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. 2026 Jan 19;28(3):2277–2285. doi: 10.1111/dom.70422

Preferences for basal insulin treatments in adults with type 2 diabetes: A discrete choice experiment in France and Spain

Amy M Jones 1,✉, Pam Hallworth 2, Helen Kendal 1, Claire Mottershead 2, Lewis Ormerod 2, Virginia Pascual 3, Clémence Antier 4, Diogo Belbute 5, Elisabeth de Laguiche 5, Virginia Bellido 6,7
PMCID: PMC12890752  PMID: 41555588

Abstract

Aim

To quantify the relative importance of frequency of administration in basal insulin treatment preferences of people living with type 2 diabetes (T2D) in France and Spain, using a discrete choice experiment (DCE).

Materials and Methods

A targeted literature review and qualitative patient interviews informed an attributes and levels grid consisting of six attributes (2–3 levels each). Pilot interviews were conducted to test the DCE. A quantitative DCE survey was administered to adults with T2D in France and Spain. Hierarchical Bayesian estimation was used to identify the relative importance of each attribute.

Results

The survey was completed by N = 239 participants from France (n = 166) and Spain (n = 73) across three treatment experience categories: basal insulin and injectable glucagon‐like peptide‐1 receptor agonists (GLP‐1 RA) naïve (n = 86), basal insulin naïve but injectable GLP‐1 RA experienced (n = 85), and basal insulin experienced (n = 68). Frequency of administration had a relative importance of 39%, nearly double that of the attribute with the next highest relative importance ‘risk of severe hypoglycemic event (insulin experienced rates)’ (21%). A preference for once weekly (OW) administration was observed relative to once daily (OD) or twice daily (BD). Reduction in the frequency of missing doses and taking doses at the prescribed time were considered the most positive impacts of OW administration. Findings were consistent across treatment experience groups.

Conclusion

This study highlights the importance of administration frequency in basal insulin treatment decisions when glycemic control is held constant. Participants indicated a preference for OW injection frequency, suggesting fewer injections may reduce the burden of insulin administration. These insights support clinical consideration of less frequent injections when making T2D treatment decisions.

Keywords: attitudes, barriers, basal insulin, perceptions, type 2 diabetes

1. INTRODUCTION

Type 2 diabetes (T2D) is a chronic metabolic disorder characterised by insulin resistance and/or impaired insulin production, leading to inadequate regulation of blood glucose levels. 1 In 2024, an estimated 4.7 million Spanish adults (representing 13.1% of the population) and 4.1 million French adults (representing 9.0% of the population) were living with diabetes, with prevalence expected to continue to rise. 2 T2D accounts for approximately 90% of all adult cases of diabetes. 3 Uncontrolled T2D can lead to diabetes‐related complications, which can have a significant impact on overall health and health‐related quality of life (HRQoL). 4 , 5 Optimising blood glucose levels is therefore essential to improve health outcomes for people living with T2D. 6 , 7

Diabetes management is individualised and involves a combination of behavioural health modifications and pharmacological interventions. 8 For people living with T2D with insufficient glycemic control despite the use of multiple glucose‐lowering agents, the Société Francophone du Diabète in France 9 and Sociedad Española de Diabetes in Spain 10 recommend the initiation of basal insulin. People living with T2D on once daily (OD) or twice daily (BD) insulin; however, often face adherence challenges, which are associated with poor glycemic control. 11 , 12 , 13 The recent development of once weekly (OW) basal insulin 14 , 15 may reduce treatment burden and improve treatment adherence and persistence, contributing to better treatment outcomes. 16 , 17 , 18

The value of incorporating the patient voice into medical product decision making is increasingly recognised by regulatory authorities and health technology assessment (HTA) bodies across Europe. The European Medicines Agency (EMA) emphasises the importance of integrating patient input into regulatory activities, including the use of evidence‐based patient experience data to support benefit–risk decision making. 19 HTA bodies, such as the Haute Autorité de Santé in France 20 and Red Española de Agencias de Evaluación de Tecnologías Sanitarias in Spain, 21 , 22 have also begun engaging patients in their processes and are increasingly receptive to patient preference evidence to inform the assessment of new treatments.

The discrete choice experiment (DCE) is a well‐established methodology to gather insights into treatment aspects that are most important to patients, and the trade‐offs patients are willing to make between treatment attributes. 23 , 24 To investigate the relative importance of frequency of administration of basal insulin treatments across countries, the authors conducted a DCE with people living with T2D in Canada, France, Spain, and Japan. 25 These countries were selected based on global diversity, anticipated willingness for HTA bodies to accept patient preference evidence, and recruitment feasibility.

While the results of the global sample are reported in Jones et al., 25 given the differing treatment landscapes across regions, an in‐depth exploration of the results from participants within European healthcare contexts was warranted. This paper reports the basal insulin treatment preferences of French and Spanish participants living with T2D.

2. MATERIALS AND METHODS

2.1. Study design

Study activities were conducted in three phases: (1) a targeted literature review, (2) qualitative patient interviews, and (3) administration of a quantitative online preference survey with DCE to people living with T2D in Canada, France, Spain, and Japan. The focus of this manuscript is on the pooled phase 3 DCE results for France and Spain. To ensure the scientific rigour of the research and support the interpretation of results, input was obtained from an advisory panel consisting of representatives of people living with T2D and clinical experts. The advisory panel provided input throughout the development and testing of the attributes and levels (A&L) grid and implementation of the DCE.

Ethical approval and oversight for the quantitative online survey with DCE was obtained from Salus institutional review board (initial approval 17 October 2023, amendments approved 28 February 2024 and 10 April 2024). All participants provided informed consent prior to any study activities.

2.2. A&L grid development

The final A&L grid, informed by the targeted literature review and qualitative interviews, comprised six attributes with 2–3 levels each: mode of administration, frequency of administration, timing of dose, dose monitoring, and risk of a severe hypoglycemic event (insulin naïve and insulin experienced rates). Both insulin naïve and insulin experienced hypoglycemic event rates were presented to all participants to reflect real‐world experiences when reading insulin product labelling. Attribute and level wording is provided in Table 1; the full version shown to participants is available in Jones et al. 25

TABLE 1.

Attributes and levels.

Attribute Levels
Mode of administration

  1. Injection pen that can provide several doses of insulin and is thrown away after 28 days

  2. Injection pen that can provide several doses of insulin and can be refilled with insulin cartridges. The pen is thrown away after 5 years
Frequency of administration

  1. Twice daily

  2. Once daily

  3. Once weekly
Timing of dose

  1. Same time for each dose (± 1 h)

  2. Same time for each dose (± 3 h)

  3. Anytime for each dose (within 24 h)
Dose monitoring

  1. Manually record the dose administered on paper

  2. Manually record the dose administered in an app

  3. Dose is automatically recorded in an app
Risk of severe hypoglycemic event (insulin naïve rates)

  1. 2 out of 10 insulin naïve patients who took this insulin for a year experienced a severe hypoglycemic event

  2. 1 out of 100 insulin naïve patients who took this insulin for a year experienced a severe hypoglycemic event

  3. No insulin naïve patients who took this insulin for a year experienced a severe hypoglycemic event
Risk of severe hypoglycemic event (insulin experienced rates)

  1. 6 out of 100 insulin experienced patients who took this insulin for a year experienced a severe hypoglycemic event

  2. 3 out of 100 insulin experienced patients who took this insulin for a year experienced a severe hypoglycemic event

  3. 1 out of 100 insulin experienced patients who took this insulin for a year experienced a severe hypoglycemic event
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Glycated haemoglobin (HbA1c) reduction was held constant (i.e., participants were told that all treatments had the same impact on HbA1c) as findings from the qualitative interviews suggested HbA1c reduction may be overly important or influential to treatment decision making and may therefore dominate preferences, limiting the ability to fully examine the relative importance of other attributes (i.e., if all treatment decisions are made with regards to HbA1c reduction, preferences between other treatment attributes would be minimised). Cost was also held constant due to differences across the countries included in this study and evidence from the literature suggesting cost could create a dominating preference. 26

2.3. Survey procedures

Survey procedures are described in detail in Jones et al. 25 Surveys were translated by CETRA Language Solutions and reviewed by the recruitment agencies in each country ahead of being administered to participants in their local language. Pilot testing of the survey in each market further ensured the validity of the translations. Following pilot testing, participants completed the DCE as part of a 30‐min quantitative online preference survey translated to their local language. Demographic and health‐related information were collected as part of the survey to support sample target monitoring and sample characterisation. Training and briefing materials were also included to provide guidance on how to complete the DCE tasks. Eleven DCE choice tasks, two practice ‘dummy’ tasks, and two hold out tasks were then presented to participants. All tasks were forced‐choice (no opt‐out option). The ‘dummy’ tasks were included for participants to practice completing the choice tasks ahead of completing the DCE; the hold out tasks (i.e., pre‐defined choice tasks that were shown to all participants at defined intervals) were used to provide indication of model accuracy. Participant comprehension and health literacy were assessed via the BRIEF health literacy tool. 27 The survey also included questions to assess the perceived impact of changing from OD to OW treatment.

2.4. Experimental design

A design file was created using Lighthouse Studio with priori estimates of standard errors of <0.05 to test for differences across levels for each attribute (main effects). 28 , 29 Two levels of the A&L grid were considered implausible if presented together in a hypothetical treatment profile (i.e., the risk of a severe hypoglycemic event for a treatment option would never be greater for insulin naïve vs. insulin experienced participants). Thus, these attributes were prohibited from appearing in the same choice task profile. Except for those indicated as prohibited, the design algorithm 28 , 30 ensured all possible combinations of choice task profiles were generated, while keeping the two alternative hypothetical treatment options as distinct as possible. 31 The DCE was designed to ensure that each level appeared an equal number of times per attribute (level balance) and with every other level of different attributes (near‐orthogonality). As it was not feasible for each participant to respond to every possible combination, 100 blocks of the design were generated and randomly assigned to each participant (using a least‐fill quota). Each block was seen at least once.

2.5. Statistical analysis

Hierarchical Bayesian (HB) estimation was applied to the DCE data to estimate the relative value each participant ascribed to each attribute level, called part‐worth utilities. 7 HB was chosen for its flexibility in modelling and handling of complex covariance structures, 32 enabling estimation of individual‐level part‐worth utility values for each attribute level.

Part‐worth utilities measure the value placed on each level relative to the value placed on other levels in the same attribute. A lower part‐worth utility indicates less value or desirability, while a higher part‐worth utility indicates high desirability or more value. Part‐worth utilities were zero‐centred for all variables (effects coded) and summed to zero within each attribute.

Using the individual‐level part‐worth utilities from the DCE analysis, the range (maximum minus minimum) was calculated for each attribute in the A&L grid and subsequently reproportioned across the attributes and averaged across the sample to calculate the relative importance of each attribute.

Relative importance scores provide an indication of how much difference each attribute could have in the total part‐worth utility of a treatment profile within the bounds of the ranges of the attribute levels. The higher a relative importance, the more influential an attribute is to treatment choice.

A covariate for patient type (insulin naïve vs. insulin experienced) was applied to the DCE analysis to account for inclusion of two severe hypoglycemic event attributes. This ensured accuracy of the utility estimation at the subgroup level, facilitating discrimination between patient types.

Responses to the BRIEF Health Literacy Tool were given a point between 1 and 5 for each question; an overall score was calculated from the sum of these points, ranging from 4 to 20. Scores were used to determine if a respondent's health literacy was limited (4–12), marginal (13–16) or adequate (17–20). Responses to the questions relating to the perceived impact of changing frequency of administration were analysed using the proportion of participants who responded with a certain response option.

2.6. Participant sample

A total of n = 280 participants from France (n = 170) and Spain (n = 110) were targeted for inclusion. Participants were identified by specialist recruitment agencies in France (Zeste Research) and Spain (Pharmore Research), via Patient Advocacy Groups (PAGs; Spain only) and healthcare professional referrals. The recruitment agencies either obtained a self‐reported diagnosis of T2D over the phone (France and Spain) or proof of diagnosis via a physician confirmation form or other documentation, such as hospital letters (Spain only). To be eligible, participants had to be at least 18 years of age, diagnosed with T2D greater than or equal to 180 days prior to the day of screening, and currently prescribed a diabetes treatment, with the exclusion of bolus insulin. Eligible individuals who expressed interest in the study were sent a link to confirm their consent to participate. Sampling targets were set to ensure a diverse sample based on treatment experience (basal insulin and injectable glucagon‐like peptide‐1s receptor agonists [GLP‐1 RA] naïve, basal insulin naïve but with injectable GLP‐1 RA experience, and basal insulin experienced) and demographic characteristics (age, sex, education). Given that no OW insulins had been approved in France or Spain at the time of data collection, it was expected that participants would only have experience with daily basal insulin injections. Targets for treatment experience were established based on the expectation that preferences may vary depending on participants' progression in the diabetes treatment pathway.

3. RESULTS

3.1. Sample characteristics

A total of n = 245 participants from France (n = 170) and Spain (n = 75) completed the survey. Following validation checks, the sample was reduced to n = 239 (France: n = 166, Spain: n = 73); five participants failed to demonstrate an understanding of the ‘dummy’ task, and one did not meet the eligibility criteria (i.e., received bolus insulin).

Participants had a mean age of 60.1 years (range: 29–90 years), more were male (54.4%), and mean time since diagnosis was 11.9 years. Most participants had marginal health literacy (48.5%). There was good representation of participants in the three treatment categories (n = 86 basal insulin and injectable GLP‐1 RA naïve; n = 85 basal insulin naïve but injectable GLP‐1 RA experienced; n = 68 basal insulin experienced). Sampling targets were achieved for sex and mostly achieved for T2D treatment experience, age, and education level, with representation across each characteristic (Supplementary Table 1).

3.2. Pilot interviews

Twelve participants from France and Spain (n = 6 in each country) took part in a pilot interview. Findings indicated the survey was well understood and easy to complete, with no information missing. Survey length and duration were also considered appropriate. Small modifications were made to improve participant comprehension.

3.3. Part‐worth utility estimates

Average root‐likelihood (RLH) was 0.845, which represents a strong model fit and suggests high internal consistency in respondents' choices. The part‐worth utility values predicted the two holdout tasks with 82% accuracy on average.

As shown in Figure 1, when looking at the frequency of administration, OW was preferred over OD injection frequency, both of which were preferred over BD. For the timing of dose, participants preferred a treatment taken anytime within 24 h, suggesting a preference for treatments that afford flexibility in the time they can be administered. Participants also preferred the use of applications that automatically record doses, rather than traditional pen and paper. Regardless of insulin experience, lower incident rates of severe hypoglycemic events were preferred to higher incident rates, suggesting that as the risk of a severe hypoglycemic event increases, participants' preferences for a treatment decrease. Finally, for the mode of administration, participants indicated a slight preference for a disposable injection pen (i.e., several doses of insulin and is thrown away after 28 days) over a refillable injection pen (i.e., several doses of insulin and can be refilled with insulin cartridges).

FIGURE 1.

FIGURE 1

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Mean part worth utility values for each attribute level (N = 239). Higher part‐worth utility values indicate greater preference relative to other levels within the same attribute.

3.4. Relative attribute importance

The relative importance of attributes included in this study are provided in Figure 2. ‘Frequency of administration’ had the highest relative importance (39%), which was nearly twice as important as the attribute with the second greatest relative importance—‘risk of severe hypoglycemic event (insulin experienced rates)’. This suggests that ‘frequency of administration’ is the most important attribute and the most notable driver of basal insulin treatment preferences within the French and Spanish sample.

FIGURE 2.

FIGURE 2

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Relative importance score per attribute (N = 239). The higher the relative importance, the more influential an attribute was to treatment choice, within the attributes tested.

Relative importance scores were generally consistent across treatment experience subgroups (Figure 3). However, the relative importance of ‘frequency of administration’ was slightly higher for basal insulin naïve but injectable GLP‐1 RA experienced participants (44%) compared to basal insulin and injectable GLP‐1 RA naïve (37%) and basal insulin experienced participants (36%). Due to the sample size being insufficient to support statistical analyses, these results should be considered directional only.

FIGURE 3.

FIGURE 3

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Relative importance scores per attribute by T2D treatment experience (N = 239). The higher the relative importance, the more influential an attribute was to treatment choice, within the attributes tested.

3.5. Impact of changing treatment frequency

The positive impact of changing to an OW treatment was most pronounced for ‘frequency of missing doses’ (36% reported much or a little better) and ‘taking doses at the prescribed time’ (35% reported much or a little better) (Figure 4). One‐quarter of participants also indicated that an OW treatment would lessen the ‘impact on daily activities’ (23% reported much or a little better whereas only 12% reported much or a little worse). More participants, however, responded that an OW treatment would worsen their concerns about ‘experiencing a hypoglycemic event’ and ‘blood glucose levels’ (for both, 31% reported much or a little worse) than improve them (17% and 15%, respectively, reported much or a little better).

FIGURE 4.

FIGURE 4

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Impact of changing treatment frequency (N = 239).

4. DISCUSSION

This patient preference study employed best practices 33 , 34 to understand the relative importance of frequency of administration of basal insulin treatment for people living with T2D in France and Spain.

Results of the DCE suggested that frequency of administration was the most important attribute and driver of basal insulin treatment preferences, compared with the other attributes tested in this study. Frequency of administration emerged as nearly twice as important as the attribute with the next highest relative importance—risk of severe hypoglycemic event (insulin experienced rates). Mean part‐worth utility values suggested a preference for OW treatments over OD or BD, indicating a higher desirability for treatments with as few injections as possible, which aligns with findings from prior preference studies conducted in the United States. 35 , 36 This study provides insights into the consistencies between patient preferences across geographies, where injection frequency remains an important consideration across countries and their correspondingly different healthcare systems. 25

When participants were asked about the anticipated impact of switching from OD to OW basal insulin, they most frequently highlighted a reduction in missed doses and improved adherence to taking their medication at the prescribed time as the most positive outcomes. These findings align with previous research, which identified an association between administration frequency and perceptions of treatment burden. 37 , 38 , 39 , 40 The need to administer basal insulin at the same time each day, for example, has been found to negatively impact aspects of HRQoL (e.g., work and social activities). 40 People living with T2D who perceive insulin injections as interfering with daily life or requiring them to plan activities around their dosing schedule are more likely to intentionally omit doses than other people. 39 Concerns about managing a complex insulin regimen and the perceived impact such therapy may have on daily life have also been cited as barriers to insulin acceptance. 41 Reducing the number of injections to OW may lessen the burden associated with administration frequency and improve patient quality of life, thereby leading to better medication adherence and treatment outcomes. 12 , 16 , 17 , 18 In the case of insulin naïve patients, the simplification of the insulin regimen and greater flexibility in dose timing may increase their willingness to initiate insulin therapy if recommended. 41

Although results from treatment subgroup analysis can only be considered directional due to sample size limitations, the relative importance of attributes was generally consistent, with frequency of administration remaining the primary driver of treatment preference. Basal insulin naïve (but injectable GLP‐1 RA experienced) participants reported a greater relative importance for frequency of administration (44%) than basal insulin and injectable GLP‐1 RA naïve (37%) and basal insulin experienced (36%) participants. Participants in the basal insulin naïve (but injectable GLP‐1 RA experienced) subgroup may have experience with OW GLP‐1 RA, and may therefore be reluctant to initiate an insulin requiring more frequent administration due to perceived treatment burden. 42 , 43 For those in the basal insulin and GLP‐1 RA naïve subgroup, the lower relative importance may reflect other concerns related to insulin initiation including risk of severe hypoglycemia. 44

Patient preference studies offer valuable insights into what matters most to patients and the trade‐offs they are willing to make between different treatment attributes. 23 , 24 Understanding the factors driving patient treatment decisions may help identify barriers to treatment initiation and adherence. Consequently, patient preference studies are gaining recognition from regulatory authorities and HTA bodies across Europe as a valuable source of insights into treatment value from a patient perspective. 19 , 20 , 21 , 34 Considering patient preferences may therefore support patient‐centric reimbursement decisions and guideline development, allowing decision‐makers to prioritise treatments that hold the greatest value for people living with T2D. This approach may foster better treatment adherence, resulting in improved clinical outcomes 16 and potential reductions in healthcare costs and resource utilisation. 44

4.1. Limitations

This study included a sample of people living with T2D with a broad spectrum of prior treatment experience. The sample included both male and female participants and reflected variation in educational background. However, 98% of participants were aged 40 or above, which aligns with the general population of people living with T2D, 45 but may limit an understanding of the perspectives of younger individuals with earlier onset of T2D. Most survey participants also provided a self‐reported diagnosis of T2D, which was largely due to data protection laws prohibiting the collection and processing of health data. As such, some survey participants may not have had an official T2D diagnosis. To mitigate this, participants were identified and recruited via healthcare referrals and PAGs to better ensure only those with T2D completed the survey. It was also not possible to evaluate the diversity in race and ethnicity of participants as collection of such data is prohibited under European Union legislation. However, a variety of methods were used to ensure diversity and representativeness in the sample, such as recruiting from multiple channels and enabling online participation to avoid travel and cost barriers. Nonetheless, it is recognised that online recruitment may favour groups with greater internet access or digital literacy.

Industry sponsorship is acknowledged. An advisory panel comprising patient representatives and clinical experts provided input to the study design, data analysis and interpretation to ensure scientific rigour and limit bias.

The basal insulin treatment options included in the DCE may not fully replicate real‐world treatment decision making, where other considerations such as cost or access to care may come into play. Every attempt was made to ensure the basal insulin treatment options included in the DCE were as representative and meaningful as possible. An average of 5.74 attributes is also supported by the existing literature. Attributes included in a DCE should also be conceptually distinct. Presenting two variations for the risk of severe hypoglycemic events could therefore be seen as a limitation. However, the inclusion of both options reflects the data available to people living with T2D in France and Spain, ensuring replication of real‐life decision making and alignment with the specific decision context. Pilot interviews were also conducted with the first six participants from each country enrolled in the survey to ensure comprehension of the DCE tasks.

The cost of hypothetical treatments presented in the DCE was held constant. The nuances of out‐of‐pocket costs, local reimbursement, or local healthcare systems may influence the treatment preferences of people living with T2D in real‐life situations. Further investigation of the impact of healthcare delivery factors on patient preferences may be warranted. Similarly, HbA1c reduction was held constant to allow for exploration of the relative importance of other attributes, but future research could explore how preferences change when HbA1c reduction is considered.

5. CONCLUSION

This study highlights the importance of frequency of administration in driving basal insulin treatment preferences among people living with T2D in France and Spain, when HbA1c reduction is held constant. Participants reported a preference for OW injection frequency over OD or BD and identified a reduction in the frequency of missing doses as the most positive anticipated impact of OW administration. OW basal insulins could therefore potentially reduce the burden associated with injection frequency, thereby improving adherence to treatment and clinical outcomes among people living with T2D in France and Spain. These findings may be useful to clinicians and other healthcare decision makers in considering patient preferences for T2D treatments, and less frequent injections, as part of patient centric decision‐making.

AUTHOR CONTRIBUTIONS

EL and DB contributed to the study conception. AMJ, PH, HK, CM, LO, and EL contributed to the study design. All authors contributed to material preparation. Data were collected by PH, CM, and LO. All authors contributed to the data analysis and interpretation of results, and all authors critically reviewed the manuscript and provided their final approval.

CONFLICT OF INTEREST STATEMENT

AMJ, PH, HK, CM, and LO are employees of Adelphi Values and Adelphi Research, which received consulting fees from Novo Nordisk A/S. DB and EL are employees and shareholders of Novo Nordisk A/S who provided funding for this study. VB has served as a consultant for or received research support, lecture fees, or travel reimbursement from Abbott, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Esteve, Merck, Novo Nordisk, and Sanofi.

Supporting information

Supplementary Table 1. Demographics and clinical characteristics (N = 239).

DOM-28-2277-s001.docx (33.8KB, docx)

ACKNOWLEDGEMENTS

The authors thank the participants of this study. The authors would also like to acknowledge the contributions of Sophi Tatlock (formally of Adelphi Values), Sophie Wallace (Adelphi Values), Elizabeth Tute (Adelphi Research), Bethany Bell (Adelphi Research), Morten Sall Jensen (Novo Nordisk), Godfrey Mau (Novo Nordisk), Riku Ota (Novo Nordisk), and Ann Besner (formerly Diabetes Canada). The research was funded by Novo Nordisk A/S. Medical writing support was provided by Alyson Young (Adelphi Values), with funding from Novo Nordisk Denmark.

Jones AM, Hallworth P, Kendal H, et al. Preferences for basal insulin treatments in adults with type 2 diabetes: A discrete choice experiment in France and Spain. Diabetes Obes Metab. 2026;28(3):2277‐2285. doi: 10.1111/dom.70422

DATA AVAILABILITY STATEMENT

All the relevant data has been reported in the manuscript and supplementary files. The datasets generated during and/or analyzed during the current study are not publicly available due to participants consenting to data being published in anonymized form and survey responses only being available to the project teams responsible for conducting and/or analyzing the research.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary Table 1. Demographics and clinical characteristics (N = 239).

DOM-28-2277-s001.docx (33.8KB, docx)

Data Availability Statement

All the relevant data has been reported in the manuscript and supplementary files. The datasets generated during and/or analyzed during the current study are not publicly available due to participants consenting to data being published in anonymized form and survey responses only being available to the project teams responsible for conducting and/or analyzing the research.

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