Development and validation of a new measure to evaluate psychological resistance to insulin treatment

Citation metadata

From: Diabetes Care(Vol. 30, Issue 9)
Publisher: American Diabetes Association
Document Type: Clinical report
Length: 3,796 words
Lexile Measure: 1460L

Document controls

Main content

Article Preview :

OBJECTIVE--To develop a psychometric questionnaire to measure psychological barriers to insulin treatment in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS--Scale development was based on principal component analyses in two cross-sectional studies of insulin-naive patients with type 2 diabetes. The structure of the questionnaire was developed in the first sample of 448 patients and subsequently cross-validated in an independent sample of 449 patients.

RESULTS--Analyses in the first sample yielded five components that accounted for 74.5% of the variance based on 14 items and led to the following subscales: fear of injection and self-testing, expectations regarding positive insulin-related outcomes, expected hardship from insulin treatment, stigmatization by insulin injections, and fear of hypoglycemia. In addition, an overall sum score of all values was calculated. The structure of the questionnaire was cross-validated in the second sample, with almost identical component loadings and an explained variance of 69.4%. An additional confirmatory factor analysis also indicated an acceptable to good model fit with root mean square error of approximation equal to 0.04 and comparative fit index equal to 0.97. Coefficients of reliability (Cronbach's [alpha] 0.62- 0.85 and 0.78 for overall sum score) were acceptable, considering the very small number of items for each scale.

CONCLUSIONS--The Barriers to Insulin Treatment Questionnaire appears to be a reliable and valid measure of psychological insulin resistance in patients with type 2 diabetes. This short instrument is easy to administer and may be used by both clinicians and researchers to assess the psychological barriers to insulin treatment.


Despite the increasing body of knowledge regarding diabetes treatment (1), a majority of patients with type 2 diabetes are still in persistently poor glycemic control (2), a state that leads to higher risks of poor health outcomes (3). A variety of factors are responsible for poor glycemic control, including the inadequacy of therapeutic regimens (1) as well as various psychosocial aspects (4,5). In recent years, researchers also have focused on the reluctance of patients to take insulin and the resistance of health care providers to prescribe insulin (6). These negative attitudes toward insulin treatment contribute to unnecessarily long delays for initiating insulin treatment and, consequently, to extended periods of hyperglycemia (7,8). This so-called "psychological insulin resistance" (9) includes, among other factors, fear of injection and self-testing, hypoglycemia, and weight gain; a perceived loss of control over one's life; poor self-efficacy concerning insulin treatment; and perceived lack of positive outcomes related to insulin (9,10).

To overcome these psychological barriers to insulin treatment, first it is necessary to identify these barriers in specific patients in order to decide which interventions are appropriate. Thus, a well-validated diagnostic tool may be helpful to identify specific obstacles against the initiation of insulin treatment. There are some questionnaires that measure different aspects of satisfaction with treatment or diabetes-related burdens or stress (11-17), but presently, to our knowledge, no specific measurement of the psychological barriers to insulin treatment has been created, validated, and published.

This article describes the development and evaluation of the self-administered Barriers to Insulin Treatment (BIT)...

Source Citation

Source Citation   

Gale Document Number: GALE|A168870949