Date of Conferral

6-6-2024

Date of Award

June 2024

Degree

Doctor of Public Health (DrPH)

School

Public Health

Advisor

Richard Palmer

Abstract

In South Africa, diabetes is a serious problem where 1 in 9 adults has diabetes, making it the country with the highest diabetes prevalence on the African continent. Even though insulin is an absolute necessity for treating diabetes, it is unaffordable to millions. Biosimilar insulins, however, are innovative medicines that are similar but not exact copies of the originator insulin, making alternative treatment affordable to patients. The problem is that, in South Africa, it is still not known whether patients have access to biosimilar insulin in a country where diabetes is rampant. The diffusion of innovation theory was used to understand the uptake of biosimilar and originator insulin glargine because the theory states that it is often quite difficult to adopt an innovation, even when the innovation brings apparent advantages. This quantitative, correlational study used secondary analysis to investigate the association between the location of a province, the specialization of a physician, and the type of dispensed insulin glargine prescriptions. A multinomial logistic regression showed that the specialization of a physician was associated with the type of dispensed insulin glargine prescriptions in South Africa (p < .001). The findings from this study support the need for educational interventions among physicians and policy implementation by policymakers. Implications for positive social change include supporting alternative, cost-effective biosimilar insulin glargine and broadening access to more affordable treatment choices for patients with diabetes. Furthermore, this study could impact public health practice by emphasizing the need for further studies on physicians using a longitudinal study design to understand how their biosimilar prescribing behavior changes over time.

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