Abstract
BackgroundInsulin therapy forms a cornerstone of pharmacological management of diabetes mellitus (DM). However, there remains a lack of acceptance and adherence to insulin, thereby contributing to poor DM control. This study aimed to determine the impact of patients’ beliefs about insulin on acceptance and adherence to insulin therapy.MethodThis was a qualitative study using grounded theory approach. The study took place from September 2019 to January 2021 at a cluster of primary healthcare clinics in Singapore. Maximum variation sampling was used to recruit adult patients with type 2 DM on basal or premixed insulin for at least 6 months. Semistructured in-depth interviews were conducted using a topic guide and audio recorded. Data collection continued until saturation. Data analysis utilised a constant comparison procedure and a synthesis approach.ResultsTwenty-one participants (mean age 61 years) were interviewed for this study. Data analyses showed that there were 6 main themes that emerged. Four themes influenced both insulin acceptance and adherence. These were concerns about insulin being a lifelong treatment, physical fear of insulin injection, erroneous beliefs about insulin, and perceived fear of DM complications. Two additional themes influenced adherence to insulin therapy. These were socioeconomic concerns, and concerns about side effects of insulin.ConclusionsPatients’ beliefs about insulin impact on the acceptance and adherence to insulin therapy. Health care providers need to elicit and address these beliefs during counselling to improve acceptance and adherence to insulin therapy.
Highlights
The prevalence of diabetes mellitus (DM) is increasing worldwide and the complications of poorly controlled diabetes contribute to patients’ disabilities and rising health care costs [1,2,3]
There has not been a recent study done locally to explore this aspect; this study aims to explore the impact of patients’ beliefs about insulin on acceptance of insulin initiation and adherence to insulin therapy
Semistructured individual interviews were conducted to elicit and explore patients’ beliefs on insulin and their impact on insulin initiation and adherence
Summary
The prevalence of diabetes mellitus (DM) is increasing worldwide and the complications of poorly controlled diabetes contribute to patients’ disabilities and rising health care costs [1,2,3]. The majority of patients with diabetes in Singapore have type 2 diabetes, which is influenced by modifiable lifestyle factors and characterised by insulin resistance along with diminished insulin secretion. The prevalence of type 2 diabetes has increased in tandem with the rising prevalence of obesity in Singapore, contributed to by excessive caloric intake and a sedentary lifestyle [6]. There remains a lack of acceptance and adherence to insulin, thereby contributing to poor DM control. This study aimed to determine the impact of patients’ beliefs about insulin on acceptance and adherence to insulin therapy
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