A qualitative study on healthcare professionals' perceived barriers to insulin initiation in a multi-ethnic population

Lee, Y.K. and Lee, P.Y. and Ng, Chirk Jenn (2012) A qualitative study on healthcare professionals' perceived barriers to insulin initiation in a multi-ethnic population. BMC Family Practice, 13 (28). ISSN 1471-2296, DOI https://doi.org/10.1186/1471-2296-13-28.

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Abstract

Background: Nationwide surveys have shown that the prevalence of diabetes rates in Malaysia have almost doubled in the past ten years; yet diabetes control remains poor and insulin therapy is underutilized. This study aimed to explore healthcare professionals' views on barriers to starting insulin therapy in people with type 2 diabetes. Methods: Healthcare professionals consisting of general practitioners (n = 11), family medicine specialists (n = 10), medical officers (n = 8), government policy makers (n = 4), diabetes educators (n = 3) and endocrinologists (n = 2) were interviewed. A semi-structured topic guide was used to guide the interviews by trained facilitators. The interviews were transcribed verbatim and analysed using a thematic analysis approach. Results: Insulin initiation was found to be affected by patient, healthcare professional and system factors. Patients' barriers include culture-specific barriers such as the religious purity of insulin, preferred use of complementary medication and perceived lethality of insulin therapy. Healthcare professionals' barriers include negative attitudes towards insulin therapy and the 'legacy effect' of old insulin guidelines; whilst system barriers highlight the lack of resources, language and communication challenges. Conclusions: Tackling the issue of insulin initiation should not only happen during clinical consultations. It requires health education to emphasise the progressive nature of diabetes and the eventuality of insulin therapy at early stage of the illness. Healthcare professionals should be trained how to initiate insulin and communicate effectively with patients from various cultural and religious backgrounds.

Item Type:	Article
Funders:	UNSPECIFIED
Additional Information:	ISI Document Delivery No.: 968II Times Cited: 6 Cited Reference Count: 52 Lee, Yew Kong Lee, Ping Yein Ng, Chirk Jenn University of Malaya We would like to acknowledge the following for their help: Prof Dr Low Wah Yun, Prof Dr CL Teng and Syahidatul Akmal for assisting in the interviews and focus group discussions; members of the Diabetes Mellitus Insulin Treatment Project for feedback on the interview guides; the University of Malaya for funding this project; and the Director-General of Health for allowing the study to be conducted in public health clinics under approval of the Medical Research and Ethics Committee, Ministry of Health (Reference: NMRR-10-1233-7299). Biomed central ltd London
Uncontrolled Keywords:	Improves glycemic control type-2 diabetes-mellitus blood-glucose therapy resistance ramadan perceptions continuity management physicians
Subjects:	R Medicine
Divisions:	Faculty of Medicine
Depositing User:	Ms azrahani halim
Date Deposited:	23 Oct 2014 02:57
Last Modified:	08 Aug 2019 03:07
URI:	http://eprints.um.edu.my/id/eprint/10225

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