Perceptions of Type 2 Diabetes Patients for Starting Insulin: A Qualitative Content Analysis

Year 2021, Volume: 5 Issue: 3, 317 - 324, 30.12.2021

Nur Izgu , Zehra Gök Metin

https://doi.org/10.25048/tudod.1015925

Abstract

Aim: Examining perceptions about insulin may provide a deeper understanding of initiation to insulin therapy and guide healthcare
professionals to develop suitable strategies to increase patient adherence. This study aimed to deeply elucidate perspectives of Turkish
insulin-naive type 2 diabetes patients who were recently scheduled to receive insulin therapy.
Material and Methods: A descriptive qualitative study design was utilized. The patient questionnaire and interview guide were used for
data collection. Individual face-to-face interviews were performed (n=14). Mean, standard deviation, and percentages were utilized to
define sample characteristics. A qualitative content analysis approach was employed to identify the key themes. Consolidated criteria for
reporting qualitative research checklist were used as a guideline to report the study.
Results: The mean age of the participants was 51.71 ± 9.78 years. Most participants were male (71.43%). The mean duration from
diabetes diagnosis was 8.02 ± 5.06 years. The emerged themes included (i) facing the reality of insulin, (ii) attributions to dependence on
insulin therapy, (iii) coming changes with the insulin in all aspects of life, and (iv) positive consequences of insulin.
Conclusion: Patients had heavily negative perceptions regarding insulin and stated significant worries related to working and sexual life
changes. On the other hand, starting insulin triggered patients to act for maintaining life in a healthier, better, and safer way. Investigating
the expectations of patients with type 2 diabetes from health care providers at the beginning of insulin therapy is needed to better
manage all aspects of the treatment process.

Keywords

Insulin, Type 2 Diabetes Mellitus, Qualitative research, Content analysis, Nursing

Supporting Institution

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Thanks

The authors thank Nuran Metinarikan, RN, MSc, and Dilek Bayram, RN, MSc, Ankara University School of Medicine Ibn-i Sina Hospital, for their help in recruiting patients to the study.

Tip 2 Diyabetli Hastaların İnsülin Tedavisine Başlamaya Yönelik Algıları: Nitel İçerik Analizi

Abstract

Amaç: İnsülin tedavisine başlama konusunda hastaların algılarını incelemek sağlık profesyonellerine daha derin bir anlayış sağlayabilir
ve hastaların tedaviye uyumunu artırmak için uygun stratejilerin geliştirilmesinde rehberlik edebilir. Bu çalışma, insülin tedavisine
başlama kararı verilen, daha önce hiç insülin tedavisi almamış tip 2 diyabet hastalarının insüline yönelik bakış açılarını derinlemesine
incelemek amacıyla yapılmıştır.
Gereç ve Yöntemler: Bu araştırmada tanımlayıcı nitel araştırma tasarımı kullanıldı. Verilerin toplanmasında hasta soru formu ve
görüşme formu kullanıldı. Yüz-yüze derinlemesine bireysel görüşmeler yapılarak araştırma verileri toplandı (n=14). Araştırma
örnekleminin özelliklerini tanımlamak için ortalama, standart sapma ve frekans dağılımı kullanıldı. Ana temaları belirlemek için nitel
içerik analizi yaklaşımı kullanıldı. Araştırmanın raporlanmasında nitel araştırmalar için birleştirilmiş kriterler kontrol listesi kullanıldı.
Bulgular: Katılımcıların yaş ortalaması 51,71±9,78 yıl idi. Hastaların çoğunluğu (%74,3) erkekti. Diyabet tanı alma yılı ortalaması 8,02
± 5,06 yıl idi. Araştırmada (i) insülin gerçeğiyle yüzleşmek, (ii) insülin tedavisine bağımlı hale gelme (iii) insülin ile birlikte yaşamın her
yönüyle değişmesi ve (iv) insülinin olumlu etkileri şeklinde dört ana tema belirlendi. Sonuç: Hastaların çoğunluğu insüline yönelik olumsuz algılara sahipti ve özellikle çalışma hayatı ve cinsel yaşamla ilgili önemli
endişeler dile getirdiler. Diğer taraftan insülin tedavisine başlamanın, hastaları yaşamlarını daha sağlıklı ve daha güvenli bir şekilde
sürdürme konusunda harekete geçirdiği belirlendi. İnsülin tedavisinin başlangıcında tip 2 diyabetli hastaların sağlık profesyonellerinden
beklentilerinin araştırılması, tedavi sürecinin tüm yönleriyle daha iyi yönetilebilmesi için gereklidir

Keywords

İnsülin, Tip 2 diyabet, Nitel araştırma, İçerik analizi, Hemşirelik.

References

• Hanefeld M, Monnier L, Schnell O, Owens D. Early treatment with basal insulin glargine in people with type 2 diabetes: lessons from ORIGIN and other cardiovascular trials. Diabetes Ther. 2016; 7:187-201.
• Inzucchi SE, Bergenstal RM, Buse JB, Diamanr M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R, Matthews DR. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015; 38(1):140-149.
• Cosson E, Mauchant C, Benabbad I, Le Pape G, Le Bleis M, Bailleul F, Lalau JD. Perceptions of insulin therapy in people with type 2 diabetes and physicians: a cross-sectional survey conducted in France. Patient Preference and Adherence. 2019; 13: 251-260. Ellis K, Mulnier H, Forbes, A. Perceptions of insulin use in type 2 diabetes in primary care: a thematic synthesis. BMC Fam Pract. 2018 ; 19:70.
• Song Y, Ku BJ, Cho J, Jun Y, Kim B, Nam S. The prevalence of insulin refusal and psychological insulin resistance among Korean patients with type 2 diabetes mellitus. Ann Transl Med. 2019;7(23):760.
• Al Hayek AA, Robert AA, Babli S, Almonea K, Al Dawish MA. Fear of self-injecting and self-testing and the related risk factors in adolescents with type 1 diabetes: a cross-sectional study. Diabetes Ther. 2017: 8:75-83.
• Lim A and Song Y. The role of psychological insulin resistance in diabetes self‐care management. Nursing Open. 2020; 7:887-894.
• Yilmaz A, Ak M, Cim A, Palanci Y, Kilinc F. Factors influencing insulin usage among type 2 diabetes mellitus patients: A study in Turkish primary care. Eur J Gen Pract. 2016; 22(4):255-261.
• Taylor Jr CG, Taylor G, Atherley A, Hambleton L, Unwin N, Adams P. 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. Journal of Clinical & Translational Endocrinology. 2017;8(8):49-53.
• Soylar P, Kadioglu BU, Kilic K. Investigation of the barriers about insulin therapy in patients with type 2 diabetes. Niger J Clin Pract. 2020; 23(1):98.
• Prommaloon S, Wattanakitkrileart D, Charoenkitkarn V, Peerapatdit T. Factors influencing insulin adherence in patients with type 2 diabetes. Nursing Science Journal of Thailand 35(1):61-71.
• Yu JH, Kim HY, Kim HY, Kim SR, Ko E, Jin YJ. Factors influencing psychological insulin resistance in type 2 diabetes patients. Int J Nurs Pract. 2019; 25:e12733. Hu J, Amirehsani KA, Wallace DC, Letwak S. The meaning of insulin to Hispanic immigrants with type 2 diabetes and their families. The Diabetes Educ. 2012; 38(2):263-270.
• Ng CJ, Lai PSM, Lee YK, Azmi A, Teo CH. Barriers and facilitators to starting insulin in patients with type 2 diabetes: a systematic review. Int J Clin Pract. 2015;69(10):1050-1070.
• Bogatean MP and Hâncu N. People with type 2 diabetes facing the reality of starting insulin therapy: factors involved in psychological insulin resistance. Practical Diabetes International. 2004; 21(7):247-52.
• Hassan HA, Tohid H, Amin RM, Long Bidin MB, Muthupalaniappen L, Omar K. influencing insulin acceptance among type 2 diabetes mellitus patients in a primary care clinic: a qualitative exploration. BMC Fam Pract. 2013; 4:164.
• Ho EY, James J. Cultural barriers to initiating insulin therapy in Chinese people with type 2 diabetes living in Canada. Can J Diabetes 2006; 30(4):390-396.
• Morris JE, Povey RC, Street CG. (2005). Experiences of people with type 2 diabetes who have changed from oral medication to self‐administered insulin injections: A qualitative study. Practical Diabetes International 22(7):239-243.
• Tan AM, Muthusamy L, Ng CC, Phoon KY, Ow JH, Tan NC. Initiation of insulin for type 2 diabetes mellitus patients: what are the issues? A qualitative study. Singapore Med J 2011; 52(11):801-809.
• Makine C, Karşıdağ Ç, Kadıoğlu P, Ilkova H, Karşıdağ K, Skovlund SE, Snoek FJ, Pouwer F. Symptoms of depression and diabetes‐specific emotional distress are associated with a negative appraisal of insulin therapy in insulin‐naïve patients with Type 2 diabetes mellitus. A study from the European Depression in Diabetes [EDID] Research Consortium. 2009; Diabet Med 26(1):28-33.
• Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, Dinccag N, Karsidag K, Genc S, Telci A,• Canbaz B, Turker F, Yilmaz T, Cakir B, Tuomilehto T, Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidem 2013; 28(2):169-180.
• Bengtsson M. How to plan and perform a qualitative study using content analysis. NursingPlus Open 2016; 2:8-14.
• Lambert VA, Lambert CE. Qualitative descriptive research: An acceptable design. Pacific Rim International Journal of Nursing Research 2012;16(4): 255-256.
• Moser A, Korstjens I. Series: Practical guidance to qualitative research. Part 3: Sampling, data collection and analysis. Eur J Gen Pract 2018; 24(1): 9-18.
• Kvale S. (1996). Interview views: An introduction to qualitative research interviewing. Thousand Oaks, CA: Sage Publications
• Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005;15(9): 1277-1288.
• Amankwaa L. Creating protocols for trustworthiness in qualitative research. J Cult Divers 2016; 23(3):121-127.
• Benroubi M. Fear, guilt feelings and misconceptions: barriers to effective insulin treatment in type 2 diabetes. Diabetes Res Clin Pract 2011; 93 (Suppl 1): S97-S99.