Which Aspect of Patient–Provider Relationship Affects Acceptance and Adherence of Insulin Therapy in Type 2 Diabetes Mellitus? A Qualitative Study in Primary Care

Figures & data

Table 1 Demographic and Clinical Information (n = 21)

Age (years) Median (IQR)	63.0 (19.0)
Gender (n, %)
Male	11 (52.4)
Female	10 (47.6)
Ethnicity (n, %)
Chinese	16 (76.2)
Malay	2 (9.5)
Indian	3 (14.3)
Educational Level (n, %)
Primary education and below	10 (47.6)
Secondary education	9 (42.9)
Tertiary education	2 (9.5)
Living Arrangement (n, %)
Alone	3 (14.3)
With family	18 (85.7)
Employment Status (n, %)
Working	12 (57.1)
Not working	9 (42.9)
DM Duration (years) Median (IQR)	13.0 (7.5)
Latest Hba1c (%) Median (IQR)	8.2 (1.1)
Insulin Duration (years) Median (IQR)	5.0 (8.5)
Insulin Regime (n, %)
Basal	9 (42.9)
Premix	12 (57.1)
Insulin Device (n, %)
Vial and syringe	4 (19.0)
Pen	17 (81.0)
Insulin Adherence
Fully adherent	12 (57.1)
Not fully adherent	9 (42.9)

Table 2 Themes and Subthemes

Themes	Subthemes
1. Patient–provider interaction	1.1. Trust in doctor’s knowledge and recommendation 1.2. Communication skills 1.3. Fear of being judged by the provider 1.4. Patient-centred decision-making 1.5. Positive effects of continuity of care
2. Addressing the psychological fears	2.1. Overcoming the fear of needle and pain
3. Gaining confidence in handling insulin equipment	3.1. Practical skills and knowledge about insulin use
4. Follow up after insulin initiation	4.1. Pro-active assessment of injection related issues