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

Diabet Med. 2015 May;32(5):635-44. doi: 10.1111/dme.12648. Epub 2014 Dec 16.


Aim: To explore attitudes towards insulin acceptance an ethnically diverse population of people with Type 2 diabetes.

Methods: We 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.

Results: Participants 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.

Conclusions: When 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.

Publication types

  • Case Reports
  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Asia, Southeastern / ethnology
  • Asian People / psychology*
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / psychology
  • Disease Management
  • Female
  • Health Knowledge, Attitudes, Practice / ethnology*
  • Health Personnel / psychology*
  • Humans
  • Hypoglycemic Agents / administration & dosage
  • Hypoglycemic Agents / therapeutic use
  • Insulin / administration & dosage*
  • Insulin / therapeutic use*
  • Interview, Psychological
  • Male
  • Middle Aged
  • Patient Compliance / psychology
  • Psychology
  • Qualitative Research
  • Self Concept*
  • United Kingdom
  • White People / psychology


  • Hypoglycemic Agents
  • Insulin