SS symmetry

Article
Predicting the Intention to Donate Blood among Blood Donors
Using a Decision Tree Algorithm
Cristian Salazar-Concha 1 and Patricio Ramírez-Correa 2, *

1 Administration Institute, Faculty of Economic and Administrative Sciences, Universidad Austral de Chile,
Independencia 631, Valdivia 5110566, Chile; [email protected]
2 School of Engineering, Universidad Católica del Norte, Larrondo, Coquimbo 1781421, Chile
* Correspondence: [email protected]

Abstract: The blood donation process is essential for health systems. Therefore, the ability to predict
donor flow has become relevant for hospitals. Although it is possible to predict this behaviour
intention from donor questionnaires, the need to reduce social contact in pandemic settings leads to
decreasing the extension of these surveys with the minimum loss of predictivity. In this context, this
study aims to predict the intention to give blood again, among donors, based on a limited number of
attributes. This research uses data science and learning concepts based on symmetry in a particular
classification to predict blood donation intent. We carried out a face-to-face survey of Chilean donors
based on the Theory of Planned Behaviour. These data, including control variables, were analysed
using the decision tree technique. The results indicate that it is possible to predict the intention to



donate blood again with an accuracy of 84.17% and minimal variables. The added scientific value of


this article is to propose a more simplified way of measuring a multi-determined social phenomenon,
Citation: Salazar-Concha, C.; such as the intention to donate blood again and the application of the decision tree technique to
Ramírez-Correa, P. Predicting the achieve this simplification, thereby contributing to the field of data science.
Intention to Donate Blood among
Blood Donors Using a Decision Tree Keywords: artificial intelligence; blood donation; theory of planned behaviour; human factors
Algorithm. Symmetry 2021, 13, 1460.
https://doi.org/10.3390/sym13081460

Academic Editors:
1. Introduction
Waldemar Karwowski,
Boback Parsaei, Hamid R. Parsaei and
Since the COVID-19 pandemic outbreak, tens of thousands of scientific papers have
José Carlos R. Alcantud researched the associations with it, many of which use artificial intelligence and data
science. For some authors, data science will be a crucial element in the global response to
Received: 9 July 2021 the pandemic [1]. According to Van der Aalst [2], data science is a cross-disciplinary field
Accepted: 8 August 2021 of transforming data into absolute values. Data can be structured or unstructured, large or
Published: 10 August 2021 small, static or dynamic. The value is provided in predictions, automated decisions, data
models, or any data visualisation that gives information. This field can be considered a mix
Publisher’s Note: MDPI stays neutral of classic disciplines such as statistics, data mining, databases, and distributed systems.
with regard to jurisdictional claims in Data science techniques have been widely applied in past epidemics to help health pro-
published maps and institutional affil- fessionals and authorities take better measures against the disease [3]. Today, data science
iations. applications tackle COVID-19 in three main phases: screening, tracking and forecasting,
and medical aid [4]. In particular, the different use cases can be arranged in eight lines of
application: assessing risk and prioritising patients; testing and diagnostics; simulating
and modelling; contact tracing; comprehending social interventions; logistic planning and
Copyright: © 2021 by the authors. economic action; automated patient services; and supporting the development of vaccines
Licensee MDPI, Basel, Switzerland. and new therapies [1]
This article is an open access article As part of the data science’s applications to support a pandemic response, prediction
distributed under the terms and systems to improve the healthcare supply chain appear necessary. Furthermore, the
conditions of the Creative Commons changing and uncertain COVID-19 environment, and the need to maintain social distancing,
Attribution (CC BY) license (https:// are barriers to effective supply chain systems. In that context, data science-based cutting-
creativecommons.org/licenses/by/ edge technology plays a critical role in supply chain operations [5].
4.0/).

Symmetry 2021, 13, 1460. https://doi.org/10.3390/sym13081460 https://www.mdpi.com/journal/symmetry

Symmetry 2021, 13, 1460 2 of 13

Managing the supply and demand for blood is central to the health care supply chain,
as blood plays an essential role in saving lives. Blood supply forecasting is critical for
making supply chain decisions, such as scheduling donation units, transportation policies
and inventory management in transfusion centres and hospitals. For example, accurate
forecasts of the timing and number of upcoming blood requests have been considered
essential for donor recruitment decisions and inventory control [6]. Likewise, in the case
of blood components with a short shelf-life, the importance of correctly predicting the
demand enables minimising the loss of blood material, as in the case of platelets [7,8]. This
example is part of optimising the blood supply control strategy and minimising the risk of
over-supply in hospitals [9].
Recently a blood bank management system based on three integral aspects has been
developed: (i) an accurate forecast of future blood unit needs and reducing the imbalance
of supply and demand in the health sector; (ii) planning blood donation campaigns in an
effective and timely manner; and (iii) ensuring a safe blood supply chain [10]. The blood
supply chain involves three main sectors: hospitals, where doctors order blood transfusions
for patients; the blood centre, a centralised location that receives requests from hospitals;
and providers (blood donation sites), an entity that participates in donor management.
Uncertainties related to blood donation and demand, the perishability of blood products,
and different levels of blood supply chains are the attributes and factors that significantly
impact blood management [11].
Predicting the need for blood material has become more difficult recently, due to the
effect of the COVID-19 pandemic, because of the drastic changes in the health situation
and behaviour of donors [12,13]. Overall, since the outbreak of COVID-19, the number of
blood donors has declined. For instance, in Iran, the decline was 23% to 27%; this reduction
was more significant for regular donors and male donors aged 25 to 34 [14]. In Washington
State (USA), the blood donor decline was between 10 and 30%, in Canada it was 30% [15],
and in Italy 10% [16]. At the beginning of COVID-19, blood demand decreased due to
reduced surgeries and medical treatments offset this trend. However, the health services
cannot maintain this reduction for long.
The top donation factors for maintaining an adequate blood supply during the COVID-
19 pandemic, According to Stanworth et al. [15], can be highlighted: (i) donor recruitment;
(ii) donor eligibility; (iii) blood drive planning; (iv) inventory management; (v) protection
of staff and donors; (vi) availability of personnel; (vi) plasma for fractionation; and (vii)
product safety. While the number of factors to consider when organising an effective
donation has increased during the pandemic, donor recruitment and inviting regular
donors and the general public to donate blood has proven to be an effective mechanism
for replenishing the blood supply in this period [16,17]. Therefore, in parallel with the
prediction of the demand for blood materials, the importance of predicting donor behaviour
arises in order to know if a person is interested in donating again or not. This prediction
may help personalise and optimise the appeal process for potential repeatable donors.
Decision trees have been used in studies related to the prediction of human blood
donation [18–22]. A decision tree is a non-parametric technique that identifies a model that
most closely corresponds to the relationship between the attribute set and the class label of
the input data. Algorithm C4.5 is a particular case of this technique [23]. It is a popularly
used data mining algorithm for classification purposes [24]. The algorithm builds the
decision tree with a divide-and-conquer strategy [18]. C4.5 takes the training data and
generates a single tree, optimising the use of energy and processing [25]. Although the
decision tree technique based on C4.5 has been utilised in some studies related to human
blood donation [18,21,22], no evidence has been found in the publications that analysed
the prediction of blood donation in repeat donors.
The theory of planned behaviour (TPB) was suggested by [26], in which there was
an additional factor to the theory of reasoned action [27], and that factor was perceived
behavioural control. As exhibited in Figure 1, TBP has three factors in the model that lead
to intention and form the behaviour. Attitude (ATT, positive or negative assessments of a
 The theory of planned behaviour (TPB) was suggested by [26], in which there was an
Symmetry 2021, 13, 1460
additional factor to the theory of reasoned action [27], and that factor was perceived 3 of 13
behavioural control. As exhibited in Figure 1, TBP has three factors in the model that lead
to intention and form the behaviour. Attitude (ATT, positive or negative assessments of a
behaviour), subjective norm (SN, general perception of social pressure to adopt or not
behaviour), subjectiveand
adopt a behaviour), norm (SN, general
perceived perception
behavioural of social
control (PBC, pressure to adopt
perceived or not
control overadopt
or a
acapacity
behaviour), and perceived
to perform behavioural
a behaviour). control
TPB has been(PBC,
widelyperceived
used incontrol
severalover or a capacity
research topics.
to performTPB
Recently, a behaviour).
has been usedTPBashas been in
a basis widely used
studies on in several
social researchin
phenomena topics.
Latin Recently,
America
TPB has been used as a basis in studies on social phenomena in Latin America
as examples to explain the intention to adopt electronic commerce by SMEs [28], to predict as examples
to
theexplain
purchase the of
intention
productsto adopt electronic
[29], and commerce of
in the modelling bybehaviours
SMEs [28], to predict the
associated purchase
with public
of products
health, such[29], and in the
as condom usemodelling of behaviours
[30] and telemedicine associated
[31,32]. with
In these public
TPB health, such
applications, the
as condom use
behavioural [30] andistelemedicine
intention explained in [31,32]. In these
a range fromTPB 35 applications, the behavioural
to 85%, depending on the
intention
phenomenon is explained
studied.inRegarding
a range fromthe35 to 85%,
three depending of
determinants onbehavioural
the phenomenon studied.
intention, all
Regarding the three determinants of behavioural intention, all studies supported
studies supported the effect of ATT. However, in some studies, the impacts of the SN the effect
or
of
PBCATT.
areHowever, in some studies, the impacts of the SN or PBC are not supported.
not supported.

Figure 1. The TPB model.

In general, TPB has been used to model blood donation intent and behaviour behaviour [33].
For example, to determine the return behaviour of blood blood donors
donors [34,35]
[34,35] and
and understand
understand
different
different underlying
underlying motives
motives thatthat influence
influence thethe intention
intention toto perform
perform voluntary
voluntary blood
blood
donation [36–40]. Regarding re-donation behaviour, Wevers et al. [34]
donation [36–40]. Regarding re-donation behaviour, Wevers et al. [34] reported that thereported that the act
of donating blood stimulates re-donation behaviour. However, the pressure
act of donating blood stimulates re-donation behaviour. However, the pressure exerted exerted by the
blood
by thebank
bloodcan
bank affect
canthis behaviour,
affect so interventions
this behaviour, that promote
so interventions donor retention
that promote should
donor retention
be carried out to avoid forcing the behaviour of the individuals. In this
should be carried out to avoid forcing the behaviour of the individuals. In this vein, vein, M’Sallem [35]
indicates
M’Sallemthat [35]internal motivation
indicates to re-donate
that internal prevails
motivation toover externalprevails
re-donate reasons and
overconsiders
external
that blood donation centres can believe in their retention programmes,
reasons and considers that blood donation centres can believe in their retention showing that both
the ATT and the PBC affect the re-donate blood intention.
programmes, showing that both the ATT and the PBC affect the re-donate blood intention.
Giles
Giles and
and Cairns
Cairns [41]
[41] first
first applied
applied TBP
TBP inin blood
blood donation
donation toto examine
examine thethe perceived
perceived
behavioural
behavioural control factor. They [41] demonstrated that the perception of control has
control factor. They [41] demonstrated that the perception of control has an
an
important impact on behavioural motivation. The subsequent research
important impact on behavioural motivation. The subsequent research by [42] supported by [42] supported
the results of [41]. It showed evidence for the inclusion of self-efficacy, moral norms and
the results of [41]. It showed evidence for the inclusion of self-efficacy, moral norms and
self-identity as other influential predictors. Self-efficacy comes from social cognitive theory;
self-identity as other influential predictors. Self-efficacy comes from social cognitive
although it is conceptually similar to PBC [43], the main difference is operational. PBC
theory; although it is conceptually similar to PBC [43], the main difference is operational.
is often evaluated by the ease or difficulty of the behaviour, whereas the individual’s
PBC is often evaluated by the ease or difficulty of the behaviour, whereas the individual’s
confidence performs self-efficacy. Armitage and Conner [42] showed in an empirical
confidence performs self-efficacy. Armitage and Conner [42] showed in an empirical
study that self-efficacy is a significant predictor and has the highest impact on blood
study that self-efficacy is a significant predictor and has the highest impact on blood
donation. Moreover, in another study [44], self-efficacy was the most significant predictor
donation. Moreover, in another study [44], self-efficacy was the most significant predictor
for blood donation. Moral norms consider “personal feelings of . . . responsibility to
for blood donation. Moral norms consider “personal feelings of … responsibility to
perform, or refuse to perform a certain behaviour” [42]. Furthermore, self-identity was
perform, or refuse to perform a certain behaviour” [42]. Furthermore, self-identity was
proposed from identity theory by [42] as the extension of social norms while having a
different interpretation. Social norms are supposed to be what we believe others want
us to do, but self-identity reflects the individual’s perception of a particular social role.
The more an individual perceives a role, the more impact their self-identity will have on
intention [42]. When it comes to moral norms, it should be considered that they have
Symmetry 2021, 13, 1460 4 of 13

a different concept from religious beliefs. Another study by [45] showed that religious
beliefs among young donors significantly impact their intention to donate blood. An
empirical study was conducted by [44] to study blood donation in young people. It turned
out that self-efficacy, attitude and moral norms were the most influential correlates in
producing an intention to become a blood donor. Contrary to previous studies, Robinson
et al. [46] studied blood donation among nondonors. They proposed descriptive norms,
donation anxiety and anticipated regret in addition to the previous predictors. Moral norms
explain perceived moral duty; subjective norms describe perceived pressure from others.
However, descriptive norms show the same as others [46]. Donation anxiety is defined
as concern about needles, exposure to blood or pain [46]. Meanwhile, in another study
by [47], donation anxiety focused more on fear, which plays a crucial role in anticipating
donation intentions. Additionally, anticipated regret is an expectation of predicted future
experience of regret considering anticipated future action. The result of [46] illustrated
that all predictors were directly correlated with blood donation for nondonors except the
subjective norm. In their research, Masser et al. [48] proposed a new framework to divide
predictors in blood donors into direct and indirect factors. They introduced donation
anxiety, moral norms and self-identity as indirect predictors for intention directly related
to attitude. On the other hand, they presented attitude, subjective norms, self-efficacy and
anticipated regret as direct predictors in their framework. Bednall et al. [28] reviewed
61 studies associated with blood donations from a broader perspective. They concluded
that PBC, attitude, self-efficacy, role identity and anticipated regret are the strongest positive
predictors. At the same time, moral norms, satisfaction and service quality have a medium
impact on donor’s intentions. In 2011, Masser et al. [49] studied the donor’s behaviour
in the emergence of an outbreak due to influenza in Australia. Based on their research,
the impact of the outbreak on blood donation was scarce. However, in two low-risk and
high-risk scenarios, attitude and subjective norm were influential. In low-risk scenarios,
gender was an additional significant predictor, but in high-risk circumstances, this was PBC.
With the advent of Covid-19, another article by [50] conducted an empirical investigation
to find the most critical predictor concerning blood donors based on TPB and its extension.
It turned out that trust in blood collection agencies anticipated a higher evaluation and,
therefore, a more vital subjective norm. Thus, self-efficacy and subjective norms play a
crucial role in predicting donors’ intention in the Covid-19 era. When it comes to trust,
the feelings of trust were shown as attitudes to assess blood donation by using digital
platforms [37].
In this context, this study aims to predict the intention of donors to give blood again
based on a limited number of attributes. Given a set of variables used to predict behaviour
based on a social science theory, the problem to be solved is to determine a smaller number
of variables that can predict this behaviour. In general, this research process is an example of
using data science and learning concepts based on symmetry for a particular classification
and subsequent forecasting. The added scientific value of this article is to propose a more
simplified way of measuring a multi-determined social phenomenon, such as the intention
to donate blood again; the application of the decision tree technique to achieve this is a
significant contribution to the field of data science.
We want to emphasise this study’s contributions. From the practical point of view,
the contributions are related to improving information capture for predicting future blood
donations, an event of fundamental importance given the context where this activity is
carried out, and the current global health emergency. From the academic point of view, the
main contribution of this work is associated with the application of a known data science
technique in a novel way in social sciences, specifically, to determine a smaller number of
attributes that predict behaviour based on a social theory that initially requires a larger
number of attributes.
This paper is organised as follows. In Section 2, we describe the data collection
procedure and techniques used to examine the data. We present the results of this data
Symmetry 2021, 13, 1460 5 of 13

analysis in Section 3. Section 4 offers a discussion of these findings. Lastly, the final section
gives a brief summary of the outcome of this paper.

2. Methods
2.1. Data
For the empirical study, a convenience sampling technique was used to gather the
data of Chilean blood donors. The data were obtained through an in-person questionnaire
for adult users in two health centres in Valdivia (Chile). In particular, a cross-section survey
was conducted between March and April 2020. All surveys were conducted as a final action
in the blood donation process. The respondents were maintained anonymous during the
data collection process. According to standard socio-economic studies, there are no other
ethical concerns than to preserve the participants’ anonymity. The scales were adapted
from Jen and Hung. A 7-point Likert scale was used. Table 1 shows the items used to
measure the study’s variables.

Table 1. Items used to measure the latent variables.

Latent Variable Item Description Average SD Asymmetry Kurtosis

People who are important to me would
SN1 4.61 0.719 −2.059 4.598
recommend that I donate blood
Subjective I believe that the people who are important to me
SN2 4.26 0.953 −1.015 0.012
Norms think that I should donate blood
If I donated blood, the people who are important to
SN3 4.57 0.730 −1.627 1.822
me would approve
I have complete control over whether I will donate
PBC1 4.55 0.875 −2.181 4.557
blood or not in the next six months
Perceived How much control do you have over whether you
Behavioural PBC2 donate blood or not in the next six months? (No 4.48 0.834 −1.798 3.275
Control control/complete control)
I am confident that I will be able to
PBC3 4.32 1.060 −1.670 2.134
donate blood in the next six months
Donating blood in the next six months will be an
ATT1 4.48 0.873 −2.088 4.722
action: Unpleasant/Pleasant
Donating blood in the next six months will be an
ATT2 4.66 0.648 −2.178 5.913
action: Bad/Good
Attitude
Donating blood in the next six months will be an
ATT3 4.54 0.810 −1.933 3.812
action: Unsatisfactory/Satisfactory
Donating blood in the next six months will be an
ATT4 4.64 0.685 −2.197 5.507
action: Pointless/Worthwhile
BI1 I would like to donate blood in the next six months 4.55 0.854 −2.361 5.946
Behavioural
BI2 I intend to donate blood in the next six months 4.31 1.054 −1.669 2.322
Intention
BI3 I will donate blood in the next six months 4.19 1.014 −1.243 1.119

Using TPB modelling, the questionnaire was developed to obtain primary microdata.
The research model has been tested using this data. This study meets the ethical standards
of social research established by Universidad Austral de Chile (UACh, Valdivia, Chile) for
its researchers. The health centres where the data were collected are associated with that
institution. Moreover, as in other eHealth studies carried out by the leader of this research
team [37], the study followed the Checklist for Reporting Results of Internet E-Surveys
(CHERRIES) guidelines [51].
A total of 197 surveys were completed for this study. Most of the completed surveys
were females (52%), and the average age was 32.1 years old. See Table 2 for more details of
the distribution of the variables of interest.
Symmetry 2021, 13, 1460 6 of 13

Table 2. Distribution of the variables of interest.

Variable N %
Education
Primary 22 11
Secondary 74 38
Tertiary 101 51
Previous donations
Never 73 37
1 to 3 77 39
4 or more 47 24
Donation reason
Knowing someone 72 37
Another reason 125 63
Gender
Male 95 48
Female 102 52
Total 197 100
Mean 32.1 ± 11.00
Age
Range 18–60 years

2.2. Decision Tree Algorithm

We used a decision tree algorithm to predict intended blood donation. A decision
tree algorithm is a nonparametric technique that identifies a pattern that best matches
the relationship between the attributes set and the class label of the input data. In this
context, a decision tree refers to a reverse tree scheme consisting of nodes intended to
decide the values affiliated to the class. According to [52], there are six reasons for using this
method: (1) a decision tree does not require prior assumptions on the type of probabilistic
distributions met by the class and other attributes; (2) regarding computational time,
a decision tree is inexpensive and fast, even when the size of the training package is
significant; (3) an interpreting decision tree, in particular smaller trees, requires less effort;
(4) decision tree algorithms are quite robust to the presence of noise, particularly when
methods to prevent overtaking are used; (5) the accuracy of a decision tree is not affected
by highly correlated and irrelevant attributes during pretreatment, and; (6) the technique is
useful for predictive modelling. Algorithm C4.5 is a particular case of this technique [23]. In
accordance with [24,53], we detail C4.5 below. Given a dataset D, C4.5 initially grows a tree
using the divide-to-conquer strategy as follows. If all cases in D belong to the same class, or
D is small, the tree is a leaf tagged with the most common class in D. If not, a test is selected
based on one attribute having two or more results. This test is made the root of the tree
with a branch for each outcome of the test, then D is divided into corresponding subsets,
depending on the result of each case, and the same procedure is applied recursively to
each subset. C4.5 uses two heuristic criteria for classifying potential tests: information gain
and gain ratio. The former criteria minimise the total entropy of the subsets, and the latter
criteria divide the information gain by the information provided by the results test. Both
criteria are based on an impurity function that is defined as symmetric with respect to the
discrete probability vectors associated with each subset [54]. The attributes may be numeric
or nominal, and this determines the format of the test results. For a numerical attribute a,
they are {a ≤ l, a > l}. The level l is found by sorting D from the values of a and choosing the
distribution among successive values that maximise the above criterion. An attribute with
discrete values has a result for each value or the values to be grouped into two or multiple
subsets with a result for each subset. To avoid overfitting, the original tree is then pruned.
This procedure is based on a pessimistic estimation of the error rate associated with a set of
M cases, of which E does not belong to the most common category. C4.5 determines the
upper limit of binomial likelihood when E events have been observed in M tests, using a
specified confidence. Figure 2 shows the pseudocode of the C4.5 algorithm.
 values that maximise the above criterion. An attribute with discrete values has a result for
each value or the values to be grouped into two or multiple subsets with a result for each
subset. To avoid overfitting, the original tree is then pruned. This procedure is based on a
pessimistic estimation of the error rate associated with a set of M cases, of which E does
Symmetry 2021, 13, 1460 not belong to the most common category. C4.5 determines the upper limit of binomial 7 of 13
likelihood when E events have been observed in M tests, using a specified confidence.
Figure 2 shows the pseudocode of the C4.5 algorithm.

Figure2.2.Pseudocode
Figure Pseudocodeof
ofthe
theC4.5
C4.5algorithm.
algorithm.

3.3.Results
Results
The
Theintention
intentionto todonate
donateblood
bloodin inthe
thenext
nextsix
sixmonths
monthswas wascalculated
calculatedasasfollows.
follows.First,
First,
we determined the average of the items associated with the donation
we determined the average of the items associated with the donation intention variable. intention variable.
Then
Thenthis
thisaverage
averagewas wasclassified
classifiedintointothree
threelevels,
levels,the
the“no”
“no”level
levelbeing
beingaavalue
valuebetween
between
one
one and two, the “maybe” level being a value greater than two but less thanfive,
and two, the “maybe” level being a value greater than two but less than five,and
andthe
the
“yes” level being a value greater than five. The attributes used to generate
“yes” level being a value greater than five. The attributes used to generate the prediction the prediction
model
modelwerewerethetheitems
itemsassociated
associatedwithwiththe thelatent
latentvariables
variablesofofthe
theTPB
TPBmodel
modelthat
thatexplain
explain
the behavioural intention. Additionally, the control variables that were
the behavioural intention. Additionally, the control variables that were considered considered are: age,
are:
education, reason
age, education, for donation
reason and number
for donation and numberof previous donations.
of previous donations.
To
Toimplement
implementthe thedecision
decisiontree
treealgorithm,
algorithm,we weused
usedthe
theC4.5
C4.5algorithm,
algorithm,which
whichbuilds
builds
decision
decision trees based on a collection of training data using information entropy[55].
trees based on a collection of training data using information entropy [55].AAgrid
grid
optimisation strategy was used as a procedure to adjust parameters
optimisation strategy was used as a procedure to adjust parameters related to division related to division
and shutdown criteria. The split criteria assessed were information gain, gain ratio, the
and shutdown criteria. The split criteria assessed were information gain, gain ratio, the
Gini index and accuracy. The method specifies the gain ratio as the dividing criterion
Gini index and accuracy. The method specifies the gain ratio as the dividing criterion and
and value four as the maximum depth. The analyses were performed using 10-fold cross-
value four as the maximum depth. The analyses were performed using 10-fold cross-
validation to prevent overfitting. The cross-validation process involves two stages. The
validation to prevent overfitting. The cross-validation process involves two stages. The
first stage produces a model, and after that, the second stage applies the former model
first stage produces a model, and after that, the second stage applies the former model
and measures its performance. For cross-validation by 10, the procedure splits the data
and measures its performance. For cross-validation by 10, the procedure splits the data
sample into ten subsets of equal size. Out of the ten subsets, the method preserves a single
sample into ten subsets of equal size. Out of the ten subsets, the method preserves a single
subset as test data, and the other nine subsets are used as instruction data. This process is
subset as test data, and the other nine subsets are used as instruction data. This process is
repeated ten times, and each of the ten subassemblies are used once as test data. Finally, the
repeated ten times, and each of the ten subassemblies are used once as test data. Finally,
process averages the results of the ten iterations to produce an estimation. Table 3 details a
the process averages the results of the ten iterations to produce an estimation. Table 3
description of the procedure parameters.
details a description
Figure 3 shows the of the procedure
results for blood parameters.
donation intention. The attributes required for
the prediction model are PBC1, PBC3, ATT1, ATT2, ATT3, SN2, and previous donations.
The prediction outcomes in Table 4 reveal that the method performs well regarding
selection of cases that need to be chosen with an accuracy of 84.17% ± 8.21%. Figure 4
summarises the application of the decision tree technique and its results.
Symmetry 2021, 13, 1460 8 of 13

Table 3. Description of the procedure parameters.

Parameter Value Description

C4.5 sets up decision tree models based on a training dataset using the
Algorithm C4.5
concept of information entropy.
Gain Ratio normalises the information gain of an attribute against the
amount of entropy that attribute has. First, the information gain of all
features is determined, and then the average information gain is
Split criteria Gain Ratio calculated. Second, the gain ratio is calculated for all attributes whose
calculated information gain is greater than or equal to the average
information gain. Finally, the feature with the highest gain ratio is chosen
to divide the data.
Maximum depth refers to the maximum distance between the root of the
Maximum depth 4
tree and any leaf.
This strategy runs the process for all combinations of selected parameter
Optimisation strategy Grid
values and then determines the optimal values.
Of the ten sub-samples, only one subsample is preserved as validation
data for model testing, and the remaining nine subsamples are used as
Validation 10-fold cross-validation training data. Thus, the process is repeated repeatedly, with each of the
ten subsamples used exactly once as validation data. Finally, the results
ten are averaged to generate one estimate.

Table 4. Confusion matrix.

Accuracy: 84.17% No (True) Maybe (True) Yes (True) Class Precision

No (pred.) 2 2 1 40.00%
Maybe (pred.) 1 38 11 76.00%
Yes (pred.) 0 9 87 90.62%
Class recall 66.67% 77.55% 87.88%
Symmetry 2021, 13, x FOR PEER REVIEW 9 of 14

Symmetry 2021, 13, 1460 9 of 13

Figure3.3.Decision
Figure Decisiontree
treegraph
graphresults
resultsfor
forblood
blooddonation
donationintention.
intention.
 Table 4. Confusion matrix.

Accuracy: 84.17% No (True) Maybe (True) Yes (True) Class Precision

No (pred.) 2 2 1 40.00%
Symmetry 2021, 13, 1460 10 of 13
Maybe (pred.) 1 38 11 76.00%
Yes (pred.) 0 9 87 90.62%
Class recall 66.67% 77.55% 87.88%

Figure
Figure 4.
4. Explanation
Explanation of
of the
the application
application of
of the
the decision
decision tree
tree technique.
technique.

4. Discussion
4. Discussion
As far
As far as
as we
we know,
know, there
there are
are no
no studies
studies inin the
the literature
literature that predict the
that predict the intention
intention to to
re-donate among
re-donate among bloodblood donors.
donors. Nevertheless,
Nevertheless, usingusing data
data science,
science, aa recent
recent study
study explores
explores
intending to
intending to donate
donate or or non-donate
non-donate among among nondonors
nondonors from from India
India [56].
[56]. The
The present
present study’s
study’s
accuracy of 84.17% can be positively compared with the 70.37%
accuracy of 84.17% can be positively compared with the 70.37% of the previous one. We of the previous one. We
believe that using a theoretical model as a basis generates this improvement
believe that using a theoretical model as a basis generates this improvement in prediction. in prediction.
The attributes
The attributesthat thethe
that prediction modelmodel
prediction uses are associated
uses with the three
are associated withantecedents
the three
antecedents of the TPB. According to these findings, items of the PBC and ATTemerge
of the TPB. According to these findings, items of the PBC and ATT variables variablesas
strongeraspredictors,
emerge consistentconsistent
stronger predictors, with other withstudies
otheramong
studies blood
amongdonors [48,57]. [48,57].
blood donors These
results suggest that for experienced donors, blood donation remains
These results suggest that for experienced donors, blood donation remains a behaviour a behaviour that is, at
that is, at least in part, a rational decision. On the other hand, the item associated withthat
least in part, a rational decision. On the other hand, the item associated with SN shows SN
this variable has some importance in determining the intention to donate in experienced
shows that this variable has some importance in determining the intention to donate in
donors, which is in line with previous studies [58].
experienced donors, which is in line with previous studies [58].
Of the control variables used as predictors, only previous donations were helpful. Edu-
Of the control variables used as predictors, only previous donations were helpful.
cation level, age, gender or the primary reason for donating do not predict the intention for
Education level, age, gender or the primary reason for donating do not predict the
experienced donors to repeat donate. However, previous donations emerge in the model as
intention for experienced donors to repeat donate. However, previous donations emerge
an essential attribute in the prediction. Blood donors who previously have donated blood
in the model as an essential attribute in the prediction. Blood donors who previously have
are more likely to donate blood in the future. In line with Guglielmetti Mugion et al. [57],
donated blood are more likely to donate blood in the future. In line with Guglielmetti
this variable may represent the lower presence of inhibitors such as fear or lack of informa-
Mugion et al. [57], this variable may represent the lower presence of inhibitors such as
tion on the transparency of the process.
fear or lack of information on the transparency of the process.
Although the literature indicates that artificial intelligence-based systems have achieved
Although
significant successthe in
literature
healthcare indicates that [59],
since 2016 artificial intelligence-based
the prediction associated systems
with bloodhave
achieved significant success in healthcare since 2016 [59], the prediction
donation has not been an area with significant development. We believe that this study associated with
blood donation
provides has notadvance.
a significant been an In area with significant
particular, this study development. We believe
has three practical that this
implications.
study provides a significant advance. In particular, this study
First, the result of this study implies a minimisation of the number of questions and, has three practical
implications.
therefore, theFirst,responsethe result
time for of people
this study
whoimplies
donate.a Clearly,
minimisation of the
this will cause number
a higher of
questions and, therefore, the response time for people who donate.
percentage of survey completion and the possibility of improving blood management Clearly, this will cause
aplanning.
higher percentage
Second, the of survey
registry completion
of donation and thewill
intentions possibility of improving
allow customisation, blood
targeting
management
and the development planning. Second, and
of attractive the appealing
registry practices.
of donation intentions
So, there will be will allow
an increase
customisation,
of the people who targeting
intendand the development
to repeat blood donation, of attractive
voluntarilyandandappealing practices.
altruistically, So,
thereby
there will be an increase of the people who intend to repeat blood donation,
raising the availability of blood. Finally, a reduction in costs derived from contacting people voluntarily
and
who altruistically,
wish to donatetherebyblood, andraising the availability
in general of blood.
from the blood Finally, asystem,
management reduction in costs
is expected,
derived from contacting people
thanks to the two previous implications. who wish to donate blood, and in general from the blood
management system, is expected, thanks to the two previous implications.
5. Conclusions
Prediction systems to improve the healthcare supply chain are necessary for the
changing and uncertain environment of COVID-19. In that sense, blood supply forecasting
is critical to making supply chain decisions and can help personalise and optimise the
process for potential donors. In the past, the TPB has been used to predict blood donations,
but the data collection time is currently critical. Therefore, the decrease in these times
permits data capture and enables donation prediction. Thus, the research objective of this
study was to predict the intention to repeat blood donations amongst donors based on a
limited number of attributes. These data were analysed using the decision tree technique.
Symmetry 2021, 13, 1460 11 of 13

The experiment results indicate that it is possible to predict the intention to repeat
blood donations with an accuracy of 84.17%, using only seven variables. Furthermore,
the findings reveal that the attributes used by the prediction model are associated with
the three antecedents of the TPB. According to these findings, items of the PBC and ATT
variables emerge as the strongest predictors.
Some limitations that must be taken into account in the present study are related
to the sample size and the donors’ culture. The sample size limitation does not allow
generalising this result to the whole population. Furthermore, the sample donors’ culture
does not apply these findings to a country with a different culture. In future studies, it
will be helpful to carry out a replication of the procedure in a bigger sample and study
different cultures (for example, with other religious beliefs). Additionally, future research
should apply the decision tree technique in other areas of social sciences to determine a
smaller number of attributes that predict behaviour based on an established theory, such
as predicting learning styles based on the Felder-Silverman learning style model [60] or
predicting the purchase of products or services based on the reasoned action theory [27].

Author Contributions: Conceptualisation, C.S.-C. and P.R.-C.; methodology, P.R.-C.; software, C.S.-C.
and P.R.-C.; validation, P.R.-C. and C.S.-C.; formal analysis, P.R.-C. and C.S.-C.; investigation, P.R.-C.
and C.S.-C.; resources, P.R.-C. and C.S.-C.; data curation, C.S.-C. and P.R.-C.; writing—original draft
preparation, C.S.-C. and P.R.-C.; writing—review and editing, P.R.-C.; visualisation, P.R.-C. and
P.R.-C.; supervision, P.R.-C.; project administration, P.R.-C.; funding acquisition, C.S.-C. and P.R.-C.
All authors have read and agreed to the published version of the manuscript.
Funding: This research was partially funded by Universidad Austral de Chile (CHILE) and Universi-
dad Católica del Norte (CHILE) and supported by ANID-Chile, through the FONDECYT program,
grant no. 1210130.
Institutional Review Board Statement: Ethical review and approval were waived for this study
because all the data used involving research on human subjects have been published before.
Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.
Data Availability Statement: The data presented in this study are available on request from the
corresponding author.
Conflicts of Interest: The authors declare no conflict of interest.

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