'Why I do not want to take insulin shots': findings from a qualitative study among diabetic patients in Malaysia

Aim: To gain insight into type-2 diabetic patients perceptions and beliefs about the use of insulin, to explore barriers to initiation of insulin and to evaluate the impact of a short educational intervention regarding patients resistance to using insulin injections. Subjects and methods: This is an exploratory qualitative study. One-to-one in-depth interviews were conducted with a purposive sample of type-2 diabetic patients. Then, a short educational intervention was conducted with the participants. After the intervention, the participants were interviewed to evaluate their acceptance of insulin initiation. The interviews were audio-taped and transcribed verbatim. Thematic content analysis was conducted and the analysis was reviewed independently by two researchers. Results: A total of 13 diabetic patients were included in the study. Before the intervention, 11 subjects refused initiation of insulin. Resistance to initiation of insulin was influenced by misconceptions about insulin therapy, psychological barriers and fear, lack of self-efficacy and fear of adverse effects. All subjects perceived that insulin should only be initiated in very severe diabetes. Some participants demonstrated lack of belief in insulin efficacy. Psychological barriers and fears such as fear of self-injection and personal phobia about blood, needle and pain as well as perceived side effects also hindered insulin acceptance. Conclusion: The study findings revealed that misconceptions about insulin use and psychological barriers played a major role in patients resistance to initiation of insulin therapy. The study demonstrated, however, that a short educational intervention could dispel patients fears and erroneous beliefs and help them to start insulin therapy.