PSYCHOLOGICAL INSULIN RESISTANCE AMONG INSULIN NAÏVE TYPE 2 DIABETES MELLITUS PATIENTS IN PENANG, MALAYSIA: A MIXED METHODS STUDY PROTOCOL
Background: The insulin usage among the type 2 diabetes mellitus (T2DM) patients in Malaysia is low despite of majority of them have poorly controlled glycaemic level. Studies also found that high prevalence of insulin initiation refusal among these patients. In this study context, psychological insulin resistance (PIR) is referred to patients reluctant to initiate insulin therapy. This study is to determine the predictors of PIR among the insulin naïve T2DM patients and to understand the barriers of insulin initiation among them.
Methods: This is an explanatory sequential mixed methods study conducted in the primary care health clinics of Penang. The first quantitative phase is conducted through interviewer-assisted questionnaire among the adult insulin naïve T2DM patients in the studied clinics. Simple random sampling methods is used to select the participants. The dependent variable is PIR which is assessed using Insulin Treatment Appraisal Scale (ITAS). Multiple linear regression analysis is conducted to determine the predictors of PIR. Using the quantitative results, the informants of qualitative phase are purposively selected to recruit those who are indicated but refuse insulin initiation. The second qualitative phase is conducted through in-depth interview using semi structured interview protocol. Thematic analysis is conducted to identify the themes of PIR. Both the quantitative and qualitative findings are integrated and interpreted in the discussion to explain the factors of PIR.
Conclusion: Using mixed methods approach, the complex and multifaceted PIR issue is comprehensively assessed. The richness of the evidences will imply to the current practice.Keywords: ITAS, mixed methods study, psychological insulin resistance, refuse insulin initiation, Social Ecological Model, study protocol, type 2 diabetes mellitus