Abstract
Diabetes Mellitus (DM) affects 425 million adults world-wide and one in every two people are undiagnosed according to the International Diabetes Federation (IDF). It is a serious and costly disorder which needs timely and adequate treatment, to prevent complications such as blindness, kidney failure, and strokes. There are three main types of diabetes, Type 1 Diabetes Mellitus (T1DM), Type 2 Diabetes Mellitus (T2DM), and Gestational Diabetes Mellitus (GDM). The most common type of DM affecting 90% of the population with diabetes is T2DM, followed by T1DM which affects up to 10%. Insulin therapy is the only effective treatment for people with T1DM and for women with GDM; but is often required for treatment in people with T2DM, when oral medications fail to adequately control their diabetes.
However, a phenomenon termed Psychological Insulin Resistance (PIR) has been recognised as a significant barrier to timely initiation and continuation of insulin therapy. Therefore, since PIR generates substantial barriers to insulin treatment causing significant delays to optimal treatment of DM, it is important to explore and find ways to address this phenomenon. The literature also highlights that PIR is common in people with T2DM and more apparent in ethnic minority groups. Therefore, it was increasingly necessary to study this phenomenon in culturally sensitive conditions. Consequently, this research explored PIR in two Pacific Islands (PI) clients with T2DM, who are New Zealand (NZ) residents.
The study used a qualitative Case Study (CS) methodology to investigate how two PI clients diagnosed with T2DM, responded to the prescription and ongoing use of insulin treatment. A "two-case" CS procedure as described by Robert Yin was used to explore in-depth, how two PI women received and achieved their instructions on the use of insulin therapy. The three methods of data collection used were semi-structured interviews, direct participant observations and relevant information from the participants' medical notes. The data collection and analysis were guided by seven propositions (Table 1), while the Fonua Health Model (Figure 2) was used as the theoretical framework for cultural and analytic applications.
The findings of this research revealed that the two PI participants experienced the same multifaceted psychosocial issues and physical complications, identified in the literature regarding PIR. The holistic outlook for the current and long-term health status of both participants were unacceptably poor and out of balance, according to the Fonua Health Model. For PI persons with diabetes to have acceptable holistic health status, they need to have life balance according to the Fonua Health Model. However, if they require insulin therapy to effectively control their diabetes and to help minimise the incidence and severity of diabetes complications, they will need extra support from Health Care Professionals (HCP), that are culturally and clinically competent.