BLOOD DONORS AND BLOOD COLLECTION African culturally and linguistically diverse communities’ blood donation intentions in Australia: integrating knowledge into the theory of planned behavior Michael Jay Polonsky, André M.N. Renzaho, Ahmed Shahriar Ferdous, and Zoe McQuilten BACKGROUND: The Theory of Planned Behavior (TPB) has been extensively used to examine donation intentions in the general community. This research seeks to examine whether TPB applies to one culturally and linguistically diverse (CALD) community in Australia and also incorporates blood donation knowledge as an antecedent in the model, given that the TPB assumes people make informed decisions regarding blood donation. STUDY DESIGN AND METHODS: A cross-section of 425 members of African CALD communities was sur- veyed face to face using bilingual workers, ensuring inclusion across literacy levels within the CALD commu- nity. Constructs used within the survey were drawn from the TPB blood donation literature (i.e., attitudes, social norms, and self-efficacy). A new measure of blood donation knowledge was included. RESULTS: Structural equation modeling found that the Basic TPB model did not hold for African CALD com- munities in Australia. The Basic TPB model was modi- fied and within this Adapted TPB model attitudes were found not to impact intentions directly, but had a medi- ating effect through self-efficacy. An Extended TPB model including overall knowledge was then tested and improved the model fit statistics, explaining 59.8% variation in intentions. Overall knowledge was found to indirectly impact intentions, through self-efficacy, social norms, and attitudes. CONCLUSION: The TPB applies differently when examining African CALD communities’ blood donation intentions in Australia. Knowledge is an important medi- ating component of the Extended TPB model rather than directly affecting intentions. Addressing CALD communities’ psychographic characteristics may assist blood services in developing targeted strategies to increase donations within these communities. M uch of the developed world relies on volun- tary blood donations from members of the community, which is often preferred to other methods of sourcing blood supplies. 1 Australia relies solely on voluntary blood donations, and the Australian Red Cross Blood Service (the Blood Service) is the exclusive provider of blood products. 2 Ensuring that Australia is self-sufficient in blood donations is difficult as only 3.5% of all Australians donate, yet, over their life, one in three Australians will need blood products. 3 Therefore, the Blood Service needs to effectively engage with poten- tial donors from across the Australian population. Australia is a multicultural nation and many of its migrant communities come from culturally and linguisti- cally diverse (CALD) backgrounds, with such communi- ties having lower donation rates. 4 Hence, there are some ABBREVIATIONS: AVE = average variance extracted; CALD = culturally and linguistically diverse; CFA = confirmatory factor analysis; CFI = confirmatory fit index; KR20 = Kuder– Richardson-20 coefficient; LB = lower bound; RMSEA = root mean square of approximation; SEM = structural equation modeling; TLI = Tucker-Lewis index; TPB = Theory of Planned Behavior; UB = upper bound. From the School of Management and Marketing, Deakin Uni- versity, Burwood, Victoria, Australia; Migration, Social Disad- vantage, and Health Programs, International Public Health Unit, School of Public Health and Preventive Medicine, and the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne,Victoria, Australia; and Research and Development, Australian Red Cross Blood Service, West Mel- bourne, Victoria, Australia. Address reprint requests to: Michael Jay Polonsky, School of Management and Marketing, Deakin University, 70 Elgar Road, Burwood, Vic 3125, Australia; e-mail: Michael.Polonsky@deakin.edu.au. Received for publication June 3, 2012; revision received August 19, 2012, and accepted August 19, 2012. doi: 10.1111/j.1537-2995.2012.03915.x TRANSFUSION 2013;53:1475-1486. Volume 53, July 2013 TRANSFUSION 1475