Original Research

Organ donation attitudes and general self-efficacy: exploratory views from a rural primary care setting


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Emmanouil Symvoulakis1
MD, PhD, Assistant Professor

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Adelais Markaki2
PhD, APRN-BC, Associate Professor *

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George Rachiotis3
MD, PhD, Associate Professor

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Manolis Linardakis4
PhD, Statistician

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Spyridon Klinis5
MD, MSc, General Practitioner

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Myfanwy Morgan6
PhD, FFPH, FHEA, Professor


1 Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Greece

2 School of Nursing, University of Alabama at Birmingham, USA

3 Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Greece

4 Department of Social Medicine, Faculty of Medicine, University of Crete, Greece

5 Primary Health Care Unit of Alonakia, Siatista, Greece

6 Institute of Pharmaceutical Science King’s College London, London, UK

ACCEPTED: 9 September 2019

early abstract:

Background: Behavioral determinants can enable or hinder motivation towards registration and donorship and subsequently, action or inertia towards organ donation. Nevertheless, there is limited information about the role of self-efficacy in relation to organ donation awareness and presumed consent among individuals and their families.

Aims: To explore knowledge, attitudes and general self-efficacy as behavioral determinants for organ donation among rural primary care attendants, in order to tailor awareness strategies for reversing inertia within an opt-out system.

Methods: A prospective face-to-face survey during regularly scheduled appointments of 203 attendants at a rural primary care unit in northern Greece. Responses to a 12-item adapted “Organ Donation Awareness” questionnaire measuring knowledge, attitudes and awareness were related to participants’ “General Self-Efficacy (GSE) Scale” score. Hierarchical modeling of a multiple linear regression model was adopted with GSE scale score added.

Results: About one third of respondents (34.0%) had discussed presumed consent with a partner, family member or friend. More than half (54.2%) were concerned that donated organs might be used without consent for other purposes, such as medical research. A 30% found organ donation unacceptable because of religious beliefs. Organ donation awareness was not influenced by respondents’ specific characteristics, but was significantly related to the GSE score (stand. beta=0.155, p=0.033).

Conclusion: Overall, organ donation perceptions among rural primary care recipients were determined by knowledge of the presumed consent procurement system, pre-conceptions, religious beliefs, altruism, and GSE scores. The association of self-efficacy with raised awareness could potentially explain the gap between high intent to consent as a donor and subsequent lack of follow-up action. Further comparative research across behavioral determinants between rural/urban groups is needed in order to tailor awareness strategies suitable for an opt-out system.