title: Development and validation of a new measure to evaluate psychological resistance to insulin treatment.
abstract: OBJECTIVE
  To develop a psychometric questionnaire to measure psychological barriers to insulin treatment in patients with type 2 diabetes.
  
  
  METHODS
  Scale development was based on principal component analyses in two cross-sectional studies of insulin-naïve patients with type 2 diabetes. The structure of the questionnaire was developed in the first sample of 448 patients and subsequently cross-validated in an independent sample of 449 patients.
  
  
  RESULTS
  Analyses in the first sample yielded five components that accounted for 74.5% of the variance based on 14 items and led to the following subscales: fear of injection and self-testing, expectations regarding positive insulin-related outcomes, expected hardship from insulin treatment, stigmatization by insulin injections, and fear of hypoglycemia. In addition, an overall sum score of all values was calculated. The structure of the questionnaire was cross-validated in the second sample, with almost identical component loadings and an explained variance of 69.4%. An additional confirmatory factor analysis also indicated an acceptable to good model fit with root mean square error of approximation equal to 0.04 and comparative fit index equal to 0.97. Coefficients of reliability (Cronbach's alpha 0.62-0.85 and 0.78 for overall sum score) were acceptable, considering the very small number of items for each scale.
  
  
  CONCLUSIONS
  The Barriers to Insulin Treatment Questionnaire appears to be a reliable and valid measure of psychological insulin resistance in patients with type 2 diabetes. This short instrument is easy to administer and may be used by both clinicians and researchers to assess the psychological barriers to insulin treatment.
authors.affiliation: Department for Psychosomatic Medicine and Psychotherapy, LWL-Clinic Dortmund/Ruhr-University of Bochum, Dortmund, Germany. mail@dr-frank-petrak.de
authors.forename: Frank
authors.initials: F
authors.lastname: Petrak
authors.forename: Elmar
authors.initials: E
authors.lastname: Stridde
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Leverkus
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Crispin
authors.forename: Thomas
authors.initials: T
authors.lastname: Forst
authors.forename: Andreas
authors.initials: A
authors.lastname: Pfützner
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007267:Injections / Q000523:psychology; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011594:Psychometrics; D011795:Surveys and Questionnaires; D016312:Treatment Refusal / Q000523:psychology*
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin