C.LIU1, J.DEROZA1, C.W.OOI1, B.MATHEW1, ELYA2, W.E.TANG2
NHG Polyclinics1, National Healthcare Group HQ2
Insulin therapy forms a cornerstone of pharmacological management of Diabetes Mellitus (DM). However, patients’ lack of acceptance and adherence to insulin remain as challenges in DM management contributing to poor DM control. This may be influenced by patients’ beliefs which are shaped by sociocultural context. This study aimed to determine the impact of patients’ beliefs about insulin on acceptance and adherence to insulin therapy.
This qualitative study used 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. Data was collected using semi-structured in-depth interviews based on a topic guide. Data collection continued until saturation. A constant comparison method was used to elicit themes.
21 participants (mean age 61 years, 47.6% females, 76.2% Chinese, 9.5% Malay, 14.3% Indian) were interviewed. 6 main themes emerged. 4 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. 2 additional themes influenced adherence to insulin therapy. These were socioeconomic concerns, and concerns about side effects of insulin.
Patients’ beliefs about insulin impact their acceptance and adherence to insulin therapy. By eliciting and addressing these concerns and misbeliefs during counselling, healthcare providers may reduce barriers to insulin initiation and improve adherence.