| Abstract|| |
The study was set to determine whether knowledge and attitudes toward organ donation differ according to geographical location. Self-administered questionnaires were employed to collect data such as demographic characteristics, basic knowledge, attitudes and source of information about organ donation from subjects in rural and urban areas. The questionnaires were distributed randomly to 1,000 individuals in both areas during 2008. The data were analyzed in a descriptive fashion. Despite similarities in knowledge and attitudes of respondents in both areas, rural respondents were less likely to have information about organ donation, to report willingness to donate organs, and to have knowledge about "brain death" or the "organ donation card" than their counterparts in urban areas. The study identified that the principle respondents' source of information about organ donation was the television. More than 90% of respondents in rural and urban areas reported that the contribution of health care providers in providing them with knowledge about organ donation and transplantation was "none" or "little". Respondents identified several reasons, which may influence their decisions to donate organs. In conclusion, the deficit in knowledge and attitudes of rural respondents about organ donation may be justified by the lack of information about this significant issue. Accordingly, health facilities, local mass media and educational institutions should provide intensive educational programs to encourage the public donate organs.
|How to cite this article:|
Alghanim SA. Knowledge and attitudes toward organ donation: a community-based study comparing rural and urban populations. Saudi J Kidney Dis Transpl 2010;21:23-30
|How to cite this URL:|
Alghanim SA. Knowledge and attitudes toward organ donation: a community-based study comparing rural and urban populations. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2013 May 25];21:23-30. Available from: http://www.sjkdt.org/text.asp?2010/21/1/23/58703
| Introduction|| |
The Saudi Center for Organ Transplantation (SCOT), previously known as the National Kidney Foundation, was established in 1984 with an objective to supervise activities of organ donation and transplantation in Saudi Arabia. SCOT adopted strategies that included research conduction, distribution of donation cards, public awareness and health professionals' education. ,,, Despite efforts to educate and encourage the public about donation and transplantation, the number of organ donors has not paralleled the growing waiting list, ,, and inadequate organ donation in Saudi Arabia remains a major limiting factor for transplantation.
Providing the general public by relevant information and correcting some of the misconceptions are likely to increase the number of individuals willing to donate organs. Several strategies have been adopted in order to maximize the number of donors in many countries, including increasing the number of organs transplanted from living donors, legislation  and making the deceased's persons wishes expressed on an organ donor card (e.g. driver's license) legally binding. 
Studies on factors associated with knowledge and attitudes towards organ donation have shown contradicting results and have indicated that it is not clear which factors are most significantly related to decision-making for donation. ,,,,
Some studies identified that the place of public residence may influence the knowledge, attitudes and the willingness for organ donation. , This may stem from the fact that people living in rural or remote areas may have poorer knowledge due to difficulty in accessing health information resources.  No studies have been carried out in Saudi Arabia to assess the general public knowledge, attitudes, and sources of information regarding organ donation among rural populations.
The main objective of this study is to determine whether knowledge, attitudes and sources of information about organ donation and transplantation differ according to geographical location.
| Materials and Methods|| |
In this cross-sectional study, 1000 subjects were selected using a stratified random sampling technique in order to represent respondents from both rural and urban areas. Fortyfour males and 59 females from both areas were excluded from the study due to incomplete questionnaires, refusal to give their consent to participate, or failure to complete the questionnaire due to lack of time. A total of 897 participants successfully completed the questionnaires; a response rate of 89.7%.
The study was conducted in a randomly selected primary health care (PHC) centers during 2008. PHC centers are considered the first point of contact between the general public and the health care system in Saudi Arabia, and it is therefore an ideal location to obtain a more representative sample from people with different socio-demographic and cultural characteristics.
The survey instrument was a standardized selfadministered questionnaire and was designed to capture information relevant to the study. The questionnaire was divided into four sections with a total of 30 items. Section I included questions on demographic characteristics (6 items). Section II consisted of questions on knowledge about organ donation (8 items). Section III consisted of statements regarding respondents' attitude towards organ donation and transplantation (10 items). In section IV, respondents were asked about their sources of information concerning organ donation (6 items). The responses for items on knowledge and attitudes were in "yes" and "no" form. Items on respondents' source of information about organ donation were scored on a 5-point Likert scale ranging from "none" to "very much".
A number of steps were taken to increase the content validity of the questionnaire. Firstly, a review of the relevant literature was carried out in order to select some statements pertaining to respondents' knowledge and attitudes. Secondly, two academic staff reviewed the questionnaire and their suggestions were incorporated into the final questionnaire. Finally, a pilot survey of 20 adult persons in each geographical area (10 males and 10 females) was conducted. On the basis of the outcome of the pilot survey, a few questions were reformed and some were either added or excluded. The pilot survey results were not included in the main survey. The covering letter of the questionnaire outlined the title and the purpose of the study and the identity of the researcher. The participants were informed about the importance of the study and were encouraged to participate and were informed on the issue of anonymity; no identifying information was included on the questionnaire.
| Statistical Analysis|| |
The data for this study were collected by a group of health services administration students and were analyzed in a descriptive fashion using the Statistical Package for Social Sciences (SPSS). In making comparison between rural and urban areas, the mean values of continuous variables were compared using student's t-tests and the proportions of categorical variables were compared using chi-square analysis. The level P< 0.05 was considered as the cutoff value for significance.
| Results|| |
Profile of respondents
[Table 1] shows the general profile of the 897 respondents included in the study. Respondents from the urban areas comprised 57.3% of the study sample. Demographic variables indicated that respondents in both the rural and urban areas were well matched with respect to their age, nationality, educational level, employment status and marital status. The differences between the respondents from the rural and urban areas with respect to the demographic variables were not statistically significant. However, a significantly higher percentage of males than females in rural areas were represented in the study sample compared with that in the urban areas (P< 0.0001).
Knowledge about organ donation
[Table 2] shows that the respondents in the rural areas had a significantly lower percentage of knowledge about organ donation and transplantation than the respondents in the urban ones. For example, respondents in rural areas reported having less information about organ donation than their counterparts in urban areas (P< 0.0001). When the respondents were asked whether they knew who should be contacted if they wished to donate an organ, a significantly lower percentage of those in the rural than the urban areas answered in an affirmative (P< 0.0001). Similarly, a significantly lower percentage of respondents in the rural areas reported less knowledge about the requirements and procedures for organ donation than respondents in the urban areas (P< 0.001). Only about one-third of respondents in the rural areas and one-half of respondents in the urban areas knew the types of organs that can be donated (P< 0.0001). Respondents in the urban areas were more knowledgeable about the brain death concept (P< 0.0001) and the donation card (P< 0.0001) than respondents in the rural areas. A significantly higher percentage of respondents in the rural areas believed more than their counterparts in the urban areas that "only organs of young people can be donated" (P< 0.01).
Attitudes towards organ donation
[Table 3] shows the attitudes of subjects toward organ donation according to place of residence, which indicates that the rural respondents differed significantly from their counterparts in the urban areas in a number of attitudinal aspects. For instance, a significantly higher percentage of respondents in the urban areas 343 (66.7%) expressed willingness to donate an organ than those in the rural areas 164 (42.8%) (P< 0.0001). Those who were willing to donate, in both the rural and urban areas, did not differ significantly in the timing of donation. The vast majority of respondents in the rural and urban areas were willing to donate after their death only (51.8% and 58.0%, respectively). However, a higher percentage (34.8%) of respondents in the rural areas was willing to donate during life time than respondents in urban areas (26.2%). The percentage of the respondents who were willing to donate at anytime (either during life or after death) was similar in the rural and urban areas (13.4% and 15.7% respectively).
The respondents in the rural and urban areas provided different reasons inhibiting them from organ donation. The respondents in the rural areas were more likely to report "worries about receiving inadequate health care after donation" (P< 0.0001), "lack of family support" (P< 0.0001) and "lack of information about organ donation" (P<0.0001) than those in the urban areas. On the contrary, the respondents in the urban areas were more likely to report "lack incentives" (P< 0.0001) and "other reasons" (P< 0.0001) than those in the rural areas. Despite a higher percentage of respondents in the rural areas had expressed "fear of complications after donation" and "religious reasons" than those in the urban areas as reasons for not donating, the difference was not statistically significant.
Source of information
[Table 4] shows that respondents in the rural and urban areas differ significantly according to the source of information about organ donation. The respondents in the urban areas had a significantly higher mean score (3.95) than those in the rural areas (3.01) about receiving information from television (P< 0.001). Moreover, the respondents in the urban areas had a significantly higher mean score (2.54) than those in the rural areas (2.12) regarding newspapers as a source of information (P< 0.001). Similarly, respondents in the urban areas had significantly higher mean scores in receiving information from posters and health care providers (1.66 and 1.36 respectively) than those in the rural areas (1.36 and 1.20 respectively) (P< 0.001). The respondents in both the rural and urban areas had similar mean scores in receiving information from families (1.13 and 1.14 respectively) and from "other sources" (2.28 and 2.31 respectively). The difference between the rural and urban areas in receiving information about organ donation from these sources was not statistically significant.
| Discussion|| |
The results of our study demonstrate several characteristics of the respondents. In general, those who live in the rural areas were less likely to have information about organ donation than their counterparts in urban areas. For instance, they were less likely to know "whom should be contacted" for organ donation, to know the "types of organs that can be donated" and more likely to believe that "only organs of young people can be donated". The vast majority of respondents in rural areas had never before heard either about "brain death" or the "organ donation card".
Our results indicate that more than half of the rural respondents and more than forty percent of the respondents living in the urban areas were not willing to donate organs. Similarly, the vast majority of respondents in both geographical areas were not willing to sign the donation card. These results demonstrate that the level of knowledge about organ donation in both the rural and urban areas is not optimal. In fact, the rural respondents from the areas were less likely to report willingness to donate organs than respondents in urban areas. Interventional programs to improve the awareness of the general public, particularly those living in remote areas, is required. Once these programs are established, they need to be evaluated in order to assess the progress of the attitudes toward organ donation.
Our study identified that the principle respondents' source of information about organ donation was the television (TV). The contribution of other sources of information in providing respondents with knowledge about organ donation was minimal. Generally, studies had shown the importance of visual media in increasing the awareness of the public about organ donation. ,
Our study also identified several reasons that may influence the decision-making of the public toward organ donation. Many of these reasons can be manipulated. For example, the vast majority of respondents in rural areas were concerned about not receiving adequate health care after donation. Therefore, it is possible that establishing legislations that will guarantee the donors better health care and easy access to health facilities might encourage people to donate organs during their life times. Similarly, respondents in urban areas were more likely to report "lack of incentives" as one of the main reasons for not willing to donate. Accordingly, financial and non-financial incentives should be considered to encourage the public to donate organs.
The results of this study showed that respondents in both the rural and urban areas reported that lack of family support was one of the limiting factors for donating organs. Efforts should be made to increase discussions about organ donations among the family members. Previous research had reported direct correlation between willingness to donate and family support  and indicated that appropriate public exposure to knowledge about organ donation would result in more family discussions and more frequent declaration of one's wishes to donate, decreasing uncertainty at critical times (brain death of a loved one) and would likely to increase organ donation.
Moreover, our results surprisingly indicated that more than 90% of respondents in the rural and urban areas reported that the contribution of health care providers in providing them with knowledge about organ donation and transplantation was "none" or "little". This may question health education activities held in health care facilities such as primary health care centers, where health education is considered one of their principles.
The majority of the respondents in both areas reported "lack of information" about organ donation and transplantation. These findings are comparable with those reported from neighboring countries , as well as studies conducted in the West , and Saudi Arabia; ,,, all indicate the importance of public education about the importance of organ donation.
One major limitation of this study is that it did not examine the relationship between respondents' willingness to donate and their socio-demographic characteristics, their knowledge and attitudes about organ donation. This could be an important topic for future research. Second, this study does not claim to be comprehensive because the study took place in Riyadh region only. Accordingly, the results may have limited applicability to other regions in the Kingdom. Third, the results reported here were based on information collected by questionnaires and were subjected to the disadvantages of using this data collection tool. However, the questionnaire was anonymous, which should have encouraged accurate and honest self-disclosure. Future research should attempt to address some of the concerns indicated in the limitations.
In conclusion, the negative attitudes of respondents towards organ donation reported by this study are justified by the inadequate information acquired by the public about this significant issue. Accordingly, the general public should not be held alone responsible for the unwillingness to donate organs; other parties such as local mass media, health care providers, and educational institutions are responsible too for this result.
| Acknowledgement|| |
The author of this study would like to thank the Research Center in the College of Business Administration for the financial support of the study.
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Saad Abdullah Alghanim
Health and Hospital Administration Program, King Saud University, P.O. Box 271373, Riyadh
[Table 1], [Table 2], [Table 3], [Table 4]