Highlights
- •The Insulin Appraisal Treatment Scale (ITAS) has not been used to assess barriers to insulin therapy in South Africans living with diabetes.
- •An expert panel found that the ITAS is relevant to the South African context.
- •Insulin-naïve participants held more negative beliefs towards insulin than those who were on insulin.
- •The negative attitudes of non-insulin users were related to injection-related anxieties including fear of injection and pain.
Abstract
Aims
To assess barriers to insulin therapy among people with type 2 diabetes after adapting
the Insulin Treatment Appraisal Scale (ITAS) to the South African context.
Methods
A panel of experts reviewed the original ITAS for clarity and relevance to the South
African context. The ITAS was administered to 253 adults with type 2 diabetes attending
diabetes outpatient clinics in the Tshwane Metropolitan Municipality. Internal consistency
(Cronbach's alpha) was tested and construct validity was examined using exploratory
factor analysis (EFA). PIR was appraised in insulin users and non-users.
Results
The EFA revealed that the adapted ITAS had a two-factor structure, similar to the
original scale, with acceptable internal consistency (α = 0.85). Insulin-using participants
had significantly less negative attitudes to insulin therapy than non-users (40.7 ± 7.1
vs. 51.5 ± 11.2, p < 0.001). Compared to participants who used insulin, participants who did not use
insulin were afraid of injecting themselves with a needle (71% vs. 11%, p < 0.001) and saw insulin treatment as a sign of worsening diabetes (63% vs. 29%,
p < 0.001).
Conclusions
Consistent with previous studies, participants who were not using insulin had more
negative beliefs and attitudes towards insulin treatment than those who were already
using insulin. South African clinicians should use the ITAS to assess positive and
negative perceptions regarding insulin therapy in both insulin-naïve and insulin-treated
people, to evaluate interventions to reduce PIR and improve treatment outcomes.
Keywords
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References
- Sulfonylurea inadequacy: efficacy of addition of insulin over 6 years in patients with type 2 diabetes in the UK Prospective Diabetes Study (UKPDS 57).Diabetes Care. 2002; 25: 330-336
- Challenges associated with insulin therapy in type 2 diabetes mellitus.Am. J. Med. 2014; 127: S11-S16
- Barriers and facilitators to starting insulin in patients with type 2 diabetes: a systematic review.Int. J. Clin. Pract. 2015; 69: 1050-1070
- Poor glycaemic control in type 2 diabetes: a conspiracy of disease, suboptimal therapy and attitude.QJM. 2000; 93: 369-374
- Psychological insulin resistance in patients with type 2 diabetes: the scope of the problem.Diabetes Care. 2005; 28: 2543-2545
- Assessing psychological insulin resistance in type 2 diabetes: a critical comparison of measures.Curr. Diabetes Rep. 2017; 17: 46
- Estimating the burden of disease attributable to diabetes in South Africa in 2000.J. Endocrinol. Metab. Diabetes S. Afr. 2007; 12: 65-71
- Treatment gaps found in the management of type 2 diabetes at a community health centre in Johannesburg, South Africa.J. Diabetes Res. 2017;
- Diabetes care and complications in primary care in the Tshwane district of South Africa.Prim. Care Diabetes. 2015; 9: 147-154
- Suboptimal control for patients with type 2 diabetes in the Central Chronic Medicine Dispensing programme in South Africa.Afr. J. Prim. Health Care Fam. Med. 2021; 13: e1-e7
- Audit of public sector primary diabetes care in Cape Town, South Africa: high prevalence of complications, uncontrolled hyperglycaemia, and hypertension.Diabet. Med. 1997; 14: 1073-1077
- Diabetes in rural South Africa-an assessment of care and complications.South Afr. Med. J. 2002; 92: 536-541
- Patients with type 2 diabetes and difficulties associated with initiation of insulin therapy in a public health clinic in Durban.S. Afr. Fam. Pract. 2012; 54: 436-440
- Willingness of people with type 2 diabetes to start insulin therapy: evidence from the South African Tshwane Insulin Project (TIP).Diabetes Res. Clin. Pract. 2020; 168108366
- Development and validation of the insulin treatment appraisal scale (ITAS) in patients with type 2 diabetes.Health Qual. Life Outcomes. 2007; 5: 69
- Development and validation of a new measure to evaluate psychological resistance to insulin treatment.Diabetes Care. 2007; 30: 2199-2204
- Development and validation of the Chinese Attitudes to Starting Insulin Questionnaire (Ch-ASIQ) for primary care patients with type 2 diabetes.PLoS One. 2013; 8e78933
- Designing an integrated, nurse-driven and home-based digital intervention to improve insulin management in under-resourced settings.Ther. Adv. Endocrinol. Metab. 2021; 12 (20420188211054688)
- Selection and use of content experts for instrument development.Res. Nurs. Health. 1997; 20: 269-274
- African primary care research: performing surveys using questionnaires.Afr. J. Prim. Health Care Fam. Med. 2014; 6: 1-7
- Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline.J. Eval. Clin. Pract. 2011; 17: 268-274
- Further investigation of the psychometric properties of the insulin treatment appraisal scale among insulin-using and non-insulin-using adults with type 2 diabetes: results from diabetes MILES – Australia.Health Qual. Life Outcomes. 2014; 12: 87
- Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis.Pract. Assess. Res. Eval. 2005; 10 (URL http://pareonline. net/getvn. asp, 10 (2005))
- Using effect size-or why the P value is not enough.J. Grad. Med Educ. 2012; 4: 279-282
- A morbidity survey of South African primary care.PLoS One. 2012; 7e32358
- Validation of the Chinese version of the insulin treatment appraisal scale.Diabetes Res. Clin. Pract. 2020; 170108485
- Translation and validation of the Insulin Treatment Appraisal Scale in Hong Kong primary care patients.J. Diabetes Investig. 2018; 9: 311-320
- Prevalence of psychological insulin resistance among patients with type 2 diabetes at Kenyatta National.Hosp. Kenya Health Sci. J. 2017; 11
- The Barbados Insulin Matters (BIM) study: barriers to insulin therapy among a population-based sample of people with type 2 diabetes in the Caribbean island of Barbados.J. Clin. Transl. Endocrinol. 2017; 8: 49-53
- What's so tough about taking insulin? Addressing the problem of psychological insulin resistance in type 2 diabetes, Clinical.Diabetes. 2004; 22: 147-150
- Barriers to insulin injection therapy.Diabetes Educ. 2009; 35: 1014-1022
- Addressing barriers to initiation of insulin in patients with type 2 diabetes.Prim. Care Diabetes. 2010; 4: S11-S18
- Psychological insulin resistance: patient beliefs and implications for diabetes management.Qual. Life Res. 2009; 18: 23-32
- Negative appraisals of insulin therapy are common among adults with Type 2 diabetes using insulin: results from Diabetes MILES–Australia cross‐sectional survey.Diabet. Med. 2015; 32: 1297-1303
- Barriers to insulin treatment among Australian Torres Strait Islanders with poorly controlled diabetes.Aust. J. Rural Health. 2016; 24: 363-370
Article info
Publication history
Published online: June 08, 2022
Accepted:
May 27,
2022
Received in revised form:
December 20,
2021
Received:
July 14,
2021
Identification
Copyright
© 2022 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
