Interoceptive awareness and injection related fear among insulin treated adults with diabetes mellitus: A concurrent convergent mixed methods study

Title : Interoceptive awareness and injection related fear among insulin treated adults with diabetes mellitus: A concurrent convergent mixed methods study

Abstract:

Background: Fear of injections is a major psychological barrier to insulin adherence and glycaemic management in persons with diabetes mellitus. Interoceptive awareness, a marker of sensitivity to internal physiological sensations, may have an impact on the emotional reaction to insulin delivery, however there is no data from India.

Objective: To evaluate the association between interoceptive awareness and injection-related fear in adults with diabetes mellitus treated with insulin, and to explore the lived experience of insulin therapy and self management.

Methods: A concurrent convergent mixed-methods study was conducted among 150 insulin treated adults with Type 1 and Type 2 diabetes mellitus (DM) at a tertiary institute in Eastern India. Quantitative data were gathered with the Multidimensional Assessment of Interoceptive Awareness (MAIA-2) and the Diabetes Fear of Injecting and Self-Testing Questionnaire (D-FISQ). We used multivariable linear regression to identify predictors of injection related fear. The qualitative data was collected by in depth interview and analysed by thematic content analysis. A joint display approach was used to integrate both datasets.

Results: Participants reported moderate interoceptive awareness (MAIA: 81.51 ± 11.70) and mild-to-moderate injection-related fear (D-FISQ: 18.19 ± 7.29). A statistically significant positive correlation was found between MAIA and D-FISQ scores (r = 0.633, p < 0.001). Higher HbA1c and greater interoceptive awareness predicted higher injection-related fear, whereas longer duration of diabetes and previous injection training predicted lower injection-related fear. Qualitative findings revealed themes of emotional burden, adherence challenges, bodily discomfort, social vulnerability, socioeconomic stress, and the need for ongoing educational and professional support.

Conclusion: Fear of injection is a multidimensional phenomenon influenced by psychological, clinical and context factors. Structured education combined with emotional counselling and ongoing professional support in diabetes care may improve adherence and self management outcomes in adults with insulin treatment

Biography:

Ms. Lishma Shann Mathew is a nursing educator and researcher currently serving as a Tutor/Clinical Instructor in the College of Nursing at the All India Institute of Medical Sciences (AIIMS), Deoghar, Jharkhand, India. She has contributed to nursing education through teaching, mentoring, and research activities, with particular interests in Medical-Surgical Nursing, rehabilitation, disability studies, and emerging healthcare technologies. She completed her nursing education at Christian Medical College (CMC), Vellore, where she pursued her undergraduate nursing degree and subsequently obtained a Master of Science (M.Sc.) in Nursing, specializing in Medical-Surgical Nursing. At AIIMS Deoghar, her active role involves undergraduate nursing education, facilitating the development of clinical competencies among nursing students. Her scholarly work includes publications in areas such as prosthetic technology, rehabilitation, and the psychosocial aspects of chronic illness and disability. Her notable contributions include studies on adaptation, disability, and resilience among individuals with amputations, as well as reviews on advances in sensory-enabled prosthetic technologies.