The Effect of Education and Positive Social Behaviour on Attitudes to Organ Donation: A Quasi-Experimental Study

doi:10.21203/rs.3.rs-3745012/v1

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The Effect of Education and Positive Social Behaviour on Attitudes to Organ Donation: A Quasi-Experimental Study

https://doi.org/10.21203/rs.3.rs-3745012/v1

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Objective

The aim of this study was to determine the effect of education and positive social behaviour on attitudes to organ donation.

Material and Methods

This analytical interventional study was designed as an observational, cross-sectional, questionnaire-based, single-arm, semi-experimental study. A Personal Information Form, the Attitudes to Organ Donation Scale (AODS), and the Online Positive Social Behaviour Scale (OPSBS) were used in the collection of the research data before and after the delivery of education about organ donation.

Results

There was seen to be a statistically significant increase after the education in the AODS attitude (p = 0.048), subjective (p = 0.000), and total (p = 0.007) mean points. There was determined to be a statistically significant relationship between the AODS intention and attitude subscales and the applied and total OPSBS points (p < 0.05). A statistically significant relationship was determined between the perceived behavioural control subscale and AODS total points and all the OPSBS subscales (p < 0.001).

Conclusions

Education given on the subject of organ donation and positive social behaviour were determined to have an effect on organ donation. With education given by nurses, a positive attitude to organ donation and the development of social behaviour can be provided, thereby contributing to an increase in the number of donated organs in Turkey.

Organ donation

death

education

positive social behaviour

nurse

Organ donation is defined as a person giving of their own free will documented permission for their organs and tissues to be taken after brain death has occurred (Şıpkın et al., 2010). According to the 2022 statistics for Turkey, there were 562,990 organ donors who volunteered while alive to donate their organs after brain death, 2509 cadaver donors on the request of the family after brain death, and 256,238 individuals were waiting for an organ donation to be able to continue living (Türkiye Transplantasyon, Diyaliz ve İzlem Sistemleri, 2019). Thus, it can be understood from these data, that the number of organs donated does not correspond to the number of patients waiting for transplantation.

The shortfall in the number of organs is currently increasing throughout the world for various reasons, and many patients are dying because of this (Krupic et al., 2019 ; Akbulut et al., 2020). Despite there having been great developments together with the advances in the technology and science of organ transplantation in recent years, the greatest failure in organ transplantation is the inability to obtain organs to be transplanted (Şantaş & Şantaş, 2018). In most developed countries, the majority of organ needs are met by cadaver donors, but in developing countries such as Turkey, the basic problem is that the number of cadaver organ transplants is not at a sufficient level (Soylu et al., 2022).

Factors with a negative effect on organ donation have been reported in many studies. There are many barriers to organ donation, such as age, gender, education, marital status, ethnicity, socioeconomic status, family education level, the societal view of organ donation, and the attitude of religious leaders (Aktaş & Kındap, 2020; Roberts et al., 2014; Soylu et al., 2022). However, the findings related to factors that encourage an individual to donate organs are extremely limited. A study in literature reported that factors such as wanting to help others and wanting to be appreciated by others had a positive effect on the organ donation decision (Kaça et al., 2009).

Positive social behaviour includes helping, sharing, donating and volunteering behaviours directed towards a person or society (Anlı, 2019). Positive social behaviour in adulthood is directly related to empathy/sympathy capacity (Gözün & Kurt, 2013 ; Aktaş & Kındap, 2020). In the enactment of postive social behaviour an individual thinks about the well-being of other people. The main theme of positive social behaviour is the wish to help others without any benefitt to oneself. The stronger the empathy capacity of an individual then the greater their volunteering behaviour will be (Roberts et al., 2014). Organ donation in Turkey is based on volunteerism like positive social behaviour (Soylu et al., 2022). It has been reported that helping others and receiving appreeciation from others on this subject have a positive effect on the decision for organ donation (Kaça et al., 2009). It has been reported in other studies that many voluntary donors experience many psychological benefits such as an increase in self-image from saving another person’s life (Papachristou et al., 2004; Huml et al., 2020 ; Jernigan et al., 2013).

It is a legal requirement in Turkey that even if a person has donated their organs while alive, without permission from the family after brain death has occurred there can be no transplantation to another patient (T.C. Sağlık Bakanlığı, 2008). The most important function for organ donation falls to nurses. The attitudes of nurses to organ donation, the approach to the patient after brain death, their education and experience on this subect, communication and motivation can have a highly positive effect on the decision-making process of the family (Soylu et al., 2022). The organ transplantation co-ordinator has duties to increase social awareness, such as organising donation promotion campaigns, educating the public, especially families, and organising activities to increase organ donation in which nurses participate (T.C. Sağlık Bakanlığı, 2008). Many more people can be reached in this process by the nurse using technology.

The current young population uses technology very well, and they are especially active on social media platforms (Şıpkın et al., 2010). People cannot only communicate with each other on social media but can also share data and information (İnce & Koçak, 2017). In the development of positive social behaviour, online applications can be easily used to create positive awareness about organ donation, and to organize promotional campaigns and donations and to deliver education to young people about organ donation. Especially for one person to help another person in need, communication can be easily established online, and support can be provided (Şıpkın et al., 2010). In a study by Xiong et al., the impotance of social media in organ donation was examined, and it was determined that organ donation rates can be increased with the use of social media to communicate correct information to encourage organ donation and to overcome misunderstandings (Xiong et al., 2021).

The need for education to develop positive social behaviour and a positive attitude to organ donation has been reported in literature (Dumanli et al., 2019; Soylu et al., 2022; Yücetin et al., 2003). By determining attitudes to organ donation, the factors affecting these attitudes, incorrect beliefs, and lack of information, education can be planned directed to these subjects, and by helping to develop a positive attitude to organ donation the number of organ donations can be increased (Gürler et al., 2020). In a study of medical faculty students by Yılmaz and Demirağ (2019), the main reason for students not wanting to donate organs was found to be lack of information, and it was shown that effective education would have a positive effect on the number of organ donations (Yilmaz & Demiraǧ, 2019).

Aim

The aim of this study was to develop online positive social behaviour with online education about organ donation and to determine the as yet unknown barriers to organ donation.

The following hypotheses were established for the study:

H₁ = Positive social behavior has an effect on the attitude to organ donation.

H₂ = There is a relationship between positive social behaviour and organ donation.

H₃ = Informative education given about organ donation has an effect on positive social behaviour related to organ donation.

Study Design

This analytical interventional study was designed as an observational, cross-sectional, questionnaire-based, single-arm, semi-experimental study.

Time and Place of the Study

The study was conducted between May and July 2023.

Study Universe and Sample

The study universe consisted of students in the KSU SHMYO/ Anaesthesia program. The snowball sampling method was used to reach adults who responded to a questionnaire delivered by mobile telephone. G*Power analysis was performed with reference to the results obtained in the study by Eren and Mermer (2021) (Eren & Mermer, 2021). According to the analysis results, a sample size of 212 subjects was calculated to be necessary to provide an effect size of d = 0.6088889, α = 0.05, and power (1-β err prob) = 0.99.

The study inclusion criteria were defined as;

Age ≥ 18 years,
Active use of social media,
Agreement to participate in the study,
Completion of all the questions on the data collection forms.

2.1. Data Collection Tools

The study data were collected using a Personal Information Form, the Attitudes to Organ Donation Scale (AODS), and the Online Positive Social Behaviour Scale (OPSBS).

Personal Information Form

This form was created by the researchers with reference to the literature (8, 12) and included 7 questions related to the sociodemographic characteristics of the study participants (age, education, profession, etc).

The Attitudes to Organ Donation Scale (AODS)

This scale was developed by Ajzen (2002), based on conceptual and methodological recommendations to measure the structures in the Planned Behaviour Concept. Validity and reliability studies of the Turkish version of the scale were conducted by Kaça et al. (2009)(Kaça et al., 2009). It includes 14 items with 7-point Likert-type responses of 1: definitely disagree, 2: mostly disagree, 3: disagree, 4: undecided, 5: slightly agree, 6: strongly agree, 7: absolutely agree. Item numbers 4, 7, and 8 are reverse scored. The scale measures the attitudees of an individual to organ donation, subjective norms, perceived behavioural control, and behavioural intentions (α = 0.70). The scale has 4 subscales of Intention (α = 0.91), Subjective Norm (α = 0.59), Attitude (α = 0.77), and Perceived Behavioural Control (PBC) (α = 0.74) (Kaça et al., 2009).

Items 1–3 on the scale are related to the subject’s behavioural intentions on the subject of organ donation (I am thinking about organ donation – I am planning to donate organs – I want to donate organs). Items 4–8 are related to attitudes towards organ donation (organ donation is harmful- it is right to be an organ donor – it is good to be an organ donor -it is dangerous to be an organ donor – it is risky to be an organ donor). Items 9–11 are related to subjective norms (the people who are important to me think I shoud be an organ donor – I feel societal pressure to be an organ donor – I am expected to be an organ donor). Items 12–14 are related to perceived behavioural control (If I want to I will be an organ donor and I trust myself on this subject – whether or not I donate organs is completely up to me – it is easy for me to be an organ donor).

The points from each item are added to give a total score for each subscale with higher scores evaluated as that area being more positively affected (Kaça et al., 2009). The Cronbach alpha value of the scale was calculated as 0.64 in this study.

The Online Positive Social Behaviour Scale (OPSBS)

This 5-point Likert-type scale was developed by Erreygers et al. (2018) to measure online positive social behaviours, and the validity and reliability of the scale in Turkish was examined by Anlı (2019) (Anlı, 2019). The scale has two subscales of “experienced online positive social behaviour” and “applied online positive social behaviour”, each with 10 items. The Cronbach alpha internal consistency coefficient was determined to be 0.91 for the experienced OPSB subscale, 0.90 for the applied OPSB subscale, and 0.94 for the whole scale. These values showed that the internal consistency of the scale was extremely high. The scale item total correlations ranged from 0.60 to 0.74. These values showed that the reliability level of the scale was sufficient and that consistent responses were given when the scale was applied. A 16-item modified scale was obtained, with 8 items in each of the two subscales. The maximum score from the 5-point Likert-type responses ranged from 16 to 80 points. No items were reverse scored(Anlı, 2019). The Cronbach alpha value of the scale was calculated to be 0.92 in this study.

Educational Booklet

The content of the educational booklet was written according to the relevant literature. Section headings and content were formed by listing the subjects of interest for organ donation, such as what is organ donation, what are the conditions for donation, and where are donations made. After preparation of the booklet, it was sent to 8 specialists in this field to obtain feedback. The evaluations of the appropriacy of the material were made by the specialists using the measurement tools of “Evaluation of the Appropriacy of Written Material” and DISCERN (Quality Criteria for Consumer Health Information) and they were requested to write their opinions for corrections to the booklet.

The content of the educational booklet was planned, and in accordance with the recommendations of the specialists the final form was produced with the section headings of “organ transplantation/donation – sources of organ transplantation – which organs and tissues can be transplanted – the law in Turkey related to organ transplantation and donation – the National Organ and Tissue Information System – brain death – how a diagnosis of brain death is made – religious aspects of organ donation – does donation disrupt the donor appearance and bodily integrity? – notification in Turkey of waiting for/transplantation/donation of an organ and brain death – family permission status – who can be an organ donor – where and how organ donations are made – is family permission necessary for organ donation?

The Evaluation Form of the Appropriacy of Written Material

This form was developed by Doak et al. in 1996, and was used in studies in Turkey by Uğurlu and Akgün (2019) and Demir et al. (2008)(Demir et al., 2008 ; Uğurlu & Akgün, 2019). The form consists of 27 items in 6 sub-sections of content (4 tems), literacy (5 items), images-graphs (5 items), text plan (8 items), learning motivation (3 items), and cultural appropriacy (2 items). Each item is answered as “yes” (1 point) or “no” (0 points) to give a total score in the range of 0–27 points (Uğurlu & Akgün, 2019). The mean score of the evaluation of the educational booklet in this study was 21.1 points showing a high degree of readability of the material.

DISCERN

This scale was developed by Charnock et al. (1997), and was then translated into Turkish by Gökdoğan et al. in 2003. The scale consists of 15 items in two sections of general information (8 items) and surgical process (7 items). The total score can range from 15 to 75 points with higher points indicating high quality (Uğurlu & Akgün, 2019). The mean points of the evaluation of the educational booklet in this study were calculated to be 68.3.

The design was completed with the final form of the educational booklet content created in accordance with the evaluations and recommendations of the specialists.

2.1. Data Collection

The questionnaire was prepared using Google Forms, then delivered to the participants via a mobile phone link. Pre-test data were collected before the education was given. The education was delivered to the students on an online platform without interrupting their lesson programs. The final test data were collected 2 months after the education had been given. This period was determined as it has been shown that a period of at least 2 months is required for the development of a change in attitude after education (Ege & Eryılmaz, 2006; Erol et al., 2016).

Education about Organ Transplantation and Donation

The educational program was in the form of a Powerpoint presentation appropriate to the content of the educational booklet, which was prepared by evaluating the content and the opinions of the specialists. The education, which lasted approximately 50 mins, was delivered to the students on an online platform without interrupting their lesson programs. During the education, the students participated interactively by responding to the questions. The teaching methods used were explanation, question-response, feedback, consolidation, and summarising. Following the online education, the booklet was shared to the mobile phone communication groups of the students.

Statistical Analysis

Data obtained in the study were analyzed statistically using SPSS vn. 21.0 software. Data were stated as mean ± standard deviation, minimum and maximum values, or number (n) and percentage (%). Conformity of the data to normal distribution was assessed with skewness and kurtosis coefficients. Groups with skewness and kurtosis measurement values in the range of + 2 to -2 were accepted as showing normal distribution (George & Mallery, 2010). Correlation analysis was applied to determine relationships between the OPSBS and the AODS sub-dimensions. A value of α < 0.05 was accepted as the level of statistical significance in all the tests.

Ethical Approval

Approval for the study was granted by the Ethics Committee of Kahramanmaraş Sütçü İmam University Medical Faculty (decision no: 2022/37, dated: 13.12.2022). Informed consent was obtained from all the study participants with their signing an agreement to participate before completing the questionnaire.

The study participants comprised 71.3% females and 28.7% males with a mean age of 20.31±2.26 years. The education level was reported to be primary school for 75.1% of the mothers and 53.2% of the fathers of the students. Organ donation education had been previously received by 80.2% of the study participants but 54.4% wished to receive it again (Table 1).

The mean points obtained on the scales before and after the organ donation education were compared according to the age and gender of the participants (Table 2). Before the education, a difference was determined between age and the AODS attitude subscale (p=0.036), AODS total points (p=0.050), and the applied OPSB (p=0.031), experienced OPSB (p=0.005), and total OPSB points (p=0.006). The difference between the groups was determined to originate from the group aged ≤20 years. Following the education, there was no difference between the groups, and the mean points of the students aged ≥21 years were determined to have increased after the education (p>0.05).

Before the education, a statistically significant difference was determined between the female and male subjects in respect of the AODS intention (14.02±4.34) and attitude (28.36±5.78) subscales and the total mean points (65.56±12.83) (p=0.004, p=0.001, p=0.016, respectively). Before the education, the OPSBS total mean points of the females (56.49±8.61) were statistically different from those of males (p=0.050). Following the education, the mean points of the males were determined to have increased from the pre-education values, but there was no significant difference between the groups (p>0.05).

The mean scale points and the maternal and paternal education levels were compared (Table 3). There was no statistical difference between the mean scale points according to the maternal education level (p>0.05). No difference was found between the AODS according to paternal level of education, and there was determined to be a statistically significnt difference in the experienced OPSB (p=0.016) and the total OPSB mean points (p=0.029).

The mean AODS and OPSBS were compared according to whether the participants had previously received organ donation education (Table 4). No statistically significant difference was determined in the scale points according to previous education (p>0.05). The mean points obtained on the scales before and after the organ donation education were compared, and there was seen to be a statistically significant increase after the education in the AODS attitude (p=0.048), subjective (p=0.000), and total (p=0.007) mean points. No statistically significant difference was determined in the OPSBS points before and after the organ donation education (p>0.05).

Comparisons were made of the mean AODS points before and after the organ donation education (Table 5). The mean points of the responses to the item, “It is dangerous to be an organ donor” statistically significantly decreased after the education compared to before (p=0.012). Following the education, there was seen to be a statistically significant decrease in the points of the responses given to the item “It is risky to be an organ donor”(p=0.001). The mean points of the responses to the item, “The people who are important to me think I should be an organ donor” statistically significantly decreased after the education compared to before (p=0.024). The mean points of the responses to the item, “I feel societal pressure to be an organ donor” statistically significantly decreased after the education compared to before (p=0.010). Following the education, there was seen to be a statistically significant decrease in the points of the responses given to the item “I am expected to be an organ donor”(p=0.001).

Correlations between the AODS and OPSBS are shown in Table 6. There was determined to be a statistically significant relationship between the AODS intention and attitude subscales and the applied and total OPSBS points (p<0.05). No statistically significant relationship was determined between the subjective subscale and OPSBS points (p>0.05). A statistically significant relationship was determined between the perceived behavioural control subscale and AODS total points and all the OPSBS subscales (p<0.001).

The shortfall in the number of organ donations is currently increasing throughout the world for various reasons, and many patients are dying because of this (Yilmaz & Demiraǧ, 2019; Kaya & Genç, 2023). Despite there having been great developments together with the advances in the technology and science of organ transplantation in recent years, the greatest failure in organ transplantation is the unavailability of organs to be transplanted (Özaykal, 2023). For all these reasons, positive social behaviour towards organ donation shown by an individual and being an organ donor using empathy are of great importance. No study could be found on this subject in the literature. When evaluated in this respect, the current study will make an important contribution to the literature. However, as there are few studies related to this subject, the current study findings have been discussed with the results of similar research.

The results of this study showed that before the education was given, the AODS attitude and total points were lower in the ≥21 years age group compared to those aged ≤ 20 years, and although the mean AODS attitude points of the ≥21 years age group decreased after the education and the AODS total points increased, no significant difference was determined between the age groups (p>0.05). While there was a difference in the OPSBS total and subscale points according to age before the organ donation education, no difference was determined after the education (p>0.05). In a study by Gürler and Hançer (2020), it was determined that as age increased, the positive attitude to organ donation decreased (Gürler & Topal, 2020). Çam et al. (2022) reported no difference in attitude to organ donation according to age (Çam et al., 2022). The reason that young people have a more positive attitude may be due to their more active use of social media and therefore a greater potential to reach current information related to oorgan donation and transplantation.

In the current study, the mean AODS intention, attitude, and total points of males were lower than those of females before the education. After the education, the mean points of the males increased and there was determined to be no difference in the AODS subscale points acccording to gender (p>0.05). In a study by Tokay (2016), it was reported that the knowledge levels of male students on the subject of organ donation were higher and more males were organ donors ( Tokay, 2016). In contrast, Çam et al. (2022) found that females had a higher level of positive attitude towards organ donation than males (Çam et al., 2022). Gürler and Topal (2020) investigated the attitudes to organ donation of individuals presenting at a family health centre, and reported that gender had no effect (Gürler & Topal, 2020). A potential explanation for these results could be the prescriptive nature of gender roles related to helping behaviour. Donation after death seems to be a female type of helping behaviour requiring sacrifice with minimum risks and physical difficulties. Consequently, this can be associated with the fact that females feel greater empathy and a stronger moral obligation to be a potential donor than males, which is consistent with societal gender stereotypes Çam et al. (2022).

The results of this study showed that the maternal and paternal education level had no effect on the attitude to organ donation. In a study by Dumanli et al. (2019), which investigated the knowledge, attitudes, and behaviour of medical faculty students towards organ and tissue transplantation and organ donation, no significant difference was determined in the wish to donate organs according to the father’s education, whereas a significant difference was determined according to the mother’s level of education (Dumanli et al., 2019). Kılıç et al. (2010) found that a more positive approach to organ donation was exhibited as the educational level of the father increased (Kılıç et al., 2010). Sünbül and Güçray (2016) also reported a significant differentiation in positive social behaviour according to the variables of maternal and paternal education level (Sünbül & Güçray, 2016). Karaca et al. (2011) found that positive social behaviour dimensions showed significant differences according to the education level of the parents (Karaca et al., 2011). As the father is a role model in the family, the behaviours displayed by the father have an important place in the development of the social aspect of an indivdual.

In the current study, although 80.2% of the participants stated that they had previously received organ donation education, 54.4% wished to receive the education again. To encourage an individual in organ donation, all aspects (biopsychosocial and social) of the lack of information must be removed. Demir et al. (2016) evaluated the knowledge levels and opinions of organ donation of university students. Although 56% of the participants stated that they had received information about organ donation, it was determined that 36% of the students showed negative behaviours about organ donation (Demir et al., 2016). In a study of middle-school students by Tetik and Cebesoy (2018), it was reported that 77.2% of the students wanted to receive information on the subject of organ donation (Tetik & Cebesoy, 2018). Tokay (2016) reported that students had a moderate level of knowledge about organ donation, and when the intention for organ donation was examined, 17.5% had definitely decided to donate (Tokay, 2016). The results of the current study are consistent with findings in literature.

After the education was delivered to the students in the current study, the differences in the AODS attitude and subjective subscale points and AODS total points were found to be statistically significant (p<0.05). In a study of intensive care nurses and organ donation by Jawoniyi et al. (2015), it was reported that the higher the level of education of the nurses about organ donation, then the greater the increase in organ donations (Jawoniyi & Gormley, 2015). Ordin and Söylemez (2018) examined the effect of peer education on the attitudes to organ donation of student nurses and stated that there was no positive change ( Ordin & Söylemez, 2018). In a systematic review by Hunt et al. (2018) of the information and communication about organ donation, it was recommended that educational programs should be developed, refined and made more widespread to be able to improve the access to transplantation for more patients who required organ donation (Hunt et al., 2018).

Kazley et al. (2016) conducted a study on the use of social media between living kidney donors and recipients, and reported that social media and online education was highly promising to be able to increase awareness and organ transplantation (Kazley et al., 2016).

Harel et al. examined the effect of media presentations on organ donation, and reported that the sharing on social media of the experiences of organ recipients was important in increasing organ donor rates (Harel et al., 2017). It can be connsidered that in the light of the correct information obtained by the students from the education, they would make their own decision to show a positive attitude to organ donation.

The results of the comparisons of the mean AODS points of the current study participants before and after the organ donation education are shown in Table 5. Compared to before the education, there was a decrease in the mean points of the responses to the items, “ It is dangerous to be an organ donor”, It is risky to be an organ donor”, “The people who are important to me think I shoud be an organ donor”, “ I feel societal pressure to be an organ donor”and “I am expected to be an organ donor”. These decreases were determined to be statistically significant (p<0.05). In the study by Ordin et al. (2018), it was seen that with increasing years of study of the students there was an increase in the perception of “fear of medical neglect” ( Ordin et al., 2018). Gürler and Hançer (2020) reported that the positive attitude scale score was higher in individuals with a high level of education, and the negative attitude and negative attitude subscale scores were lower (Gürler & Hançer, 2020). Following the education in the current study, a decrease was determined in the scores of many items that expressed negativity. This reflects the importance of the education, the knowledge, and increasing awareness to encourage organ donation.

The current study results showed a correlation between the AODS intention and attitude subscales and the applied and total OPSBS points of the participants (p<0.05). In a study by Kaça et al. (2009) that examined attitudes to organ donation with the planned behaviour concept, it was reported that patients with organ failure and their families had more positive attitudes to organ donation than patients with a chronic disease and healthy groups, and their perceptions of social pressure on their behaviour were stronger (Kaça et al., 2009). Cameron (2015) examined the effect of social media on organ donation and recommended that increasing educational studies using social media and social networks to increase the social awareness of organ donation could overcome the failures in donation (Cameron, 2015). The experience of an individual to encourage organ donation can have a positive effect on the social attitude and perception of another person. Making the decision to become an organ donor after acquiring correct information is a sign of the social characteristics and human sensitivity of an individual.

A statistically significant relationship was determined in this study between the AODS perceived behavioural control subscale points and the AODS total points and all the OPSBS subscale points (p<0.001). In the study by Tetik and Cebesoy (2018), it was reported that the students stated reasons to be an organ donor as “saving life” at 45.2%, and “to help people” at 18.01% (Tetik & Cebesoy, 2018). Demir et al. (2016) examined the opinions of university students about organ donation and reported that 49.5% thought that organ donation was a “human service” (Demir et al., 2016). The findings of those two studies support the results of the current study. The thought of becoming an organ donor is a characteristic of individuals with high social attitude showing a tendency to empathy.

Strength and Limitations of the Study

One of the researchers had experience of 12 years as an organ transplantation co-ordinator, and a certificate in this field. Strengths of the study were that the data collection forms were tested and found to be reliable, and that all the education was given by a single researcher. That the study was conducted in a single centre could be said to be a limitation of the study.

The results of this study demonstrated that the organ donation education delivered online was effective on the attitude to organ donation but did not have an effect on positive social behaviour. In accordance with the data obtained in this study, it can be said that educational programs and campaigns on social media organised by nurses will be able to contribute to the development of positive social behaviour on this subject. In this way nurses can contribute to the development of positive attitudes to organ donation and increase the number of organ donors in Turkey.

Funding

No financial support was received for this study from any public, private, or non-profit institiution.

Conflict of Interests

The authors havee no conflict of interests to declare.

Ethics Committee Approval

All stages of this study complied with the ethical standards of the National Research Committee, and the principles of the 1964 Helsinki Declaration and later revisions.

Data Availability

Information supporting the study results can be obtained from the corresponding author onn reasonable request. The article contains the information used to support the results. All the authors have given permission for the use of the study data.

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Table 1. Sociodemographic Characteristics of the Participants

		Sayı	%
Age	≤ 20	166	70.0
Age	≥21	71	30.0
Gender	Female	169	71.3
Gender	Male	68	28.7
Maternal education level	Primary education	178	75.1
	Secondary education	45	19.0
	High education	14	5.9
Paternal education level	Primary education	126	53.2
	secondary education	75	31.6
	High education	36	15.2
Did you receive training on Organ Donation during your university education?	Yes	47	19.8
	No	190	80.2
Was the education you received sufficient?	Yes	29	12.7
	No	1	.8
	Partially	17	7.6
Would you like to get an education?	Yes	54.4	54.4
Would you like to get an education?	No	45.6	45.6

Table 2. Comparison of The Average Scores Obtained From The Scales Before And After The Education According to The Age And Gender of The Participants

		AGE				Test/p
		≤20		≥21		Test/p
						t	p
Before the education	Intention	13.84	4.43	12.63	5.02	1.848	.066
	Attitude	36.26	6.37	36.00	7.09	2.109	.036
	Subjective Norm	9.17	3.47	9.30	3.37	-.277	.782
	PBC	14.22	3.81	13.33	3.09	1.727	.086
	AODS total points	65.36	13.00	61.64	13.87	1.973	.050
	Applied OPSB	29.63	5.18	27.70	6.60	2.408	.031
	Experienced OPSB	27.19	5.50	24.46	7.13	28.83	.005
	OPSB total points	56.83	9.53	52.16	12.46	2.819	.006
After the education	Intention	14.12	4.35	13.30	4.63	1.297	.196
	Attitude	28.74	5.76	28.29	5.73	.553	.581
	Subjective Norm	10.43	2.97	10.12	2.92	.745	.457
	PBC	14.35	3.45	14.52	3.39	-.340	.734
	AODS total points	67.66	12.76	66.25	12.37	.789	.431
	Applied OPSB	29.40	5.78	29.87	6.94	-.538	.343
	Experienced OPSB	26.84	6.11	26.02	5.88	-.538	.810
	OPSB total points	56.24	10.77	55.90	11.62	.221	.825
		GENDER				Test/p
		Female		Male		Test/p
						t	p
Before the education	Intention	14.02	4.34	12.11	5.077	2.916	.004
	Attitude	28.36	5.78	25.67	5.81	3.233	.001
	Subjective Norm	9.02	3.41	9.69	3.48	-1.354	.177
	PBC	14.14	3.70	13.48	3.40	1.273	.204
	AODS total points	65.56	12.83	60.97	14.11	2.422	.016
	Applied OPSB	29.59	4.79	27.70	7.36	1.957	.053
	Experienced OPSB	26.89	5.26	25.08	7.83	1.753	.083
	OPSB total points	56.49	8.61	52.79	14.37	1.986	.050
After the education	Intention	14.00	4.55	13.57	4.17	.676	.500
	Attitude	28.67	5.85	28.45	5.50	.265	.792
	Subjective Norm	10.30	2.90	10.45	3.10	-.362	.718
	PBC	14.65	3.45	13.77	3.29	1.791	.075
	AODS total points	67.63	13.09	66.26	11.46	.756	.450
	Applied OPSB	29.69	6.14	29.1765	6.16185	.584	.560
	Experienced OPSB	26.89	5.26	25.08	7.83	1.206	.229
	OPSB total points	56.49	8.61	52.79	14.37	.988	.324

Independet-Sample T test, p<0.001, p<0.05

Table 3. Comparison of The Education Levels of The Parents of The Participants And The Mean Score of The Scale

	Maternal education level						Test/p
	Primary Education		Secondary Education		Higher Education		Test/p
							F*	p
Intention	Mean Rank 117.24	Min-max (3-21)	Mean Rank 129.57	Min-max (3-21)	Mean Rank 107.36	Min-max (3-21)	1.627**	.443
Attitude	27.51	5.72	27.73	6.48	28.14	6.72	.087	.916
Subjective Norm	8.97	3.49	9.80	3.18	10.35	3.22	1.860	.158
PBC	13.89	3.51	14.68	3.87	12.42	3.87	2.207	.112
AODS total points	63.78	12.66	66.28	15.15	63.64	15.98	.647	.524
Applied OPSB	29.24	5.52	28.15	6.48	29.50	5.38	.701	.497
Experienced OPSB	26.67	5.91	25.42	7.27	25.71	5.13	.799	.451
OPSB total points	55.92	10.36	53.57	12.49	55.21	8.15	.866	.422
	Paternal education level						Test/p
	Primary Education		Secondary Education		Higher Education		Test/p
							F*	p
Intention	13.73	4.782	13.57	4.44	12.41	4.50	1.146	.320
Attitude	27.61	5.99	27.94	5.90	26.77	5.68	.476	.622
Subjective Norm	Mean Rank 116.91	Min-max (3-18)	Mean Rank 118.28	Min-max (3-20)	Mean Rank 127.82	Min-max (4-18)	.728**	.695
PBC	14.05	3.36	13.86	4.16	13.80	3.41	.100	.905
AODS total points	64.47	13.45	64.60	13.78	62.72	12.25	.278	.758
Applied OPSB	29.50	5.39	29.09	5.79	27.41	6.38	1.884	.154
Experienced OPSB	27.30	5.64	25.90	5.91	24.11	7.67	4.219	.016
OPSB total points	56.80	10.11	55.00	10.17	51.52	12.78	3.586	.029

*One-Way ANOVA, **Kruskal-Wallis H, p<0.001, p<0.05

Table 4. Comparison of the AODS and OPSBS mean scores according to the Organ Donation Education Status of the Participants

Scales	Did you receive training on Organ Donation during your university education?				Test/p
	Yes		No
					t	p
Intention	13.85	4.54	13.38	4.6	.610	.542
Attitude	27.42	6.31	27.63	5.82	-.219	.827
Subjective Norm	9.68	3.64	9.10	3.38	1.037	.301
PBC	14.59	3.35	13.80	3.68	1.348	.179
AODS total points	65.55	13.69	63.92	13.28	.747	.456
	Organ Donation Education				Test/p
	Before the education		After the education
					t	p
Intention	13.48	4.63	13.95	4.46	-1.157	.248
Attitude	27.59	5.90	28.63	5.71	-1.983	.048
Subjective Norm	9.21	3.43	10.40	2.94	-4.093	.000
PBC	13.95	3.62	14.41	3.45	-1.428	.154
AODS total points	64.24	13.35	67.41	12.66	-2.690	.007
Applied OPSB	29.05	5.70	29.54	6.14	-.910	.364
Experienced OPSB	26.37	6.15	26.59	6.04	-.401	.689
OPSB total points	55.43	10.68	56.14	11.01	-.733	.465

*Paired Samples Test, p<0.001, p<0.05

Table 5. Comparison of Mean Aods Scores Before And After Organ Donation Education

	Before the education		After the education		Test/p
					t*	p
1. I'm thinking of donating organs.	4.62	1.56	4.65	1.53	-.260	.795
2. I'm planning to donate my organs	4.41	1.58	4.59	1.49	-1.241	.216
3. I want to donate my organs	4.45	1.65	4.63	1.52	-1.218	.224
4. Organ donation is harmful	2.21	1.40	2.19	1.34	.098	.922
5. Organ donation is right	5.46	1.41	5.63	1.33	-1.376	.170
6. It's good to donate organs	5.62	1.40	5.69	1.26	-.548	.584
7. It is dangerous to be an organ donor	2.53	1.38	2.21	1.31	2.546	.012
8. It is risky to be an organ donor	2.76	1.51	2.30	1.35	3.403	.001
9. The people who are important to me think I should be an organ donor	3.73	1.50	4.02	1.31	-2.265	.024
10. I feel societal pressure to be an organ donor	2.32	1.51	2.63	1.51	-2.615	.010
11. I am expected to be an organ donor	3.16	1.73	3.67	1.60	-3.390	.001
12. I feel confident that I can donate organs if I want to.	4.17	1.61	4.46	1.61	-1.949	.053
13. Whether or not to donate organs is completely up to me.	5.73	1.56	5.59	1.55	.896	.371
14. Organ donation is easy for me	4.06	1.54	4.33	1.50	-1.958	.051

*Paired Samples Test, p<0.001, p<0.05

Tablo 6. AODS and OPSBS Correlation Results

OBİTÖ		Applied OPSB	Experienced OPSB	OPSB total points
Intention	p	.238**	.079	.172*
Intention	r	.000	.226	.008
Attitude	p	.253**	.127	.208**
Attitude	r	.000	.051	.001
Subjective Norm	p	-.012	-.044	-.031
Subjective Norm	r	.859	.505	.632
PBC	p	.298**	.211**	.281**
PBC	r	.000	.001	.000
Total points	p	.272**	.130*	.220**
Total points	r	.000	.046	.001

*Pearson Correlation Analysis, p<0.001, p<0.05

r= Correlation Coefficient.

0.00<r<0.25 very weak,

0.26<r<0.49 weak,

0.50<r<0.69 moderate,

0.70<r<0.89 high,

0.90<r<1.00 very high

No competing interests reported.

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The Effect of Education and Positive Social Behaviour on Attitudes to Organ Donation: A Quasi-Experimental Study

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2.1. Data Collection Tools

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The Attitudes to Organ Donation Scale (AODS)

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Educational Booklet

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Education about Organ Transplantation and Donation

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