Using the Theoretical Domains Framework and the Theoretical Framework of Acceptability to understand gay, bisexual, and other men who have sex with men’s willingness to participate in a plasma donation program


Men who have had sex with a man in the previous three months are not eligible to donate blood or plasma in Canada. Canada is considering reducing restrictions to plasma donation by gay, bisexual, and other men who have sex with men (gbMSM) as an incremental step to redressing policies that are viewed as discriminatory by LGBT2Q+ communities. Such a change may be beneficial to addressing Canada’s insufficient supply of domestically collected plasma.  The present study is part of a larger project that aims to: 1) evaluate the acceptability and feasibility of new screening processes for plasma donation by gbMSM from the perspectives of gbMSM and donor centre staff; and 2) to co-develop strategies to address any barriers and enablers to donation and implementation should changes to eligibility for gbMSM be approved. The objective of the present study was to investigate how gbMSM’s views on current and proposed plasma donation policies may affect their willingness to donate in the future.


The study is rooted in an integrated knowledge translation approach and involves close collaboration with Canadian Blood Services, one of Canada’s two national blood operators, ensuring the research activities remain aligned with and simultaneously inform progress made in changing donation policies over time. We also take a participatory research approach and have engaged a public involvement research group of seven gbMSM who are active partners in the research. This was a qualitative study focused in a medium-sized city that will be one of the sites for first implementation of new screening processes if approved. We invited gbMSM to participate in two consecutive semi-structured interviews to explore their views on blood and plasma donation policy, plasma donation, and the proposed Canadian plasma donation program for gbMSM. Interview transcripts were analysed thematically, guided by the Theoretical Domains Framework (TDF) and the Theoretical Framework of Acceptability (TFA).


Seventeen men identifying as gay, bisexual, or as having sex with men participated in 33 interviews. The proposed screening processes were viewed as discriminatory. Acceptability of the proposed program was a key environmental barrier to donation intention in this population. This was influenced by the perceived high opportunity costs of putting aside one’s values of fair treatment for oneself and one’s community and associated negative emotions in order to participate in the proposed program and donate plasma. Opportunities to lessen perception of the conflict between one’s values of equity and one’s desire to contribute through donation will be discussed.


Findings highlight the blood ban in Canada as a unique and critical part of the context of donation behaviour among gbMSM. Combining the TDF and TFA enabled connections between beliefs and emotions about donation within the broader social and environmental context. This research will help inform the development of strategies to support possible implementation. The continued engagement of the blood operator and gbMSM communities in this research will ensure that the strategies developed are sensitive, appropriate and effective.



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