Research Questions

The aim of this study is to investigate the attitudes of potential heterosexual blood transfusion
recipients towards the notion of receiving a transfusion of blood donated by a homosexual
male, in comparison to blood donated by a heterosexual male. Furthermore, the study aims to
examine the emotional underpinnings of these attitudes. Three emotions are proposed to
potentially influence responses: gratitude, anxiety, and disgust. The study will also explore
moderation of the effect of male donor sexuality on attitudes and emotions by demographic
characteristics (i.e., participant age and gender) and by individual difference constructs (i.e.,
blood-injection-injury phobia, anxiety sensitivity, disgust sensitivity, and anti-homosexual
attitudes).

The present study builds upon previous research which had demonstrated that heterosexual
recipients are less willing to receive a transfusion from a lesbian, gay, bisexual or transgender
(LGBT) donor (52%) compared to a heterosexual donor (77.8%) (Gobrial & Lui, 2021).
However, this previous study was limited by its focus on the broader category of LGBT
donors, rather than specifically on homosexual male donors. This is a key limitation as risk of
contracting the Human Immunodeficiency Virus (HIV) is central to an individual’s concern
regarding the health risks of blood transfusions (Lee, 2006) and prevalence of HIV is higher
among homosexual males relative to others, at least in Western countries (e.g., Australia:
Haire, Whitford, & Kaldor, 2018). Taken together, a key research question that has yet to be
explored surrounds heterosexual individuals’ willingness to receive a transfusion of blood
donated by a homosexual man. Gobrial and Lui (2021) also did not investigate the emotional
underpinnings of attitude discrepancies, nor potential moderation of the effects of donor
sexuality by age, gender, blood-injection-injury phobia, anti-homosexual sentiment, anxiety
sensitivity, or disgust sensitivity in this context.

Hypotheses
Male donor sexuality effect. Overall, participants were hypothesised to report more negative
overall attitudes, higher levels of disgust, and higher levels of anxiety towards the idea of
receiving a potential transfusion of blood from a homosexual male donor, relative to a
heterosexual male donor (herein referred to as the donor sexuality effect). The donor sexuality
effect on gratitude was not expected to be significant.

Moderation of the donor sexuality effect by participant age. The donor sexuality effect on
overall attitudes, anxiety, and disgust was hypothesized to be stronger for older, relative to
younger participants. The predicted null donor sexuality effect on gratitude was not expected
to be moderated by participant age.

Moderation of the donor sexuality effect by participant age. The donor sexuality effect on
anxiety was hypothesized to be stronger for female participants, relative to male participants.
The donor sexuality effect on disgust was hypothesized to be stronger for male participants,
relative to female participants. The donor sexuality effect on attitudes, and the predicted null
donor sexuality effect on gratitude, were not hypothesized to be moderated by participant
gender.

Moderation of the donor sexuality effect by individual difference constructs. Given the
conceptual relevance of blood-injection-injury-phobia, anxiety sensitivity, disgust sensitivity,
and anti-homosexual attitudes to transfusion-related attitudes and emotions, their potential

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moderation of donor sexuality effects will be examined. Directional hypotheses were not set
regarding these moderation patterns.

Intercorrelations among individual difference constructs. Intercorrelations among the

individual difference constructs were expected to mirror those observed in prior research.
Specifically, positive correlations were predicted between disgust sensitivity and anxiety
sensitivity (Thorpe, Patel, & Simonds, 2003), between disgust sensitivity and blood-injection-
injury phobia (Olatunji, Lohr, Smits, Sawchuk, & Patten, 2009), between anxiety sensitivity
and blood-injection-injury phobia (Cisler, Olatunji, Sawchuk, & Lohr, 2008) and between
anti-homosexual attitudes and disgust sensitivity (Wang et al., 2019).

Indirect effects. Leveraging views that emotions predict attitudes (e.g., Allen et al., 2005),
disgust and anxiety were posited as mediators of the relationship between donor sexuality and
attitudes. To the extent that the idea of receiving a transfusion of blood from a homosexual
male donor, relative to heterosexual male donor, elicits disgust and anxiety, more negative
attitudes are expected to result. More specifically, non-zero, negative indirect effects of donor
sexuality on attitudes via disgust and anxiety were hypothesized.

Sampling Plan

This is a pre-registration prior to data analysis. At the time of lodging this pre-registration,
data collection is complete, but analyses have yet to be conducted.

The survey was conducted solely online with participants recruited via Prolific; an online
research participant recruitment tool. Participants were financially remunerated for their time.
Recruitment on Prolific was restricted to users who self-identified as heterosexual and who
reside in the UK, USA, or Australia in a user profile survey.

We aimed for a total minimum sample size of N = 500 for analysis after exclusions. As such,
data were collected from a total of N = 550 participants in anticipation of data exclusions.
This sample size was set in light of (1) planned analyses of moderation of the within-
participants effect of donor sexuality by between-participants factors (i.e., gender, age, and
individual difference constructs), and (2) planned analyses of indirect effects. Regarding (1),
assessing moderation of a within-participants effect involves estimating a regression model
predicting a difference score (reflecting the effect of the within-participants effect) from the
between-participants moderator (Montoya, 2019). Power analyses carried out in R using the
pwr.f2.test function of the ‘pwr’ package (Champely, 2020) revealed that a sample size of
500 provides power in excess of 0.86 for models with 1-3 predictors (reflecting variability in
the number of subscales of a given individual difference variable in the present study), for an
effect capturing 2.5% of the variance in difference scores (i.e., a small effect) with alpha set
at 0.05.

Regarding (2), Monte Carlo simulation using a Shiny app developed by Shoemann, Bolton,
and Short (2017) was carried out for a parallel mediator model with correlations between x,
m1, m2, and y set at .21 (i.e., the average effects in the fields of social and personality
psychology; Fraley & Marks, 2007; Richard, Bond, & Stokes-Zoota, 2003) and standard
deviations set at 1.00. This revealed that a sample size of 500 provides power of .92
(95%CI .90, .94) to detect each indirect path. Note that this modelling presumes between-
participants design. According to Montoya (2020), the required sample size to achieve a

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given power level for within-participants designs is typically half that required for between-
participants designs. Given the within-participants design of the planned indirect effects
model, the model is very well-powered.

Note that this sample size also well-exceeds that required to identify a correlation of 0.2 with
0.80 (and, indeed, .95) power, two-tailed with alpha set at .05 (i.e., 194 (443) participants via
G*Power; Faul, Erdfelder, Lang, & Buchner, 2007).

Study Design, Procedure, and Variables

As the study was completed online, no research staff were directly involved in the data
collection. A copy of the Qualtrics questionnaire (in Word, PDF, and native QSF format) is
uploaded along with this registration.

The study utilised a within-subjects design for the manipulation of male donor sexuality.

After providing informed consent, participants were asked to “consider a situation within the
next year in which you will need a blood transfusion for medical reasons. A blood transfusion
is a medical procedure in which healthy blood is given to a patient through an intravenous
(IV) line. Blood transfusions replace blood that is lost through surgery or injury or provide it
if your body is not making blood properly. For people in critical condition, blood transfusions
can be lifesaving. Most of the blood used for transfusions comes from blood donations given
by volunteer blood donors. In this survey, you will be asked to consider receiving a blood
transfusion from four different blood donors, drawn from a database. You will be asked to
indicate how you feel about receiving a transfusion of their donated blood”. Participants were
additionally informed that they would “be asked to complete a number of questionnaires
about your emotional personality traits (e.g., anxiety, disgust), social attitudes (e.g., attitudes
towards other people), and opinions towards heath procedures (e.g., towards needle
injections)”.

Participants were then presented with four donors in a randomized order. These four donors
included a heterosexual male and a homosexual male both in their 30’s, a heterosexual
female in her 20’s, and a heterosexual female in her 60’s. The latter two donors were
included to disguise the primary focus on male donors of differing sexual orientations.
Participants were asked to consider potentially receiving a blood transfusion from a particular
donor, then respond to questions assessing their attitude, as well as questions assessing their
emotional responses towards that hypothetical transfusion.

Overall attitudes were assessed with 3 items (i.e., willingness, comfort, openness).
Participants were asked to rate: “How willing/comfortable/open would you be to receive a
transfusion of blood donated by (donor name)?”, on 7-point scales. For emotions,
participants were asked to respond on 7-point scales for 16 emotion items using the prompt:
“Overall, the idea of receiving a transfusion of blood donated by (donor name) makes me
feel…”. Five emotion items assessed disgust (i.e., grossed out, nauseous, disgusted,
revulsion, sickened; Harmon-Jones, Bastian, & Harmon-Jones, 2016), four items assessed
anxiety (i.e., worried, dread, nervous, anxious; Harmon-Jones et. al., 2016), and three items
assessed gratitude (i.e., grateful, thankful, appreciative; DeSteno, Li, Dickens, & Lerner,
2014). The remaining four emotion items (i.e., curious, interested, content, calm) were
included as filler items to help balance positive and negative states.

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Once participants completed attitude and emotion questions for all four donors, they
completed scales measuring blood-injection-injury phobia, anti-homosexual sentiment,
anxiety sensitivity, and disgust sensitivity, in a randomized order.

Blood-injection-injury phobia was measured via the Injection Phobia Scale–Anxiety (Öst et.
al., 1992). This scale includes 18 items assessing both distal and contact fear relating to
needle injection. Responses were made on 5-point scales anchored by No Anxiety and
Maximum Anxiety.

Anti-homosexual attitudes were measured via an adapted version of the Lesbians, Gay, and
Bisexual Knowledge and Attitudes Scale for Heterosexuals (LGB-KASH, Worthington,
Dillon, & Becker-Schutte, 2005), in which the questions referenced homosexual males
specifically rather than LGBT individuals broadly. This study utilized 10 items from the
Hatred and Internalized Affirmation subscales of the LGB_KASH. Responses were made on
7-point scales anchored by Very Uncharacteristic of Me or My Views and Very
Characteristic of Me or My Views.

Anxiety sensitivity was measured with the Anxiety Sensitivity Index-3 (Taylor et. al., 2007).
This scale assesses physical, cognitive, and social anxiety in three subscales, with 6 items
each. Responses were made on 5-point scales anchored by Very Little and Very Much.

Disgust sensitivity was measured via the Three-Domains of Disgust Scale (Tybur et. al.,
2009). This scale comprises 21 items, assessing pathogen, sexual, and moral disgust.
Responses were made on 7-point scales anchored by Not at All Disgusting and Extremely
Disgusting.

Finally, participants completed items assessing their knowledge regarding blood donation
deferral policies in their country of residence, and demographic information (i.e., age, gender,
ethnicity, prior history of receiving a transfusion and donating blood, country of residence,
sexual orientation). Following the demographic questions, participants were provided an
opportunity to leave a comment regarding the study before being debriefed.

Analysis Plan

Filler/distractor items are excluded from planned analyses. These include all attitude and
emotion items in response to the two heterosexual female donors and the four filler emotion
items (i.e., curious, interested, content, calm).

Scale Formation
Internal reliabilities will be assessed for: overall attitude (open, willing, comfortable), disgust
(grossed out, nauseous, disgusted, revulsion, sickened), anxiety (worried, dread, nervous,
anxious), and gratitude (grateful, thankful, appreciative) towards the homosexual male donor
and the heterosexual male donor separately. For the individual difference measures internal
reliability will be assessed for:
- all items in the Injection Phobia Scale–Anxiety (IPS-A),
- hatred and internalised affirmation subscales of the Lesbians, Gay, and Bisexual
Knowledge and Attitudes Scale for Heterosexuals (LGB-KASH),

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- physical, cognitive, and social anxiety subscales of the Anxiety Sensitivity Index-3 (ASI-
3),
- pathogen, sexual, and moral disgust subscales of the Three-Domains of Disgust Scale
(TDDS).

Should the internal reliability of any of these scales not reach acceptable standards (i.e.,
Cronbach’s alpha > .70), the impact of dropping one or more items will be assessed and
carried out as relevant, though with preference given to maintaining published scales in their
original form. Following establishment of acceptable internal reliability, scales will be
computed by calculating the mean across contributing items (for attitudes, anxiety, disgust,
gratitude, and the LGB-KASH subscales) and the sum across contributing items (for IPS-A
total, the ASI-3 subscales, and the TDDS subscales).

Donor sexuality effect

The donor sexuality effect on attitudes, disgust, anxiety, and gratitude will be assessed via
two-tailed paired-samples t-tests, each evaluated against an alpha of .05.

Moderation
Moderation analysis will be carried out using the MEMORE macro for SPSS (Montoya,
2019). These models will assess whether the within-participants effect of donor sexuality is
moderated by the following constructs, each construct to be assessed in a separate model:
- Participant gender
- Participant age
- Blood-injection-injury phobia (IPS-A total score)
- Anti-homosexual attitudes (LGB-KASH hatred and internalised affirmation subscales)
- Anxiety sensitivity (ASI-3 physical, cognitive, and social anxiety subscales)
- Disgust sensitivity (TDDS pathogen, sexual, and moral disgust subscales)
Significant moderation effects (p < .05) will be explored via the simple slopes method in the
case of a dichotomous moderator (i.e., gender), or via the Johnson-Neyman procedure in the
case of continuous moderators.

Correlations
Correlations among individual difference variables (including subscales as relevant) will be
calculated via Pearson’s r, each evaluated against an alpha of .05.

Indirect effects
The indirect effects of donor sexuality on attitudes via anxiety and disgust will be modelled
using the MEMORE macro for SPSS (Montoya & Hayes, 2017). This macro appropriately
models mediation of within-participants effects using a path-analytic framework. Indirect
effects will be estimated via bias-corrected bootstraps and assessed via 95% confidence
intervals (i.e., indirect effects whose 95% CIs exclude 0 will be considered nonzero). Further,
the pairwise contrast between the two indirect effects will be evaluated via a 95% CI.

Data Exclusions

Data from participants who meet the following criteria will be excluded from analyses:
 Didn’t complete the study.
 Didn’t report residing in Australia, the US, or the UK.
 Didn’t report heterosexual sexual orientation.

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  Completed the entire study in less than half the average expected completion time
based on pretesting (i.e., completion time of less than 6.5 minutes will be excluded).
 Showed no variance across all 16 emotions items for a particular donor (i.e., zero
variance for homosexual male donor, heterosexual male donor, heterosexual female
donor in 20’s, or heterosexual female donor in 60’s).
 Comments written at the end of survey which suggest a non-human participant/bot, or
those which a reasonable person would deem to invalidate corresponding data.
 For analyses including participant gender, participants who do not identify as male or
female will be excluded. This is to ensure that conclusions regarding gender are
sufficiently statistically powered.
 Missing data: if a participant is missing data for all items from a particular measure,
their data will be excluded from any analysis involving that measure.

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