Abstract
BackgroundTimely initiation of insulin therapy in type 2 diabetes is important to achieve metabolic control but can be hindered by negative perceptions of patients regarding insulin treatment. To assess the appraisal of insulin therapy of persons with type 2 diabetes, we developed the insulin treatment appraisal scale (ITAS) and tested its reliability and validity in insulin treated type 2 diabetes patients.MethodsA sample of 282 patients with type 2 diabetes form the United States (US) completed the ITAS, the WHO-5 Well-being index (WHO-5) and the Problem Areas in Diabetes (PAID) Survey. Exploratory factor analysis (EFA), internal consistency (Cronbach's alpha) and item-total correlations were determined to test the reliability of the instrument. Concurrent validity was examined by calculating Pearson correlation coefficients between the different measures. Discriminant validity was examined by comparing ITAS scores of insulin naive and insulin using patients.ResultsEFA suggested a two-factor structure, separating positively worded and negatively worded items. Cronbach's alpha was 0.90 for the negative appraisal scale and 0.68 for the positive appraisal scale. Yet, Cronbach's alpha of the total 20-item scale was 0.89, suggesting high homogeneity and allowing for calculation of an overall score. Item-total correlations were in the range of 0.46–0.74 for the negative and 0.34 – 0.53 for the positive appraisal scale. The item pertaining to weight gain, as part of the negative appraisal subscale, showed low communality and deserves further testing. Concurrent validity was confirmed with low to moderate correlations in the expected direction between ITAS and WHO-5 and PAID. Discriminant validity was confirmed by the fact that patients using insulin had significantly less negative appraisals than insulin naive patients.ConclusionThe ITAS is a brief, psychometrically sound instrument that can be used in insulin naive and insulin-treated patients to assess positive and negative perceptions regarding insulin treatment and changes therein.
Highlights
Initiation of insulin therapy in type 2 diabetes is important to achieve metabolic control but can be hindered by negative perceptions of patients regarding insulin treatment
Initiation of insulin therapy is often delayed due to a variety of reasons, including patients' reluctance to accept insulin therapy [3,4]
To assist health care professionals and researchers in assessing barriers to timely insulin initiation and explore patients' attitudes towards insulin therapy, a short, comprehensive tool would be helpful. Such a measure would be useful to prospectively measure changes in the patient's appraisals of insulin therapy in due course. For these purposes we developed the insulin treatment appraisal scale (ITAS), a 20-item self-report measure pertaining to both negative and positive beliefs regarding insulin treatment
Summary
A sample of 282 patients with type 2 diabetes form the United States (US) completed the ITAS, the WHO-5 Well-being index (WHO-5) and the Problem Areas in Diabetes (PAID) Survey. Concurrent validity was examined by calculating Pearson correlation coefficients between the different measures. Discriminant validity was examined by comparing ITAS scores of insulin naive and insulin using patients. Development of ITAS The ITAS was developed to capture type 2 diabetes patient's current appraisal of insulin therapy. The instrument assesses both positive and negative attitudes. The ITAS was conceptualized as a two-dimensional instrument, with "appraisal of insulin therapy" as a single underlying construct, allowing for calculating a total score and two subscale scores. The ITAS has been designed as a diagnostic tool as well as an evaluation instrument to track changes in perceptions regarding insulin therapy over time
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