title: Studying the Hurdles of Insulin Prescription (SHIP): development, scoring and initial validation of a new self-administered questionnaire.
abstract: BACKGROUND
  Although insulin therapy is well-accepted by symptomatic diabetic patients, it is still often delayed in less severe patients, in whom injectable insulin remains under-used. A better understanding of patients' perception of insulin would eventually help physicians to adopt the most appropriate dialogue when having to motivate patients to initiate or to intensify insulin injection.
  
  
  METHODS
  The 'Studying the Hurdles of Insulin Prescription' (SHIP) questionnaire was developed based on a list of concepts derived from three diabetic patients' focus groups, and was included into two cross-sectional studies with similar design: SHIP Oral study and SHIP Premix study. Diabetic patients treated with oral hypoglycaemic agents (OHA; n = 1,494) and patients already treated with insulin (n = 1,150) completed the questionnaire at baseline, 6- and 12 months. Psychometric properties were assessed: 1) structure analysis by Principal Component Analysis (PCA) with Varimax rotation, 2) internal consistency reliability (Cronbach's alpha), and 3) concurrent validity (Spearman correlation coefficients with the Fear of Self-Injecting (FSI) score of the Diabetes Fear of Injecting and Self-testing Questionnaire. Reluctance/motivation towards insulin was assessed. Scores' ability to predict patients' insulin injection reluctance/motivation and initiation/intensification was evaluated with the Area Under the Receiver Operating Characteristic (ROC) Curve (AUC).
  
  
  RESULTS
  PCA analysis confirmed the structure of the 14 items grouped into 3 dimensions: 'acceptance and motivation', 'fear and constraints', and 'restraints and barriers' towards insulin injection. Internal consistency reliability was excellent (Cronbach's alpha > 0.70); concurrent validity was good. The three scores were significantly predictive of patients' reluctance/motivation towards insulin injection initiation, as they were of patients' actual switch, except for the 'restraints and barriers' dimension. 'Acceptance and motivation' and 'fears and constraints' dimensions were also significantly predictive of patients' reluctance/motivation towards insulin intensification. By the end of the 12-month study, 179 of the initially OHA-treated patients had started insulin injections; 186 of the patients already treated with insulin had increased their injections.
  
  
  CONCLUSIONS
  The SHIP questionnaire provides reliable and valid assessment of diabetic patients' attitude towards insulin and injections. The predictive power of scores for patients' reluctance/motivation and actual treatment decisions demonstrates encouraging potential for further application in clinical practice.
authors.affiliation: French Society of General Medicine, Issy les Moulineaux, France. uc.martinez@wanadoo.fr
authors.forename: Luc
authors.initials: L
authors.lastname: Martinez
authors.forename: Silla M
authors.initials: SM
authors.lastname: Consoli
authors.forename: Louis
authors.initials: L
authors.lastname: Monnier
authors.forename: Dominique
authors.initials: D
authors.lastname: Simon
authors.forename: Olivier
authors.initials: O
authors.lastname: Wong
authors.forename: Bernard
authors.initials: B
authors.lastname: Yomtov
authors.forename: Béatrice
authors.initials: B
authors.lastname: Guéron
authors.forename: Khadra
authors.initials: K
authors.lastname: Benmedjahed
authors.forename: Isabelle
authors.initials: I
authors.lastname: Guillemin
authors.forename: Benoit
authors.initials: B
authors.lastname: Arnould
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000523:psychology; D017144:Focus Groups; D005602:France; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D025341:Principal Component Analysis; D011594:Psychometrics / Q000295:instrumentation*; D012646:Self Administration / Q000523:psychology*; D011795:Surveys and Questionnaires / Q000592:standards*
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin