Aim:  To determine the factors that deter the initiation of insulin therapy among type 2 diabetes patients with secondary drug failure. Methods:  An observational cross sectional study of 72 refusors (cases) and 72 acceptors (controls) of insulin therapy in primary care polyclinics in Singapore. Results:  Refusors have more concerns about insulin injections than acceptors (69.4 vs 22.2%, p < 0.001). Refusors cited ‘fear of pain from the needle’ as the main reason for refusing to start insulin therapy (45.8%), followed by ‘financial constraint’ (18.4%) and ‘inconvenience’ (12.5%). Refusors were less aware of the action of insulin (58.2 vs 34.6%, p = 0.015), perceived that insulin ‘is unnecessary (because) other treatment is available’ (70.8 vs 36.1%, p = 0.001) and regard regular injections as a hassle (50 vs 26.4%, p = 0.001). Acceptors were more likely to perceive insulin injection as ‘effectively controls blood glucose levels’ (84.7 vs 59.7%, p = 0.002), ‘helps one feel better’ (77.8 vs 40.3%, p = 0.001), ‘helps one feel more energetic’ (68.1 vs 31.9%, p = 0.001), and ‘more effective than oral medication’ (72.2 vs 43.1%, p = 0.001). Nonetheless, both groups were as likely to perceive that being put on insulin therapy is an indication of an ‘advanced phase of illness’ (65.3 vs 63.9%, NS), and a ‘failure to care for oneself’ (66.7 vs 55.6%, NS). Conclusions:  The two major barriers to insulin initiation among refusors are perception of pain and financial constraints. Refusors are more likely than acceptors to have concerns over insulin injection and regard insulin therapy as a last resort, although both groups possessed a number of negative perceptions regarding insulin therapy, which need to be addressed.

Introduction:Nurses are encouraged to engage in research activities in order to stay abreast with the current nursing practice. However, limited knowledge about the research process may influence their level of involvement and utilisation of research in their daily nursing practices. This study examines Singapore nurses' perceived knowledge and educational needs in research as well as to explore their preferred mode and duration of education delivery.

ObjectiveThis pilot study aimed to determine the proportions, level of knowledge, anxiety and confidence of foreign domestic workers (FDWs) who were involved in supporting the healthcare needs of older persons with long-term non-communicable diseases.DesignThe pilot study used a cross-sectional and descriptive design.FDWs who accompanied the older adults attending a primary healthcare setting in Singapore. 100 eligible FDWs’ demographic data, knowledge and confidence level of caregiving in food preparation, medication supervision, exercise, blood pressure (BP), blood glucose (BG) monitoring and anxiety level assessed by the Generalised Anxiety Disorder-7 scale were recorded. Descriptive statistics were performed and presented. Items on confidence were regrouped into two groups of ‘very’ versus ‘no/a little/moderate’. Knowledge scores and caregiving tasks were assessed with items on confidence using Mann-Whitney U test and χ2 test, respectively.ResultsThe FDWs were from Indonesia (60%), Philippines (23%) and Myanmar (14%). Their mean age was 33 years with an average of 5.8 years working experience; 62% self-reported previous caregiver training for elderly. The mean age of care-recipients was 81 years. Knowledge of FDWs on BP and BG monitoring was low (<50% answered correctly). Among the 55 FDWs who were required to perform BP monitoring, 45.5% lack confidence. Similarly, 40% of the 30 FDWs were not confident in performing BG monitoring. Those with very high confidence levels had higher knowledge on BP and BG monitoring. Of those who were involved in medication supervision (n=86), 36% lacked confidence. The majority of the FDWs (96%) were not affected by anxiety in managing these healthcare tasks for older persons.ConclusionMore than half of the FDWs supported healthcare needs of older persons but they had inadequate knowledge and lacked confidence in performing the healthcare-related tasks.