NIDDM patients' fears and hopes about insulin therapy. The basis of patient reluctance.
OBJECTIVE
This study examines NIDDM patients' attitudes toward insulin injections, the basis of these attitudes, and how they may affect patients' willingness to take insulin.


METHODS
Forty-four low-income Mexican American NIDDM patients were interviewed using open-ended in-depth interviewing techniques. Transcripts were analyzed using techniques of content analysis. Data classification was cross-checked in analysis conferences and through a second researcher coding 50% of the cases, comparing the results, then resolving any discrepancies.


RESULTS
Patients' positive attitudes toward insulin focus on its efficacy and efficiency, the avoidance of complications, and feeling better and more energetic. Negative attitudes were much more frequently discussed and include "technical concerns": anxiety about the pain, proper techniques, and general hassles of taking injections; about hypoglycemic symptoms; and about insulin causing serious health problems; and "experimental concerns": sensing that the disease has progressed into a serious phase, that past treatment efforts have failed, and that the patient has not taken proper care. Attitudes were based on personal experience, observation, what others say, and interactions with health care professionals.


CONCLUSIONS
Results from the few published reports on NIDDM patients' attitudes about insulin from various cultural settings were consistent with our findings, indicating that these themes may be generally applicable to a wider population. It is recommended that health care providers take care to avoid unwitting promotion of negative attitudes toward insulin and actively elicit and respond to patient attitudes to reduce reluctance to take the medication.
Hunt
L M
LM
Mexican American Medical Treatment Effectiveness Research Center, Department of Medicine, San Antonio, Texas, USA.
Valenzuela
M A
MA
Pugh
J A
JA
D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000208:ethnology / Q000523:psychology*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D007407:Interviews as Topic; D008297:Male; D017058:Mexican Americans / Q000523:psychology; D008875:Middle Aged; D011203:Poverty; D012959:Socioeconomic Factors; D013781:Texas; D016312:Treatment Refusal / Q000208:ethnology / Q000523:psychology*
D007004:Hypoglycemic Agents; D007328:Insulin