title: Current perspectives on psychological insulin resistance: primary care provider and patient views.
abstract: BACKGROUND
  Psychological insulin resistance (PIR) refers to reluctance of providers to prescribe and patients to take insulin. Processes and tools have been developed to address PIR. The purpose of this qualitative study was to examine current understanding and opinions of insulin therapy of primary care providers (PCPs) and patients with type 2 diabetes (both naive to insulin and insulin users).
  
  
  METHODS
  Providers (n=23 PCPs) and patients (n=96) participated in 1:1 interviews and 12 racially/ethnically diverse focus groups, respectively, conducted by trained qualitative researchers using pilot-tested scripts. Participants examined insulin devices and needles while specific questions were asked about insulin therapy. Recorded sessions were transcribed and analyzed.
  
  
  RESULTS
  Salient themes related to injection resistance, patient adherence, health system barriers, and education emerged during the sessions. Provider knowledge about insulin injection devices and approaches varied and was often limited, particularly regarding needle sizes, which influenced prescribing practices and patient education. Other barriers included limited time and personnel. However, PCPs placed priority on continuing education on devices, needles, insulin adjustment, educational approaches, and cost. Patient focus groups revealed a strong desire for knowledge on injection logistics, particularly by insulin users who felt that they had received inadequate education. Most patients had limited experience with tools like shorter needles but would consider injecting if presented. Those who had self-injection experience were more willing to accept insulin. Cost concerns and need for information were frequently reported.
  
  
  CONCLUSIONS
  Findings reveal that programs and tools designed to address problems associated with PIR have yet to be fully realized.
authors.affiliation: 1 University of Pittsburgh Diabetes Institute , Pittsburgh, Pennsylvania.
authors.forename: Jodi
authors.initials: J
authors.lastname: Krall
authors.forename: Robert
authors.initials: R
authors.lastname: Gabbay
authors.forename: Susan
authors.initials: S
authors.lastname: Zickmund
authors.forename: Megan E
authors.initials: ME
authors.lastname: Hamm
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Williams
authors.forename: Linda
authors.initials: L
authors.lastname: Siminerio
mesh_terms: D000293:Adolescent; D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D010353:Patient Education as Topic; D058007:Physicians, Primary Care / Q000193:education / Q000523:psychology*; D036301:Qualitative Research; D028761:Withholding Treatment; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin