Table 2 Attributes of Diabetes Medication Identified by Participants as Contributing to Treatment Simplicity or Complexity, along with Example Quotations1
Simple n (%) | Example Quotation | Complex n (%) | Example Quotation | |
|---|---|---|---|---|
Injection device | 17 (56.7%) | “Oh, it’s a lot easier than the vial and the needle thing. That pen makes it real easy all in all.” (M, 60 y) | 3 (10.0%) | “It’s become more complicated in the sense that I’m taking more insulin now than I was earlier, and I’m taking more insulin now because I have to use the vials instead of using pens. My life would be a lot easier with insulin if I could use the insulin pens but I can’t afford that.” (M, 72 y) |
Preparing medication (including device) | 15 (50.0%) | “All you do is put a tip on it and dial it and stick it in you…That’s very simple.” (M, 56 y) | 2 (6.7%) | “It just takes a longer time, the preparation of the skin with the alcohol wipes, filling the syringe with the insulin, and injecting it into your body…Taking the insulin is more complex than taking pills.” (M, 86 y) |
Dose timing (i.e., time of day) | 12 (40.0%) | “It’s simple, it is just before I go to bed” (M, 77 y) | 3 (10.0%) | “I think the most difficult part is like in the morning time when I got to get it all together and do it. In the morning time is the most difficult.” (F, 69 y) |
Swallowing pill | 10 (33.3%) | “Just have a little glass of water and you swallow a pill. That’s the simplest part.” (M, 56 y) | -- | |
Getting the right dose | 4 (13.3%) | “It’s simple… I don’t have to draw it. I just dial the pen.” (M, 67 y) | 2 (6.7%) | “It’s on the syringe the amount that you’re supposed to take and you have to be very careful that you’re taking the right amount.” (M, 72 y) |
Food requirement | 4 (13.3%) | “Simple. None of them say with food. So, it could be either with or without.” (F, 59 y) | 1 (3.3%) | “It could be a little bit complicated…you have to be alert, did you eat or you don’t eat? It will put you in a situation that you can do a mistake.” (M, 77 y) |
Flexibility of dose schedule | 4 (13.3%) | “It’s more simple for me to take it with all my medicine at once instead of once in the morning and once at night… I could either take it in the morning or at nighttime, that’s what they told me.” (F, 66 y) | -- | |
Dose frequency | 3 (10.0%) | “Once a week is not bad… that’s fairly simple. There’s nothing hard about that.” (M, 73 y) | 6 (20.0%) | “That’s a little bit more complicated because I take the [regular human insulin] before each meal, so we’re talking about three insulin shots a day for the [regular human insulin], so my total number of insulin shots will be five during the day.” (M, 72 y) |
Changing the needle | 3 (10.0%) | “You just screw the needle on it, so a pen and a needle, and then you just give you a shot.” (F, 66 y) | 2 (6.7%) | “Well, sometimes the needles and things are difficult to hold.” (M, 76 y) |
Refrigeration | 2 (6.7%) | “When I’m always opening the refrigerator a lot, I see it and I’m reminded. So, you know, oh, let me do this. And then it’s always so in the, you know, forefront of my mind that I take this medication on time” (F, 69 y) | 1 (3.3%) | “I can say it’s mostly troublesome …if I’m going on a trip, I got to make sure it’s kept cold, in a cool … Got to make sure I got a cooler or whatever. That’s the only thing I find that could be inconvenient.” (M, 67 y) |
Pill burden/Number of pills | 2 (6.7%) | “It was made easier for me by taking one pill, one in the morning and one at night rather than two in the morning and two at night, so that was made easier, just the pills being larger dosage so that I don’t have to be taking as many pills.” (M, 72 y) | -- | |
Cost | -- | 5 (16.7%) | “It’s become more complex…When I was first diagnosed, I was able to use the insulin pens, and so it was just a matter of maybe once a day or twice a day using the insulin pens, but now insulin is so expensive that I’ve had to go to the vials… It’s more insulin, correction insulin, that it’s become more complicated in the sense that I’m taking more insulin now than I was earlier, and I’m taking more insulin now because I have to use the vials instead of using pens. My life would be a lot easier with insulin if I could use the insulin pens but I can’t afford that.” (M, 72 y) | |
Remembering to take meds | -- | 4 (13.3%) | “Just remembering to do it is probably one of the hardest things.” (M, 73 y) | |
Time consuming | -- | 3 (10.0%) | “I can do it, it’s just that it’s burdensome…the time that it takes to get the shot ready and the amount of insulin, got it correct, monitoring throughout the day. So it’s all throughout the day it just seems like I’m doing something to monitor, and I just wish that it wouldn’t be so time-consuming and so much of what I have to do to keep my diabetes under control.” (M. 72 y) | |
Bringing medication with me | -- | 1 (3.3%) | “You’ve got to make sure you didn’t forget your pen. …You always fear that if you’re in a restroom and there’s people using the stalls and there’s no place to go that’s convenient where you can be by yourself… that’s primarily one of the biggest problems with taking it.” (M, 68 y) |