Health Science

Communication

Biosci. Biotech. Res. Comm. 10(2): 192-196 (2017)

Insulin resistance beliefs in patients with type II

diabetes according to the health belief model

Milad Borji,

Ali Shari ,

Razieh Molavi,

* Mohammad Amin Mohseni

and Asma Tarjoman

Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Science, Ilam, Iran

Assistant Professor, Department of Internal Medicine, School of Medicine, Ilam University of Medical Sciences,

Ilam, Iran

MSc Elderly Nursing, AL-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran

ABSTRACT

Regular administration of insulin injections with correct dosing results in well-controlled blood glucose levels and

decreased diabetic complications. This study aimed to investigate beliefs associated with insulin resistance in patients

with type II diabetes, according to the Health Belief Model. In this descriptive cross-sectional study, 300 patients with

type II diabetes from the hospitals of Ilam were included. Data were collected using the Insulin Resistance Beliefs in

Patients with Type II Questionnaire, which was designed using the components of the Health Belief Model from previ-

ous studies. The Kruskal-Wallis test, Mann-Whitney test, and Pearson correlation coef cient were adopted at a signif-

icance level of less than 0.05.The mean age of the study participants was 9.62 ± 47.77 years. Of them participants, 95

(31.7%) were illiterate, 156 (52%) were married, and 151 (50.3%) had an income level less than 500,000 Tomans per

month. The scores for components of perceived sensitivity, perceived severity, perceived barriers, perceived bene ts,

self-ef ciency, operation guideline, and general awareness were 5.37 (2.36), 16.79 (5.07), 27.53 (7.06), 30.83 (5.11),

19.51 (5.44), 27.51 (5.63), and 127.20 (13.91), respectively. Training packages and appropriate nursing interventions

are recommended to reduce the negative beliefs associated with insulin injection.

KEY WORDS: HEALTH BELIEF MODEL, DIABETES, INSULIN

192

ARTICLE INFORMATION:

*Corresponding Author: Raziehmolavi@yahoo.com

Received 1

Feb, 2017

Accepted after revision 22

May, 2017

BBRC Print ISSN: 0974-6455

Online ISSN: 2321-4007 CODEN: USA BBRCBA

Thomson Reuters ISI ESC and Crossref Indexed Journal

NAAS Journal Score 2017: 4.31 Cosmos IF : 4.006

reserved.

Online Contents Available at: http//www.bbrc.in/

DOI: 10.21786/bbrc/10.2/33

Milad Borji et al.

INTRODUCTION

Chronic diseases persist for a long time. Therefore, if

chronic conditions are not well-controlled, the demand

for health care services increases, leading to a reduced

quality of life in these,(Esmaeili Shahmirzadi et al.,

2012). Diabetes is a chronic disease of the endocrine

glands, resulting in a malfunction of glucose metabo-

lism. The disease has three main forms including type I

diabetes or insulin-dependent diabetes mellitus (IDDM),

type II diabetes or non-insulin-dependent diabetes melli-

tus (NIDDM), and gestational diabetes mellitus(Statistics

released by the World Health Organization showed that

228 million adults have diabetes. The prevalence of this

disease in Iran is reported to be 2%–3% and 3.7% in

individuals aged >30 years (Kabodi et al., 2016). Diabe-

tes is a silent disease that annually kills approximately

4 million people in the world (Aghayouse , et al., 2017

Aghayouse , Dehestani, & Salary, 2017).

Diabetic complications are generally divided into vas-

cular and non-vascular groups. Vascular complications

are further subdivided into microvascular & macrovas-

cular groups. Microvascular complications(MC) include

nephropathy, retinopathy,neuropathy, whereas in mac-

rovascular complications consist of coronary artery dis-

eases & peripheral vascular disease. Non-vascular com-

plications that may affect patients with diabetes include

gastroparesis, skin changes, and infections. Prevention

of these complications is necessary (Longo et al., 2014).

Since diabetes is a chronic disease that can cause

behavioral and emotional problems in patients, the

psychological aspects of diabetes are signi cant (Seye-

doshohadaee, Kaghanizade, Nezami, Hamedani, & Bar-

asteh, 2016). Because of the in uence of psychological

factors on the quality of lives of patients with diabetes,

the impact of these factors is of paramount importance.

Previous studies have shown the effects of temporal

aspects in the prevention of diabetes in patients with

pre-diabetes (Moayedi, Zare, & Nikbakht, 2015). Several

studies have been conducted in Iran and other coun-

tries concerning the factors that may affect resistance to

insulin therapy. These factors include a fear of reduced

independence, hypoglycemia complications (Funnell,

2007), increased body mass index (BMI) caused by insu-

lin therapy (Shari rad, Hazavehi, Baghianimoghadam,

& Mohebi, 2007), lifestyle changes, and resistance in

patients (Guler, Vaz, & Ligthelm, 2008).

The Health Belief Model is one of the health models,

which re ects the relationship between health beliefs

and health behaviors. This model places an emphasis on

the individual’s motivation in performing such health-

related (Glanz, Rimer, & Viswanath, 2008). In this model,

the desired behavior shall bene t the help-seekers in

various health aspects. Subsequently, educators iden-

tify barriers to a behavior and plan accordingly. Next,

a training program shall create the necessary sensitiv-

ity regarding the complications and risks of failure to

perform health behaviors. When patients understand the

disease and its complications, they would notice more

bene ts in performing preventive behaviors, be more

inclined to adopt such behaviors, and  nally, apply

the behavior appropriately (Mohebi et al., 2012; Moodi,

Moasheri, & Amirabadi Zadeh, 2016). This model has

been considered in many studies to review and assess

the health behaviors (Kohdaveisi, Salehikha, Bashirian,

& Karami, 2016; Sahraee, Noroozi, & Tahmasebi, 2013a;

Soleymanian, Niknami, Hajizadeh, Shojaeizadeh, &

Montazeri, 2014; Walker & Jackson, 2015).

If insulin is injected properly and regularly at correct

dosages, then blood glucose levels will be controlled,

and diabetic complications will be reduced. According

to the results of many studies, only 25% of patients with

diabetes who need insulin to control diabetes complete

this type of therapy (Gough, Frandsen, & Toft, 2006;

Grant, Buse, & Meigs, 2005). Given the importance of

diabetes and its increasing prevalence, this study aimed

to examine the beliefs associated with the rejection of

insulin in patients with type II diabetes.

MATERIALS AND METHODS

This study was at descriptive cross-sectional study. This

study population consisted of patients with diabetes in

the hospitals of Ilam in 2017, of whom 300 patients were

included. Inclusion criteria were being affected by dia-

betes type II, taking insulin to control diabetes, un will-

ingness to take insulin despite doctors’ emphasis, having

the ability to answer questions, and lack of psychologi-

cal problems such as psychosis and severe depression or

intellectual disabilities.

This study was initiated after researchers had met the

study participants and obtained their informed consent.

The patients were assured that their personal information

would be kept con dential by the researchers. Given that

most patients were illiterate to  ll out the questionnaires,

the interview method was used instead. The researchers

daily referred to Shahid Mostafa Khomeini and Imam

Khomeini hospitals in Ilam and completed the question-

naire by identifying patients with diabetes. Data were

collected using the Insulin Resistance Beliefs in Patients

with Type II Questionnaire, which was designed using

the constructs from the Health Belief Model accordance

with questionnaire developed by Kaboudi et al. (Kabodi

et al, 2016).

These constructs included perceived sensitivity (2

items) & perceived severity (6 items) & perceived ben-

e ts (9 items) & perceived self-ef cacy (6 items) &

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS INSULIN RESISTANCE BELIEFS IN PATIENTS WITH TYPE II DIABETES 193

Milad Borji et al.

Table 2. Mean, standard deviation, and correlation between the health belief model constructs and their relationship

with the beliefs associated with rejection of insulin injections

S.D (Mean)MaximumMinimum6*5*4*3*2*1*

Structures

constructs

5.37(2.36)102------perceived sensitivity

16.79(5.07)306-----.64**perceived severity

27.53(7.06)459----.32.48perceived bene ts

30.83(5.11)5010---.10.06-.008-perceived barriers

19.51(5.44)306--.11-.24-.02.13-perceived self-ef cacy

27.51(5.63)408-.46.18-.20-.10-.13-operation guideline

127.20(13.91)2052.36.39.27.56.58.53awareness

**Correlation is signi cant at the 0.01 level (2-tailed)

*1- 6 (constructs 1 - 6 from the Health Belief Model )

perceived barriers (10 items) & and operation guide-

line (8 items). Responses provided for all questions

were based on a Five-point Likert scale ranging from

in One (strongly disagree) to Five (strongly agree). In

all aspects of the questionnaire (except the perceived

barriers), a high score indicated acceptance of insulin

therapy as an appropriate method for diabetes by the

patient; however, a high score in the perceived barri-

ers re ected numerous obstacles to the acceptance of

insulin therapy. A questionnaire a made researcher. But

questions of accordance with and on the model of was

made by Kaboudi et al 2016) .Reliability and validity of

the questionnaire obtained by the researcher. Following

data collection, the information obtained was entered

using the SPSS software (version 20; Kruskal-Wallis test,

Mann-Whitney test, and Pearson correlation coef cient

were adopted at a signi cance level of less than 0.05.

RESULTS

According to the study  ndings, the mean age of the

study participants was 9.62 ± 47.77 years. Of these

patients, 95 (31.7%) were illiterate, 156 (52%) were mar-

ried, and 151 (50.3%) had an income level less than

500,000 Tomans per month (Table 1).

According to Table 2, the maximum and minimum

mean scores were related to the constructs operation guide-

line and perceived sensitivity, respectively. The Pearson

correlation coef cient suggested that education and level

of income had a statistically signi cant negative associa-

tion with a history of diabetes and beliefs associated with

lack of insulin injections so that older people with higher

levels of education and income had lower levels of nega-

tive beliefs about insulin rejection. However, no statisti-

cally signi cant relationship was observed between other

demographic characteristics such as age, occupation, mari-

tal status, and negative beliefs regarding insulin injection.

DISCUSSION

This study aimed to investigate the beliefs associated

with the rejection of insulin in patients with type II dia-

betes in Ilam, according to the Health Belief Model con-

structs. This model contains  ve constructs, which are

discussed separately in the following section.

Regarding the  rst construct (i.e., perceived sensitiv-

ity), the  ndings of this study showed that most patients

were not sensitive enough to feel the need for insu-

lin injections. In Kaboudi’s et al. study of 2016, which

aimed to determine beliefs associated with insulin injec-

tion, the  ndings showed that only 66.95% of the scores

revealed perceived sensitivity of patients in terms of

insulin injections. This  nding was consistent with that

of the present study. Regarding the next construct (i.e.,

perceived severity, the  ndings showed that most of the

Table 1. Demographic characteristics: School-age

children with diabetes

N(%)Variable

145(48.3)Male

Gender

155(51.7)Female

95(31.7)illiterate

Education

183(61)Diploma and low literate

22(7.3)Collegiate

151(50.3)

Less than 500 thousand

Rials

income

94(31.3)500 to 1 million

30(10)1 to 2 million

25(8.3)More than 1 million

156(52)Married

Married

144(48)No husband

133(44.3)yes

History of insulin

167(55.7)No

194 INSULIN RESISTANCE BELIEFS IN PATIENTS WITH TYPE II DIABETES BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Milad Borji et al.

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS INSULIN RESISTANCE BELIEFS IN PATIENTS WITH TYPE II DIABETES 195

scores of the studied patients did not meet the necessary

severity regarding insulin injections.

Similarly, this study (Kabodi et al., 2016) indicated

that only 60.7% of scores re ected the severity of insulin

injections. In fact, when a person feels no threat regard-

ing the disease (perceived sensitivity and severity), he/

she cannot change a behavior appropriately(Dietrich,

1996). According to Patino et al., to enhance the level

of threat perceived by the patients (perceived sensitivity

and severity), more focus should be placed on the short-

term complications of diabetes (Patino, Sanchez, Eidson,

& Delamater, 2005).

Concerning other constructs in this model, the results

indicated that the scores obtained by most patients in

terms of perceived bene ts were at a low level and unde-

sirable. Regarding these perceived barriers, the scores

were also high and undesirable, resulting in the lack of

insulin injection. In a study conducted by Vahidi et al.,

the perceived barriers in comparison with The other con-

structs in the Health Belief Model(HBF) had the greatest

impact on the construct of self-ef cacy in patients with

diabetes so that an individual’s positive beliefs to follow

the prophylactic treatment of diabetes increases by rais-

ing their awareness regarding the psychological costs

of adopting a behavior (Vahidi, Shojaeizadeh, Esmaeili

Shahmirzadi, & Nikpour, 2014).

The  ndings for the next construct (i.e., perceived

self-ef cacy) revealed that the patients’ self-ef cacy

levels were not at a desirable level. This result was in

line with the ones of Kaboudi et al (Kabodi et al., 2016),

Other studies suggested that self-ef cacy is an effective

and strong predictor of behavior (Avci, 2008; Noroozi,

Jomand, & Tahmasebi, 2011; Sahraee, Noroozi, & Tah-

masebi, 2013b; Tava an, Hasani, Aghamolaei, Zare, &

Gregory, 2009). In fact, the construct of self-ef cacy was

the best predictor of self-care behaviors. Findings asso-

ciated with the operation guidelines showed that this

construct received the highest score. According to its

relevant items, the medical staff and mass media played

the most critical roles, which was similar to the results of

previous studies indicating the signi cant impact of the

medical staff (Borhani, et al., 2010; Kabodi et al., 2016))

and mass media (Mahmoodabad et al.,2016; Taghdisi &

Nejadsadeghi, 2011) on patient awareness.

CONCLUSION

Training packages and appropriate nursing interven-

tions should be administered to reduce the negative

beliefs associated with insulin injection.

CONFLICT OF INTEREST

Ther e is no con ict of interest between authors.

SOURCE OF FUNDING

Ilam University of Medical Sciences.

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