Abstract
BackgroundEuropean countries are increasingly adopting systems of self –care support (SMS) for long term conditions which focus on enhancing individual, competencies, skills, behaviour and lifestyle changes. To date the focus of policy for engendering greater self- management in the population has been focused in the main on the actions and motivations of individuals. Less attention has been paid to how the broader influences relevant to SMS policy and practice such as those related to food production, distribution and consumption and the structural aspects and economics relating to physical exercise and governance of health care delivery systems might be implicated in the populations ability to self- manage. This study aimed to identify key informants operating with knowledge of both policy and practice related to SMS in order to explore how these influences are seen to impact on the self-management support environment for diabetes type 2.MethodsNinety semi-structured interviews were conducted with key stakeholder informants in Bulgaria, Spain, Greece, Norway, Netherlands and UK. Interviews were transcribed and analysed using thematic and textual analysis.ResultsStakeholders in the six countries identified a range of influences which shaped diabetes self-management (SM). The infrastructure and culture for supporting self- management practice is viewed as driven by political decision-makers, the socio-economic and policy environment, and the ethos and delivery of chronic illness management in formal health care systems. Three key themes emerged during the analysis of data. These were 1) social environmental influences on diabetes self-management 2) reluctance or inability of policy makers to regulate processes and environments related to chronic illness management 3) the focus of healthcare system governance and gaps in provision of self-management support (SMS). Nuances in the salience and content of these themes between partner countries related to the presence and articulation ofdedicated prevention and self- management policies, behavioural interventions in primary care, drug company involvement and the impact of measures resulting from economic crises, and differences between countries with higher versus lower social welfare support and public spending on shaping illness management.ConclusionsThe results suggest reasons for giving increasing prominence to meso level influences as a means of rebalancing and improving the effectiveness of implementing an agenda for SMS. There is a need to acknowledge the greater economic and policy challenging environment operating in some countries which act as a source of inequality between countries in addressing SMS for chronic illness management and impacts on people's capacity to undertake self-care activities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1957-1) contains supplementary material, which is available to authorized users.
Highlights
European countries are increasingly adopting systems of self –care support (SMS) for long term conditions which focus on enhancing individual, competencies, skills, behaviour and lifestyle changes
There is a need to acknowledge the greater economic and policy challenging environment operating in some countries which act as a source of inequality between countries in addressing self-management support (SMS) for chronic illness management and impacts on people's capacity to undertake self-care activities
Less attention has been paid to the contributions that may shape the uptake of SMS made by broader level influences which have been identified as increasingly relevant in an era of increasing economic crisis and uncertainty [1, 6]
Summary
European countries are increasingly adopting systems of self –care support (SMS) for long term conditions which focus on enhancing individual, competencies, skills, behaviour and lifestyle changes. European countries are increasingly adopting systems of long term condition management which include formulations for the delivery of self-management support (SMS) which stress individual motivation, goal setting, problem solving, life-style modification and information provision Such as diabetes type 2, attention has been paid to addressing the complexities of adjusting behaviour and practices through multiple behavioral and lifestyle change interventions [4, 5]. Less attention has been paid to the contributions that may shape the uptake of SMS made by broader level influences which have been identified as increasingly relevant in an era of increasing economic crisis and uncertainty [1, 6] The latter points to the need to more fully explore the economic and social policies related to food production, distribution and consumption, the structural aspects and economics of the environment relating to exercise and the structure and governance of health care delivery systems at a local and regional level [7]. Using diabetes type 2 as an orientating condition our aim was to rebalance the focus on the micro individual action focus of policy through tapping the hidden, predominantly meso level influences of political-economic, policy, and institutional organisational arrangements
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