A STEM CELL DONATION SENSATION

The problem and why it is important:

In the UK, someone is diagnosed with blood cancer every 20 minutes (Broggio & King, 2018). Often, a stem cell transplant can be the best chance of survival for someone with blood cancer. There are around 2,000 people in the UK looking for a stem cell donation. However, the ‘tissue type’ of the donor and patient must match very closely in order for it to be successful. Doctors first look to the patient’s immediate family for a donation, but only about 30% of people in need of a transplant can find a donor match in their immediate family (Thompson, 2017). As a result, the remaining patients rely on compatible donors from the bone marrow register. Finding a matching tissue type for someone in need of a transplant is very difficult due to the vast variety of tissue characteristics. Therefore, the more people on the register, the better the chance for a match.

*** Background science***

Most blood cancers start in the bone marrow. Bone marrow is a soft tissue found in your large bones which produces stem cells that develop into new blood cells every day. But for people with bone marrow diseases, such as leukaemia and lymphoma, this process is interrupted by abnormal cancerous cells. These cells prevent blood cells from performing crucial functions, such as fighting off infections (Auday, Buratovich, Marrocco & Moglia, 2018). A stem cell transplant replaces the diseased bone marrow with healthy stem cells to produce functioning blood cells.

Stem cell transplants can be used to treat people who are fighting life-threatening diseases. Donating stem cells can be as easy and painless as giving blood (Thompson, 2017). However, there is a lack of awareness regarding bone marrow donation and many myths about the procedure which put people off. A survey found that 83% of people were unaware they could be a matching stem cell donor to help save a life (DKMS, 2019). They also found that 90% of people wrongly thought general anaesthetic was required.

(Circulatory System. Terese Winslow LLC. 2011)

Many charities have been set up to raise awareness of blood cancer and to recruit potential stem cell donors. Anthony Nolan is a UK charity that recruits donors for stem cell transplantation, currently with around 700,000 potential donors on its register (anthonynolan.org, 2019). Simply joining their register by completing a medical form and sending off a saliva swab, could save the lives of people with blood cancer. ‘Marrow’ is a student organisation working in universities across the UK in partnership with the Anthony Nolan Register. Their aim is to spread awareness of the charity to recruit potential donors, as well as informing students and the local communities about blood cancer and how easy it is to donate stem cells (anthonynolan.org, 2019). The University of Warwick’s Marrow organisation is mainly situated in the Gibbet Hill Campus which only accounts for a small portion of its students. Therefore, our project focuses on bringing the work of Marrow to main campus to target a larger population and get more people to join the register.

Target Audience and how it was tailored to them:

Our target audience for this project is of course university students. One of our main goals was to increase awareness of stem cell donation and the work of Warwick Marrow and Anthony Nolan to as many people as possible, therefore students were an ideal audience as they are easy to access and there are plenty of them. When we asked at our sports sessions who was aware of the work of Warwick Marrow, it was clear that this was a vague area for a lot of people. Students also tend to be open and engaged regarding charity work, so were more likely to react positively to our project and take an interest and get behind stem cell donation as it is a good cause that is easy to support.

We therefore tailored our intervention so that it would appeal and work most effectively towards the audience of students by understanding how to get them engaged and listening. For our intervention to work well for students we ensured that it was simple, short and had relatively low commitment. Students are busy people, so our intervention had to be direct and straight to the point in order to be effective in a campus setting. We also were aware it would be near impossible to reach vast numbers of students so using technology/social media as well as general marketing techniques like producing flyers, would be an efficient way for more people to see the message of stem cell donation awareness that we want to spread. We lastly tailored our intervention by directly targeting specific sports groups on campus, as they often already have charitable links so would be especially open to supporting good causes. They are also more likely to exhibit behaviour changes that would be beneficial for charity organisations such as Anthony Nolan and Warwick Marrow.

Our project focused on raising awareness for stem cell donation among the student population, so we made sure our interventions were tailored to be suitable for the student community and direct with the ideal goal being an increase in donor signups and knowledge surrounding stem cell donation.

Our Intervention:

Our primary goal was to generate and spread as much awareness as possible for stem cell donation among university students, and hopefully encourage more people to register as donors. In order to do this, we used a multifaceted intervention that comprised of three major aspects:

·       Flyers asking people if they would donate

o   Including a link to Anthony Nolan website and a QR code

·       Short talks to Sports Clubs

o   Including giving out Warwick Marrow merchandise e.g. badges

·       Social Media Awareness

o   Advertising Warwick Marrow events

o   Instagram/Facebook interactive stories asking about donating        

 

                       

We believe these aspects had the best effect on university students and will be something that will catch their eyes and interest them enough to learn more about stem cell donation and ideally register as donors.

Persuasion Techniques we used:

As we had previously gauged that our target audience (sports clubs on campus) weren’t very aware of Warwick Marrow or their work on campus, we decided to take a peripheral route to persuasion (which would then trigger a more central route) with our flyers - big texts to increase fluency and a striking black and white contrast in the imagery. We then provided a QR code for readers to scan, which would take them to the Anthony Nolan website. This would then trigger a more central route of persuasion, as this was from a credible source, providing facts and statistics for people to learn from.

The key technique we used for our flyers was door in the face. The flyer’s title read “STEM CELLS: WOULD YOU DONATE?” as our ‘bigger’ request, that people probably would not agree to immediately (or even at all). Underneath that, we then offered people to just read some quick information about stem cell and bone marrow donation instead, thereby spreading awareness as this was something the audience could do very easily. This way, we also gave people an “every little bit helps” opportunity, whereby they could help spread us awareness just by reading some information as opposed to by becoming a donor if they didn’t wish to do so.  

We also presented to our individual sports clubs in person during training sessions. Our key techniques used here were singling a person out for attribution of responsibility, public commitment and implementation intentions. We started our talk by singling out a person in the audience by name and asking them: “(Insert name), do you know how easy it is to donate bone marrow?”, to which that person answered they didn’t. As well as making the talk more engaging, this technique aimed to reduce the diffusion of responsibility in the audience to avoid thinking they didn’t have to read the information because other people in the audience would.

Our method of public commitment and implementation intentions were used at the end of the talk. We told the audience we would post a link online giving more information about the cause (as well as handing out flyers) and asked them to read it when they got home that day. We then specifically asked another member in the audience by name: “(Insert name), what are you going to do when you get home today?”, to which they responded, “Go onto the website and register”, or something along those lines. This therefore created a small-scale public commitment for that individual and encouraged others to do the same. It also provided an implementation intention as they would engage in this specific activity (reading online) at a specific point in the future (getting home).

Why did we choose these techniques?

Peripheral and Central Routes

The Elaboration Likelihood Model of Persuasion (Petty & Cacioppo, 1981a) organises behavioural change processes into two routes: central and peripheral. For our project, we decided that the most suitable route to start with for our target audience would be the peripheral route. We felt that because our audience was university students in sports clubs, it was important to keep the information we were providing short and snappy, to get the students’ attention. Using the peripheral route allowed our audience to rely on mental shortcuts (Petty, Barden & Wheeler, 2009), known as heuristics, resulting in minimal mental effort required from them. Due to the nature of what we were asking people to do, we did not want to scare them away with an overload of information in one go. Therefore, by creating a flyer that was quick and easy to read, it made it clear what our message was in a simple way.

However, we realised that while this was a suitable method to get people’s initial attention, it would also be important to provide them with further details and evidence, if we wanted them to actually sign up to the stem cell donor register. Therefore, our flyers contained a QR code and website link that took our audience to the Anthony Nolan website, where they could get further information about what donating stem cells and bone marrow would consist of. On the website they were also able to find out more about blood cancers, gain a deeper understanding of what a stem cell transplant is and what the impact of their donation would be. This was a shift from using the peripheral route to using the central route of the ELM. We felt that this change in route was important because alongside spreading awareness of Warwick Marrow and their work, it would allow us to give people information about how they could sign up to the donor register. When people are confident and trust the source of the information they are being provided with, the more likely they are to take in the information being given to them, and thus adapt their behaviour accordingly (Fishbein & Ajzen, 2000). Therefore, by providing our target audience with information on the Anthony Nolan website from professionals, we hoped that this would help persuade them to sign up to the register.

Door in the Face

As a group, we recognised at the beginning of the project that asking members of sports clubs to sign up to donate stem cells, when they had no previous knowledge about what would happen, would be quite a big ask. Therefore, we decided to use the ‘door in the face’ technique when asking our sports clubs to get involved with Warwick Marrow and Anthony Nolan’s work. This phenomenon has been investigated by researchers who have shown that if you ask someone a large request that is turned down, they are more likely to accept a more reasonable request that then follows. For example, Cialdini et al (1975) found that this method of persuasion increased compliance levels in participants when asked to escort children around a zoo, if they had first been asked to be a mentor for a prisoner for two years. The initial request was considered a ‘big’ ask, and so participants were more likely to agree to the second more ‘reasonable’ request. After research on this technique, we decided that this could be applied to our own project. By just asking our sports clubs initially to become a stem cell donor, we knew they were likely to turn down the request because of the time and effort it would require from them. Therefore, when we asked them to do a much simpler task of scanning the QR code or going on the website to find out more information about how to become a donor. People were unsurprisingly much more likely to agree to this!

Implementation Intention and Public Commitment

An effective persuasion technique we decided to use was asking members of our sports clubs to create an implementation intention. Gollwitzer (1999) highlighted the impact that making an implementation intention could have on achieving goals, and so we decided that if we asked our target audience to create their own implementation intention, they would hopefully be more likely to carry it through. There is strong supporting evidence for the use of implementation intentions in behaviour changes, particularly when there is a clear goal to achieve. We decided that using this technique would be effective in our project because an implementation intention requires a commitment to attaining a specific goal. This means that by getting our target audience to state exactly what they were going to do and when, they had made a goal that they were now committed to achieving. In this case, the goal was to go onto the link we had provided to the Anthony Nolan website, where they would be able to gain more information about stem cell donation and signing up to the donor register. This “if-then” strategy would prove suitable for our project because it was a simple task that our target audience had to complete when they got home, which could ultimately have a bigger impact on their behaviour. By saying that they would go on to the website when they got home that evening, the mental representation of the situation they want to achieve, becomes more activated in their brain and so also becomes more readily accessible. Once they had accessed the website, they would be able to read more about Anthony Nolan and their work, and ultimately decide whether they wanted to complete the easy steps to sign up to the donor register. Implementation intentions are effective in behaviour change because of the psychological mechanisms that are in place when a person forms them (Gollwitzer & Oettingen, 2011).

Consequences of our Project

Through our multiple interventions we received an astoundingly positive response both in person and online. People were engaged and asked questions about stem cell donation and what exactly registering as a donor involves and the impact it can have. We have also received conformation that some individuals now intend to, or have been motivated to register as donors through either Anthony Nolan or Warwick Marrow, demonstrating an increase in awareness amongst university students of stem cell donation and in some a behaviour change to sign up as a donor, both positive results of our interventions.

  

Chloe Phillimore, Emma Kirk, Olivia Jackson and Claire Koster

References

anthonynolan.org. (2019). Marrow. Retrieved from https://www.anthonynolan.org/8-ways-you-could-save-life/volunteer-us/marrow

anthonynolan.org. (2019). Our history. Retrieved from https://www.anthonynolan.org/about-us/our-history

Auday, B., Buratovich, M., Marrocco, G., & Moglia, P. (2018). Magill's Medical Guide (7th ed.). Massachusetts: Salem Press.

Broggio, J., & King, A. (2018). Cancer registration statistics, England 2016 - Office for National Statistics. Retrieved from https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/cancerregistrationstatisticsengland/final2016

Cialdini et al. (1975). Reciprocal concessions procedure for inducing compliance: The door-in-the-face technique. Journal of Personality and Social Psychology, 31(2), 206-215.

Circulatory System. (2019). Retrieved from https://www.teresewinslow.com/cirulatory/7b1g03rbnw6bvodjdup0y4t50u01ud.

DKMS. (2019). Low levels of awareness of how people can help save the life of someone with blood cancer. Retrieved from https://www.dkms.org.uk/en/low-levels-awareness-how-people-can-help-save-life-someone-blood-cancer

Fishbein, M., & Ajzen, I. (2000). Attitudes and the attitude-behaviour relation: Reasoned and automatic processes. In W. Stroebe, & M. Hewstone (Eds.), European Review of Social Psychology (pp. 1-33). New York: Wiley.

Gollwitzer, P. M. (1999). Implementation intentions: Strong effects of simple plans. American Psychologist, 54, 493-503.

Gollwitzer, P. M., & Oettingen, G. (2011). Planning promote goal striving. In K. D. Vohs & R. F. Baumeister (Eds.), Handbook of self-regulation: Research, theory, and applications (pp. 162-185). New York: Guildford Press.

Petty, R. E., & Cacioppo, J. T. (1981a). Attitudes and persuasion: Classic and contemporary approaches. Dubuque, IA: Wm. C. Brown.

Petty, R. E., Barden, J., & Wheeler, S. C. (2009). The elaboration likelihood model of persuasion: Developing health promotions for sustained behavioural change. In R. J. DiClemente, R. A. Crosby, & M. C. Kegler (Eds.), Emerging theories in health promotion practice and research (pp. 186-214). San Francisco: Jossey-Bass.

Thompson, A. (2017). Donating Bone Marrow Is Easy and Important: Here’s Why. Retrieved from https://www.cancer.net/blog/2017-01/donating-bone-marrow-easy-and-important-heres-why