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.

Aim: To explore attitudes towards insulin acceptance in 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 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 accepting insulin 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 perceived necessity of insulin (generally, inadequacy of oral medication). South Asian and White British participants had similar concerns, but these were sometimes enhanced in South Asians, due to 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 their perceptions about the necessity of insulin as well as concerns, and that this influence may be more enhanced in some South Asian populations.