PMID- 35153494
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220501
IS  - 1178-7007 (Print)
IS  - 1178-7007 (Electronic)
IS  - 1178-7007 (Linking)
VI  - 15
DP  - 2022
TI  - Which Aspect of Patient-Provider Relationship Affects Acceptance and Adherence of 
      Insulin Therapy in Type 2 Diabetes Mellitus? A Qualitative Study in Primary Care.
PG  - 235-246
LID - 10.2147/DMSO.S344607 [doi]
AB  - PURPOSE: In type 2 diabetes mellitus (T2DM), insulin therapy is often recommended 
      to achieve the optimal control of disease, thereby preventing the onset and 
      progression of diabetes-related complications. Despite knowing about the 
      benefits, it has been reported that 71% of patients refuse insulin and the 
      adherence rate ranges from 30 to 80%. Patient-provider relationship (PPR) may 
      affect such insulin-related behaviours, but little is known about which aspect of 
      PPR affects this. This study aimed to explore the key aspect of the 
      patient-provider relationship that affects the initial insulin acceptance and 
      continued adherence. PATIENTS AND METHODS: We used the grounded theory approach 
      in this qualitative research. The study was conducted at two primary care clinics 
      between September 2019 and January 2021. Patients with T2DM on basal or premixed 
      insulin were recruited using maximum variation sampling. Data were collected 
      using semi-structured in-depth interviews and transcribed verbatim for analysis 
      using constant comparison and synthesis. RESULTS: Twenty-one participants with 
      different levels of diabetes control and adherence were recruited. Four themes 
      that emerged were 1) patient-provider interaction, 2) addressing the 
      psychological fears, 3) gaining confidence in handling insulin equipment and 4) 
      follow-up after insulin initiation. Among the subthemes, trust in doctors, 
      provider's communication skills, patient-centred decision-making and continuity 
      of care positively influenced insulin acceptance and adherence. Conversely, fear 
      of being judged by the provider hindered open communication around non-adherence. 
      Various aspects of interaction with nurses helped in alleviating patient's fear 
      of injection and gaining confidence with the insulin equipment. CONCLUSION: Many 
      aspects of PPR affect insulin acceptance and adherence. Among these, gaining 
      patients' trust, effective patient-provider communication, patient-centred 
      decision-making, and ensuring continuity of care improve both insulin acceptance 
      and treatment adherence. Various interactions with nurses help in addressing 
      fears surrounding injection and gaining acceptance towards insulin therapy. 
      Patients' fear of being blamed or judged by the provider negatively affects open 
      communication around non-adherence.
CI  - (c) 2022 Mathew et al.
FAU - Mathew, Blessy Koottappal
AU  - Mathew BK
AD  - National Healthcare Group Polyclinics, Toa Payoh Polyclinic, National Healthcare 
      Group, Singapore.
FAU - De Roza, Jacqueline Giovanna
AU  - De Roza JG
AD  - National Healthcare Group Polyclinics, Geylang Polyclinic, National Healthcare 
      Group, Singapore.
FAU - Liu, Changwei
AU  - Liu C
AD  - National Healthcare Group Polyclinics, Geylang Polyclinic, National Healthcare 
      Group, Singapore.
FAU - Goh, Ling Jia
AU  - Goh LJ
AD  - National Healthcare Group Polyclinics, Hougang Polyclinic, National Healthcare 
      Group, Singapore.
FAU - Ooi, Chai Wah
AU  - Ooi CW
AD  - National Healthcare Group Polyclinics, Geylang Polyclinic, National Healthcare 
      Group, Singapore.
FAU - Chen, Elya
AU  - Chen E
AD  - National Healthcare Group Polyclinics, Clinical Research Unit, National 
      Healthcare Group, Singapore.
FAU - Poon, Shixuan
AU  - Poon S
AD  - National Healthcare Group Polyclinics, Toa Payoh Polyclinic, National Healthcare 
      Group, Singapore.
FAU - Tang, Wern Ee
AU  - Tang WE
AD  - National Healthcare Group Polyclinics, Clinical Research Unit, National 
      Healthcare Group, Singapore.
LA  - eng
PT  - Journal Article
DEP - 20220126
PL  - New Zealand
TA  - Diabetes Metab Syndr Obes
JT  - Diabetes, metabolic syndrome and obesity : targets and therapy
JID - 101515585
PMC - PMC8828446
OTO - NOTNLM
OT  - healthcare provider
OT  - insulin acceptance
OT  - insulin adherence
OT  - insulin initiation
OT  - patient interactions
OT  - primary care
COIS- The authors report no conflicts of interest in this work.
EDAT- 2022/02/15 06:00
MHDA- 2022/02/15 06:01
PMCR- 2022/01/26
CRDT- 2022/02/14 05:28
PHST- 2021/10/21 00:00 [received]
PHST- 2021/12/31 00:00 [accepted]
PHST- 2022/02/14 05:28 [entrez]
PHST- 2022/02/15 06:00 [pubmed]
PHST- 2022/02/15 06:01 [medline]
PHST- 2022/01/26 00:00 [pmc-release]
AID - 344607 [pii]
AID - 10.2147/DMSO.S344607 [doi]
PST - epublish
SO  - Diabetes Metab Syndr Obes. 2022 Jan 26;15:235-246. doi: 10.2147/DMSO.S344607. 
      eCollection 2022.