TABLE 1.

Commonly Reported Cultural Barriers to Insulin Use Among Hispanics/Latinos, African Americans, and Asians

Racial/Ethnic Group	Perceptions of Insulin	Family	Social Factors	Religion
Hispanics/Latinos	• Insulin may be believed to cause more complications or harm • Insulin use may be believed to imply failure • Fear of insulin injections	• Lack of family support may delay insulin initiation • Family members may influence patients not to use insulin • Fatalistic views are common	• Insulin use may be viewed as a burden on the family • Insulin use may be seen as interfering with daily life	• Patients may use prayer as an intervention to manage diabetes and improve health • Diabetes may be viewed as a punishment
African Americans	• Insulin may be believed to lead to organ damage • Insulin may be believed to cause negative emotions • Insulin use demands a new mindset • Fear of insulin injections	• Patients often value family support • Patients often value family input • Fatalistic views are common	• Insulin use may be seen as interfering with schedule • Injections may be viewed as inconvenient • Insulin use may cause feelings of embarrassment	• Patients may use prayer to cope with diabetes management • Patients may use prayer to help change unhealthy behaviors
Asians	• Insulin use may imply failure • Insulin may be believed to lead to more complications • Insulin may be believed to cause harm • Fear of insulin injections	• Family support for insulin use may be unattainable	• Insulin may be viewed as a form of handicap • Insulin use may be considered indicative of severe illness • Insulin use may be seen as interfering with personal and social life • Insulin use may cause feelings of embarrassment	• Insulin use may interfere with religious obligations • Muslims may be concerned about insulin origins • Insulin may be seen as making life less flexible