Interventions and working relationships of voluntary organisations for diabetes self-management: A cross-national study

Mari Carmen Portillo,Anne Kennedy,Elka Todorova,Elena Regaira,Michel Wensing,Christina Foss,Christos Lionis,Ivaylo Vassilev,Valentin Goev,Anne Rogers

doi:10.1016/j.ijnurstu.2017.02.001

Abstract

BackgroundDiabetes has become a challenging health priority globally. Given the tensions of financially burdened health systems in Europe the mobilisation of community resources like voluntary organisations and community groups is seen as a health policy strategy to sustain the management of long-term conditions like diabetes. However, little is known about how this is happening in practice in Europe. ObjectivesTo explore diabetes self-management interventions undertaken or promoted by voluntary organisations and community groups in Europe; and describe the types of working relationships between these organisations, European health systems and users when implementing diabetes self-management programmes in different areas. DesignA mixed method study (survey/qualitative interviews) was undertaken. This research formed part of a European project (7th Framework programme of the European Commission) exploring the link between resources, like community organisations, and peoples’ capacities to manage long-term conditions. SettingsSix European countries (Bulgaria, Greece, Norway, Spain, the Netherlands and the United Kingdom) participated in the study. Three areas: deprived urban area, a relatively affluent urban area and a deprived rural area were purposefully selected. ParticipantsThrough a purposeful sample and bottom up strategies 749 representatives of voluntary organisations and community groups were recruited from the geographical areas above. Organisations with at least three members, existing for at least one year that could provide information or other type of support directly or indirectly relevant to patients with diabetes were included. MethodsParticipants completed a 15 item questionnaire for the survey (n=749) and a voice recorded semi structured interview (n=300). Data collection focused on the type of activities and roles developed to promote health, and relationships and communication channels between organisations, health services and users. Descriptive and comparative statistical and qualitative content analyses were used. ResultsParticipants perceived they had better reach of people with health needs than health providers, filled the administration gaps left in their capacity to deal with basic diabetes practical needs, humanized care, and acted as mediators between services and communities. There were significant differences between countries in relation to the types of activities (p-value<0.001), roles (p-value<0.001) and funding sources (p-value<0.001) of organisations concerning diabetes self-management. In non-affluent countries organisations tend to promote social activities twice more often. ConclusionsCommunity and voluntary organisations provide complimentary and on-going support in diabetes management. This involves a shift from focusing on the illness to also longing for social cohesion, sense of community and wellbeing in diabetes health practices and policies.

Highlights

Diabetes has become a challenging health priority globally
This review suggested that the principles of: assistance, support, sharing and link constituted the backbone in the construction of relationships between professionals and voluntary organisations and community groups when planning diabetes selfmanagement programmes at a community level (Portillo et al, 2015)
Representatives had an average experience working in the voluntary organisations and community groups of 9.1 years with significant differences between some countries, Greek and United Kingdom voluntary organisations and community groups’ representatives had worked for longer compared to those in the Netherlands or Norway

Summary

Introduction

Diabetes has become a challenging health priority globally. Given the tensions of financially burdened health systems in Europe the mobilization of community resources like voluntary organisations and community groups is seen as a health policy strategy to sustain the management of long-term conditions like diabetes. Self-management programmes lack an effective mobilization of community resources to mitigate the serious consequences of chronic conditions like diabetes (such as early death, loss of limbs and sight, and isolation) in times of growing inequalities (Coulter et al, 2008; Khunti et al, 2012; World Health Organisation Regional office for Europe, 2011) In this sense, integrated models of care have potential to manage complex long-term conditions like diabetes as an attempt to avoid care delivery fragmentation and broaden out the care and support available for people beyond an illness focused approach (Coulter et al, 2008; Shrivastava et al, 2013). This is vital since day-to-day decisions related to diabetes are mainly taken by individuals in the context of their personal communities of support and own financial and social possibilities (Vassilev et al, 2013)

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