TY - JOUR
T1 - Key factors for overcoming psychological insulin resistance
T2 - An examination of patient perspectives through content analysis
AU - Stuckey, Heather
AU - Fisher, Lawrence
AU - Polonsky, William H.
AU - Hessler, Danielle
AU - Snoek, Frank J.
AU - Tang, Tricia S.
AU - Hermanns, Norbert
AU - Mundet-Tuduri, Xavier
AU - Da Silva, Maria Elizabeth Rossi
AU - Sturt, Jackie
AU - Okazaki, Kentaro
AU - Cao, Dachuang
AU - Hadjiyianni, Irene
AU - Ivanova, Jasmina I.
AU - Desai, Urvi
AU - Perez-Nieves, Magaly
PY - 2019/12/11
Y1 - 2019/12/11
N2 - Objective To understand participant perceptions about insulin and identify key behaviors of healthcare professionals (HCPs) that motivated initially reluctant adults from seven countries (n=40) who had type 2 diabetes (T2D) to start insulin treatment. Research design and methods Telephone interviews were conducted with a subset of participants from an international investigation of adults with T2D who were reluctant to start insulin (EMOTION). Questions related to: (a) participants' thoughts about insulin before and after initiation; (b) reasons behind responses on the survey that were either â € not helpful at all' or â € helped a lot'; (c) actions their HCP may have taken to help start insulin treatment; and (d) advice they would give to others in a similar situation of starting insulin. Responses were coded by two independent reviewers (kappa 0.992). Results Starting insulin treatment was perceived as a negative experience that would be painful and would lead down a â € slippery slope' to complications. HCPs engaged in four primary behaviors that helped with insulin acceptance: (1) showed the insulin pen/needle and demonstrated the injection process; (2) explained how insulin could help with diabetes control and reduce risk of complications; (3) used collaborative communication style; and (4) offered support and willingness to answer questions so that participants would not be â € on their own'. Following initiation, most participants noted that insulin was not â € as bad as they thought' and recommended insulin to other adults with T2D. Conclusions Based on these themes, two actionable strategies are suggested for HCPs to help people with psychological insulin resistance: (1) demonstrate the injection process and discuss negative perceptions of insulin as well as potential benefits; (2) offer autonomy in a person-centred collaborative approach, but provide support and accessibility to address concerns. These findings help HCPs to better understand ways in which they can engage reluctant people with T2D with specific strategies.
AB - Objective To understand participant perceptions about insulin and identify key behaviors of healthcare professionals (HCPs) that motivated initially reluctant adults from seven countries (n=40) who had type 2 diabetes (T2D) to start insulin treatment. Research design and methods Telephone interviews were conducted with a subset of participants from an international investigation of adults with T2D who were reluctant to start insulin (EMOTION). Questions related to: (a) participants' thoughts about insulin before and after initiation; (b) reasons behind responses on the survey that were either â € not helpful at all' or â € helped a lot'; (c) actions their HCP may have taken to help start insulin treatment; and (d) advice they would give to others in a similar situation of starting insulin. Responses were coded by two independent reviewers (kappa 0.992). Results Starting insulin treatment was perceived as a negative experience that would be painful and would lead down a â € slippery slope' to complications. HCPs engaged in four primary behaviors that helped with insulin acceptance: (1) showed the insulin pen/needle and demonstrated the injection process; (2) explained how insulin could help with diabetes control and reduce risk of complications; (3) used collaborative communication style; and (4) offered support and willingness to answer questions so that participants would not be â € on their own'. Following initiation, most participants noted that insulin was not â € as bad as they thought' and recommended insulin to other adults with T2D. Conclusions Based on these themes, two actionable strategies are suggested for HCPs to help people with psychological insulin resistance: (1) demonstrate the injection process and discuss negative perceptions of insulin as well as potential benefits; (2) offer autonomy in a person-centred collaborative approach, but provide support and accessibility to address concerns. These findings help HCPs to better understand ways in which they can engage reluctant people with T2D with specific strategies.
KW - patient-provider relationship
KW - psychological insulin resistance
KW - type 2 diabetes
UR - http://www.scopus.com/inward/record.url?scp=85076687282&partnerID=8YFLogxK
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85076687282&origin=inward
U2 - https://doi.org/10.1136/bmjdrc-2019-000723
DO - https://doi.org/10.1136/bmjdrc-2019-000723
M3 - Article
C2 - 31908792
SN - 2052-4897
VL - 7
JO - BMJ open diabetes research and care
JF - BMJ open diabetes research and care
IS - 1
M1 - e000723
ER -