Decisional Balance for Insulin Injection: Scale Development and Psychometric Testing

Abstract

BackgroundInsulin-naive patients are often reluctant to receive insulin treatment, and even insulin-treated patients frequently have poor rates of adherence to their prescribed insulin injection regimes. Assessing attitudes toward insulin injection may help in the design of interventions that improve the insulin injection behaviors of patients with type 2 diabetes (T2DM). The concept of decisional balance has been associated with behavior in many studies and may be useful in assessing the attitude of patients with T2DM toward insulin injection. Decisional balance for insulin injection (DBII) has not been widely assessed in patients with T2DM.PurposeThe aim of this study was to develop an insulin injection (DBII) scale that is valid for insulin-naive and insulin-treated patients and to test the psychometric characteristics of this scale based on the concept of decisional balance.MethodsThis cross-sectional study administered an 18-item DBII scale, including pro and con subscales, to 95 insulin-naive and 237 insulin-treated patients in Taiwan. The decisional balance score was calculated as the mean score of the pro subscale minus the mean score of the con subscale. Construct validity was examined using exploratory factor analysis and confirmatory factor analysis; concurrent validity was assessed by examining the association between the score of the DBII scale and the stages of behavioral change and of hemoglobin A1c for, respectively, insulin-naive patients and insulin-treated patients; and reliability was assessed using internal consistency and test–retest reliability.ResultsA 13-item DBII scale supported by exploratory factor analysis and confirmatory factor analysis was developed. The stages of behavioral change and hemoglobin A1c levels were found to be significantly associated with the scores of decisional balance of the 13-item DBII scale for both insulin-naive and insulin-treated patients. The Cronbach's α ranged between .78 and .92.ConclusionsThe 13-item DBII scale is appropriately short and possesses satisfactory validity and reliability for both insulin-naive and insulin-treated patients with T2DM. Healthcare providers may use this scale as a checklist to guide clinical discussions related to insulin therapy with both insulin-naive and insulin-treated patients with T2DM across time.

Pathways of diabetes distress, decisional balance, self‐efficacy and resilience to quality of life in insulin‐treated patients with type 2 diabetes: A 9‐month prospective study

“…Insulin‐treated T2DM patients might simultaneously hold negative attitudes towards insulin injection such as fear of pain needle injection and hypoglycaemia as well as positive attitudes towards insulin injection such as effective control of HbA1c levels and becoming more alert and energetic (Farsaei et al, 2014). Insulin‐treated T2DM patients holding positive decisional balance of injecting insulin have been found to possess significantly low levels of HbA1c (Chen et al, 2019; Hsu et al, 2019). Accordingly, decisional balance of injecting insulin might directly associate with QoL in insulin‐treated T2DM patients and is deserving of further study.…”

The Impact of Glucose-Lowering Strategy on the Risk of Increasing Frailty Severity among 49,519 Patients with Diabetes Mellitus: A Longitudinal Cohort Study

“…It is interesting to note that imbalances in comorbidities, medications, and laboratory profiles between groups receiving different glucose-lowering drugs existed. In Taiwan, insulin-naïve diabetic patients are frequently hesitant about insulin initiation and have poor compliance to insulin even if prescribed [ 25 ]. Insulin users may also have a protracted period of poor glycemic control before they start insulin treatment, as have been shown in a Pacific regional survey of patients with diabetes [ 26 ].…”

Estudo das demandas educacionais necessárias para a autogestão do diabetes de pessoas que utilizam a insulina: avaliação qualitativa e revisão sistemática

“…Conhecer as atitudes que os usuários de insulina têm com relação a esse medicamento é importante para que os profissionais da saúde identifiquem barreiras relacionadas ao seu uso e trabalhem com a elaboração de intervenções educativas voltadas para a superação dessas barreiras (FU et al, 2013;HSU et al;. Atitudes negativas sobre a insulina normalmente estão relacionadas com o medo de agulhas e de possíveis efeitos adversos, tais como ganho de peso e hipoglicemia, estigma social e interferências na rotina diária, enquanto atitudes positivas estão relacionadas com o apoio familiar e a percepção dos benefícios da insulina, tais como a prevenção de complicações, melhora do controle glicêmico e da disposição (HSU et al, 2019).…”