Abstract
AIM: The aim of this paper is to present a conceptual framework for the analysis of chronic disease prevention work according to the principles of a multilevel approach to T2DM in Denmark.METHOD: We conducted a review of published papers using PubMed, EMBASE, Web of Science, Google, Google Scholar, NICE Evidence Search, and we extended our search to include grey zone literature. We chose to focus our literature review on the collaboration between the different actors in the health system and the prevention and management of type 2 diabetes. We reviewed abstracts, and our search yielded a final total of 52 papers, of which we retained 18 and eliminated papers which were not related explicitly to the subject.RESULTS: Results showed that prevention and management of type T2DM must address multiple factors at multiple levels (intrapersonal, interpersonal and structural level) and within multiple settings (medical settings, communities/municipalities, regions and government). To analyze chronic disease prevention from a multilevel approach perspective, a conceptual framework was developed, which would guide the analytical process. Interventions should tackle specific risk factors within specific populations and by different actors who need to act in a coordinated manner.CONCLUSION: It is becoming increasingly clear that a multilevel approach is needed to prevent chronic diseases. Working at multiple levels with multiple actors in the health system will hopefully help fight the increasing numbers of chronic diseases.
Highlights
Chronic diseases are the leading causes of mortality and morbidity and are likely to impose an even larger burden in the future in Denmark (Carstensen, Kristensen, Ottosen, & Register, 2008; Guariguata, Whiting, Hambleton, & Beagley, 2013)
Aim: The aim of this paper is to present a conceptual framework for the analysis of chronic disease prevention work according to the principles of a multilevel approach to type 2 diabetes mellitus (T2DM) in Denmark
It is becoming increasingly clear that a multilevel approach is needed to prevent chronic diseases
Summary
Chronic diseases are the leading causes of mortality and morbidity and are likely to impose an even larger burden in the future in Denmark (Carstensen, Kristensen, Ottosen, & Register, 2008; Guariguata, Whiting, Hambleton, & Beagley, 2013). The definition of multilevel approach is to model effects of interactions of micro, meso and macro levels (as described later) on diabetes prevalence in the population. International research shows that health systems can be designed to prevent and manage chronic diseases more effectively by applying a multilevel approach, but it is essential that a system level change is accompanied by a supportive environment, and the empowerment and active participation of individuals, families, communities and the government (Paquette-Warren, Tompkins, & Harris, n.d.; Whittemore et al, 2016). A multilevel understanding of health signals the importance of the inter-relationship between the environment and the individual person. Using diabetes as an example of a chronic disease, it aims to identify what kinds of prevention measures are relevant on different levels and how the different levels cooperate: gjhs.ccsenet.org
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