Development and Validation of a New Measure to Evaluate Psychological Resistance to Insulin Treatment

  1. Frank Petrak, PHD1,
  2. Elmar Stridde, MD2,
  3. Friedhelm Leverkus2,
  4. Alexander A. Crispin, MD3,
  5. Thomas Forst, MD4 and
  6. Andreas Pfützner, PHD4
  1. 1Department for Psychosomatic Medicine and Psychotherapy, LWL-Clinic Dortmund/Ruhr-University of Bochum, Dortmund, Germany
  2. 2Pfizer Pharma, Karslruhe, Germany
  3. 3Department of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilian University, Munich, Germany
  4. 4Institute for Clinical Research and Development, Institut für Klinische Forschung und Entwicklung, Mainz, Germany
  1. Address correspondence and reprint requests to Dr. Frank Petrak, LWL-Klinik Dortmund/Ruhr-Universität Bochum, c/o Schulberg 7-9, 65183 Wiesbaden, Germany. E-mail: mail{at}dr-frank-petrak.de

Abstract

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-naïve 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 α 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.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 15 June 2007. DOI: 10.2337/dc06-2042.

    F.P. has received consulting fees from Pfizer Germany. T.F. and A.P. have received honoraria and grant/research support from Pfizer Germany.

    Additional information for this article can be found in an online appendix at http://dx.doi.org/10.2337/dc06-2042.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted June 6, 2007.
    • Received October 3, 2006.
« Previous | Next Article »Table of Contents

This Article

  1. Published online before print June 15, 2007, doi: 10.2337/dc06-2042 Diabetes Care September 2007 vol. 30 no. 9 2199-2204
  1. » Abstract
  2. Full Text
  3. Full Text (PDF)
  4. Online-Only Appendix
  5. All Versions of this Article:
    1. dc06-2042v1
    2. 30/9/2199 most recent

Current Issue

  1. November 2009, 32 (11)
  1. Current Issue
  1. Alert me to new issues of Diabetes Care