Concerns and perceptions about necessity in relation to insulin therapy in an ethnically diverse UK population with Type 2 diabetes: a qualitative study focusing mainly on people of South Asian origin

AimTo explore attitudes towards insulin acceptance an ethnically diverse population of people with Type 2 diabetes. MethodsWe conducted semi-structured interviews using a topic guide based on a literature review and findings from our previous study, which explored the perspectives of healthcare professionals about insulin initiation and management. Analysis of data involved undertaking an abductive reasoning approach in response to emerging themes. ResultsParticipants discussed not only their concerns about insulin therapy, but also their views and beliefs about the necessity of insulin. Their attitudes to insulin treatment could be mapped into four main typologies. These fitted with an attitudinal scale based on the Necessity-Concerns Framework described in the medication adherence literature, comprising four attitudes: accepting, sceptical, ambivalent and indifferent. Decisions about accepting insulin involved balancing concerns (such as needle size) against the perceived necessity of insulin (generally, inadequacy of oral medication). The South Asian and white participants had similar concerns, but these were sometimes greater in South Asian participants, because of the influence of negative views and experiences of other insulin users. ConclusionsWhen discussing insulin with people with Type 2 diabetes, healthcare providers need to ensure that they explore and contribute to patients' understanding and interpretation of the necessity of insulin as well as discussing their concerns. Furthermore, they should be aware of how an individual's social context can influence his/her perceptions about the necessity of insulin as well as their concerns, and that this influence may be greater in some South Asian populations. What's new? This is the first time the Necessity- Concerns Framework drawn from the medical adherence literature has been used to explore decisions to commence insulin therapy in an ethnically diverse sample of people with Type 2 diabetes. This study offers a practical insight into why it is important to elicit beliefs about the necessity of insulin therapy as well as people's concerns to help address the reluctance of some people with Type 2 diabetes to commence insulin therapy in a timely way.