Willingness of people with Type 2 diabetes to start insulin therapy: Evidence from the South African Tshwane Insulin Project (TIP)

Piotie, Patrick Ngassa; Wood, Paola; Webb, Elizabeth M.; Marcus, Tessa S.; Rheeder, Paul

doi:10.1016/j.diabres.2020.108366

Cited by 11 publications

(19 citation statements)

References 48 publications

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“…Articles included 24 cross-sectional studies [ 1 – 3 , 25 , 26 , 28 – 30 , 33 , 36 , 37 , 39 – 45 , 47 , 50 – 52 ], one abstract of a literature review [ 38 ], one prospective cohort study [ 34 ], two case reports [ 31 , 48 ], one randomized controlled trial [ 24 ], and three reports [ 27 , 32 , 49 ]. The included studies used a variety of methodology to define and assess needle fear or phobia, ranging from a single question within a broader questionnaire, face-to face interviews to assessment of fear or phobia using a dedicated validated tool (eg.…”

Section: Resultsmentioning

confidence: 99%

“…Similarly, 67/214 (31%) diabetic patients who initially refused insulin or who received insulin administration by a physician indicated fear of needles as a barrier [ 44 ]. Among Type 2 diabetic patients more than half 243/468 (52%) expressed unwillingness to start insulin therapy, the attitudinal items from the administered questionnaire that most strongly distinguished unwilling from willing participants included injection-related anxieties including fear of needles, with 218/243 (90%) of unwilling patients being afraid of needles compared to 130/225 (58%) of willing patients [ 52 ]. In 102 patients with type 1 diabetes, those with high scores for fear of blood and injury as measured by The Fear Questionnaire [ 54 ], performed fewer blood glucose measurements and had poorer glycaemic control than patients without fear [ 35 ].…”

Section: Resultsmentioning

confidence: 99%

“…The D-FISQ and its variant, the DFIQ, were used among patients with diabetes or kidney failure, as a validated measure of fear of injection and or self-testing associated with insulin or dialysis therapies [ 29 , 34 , 36 , 42 , 45 , 46 , 53 ]. However, a variety of other assessment methods were used including psychometric self-report tools [ 25 , 26 , 35 , 39 ], investigator-created surveys [ 1 , 28 , 30 , 41 , 50 , 52 ], and face-to-face interviews [ 2 , 33 , 40 ]. Moreover, needle phobia was determined by single or multiple items on self-report measures [ 2 , 24 , 28 , 51 ], not formal diagnostic assessment.…”

Section: Discussionmentioning

confidence: 99%

“…Measures that assess needle fear in the context of a therapy, such as the D-FISQ, should be utilised where available. Screening may be warranted particularly prior to treatment initiation, as needle fear is associated with treatment refusal [ 1 , 33 , 40 , 44 , 52 ], or in the early weeks and months of therapy, when fear appears heightened [ 1 , 42 , 43 , 55 ]. Early identification of patient fear or misconceptions of therapy could aid in treatment-decision making and provide opportunity for education and early intervention.…”

Section: Discussionmentioning

confidence: 99%

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The prevalence and evidence-based management of needle fear in adults with chronic disease: A scoping review

et al. 2021

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Background Little is known about the prevalence and best management of needle fear in adults with chronic disease, who may experience frequent and long-term exposure to needles for lifesaving therapies such as renal dialysis and cancer treatment. Identifying interventions that assist in management of needle fear and associated distress is essential to support these patients with repeated needle and cannula exposure. Method We followed the PRISMA methodology for scoping reviews and systematically searched PsychINFO, PubMed (MEDLINE), ProQuest, Embase and grey literature and reference lists between 1989 and October 2020 for articles related to needle discomfort, distress, anxiety, fear or phobia. The following chronic diseases were included: arthritis, asthma, chronic back pain, cancer, cardiovascular disease, chronic obstructive pulmonary disease, diabetes, and mental illness, or kidney failure. Literature concerning dentistry, vaccination, intravenous drug users and paediatric populations were excluded. Results We identified 32 papers reporting prevalence (n = 24), management (n = 5) or both (n = 3). Needle fear prevalence varied in disease cohorts: 17–52% (cancer), 25–47% (chronic kidney disease) and 0.2–80% (diabetes). Assessment methods varied across studies. Management strategies had poor evidence-base, but included needle-specific education, decorated devices, cognitive-behavioural stress management techniques, distraction, and changing the therapy environment or modality. Conclusion Although needle fear is common there is a paucity of evidence regarding interventions to address it among adults living with chronic disease. This scoping review has highlighted the need for improved identification of needle fear in adults and development of interventions are required for these cohorts.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The prevalence and evidence-based management of needle fear in adults with chronic disease: A scoping review

et al. 2021

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“…12 In practice, this is not always feasible. Besides the reported resistance of both healthcare providers and people with T2D to start insulin, 13 – 15 most primary healthcare clinics lack doctors and diabetes dedicated nurses, and nurses have a heavy workload which limits their capacity to attend comprehensively to patients with T2D. 9 In primary healthcare, many South African doctors feel they do not know enough or have enough experience of the insulin therapy guidelines.…”

Section: Introductionmentioning

confidence: 99%

Designing an integrated, nurse-driven and home-based digital intervention to improve insulin management in under-resourced settings

Piotie

Wood

Webb

et al. 2021

Therapeutic Advances in Endocrinology

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Background: In South Africa, initiating insulin for people with type 2 diabetes and subsequent titration is a major challenge for the resource-constrained healthcare system. Inadequate support systems in primary care, including not being able to access blood glucose monitors and test strips for self-monitoring of blood glucose, results in patients with type 2 diabetes being referred to higher levels of care. In primary care, initiation of insulin may be delayed due to a shortage of healthcare workers. The delayed initiation of insulin is also exacerbated by the reported resistance of both healthcare providers and people with type 2 diabetes to start insulin. In South Africa, telehealth provides an opportunity to overcome these challenges and manage insulin therapy in primary care. Methods: We describe the development of a digital health intervention including the framework used, the theoretical approach and subsequent implementation strategies. Results: This intervention is an innovative, nurse-driven and app-enabled intervention called ‘the Tshwane Insulin Project intervention’. The Tshwane Insulin Project intervention was designed and evaluated using the framework recommended by the Medical Research Council for complex interventions. The Tshwane Insulin Project intervention was developed in four sequential phases: planning, design, implementation and evaluation. The Tshwane Insulin Project intervention followed the Integrated Chronic Disease Management framework to facilitate implementation and acceptability. The Tshwane Insulin Project comprises a facility-level intervention, where nurses evaluate patients and initiate insulin, an individual-level intervention where community healthcare workers visit patients at their homes to follow-up and provide educational information, while using telehealth to enable physician-directed insulin titration if needed, and a community-level intervention aimed at empowering community healthcare workers to support people living with diabetes and raise awareness of diabetes. Conclusion: The technological advancements in digital health and telemedicine present an opportunity to improve diabetes care in resource-limited countries. This work can inform those intending to develop and implement complex interventions in primary healthcare in developing countries.

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Attitudes and beliefs of South African primary healthcare practitioners on initiating insulin in people with type 2 diabetes: Findings from the Tshwane Insulin Project (TIP)

Piotie

Wood

Muchiri

et al. 2021

Primary Care Diabetes

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Willingness of people with Type 2 diabetes to start insulin therapy: Evidence from the South African Tshwane Insulin Project (TIP)

Cited by 11 publications

References 48 publications

The prevalence and evidence-based management of needle fear in adults with chronic disease: A scoping review

The prevalence and evidence-based management of needle fear in adults with chronic disease: A scoping review

Designing an integrated, nurse-driven and home-based digital intervention to improve insulin management in under-resourced settings

Attitudes and beliefs of South African primary healthcare practitioners on initiating insulin in people with type 2 diabetes: Findings from the Tshwane Insulin Project (TIP)

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