Study On The Relationship Among Attitude, Satisfaction And Adherence With Insulin Treatment In Patients With Type2Diabetes

Objective1. To introduce and revise the Insulin Treatment Satisfaction questionnaire (ITSQ) for Chinese Type2diabetic patients.2. To investigate general condition and influencing factors of attitude, satisfaction and adherence with insulin treatment in patients with type2diabetic patients, as well as relationship among them. In order to provide theoretical basis on health education.MethodsAfter Translation, back translation and cultural adaptation of ITSQ, we initially formed the Chinese version of ITSQ.201type2diabetic patients treated with insulin were recruited from several tertiary hospitals in Shandong Province from February to November2012.The patients were evaluated with general information questionnaire, insulin treatment attitude scale (ITAS), insulin treatment satisfaction questionnaire (ITSQ) and insulin treatment adherence questionnaire(ITAQ). The data were input by excel2007and analyzed by spss16.0, Amos16.0. The reliability and validity of ITSQ were evaluated by internal consistency reliability, split-half reliability, content validi-ty and structural validity. The general condition and influencing factors of attitude, satisfaction and adherence with insulin treatment in patients with type2diabetic pa-tients, as well as relationship among them were investigated by single-factor, mul-tiple-factor analysis, correlation analysis and structural equation modeling analysis. Results1. The evaluation of reliability and validity of Chinese version ITSQ:The varimax rotation factor analysis of the scale identified5principal factors and explained for63.002%variances. The Cronbach’s a coefficient was0.817for the whole scale and0.876、0.774、0.776、0.679、0.839respectively for the subscales. The split-half coefficient of the adjusted scale was0.865.2. Total score of the ITAS was66.56±10.27,152(75.6%) of the patients with varying degrees of psychological insulin resistance.3. Total score of the ITSQ was51.13±9.35, The satisfaction of the patients on insulin treatment is in middle and low level.Single-factor analysis showed that there were sta-tistical differences of ITSQ in different social demography characteristics such as sex, age, occupation, education, monthly income, the payment of medical expenses, pay-ment method and so on (P<0.05). There were also statistical differences of ITSQ in different illness features such as duration of insulin injection, frequency of injections per day, the need to assist, whether took oral hypoglycemic agents, whether accepted health education, frequency of hypoglycemia, fasting blood glucose level and post-prandial glucose (P<0.05). Multiple regression analysis showed that ITAS score, frequency of injections per day, taking oral hypoglycemic agents, frequency of hy-poglycemia, fasting blood glucose level and sex were predictive factors of ITSQ(R2=59.9%, F=48.331, P=0.000).4. The total score of ITAQ was39.64±6.17,161(80.10%) patients with poor adhe-rence. The following Disease-related information can affect insulin treatment adhe-rence:Payment method of medical expenses, Duration of insulin injection, frequency of injections per day, the need to assist, whether took oral hypoglycemic agents, whether accepted health education (P<0.05).5. The score of ITAS was positively correlated with the score of ITSQ, and related coefficient was-0.637(P<0.01). The score of ITAS was negatively correlated with the score of ITAQ, and related coefficient was-0.418(P<0.01). The score of ITSQ was positively correlated with the score of ITAQ, and related coefficient was0.201(P <0.01). Multiple regression analysis using ITAS score as the dependent variable showed that all the subscale of ITAS,"life flexibility", and Duration of insulin in-jection are predictive factors of ITAQ(R2=32.5%, F=20.267, P=0.000) The structural equation modeling results showed insulin treatment attitude could in-fluence adherence directly and indirectly. In the direct approach, insulin treatment at-titude could make a negative effect on adherence (Beta=-0.87); Insulin treatment sa-tisfaction could make a positive effect on adherence (Beta=0.52). In the indirect ap-proach, though insulin treatment attitude could not directly affect adherence, it could indirectly affect adherence by satisfaction (Beta=-0.045).Conclusion1. The Chinese version of ITSQ is valid and reliable and it is applicable to a wide range of insulin therapies.2. Among201respondents,75.6%of the patients were with varying degrees of psy-chological insulin resistance. The satisfaction of the patients on insulin treatment is in middle and low level and80.10%of the patients with poor adherence. Both general and disease-related information can affect insulin treatment satisfaction and treatment adherence.3The attitude, satisfaction and adherence with insulin treatment are correlated. The attitude can negatively predict satisfaction and adherence. The satisfaction can posi-tively predict adherence. It prompts that healthcare provider should be concerned about the psychological insulin resistance in type2diabetes patients, improving treatment satisfaction and promoting good adherence by correcting attitude towards insulin.