NIDDM PATIENTS FEARS AND HOPES ABOUT INSULIN THERAPY - THE BASIS OF PATIENT RELUCTANCE

OBJECTIVE - This study examines NIDDM patients' attitudes toward insul in injections, the basis of these attitudes, and how they may affect p atients' willingness to rake insulin. RESEARCH DESIGN AND METHODS - Fo rty-four low-income Mexican American NIDDM patients were interviewed u sing open-ended in-depth interviewing techniques. Transcripts were ana lyzed using techniques of content analysis. Data classification was cr oss-checked in analysis conferences and through a second researcher co ding 50% of the cases, comparing the results, then resolving any discr epancies. RESULTS - Patients' positive attitudes toward insulin focus on its efficacy and efficiency, the avoidance of complications, and fe eling better and more energetic. Negative attitudes were much more fre quently discussed and include ''technical concerns'': anxiety about th e pain, proper techniques, and general hassles of taking injections; a bout hypoglycemic symptoms; and about insulin causing serious health p roblems; and ''experiential concerns'': sensing that the disease has p rogressed into a serious phase, that past treatment efforts hare faile d, and that the patient has not taken proper care. Attitudes were base d on personal experience, observation, what others say, and interactio ns with health care professionals. CONCLUSIONS - Results from the few published reports on NIDDM patients' attitudes about insulin from vari ous cultural settings were consistent with our findings, indicating th at these themes may be generally applicable to a wider population. it is recommended that health care providers take care to avoid unwitting promotion of negative attitudes toward insulin and actively elicit an d respond to patient attitudes to reduce reluctance to take the medica tion.