Insulin Treatment Satisfaction Questionnaire (ITSQ)

Transcription

1 Insulin Treatment Satisfaction Questionnaire (ITSQ) People who take insulin can have many different experiences with their treatment. Some people who take insulin may find it difficult and burdensome, while others feel that it is not much of a bother at all. The following questions are about your perceptions of your current insulin treatment and how it affects you in your daily life. When you think of your insulin treatment, please keep in mind the type of insulin you take, the dose or amount of insulin, your schedule for taking insulin, and the device or method you use to give yourself insulin. Please think about your experiences during the past 4 weeks when you answer the questions. Please answer each question by circling the number that best represents your answer. If you are unsure about how to answer a question, please give the best answer you can. 1. How much of a bother is it for you to take all your daily insulin doses as prescribed? No bother at all bother 2. How much does your current insulin treatment interfere with your ability to enjoy social or leisure activities? Does not interfere at all Interferes tremendously

2 3. How much does your current insulin treatment interfere with your work or school activities? (If you do not work or attend school, think about your regular daily activities). Does not Interferes interfere at all tremendously 4. How much do you have to plan the timing of your meals or snacks around the insulin you currently use? No planning at all amount of planning 5. How much do you have to plan what you eat with your current insulin treatment? No planning at all amount of planning 6. How much do you have to plan your physical activities (such as exercise or strenuous household chores) around your current insulin treatment? No planning at all amount of planning 7. How are you that you can avoid symptoms of low blood sugar (such as sweating, trembling, dizziness, blurred vision) with your current insulin treatment?

3 8. How are you that you can avoid severe episodes of low blood sugar that result in loss of consciousness (fainting or passing out) with the insulin you currently use? 9. In general, how bothered are you by symptoms of low blood sugar (such as sweating, trembling, dizziness, blurred vision) due to the insulin you currently use? bothered bothered 10. How much do you feel that the insulin you are currently using increases the chances that you will experience low blood sugar? 11. How worried are you about experiencing low blood sugars during the night with the insulin you currently use? worried worried 12. How are you that you can avoid symptoms of high blood sugar (such as dry mouth, thirst, frequent urination, fatigue, increased appetite) with your current insulin treatment?

4 13. How are you with the stability of your blood sugar levels with your current insulin treatment? 14. Overall, how pleased are you with the blood sugar control you achieve with your current insulin treatment? pleased pleased 15. In general, how stressful is it for you to manage taking your current insulin treatment? stressful stressful 16. How burdensome is it for you to manage your current insulin treatment? burdensome burdensome

5 The following questions are about your perceptions of your current method of taking insulin and how it affects you in your daily life. For these questions, you should only think about the device or method you use to give yourself insulin. 17. How easy is it for you to take the correct amount of insulin each time with your current method of taking insulin? easy easy 18. How convenient is your current method of taking insulin when you are away from home? convenient convenient 19. How much pain or other physical discomfort do you experience with your current method of taking insulin? No pain or amount of pain or discomfort discomfort 20. How comfortable are you taking insulin in a public place (where people might see you with your current method of taking insulin)? comfortable comfortable

6 21. How much emotional distress or anxiety do you experience related to your method of taking insulin? No distress or amount of distress anxiety or anxiety 22. Overall, how are you with your current method of taking insulin?