Community-Based Approaches to Diversifying the Blood Donor Base: A Critical Review

This review examines community-based approaches to diversifying the blood donor base, with particular attention to the persistent underrepresentation of ethnic and racial minority groups in blood donation systems across the Global North. Drawing on three influential studies of community-based initiatives, the paper critically evaluates dominant recruitment strategies and their underlying assumptions. While existing approaches often emphasize culturally tailored interventions to address group-specific barriers, this review argues that such strategies remain limited by their focus on individual behaviour and essentializing cultural difference. Through a comparative analysis of the selected cases, the review identifies contrasting organizational models of community engagement, ranging from top-down, institution-led interventions and 'double-targeted' strategies involving both communities and staff, to bottom-up, grassroots initiatives that reposition blood donation through religious meaning and practice. Building on these findings, the paper advances a typology of community-based approaches based on two dimensions: the degree to which communities are positioned peripherally or embedded, and the extent to which initiatives are driven from the top down or emerge from the bottom up. The analysis highlights how different approaches distribute agency, authority, and responsibility between blood collection agencies and communities, and demonstrates the importance of relational dynamics and organizational context in shaping participation. The findings also draw attention to structural constraints within blood collection organisations and suggest more systematic research on features of the blood supply chain.