Effect of persuasive messages on National Health Service Organ Donor Registrations: a pragmatic quasi-randomised controlled trial with one million UK road taxpayers

Abstract

BackgroundA shortage of organs available for transplantation is causing loss of life. Increasing the number of individuals on the National Health Service (NHS) Organ Donor Register (ODR) is one way to address the shortage of organs. In Great Britain, new drivers registering for their driving licence are invited to join the ODR. A further 17 million drivers renew their road tax online each year, presenting an additional opportunity to prompt drivers to join the ODR. This trial explores the effect of adding persuasive messages to a prompt to join the ODR at the end of road tax payment transactions.MethodsIn this pragmatic, parallel group, quasi-randomised controlled trial, drivers renewing their road tax or registering for a driving licence were alternately allocated, using a JavaScript randomisation code embedded in the GOV.UK website, to view a control prompt inviting sign-ups to the ODR or the same prompt plus one of seven theoretically informed persuasive messages; (i) social norms alone, (ii) social norms plus the NHS ODR logo, (iii) social norms plus an image, (iv) loss frame, (v) gain frame, (vi) reciprocity and (vii) cognitive dissonance. The trial took place over a 4-week period in June 2013. The primary outcome measure was participants completing the online registration form (sign-ups).ResultsAltogether, 1,085,322 website users were included in the study. Further, 1171 more sign-ups were completed under the most effective message (reciprocity) compared to the control prompt alone (reciprocity: n = 4256, control: n = 3085; odds ratio, OR 1.38, 95% confidence interval 1.32–1.45, p < 0.001). The loss-framed message was as effective. All messages increased sign-ups compared to the control prompt apart from the social norms message plus image (n = 2879; OR 0.94, 95% confidence interval 0.89–0.99, p < 0.05).ConclusionsShort persuasive messages alongside a prompt can persuade more ODR sign-ups for individuals renewing their road tax than a prompt alone. The most effective message remains in place today. Since the trial in 2013, the same message has been implemented across 25 government end-of-transaction websites on GOV.UK, resulting in 529,000 new registrations to the ODR up to 31st October 2017.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2855-5) contains supplementary material, which is available to authorized users.

Blood and organ donation: health impact, prevalence, correlates, and interventions

“…Interventions for posthumous donation to-date have largely focused around legislative change (e.g., changing to an opt-out policy or prioritising transplant candidates who have shown commitment to organ donation: Sallis, Harper, & Sanders, 2018).…”

“…A VRA message ("If you needed an organ transplant, would you have one? If so, please help others") was the most successful, followed by a loss framed message ("Three people die every day because there are not enough organs") (Sallis et al, 2018).…”

“…Norm based strategies ("Every day thousands of people who see this page decide to register") were the least successful, and when combined with an image of people, norm-based strategies had a detrimental effect, resulting in a reduction in donor registrations (Sallis et al, 2018). The UK NHSBT advertising campaign currently Blood and Organ Donation 40 uses VRA, asking "If you needed an organ transplant would you have one?"…”

“…Reciprocal Altruism (VRA) has been shown to be effective with respect to increasing registrations in deceased organ donor intentions (Sallis et al, 2018). The same approach is equally applicable to blood donation, with recent evidence showing that a VRA manipulation enhanced trust and reciprocity (Ferguson & Lawrence, 2018) and…”

Novel approaches to behavioral management of vasovagal reactions and donor recruitment: comment on “a randomized controlled trial of a table‐based intervention to address predonation fears among high school donors”

“…While research applying this notion to blood donation is just beginning, interventions highlighting the need for personal action in light of uncertainty about the behavior of others have shown promise in terms of openness to organ donation. 11 Once again, this could be easily embedded in Internet/tablet/app-based recruitment or preparation materials, for example, "asking if the potential donor would want a blood transfusion to save their life." 8 In sum, while current and prospective donors can be frustratingly complex, research suggests that more nuanced views of related psychological and behavioral characteristics yield not only greater understanding but avenues for clinical intervention.…”