What is the ITAS? The ITAS is a 20-item questionnaire that measures a person’s perception of insulin use. It explores both positive and negative beliefs about insulin through two subscales: Positive appraisal: 4 positive statements towards insulin use. Negative appraisal: 16 negative statements towards insulin use. Download here Why use the ITAS? Offers valuable insights into people’s thoughts and feelings about insulin therapy Helps healthcare professionals address specific concerns and barriers to insulin use Allows for early identification of potential resistance to insulin therapy Facilitates shared decision-making about insulin use between health professionals and the person with diabetes. When to use the ITAS When evaluating a person’s perspectives on insulin use for diabetes management Before initiating or reviewing insulin therapy to understand potential concerns When patients express hesitation or resistance towards insulin therapy. How to use the ITAS in clinical practice The person with diabetes rates their agreement with each statement on a scale of 1 (strongly disagree) to 5 (strongly agree). Calculate subscale scores: Positive appraisal: Sum scores for items 3, 8, 17, and 19 to produce a score between 4 and 20. Higher scores indicate more positive attitudes towards insulin. Negative appraisal: Sum scores for the remaining 16 items to produce a score between 16 and 80. Higher scores indicate more negative attitudes towards insulin. Total score (optional): While less common in clinical practice, a total score can be calculated by reversing scores on positive items and summing all 20 items to produce a score between 20 and 100. Higher scores reflect more negative attitudes. What to do with the score Focus on items with low positive scores (2 or below) and high negative scores (4 or above) as they likely indicate barriers to insulin use and require further discussion. Analyse individual item scores to pinpoint specific concerns or barriers related to insulin use. Use the scores to tailor interventions that address concerns and improve attitudes towards the benefits of insulin. Many people show positive attitudes towards the benefits of insulin despite having reservations about its use. So, endorsement of positive appraisals of insulin does not suggest an absence of psychological barriers. Referral considerations As psychological barriers to insulin use are intertwined with diabetes management, they are best addressed by the person’s diabetes health professional. In most cases, you will be able to address these barriers without referral, through education and counselling. A referral for additional mental health support may be needed if: you do not have the time and/or resources to provide the support needed you do not feel confident in your ability to address the psychological barriers the person with diabetes requests it the psychological barriers are severe (e.g. injection phobia) other psychological problems are present, such as depression or an anxiety disorder. Also consider Collaborative care with mental health professionals experienced in diabetes care to provide comprehensive and tailored support for the person experiencing mental health challenges. Clear communication between primary care providers and mental health professionals.
