Barbados Insulin Matters (BIM) study: Perceptions on insulin initiation by primary care doctors in the Caribbean island of Barbados.
With regards to insulin initiation in Barbados we explored primary care doctor (PCD) perception, healthcare system factors and predictors of PCD reluctance to initiate insulin.



PCDs completed a questionnaire based on the theory of planned behaviour (TPB) and a reluctance to initiate insulin scale. Using linear regression, we explored the association between TPB domains and the reluctance to initiate insulin scale.



Of 161 PCDs, 70% responded (75 private and 37 public sector). The majority felt initiating insulin was uncomplicated (68%) and there was benefit if used before complications developed (68%), but would not use it until absolutely necessary (58%). More private than public sector PCDs (p<0.05) thought that the healthcare system allowed enough flexibility of time for education (68 vs 38%) and initiating insulin was easy (63 vs 35%), but less thought system changes would help initiating insulin (42 vs 70%). Reasons for reluctance to initiate insulin included patient nonadherence (83%) and reluctance (63%). Only the attitudes and belief domain of the TPB was associated with the reluctance to initiate insulin scale (p<0.001).



Interventions focusing on PCD attitudes and beliefs and restructuring services inclusive of the use of diabetes specialist nurses are required.
Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, St. Michael, Barbados.
Charles Grafton
CG
Taylor
Department for Health, University of Bath, 1 West 5.115, Claverton Down, BA2 7AY, United Kingdom. Electronic address: g.j.taylor@bath.ac.uk.
Gordon
G
Taylor
Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, St. Michael, Barbados. Electronic address: anique.atherley@gmail.com.
Anique
A
Atherley
Chronic Disease Research Centre, University of the West Indies, Cave Hill, Barbados. Electronic address: ian.hambleton@cavehill.uwi.edu.
Ian
I
Hambleton
Chronic Disease Research Centre, University of the West Indies, Cave Hill, Barbados. Electronic address: nigel.unwin@cavehill.uwi.edu.
Nigel
N
Unwin
Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, St. Michael, Barbados. Electronic address: peter.adams@cavehill.uwi.edu.
Oswald Peter
OP
Adams
D000328:Adult; D001291:Attitude of Health Personnel; D001460:Barbados; D016009:Chi-Square Distribution; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010465:Perception; D058007:Physicians, Primary Care / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care
D007004:Hypoglycemic Agents; D007328:Insulin
Beliefs; Clinical inertia; Education; Initiation; Insulin; Primary care