракать. чем-нибудь таким более-менее плотным: каша, фрукты, сладкий чай обязательно. (мужчина, 22 года, #9)

Several donors mentioned the difficulty in refusal from some products before the donation, but emphasized a strict fulfillment of the instructions. Supporting this idea, one individual described some difficulties in refusal from fat and spicy food, which is a part of a traditional nutrition for his nationality. As this informant said:

I cannot refuse from the fat, because I am the Caucasian, and we eat spicy food. You cannot eat fat, meaty food before the donation. I used to eat meat, eat bread, and drink compote, tea. It is hard for me to give up all that for two days and eat the boiled. (male, 26 y.o., #5) Я не могу отказаться от жирного, потому что я, в силу своей врожденности, кавказец, и мы любим все очень острое. А для сдачи нельзя есть жирное, мясистое такое. А я привык есть мясное, сытное такое, и заедать еще хлебом, и запивать еще компотом, чаем. И мне вот тяжеловато на два дня отказаться от этого всего, есть что-то вареное. (мужчина, 26 лет, #5)

What is more, some informants add particular products before the procedure to improve their analysis. For instance, one individual reported about consumption of tablets, which increase hemoglobin, because of the risk of bad analysis. The participant commented:

I often have a low hemoglobin. If I suspect that I have eaten little meat during this period, I realize that I may have a low hemoglobin. I start taking iron tablets several days before the donation. (female, 26 y.o., #7) У меня часто бывает низкий гемоглобин. Если я подозреваю, что я ела мало мяса в этот период, я понимаю, что у меня может быть низкий гемоглобин. Я за пару дней начинаю пить железо в таблетках. (женщина, 26 лет, #7)

Both measures, breaking bad habits and proper diet, were followed by all the donors for the purpose to have good analysis at the donation. Additionally, the informants tried to follow all the requirements because of their status of “blood donor”. Following their ideas, a blood donor should be healthy to prevent from medical exemptions. Speaking about the compliance of the requirements one donor told about negative experience because of inappropriate results of the diagnostics, when she was banned of the donation. As she reported:

I had a low hemoglobin. I was just a little reached the lower limit. I was also so offended that I came to give blood, but they did not take it from me. Now before each donation <...> I have a fear that the hemoglobin can be low, and I again came in vain. Now I do everything as it should [follow the recommendations to prevent from such situations. (female, 21 y.o., #6) А у меня был низкий гемоглобин. Я совсем чуть-чуть не дотянула до нижней границы. Мне тоже было так обидно, что я пришла, чтобы отдать, а у меня не берут. Поэтому теперь перед каждой донацией <…> у меня есть страх, что с первого раза: сейчас, как скажут, что гемоглобин низкий, и я опять зря приехала. Поэтому я на всякий случай делаю все, как надо [соблюдаю рекомендации], чтобы там не было ничего такого. (женщина, 21 год, #6)