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Barriers and facilitators to accessing insulin pump therapy by adults with type 1 diabetes mellitus: a qualitative study

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Abstract

Aims

Uptake of continuous subcutaneous insulin infusion (CSII) by people with diabetes (PwD) in Ireland is low and exhibits regional variation. This study explores barriers and facilitators to accessing CSII by adults with Type 1 diabetes mellitus.

Research design and methods

A qualitative study employing focus groups with adults with Type 1 diabetes mellitus (n = 26) and semi-structured interviews with health care professionals (HCP) and other key stakeholders (n = 21) was conducted. Reflexive thematic analysis was used to analyze data, using NVivo.

Results

Four main themes comprising barriers to or facilitators of CSII uptake were identified. These included: (1) awareness of CSII and its benefits, (2) the structure of diabetes services, (3) the capacity of the diabetes service to deliver the CSII service, and (4) the impact of individuals’ attitudes and personal characteristics—both PwD, and HCP. Each of these themes was associated with a number of categories, of which 18 were identified and explored. If the structure of the health-service is insufficient and capacity is poor (e.g., under-resourced clinics), CSII uptake appears to be impacted by individuals’: interest, attitude, willingness and motivation, which may intensify the regional inequality in accessing CSII.

Conclusions

This study identified factors that contribute to gaps in the delivery of diabetes care that policy-makers may use to improve access to CSII for adult PwD.

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Acknowledgements

We would like to acknowledge Diabetes Ireland and Thriveabetes for their support in recruitment and data collection. We are grateful to all participants who took part in the study for their time, commitment and openness.

Funding

This research was funded by the Health Research Board (HRB) SPHeRE/2013/1 as a part of the PhD programme and K.A.G. is a HRB SPHeRE Programme scholar. K.B. is funded by a Health Research Board Award (RL-15-1579).

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Authors and Affiliations

  1. Division of Population Health Sciences, RCSI: University of Medicine and Health Sciences, Beaux Lane House, Mercer Street Lower, Dublin 2, Dublin, Ireland

    Katarzyna A. Gajewska & Kathleen Bennett

  2. Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, Groningen, The Netherlands

    Regien Biesma

  3. 3U Diabetes, RCSI: University of Medicine and Health Sciences, Dublin, Ireland

    Seamus Sreenan

  4. Department of Diabetes and Endocrinology, RCSI: University of Medicine and Health Sciences, Connolly Hospital, Dublin, Ireland

    Seamus Sreenan

Authors
  1. Katarzyna A. Gajewska
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  2. Regien Biesma
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  3. Kathleen Bennett
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  4. Seamus Sreenan
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Contributions

All authors contributed to the study design and manuscript write-up. K.A.G. conducted the study and collected the data, transcribed and analyzed the datasets. R.B. and S.S. were involved in the final parts of the data analysis. All authors (K.B., R.B., S.S.) reviewed and edited the manuscript prepared by K.A.G. K.A.G. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Correspondence to Katarzyna A. Gajewska.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee of the Royal College of Surgeons in Ireland (RCSI) (Ethics reference no: REC Ref. 1494b) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all participants at the time of data collection.

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This article belongs to the topical collection Health Education and Psycho-Social Aspects. Managed by Massimo Porta and Marina Trento.

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Gajewska, K.A., Biesma, R., Bennett, K. et al. Barriers and facilitators to accessing insulin pump therapy by adults with type 1 diabetes mellitus: a qualitative study. Acta Diabetol 58, 93–105 (2021). https://doi.org/10.1007/s00592-020-01595-5

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