title: Insulin initiation and management in people with Type 2 diabetes in an ethnically diverse population: the healthcare provider perspective.
abstract: OBJECTIVE
  To explore barriers to prescribing of insulin, particularly delays in initiation, from the perspective of healthcare professionals involved in managing Type 2 diabetes in a multi-ethnic setting.
  
  
  METHODS
  The study was carried out in a UK population with high numbers of people of South Asian (mainly Indian) origin. Semi-structured interviews were conducted with 14 healthcare professionals from primary and secondary care. Analysis involved exploring interview transcripts in terms of themes and sub-themes identified through a process of progressive focusing.
  
  
  RESULTS
  Initiation of insulin therapy was described as challenging in all patients irrespective of ethnicity, but some barriers were perceived to be accentuated because of language needs and lower levels of understanding about diabetes and insulin. Additionally, some South Asians were viewed as more likely than their white European counterparts to be influenced by negative observations and experiences about insulin therapy within community networks. Time restrictions were seen as a barrier that was accentuated in the management of South Asian patients. Participants suggested strategies for overcoming patient barriers; with South Asians these included involvement of families and patient peers and availability of South Asian healthcare providers.
  
  
  CONCLUSIONS
  The challenge for healthcare providers is to how to address the tension between the optimal clinical time for commencing insulin therapy and the time when the patient feels psychologically ready. To help make these two time points coincide, our findings suggest the need to adopt a holistic approach involving consideration of the cultural context of patients, including their ethnic background.
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK. np89@le.ac.uk
authors.forename: N
authors.initials: N
authors.lastname: Patel
authors.forename: M A
authors.initials: MA
authors.lastname: Stone
authors.forename: A
authors.initials: A
authors.lastname: Chauhan
authors.forename: M J
authors.initials: MJ
authors.lastname: Davies
authors.forename: K
authors.initials: K
authors.lastname: Khunti
mesh_terms: D044466:Asian People / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D003144:Communication Barriers; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology / Q000208:ethnology*; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D036301:Qualitative Research; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology / Q000208:ethnology; D044465:White People / Q000706:statistics & numerical data
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin