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Meso level influences on long term condition self-management: stakeholder accounts of commonalities and differences across six European countries

Meso level influences on long term condition self-management: stakeholder accounts of commonalities and differences across six European countries
Meso level influences on long term condition self-management: stakeholder accounts of commonalities and differences across six European countries
Background

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. 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.

Methods

Ninety 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.

Results

Stakeholders 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.

Conclusions

The 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.
1471-2458
1-11
Rogers, Anne
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Vassilev, Ivaylo
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Pumar, Maria J. Jesús
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Todorova, Elka
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Portillo, Mari Carmen
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Foss, Christina
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Koetsenruijter, Jan
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Ratsika, Nikoleta
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Serrano, Manuel
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Knutsen, Ingrid A. Ruud
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Wensing, Michel
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Roukova, Poli
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Patelarou, Evridiki
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Kennedy, Anne
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Lionis, Christos
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Rogers, Anne
105eeebc-1899-4850-950e-385a51738eb7
Vassilev, Ivaylo
d76a5531-4ddc-4eb2-909b-a2a1068f05f3
Pumar, Maria J. Jesús
af1d9c73-a81b-491c-9d36-dd3e37e851fb
Todorova, Elka
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Portillo, Mari Carmen
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Foss, Christina
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Koetsenruijter, Jan
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Ratsika, Nikoleta
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Serrano, Manuel
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Knutsen, Ingrid A. Ruud
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Wensing, Michel
8702046c-6c87-404a-81a7-fcfcdebfb9cc
Roukova, Poli
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Patelarou, Evridiki
cd27250e-ca5e-4161-ae39-d35218d48017
Kennedy, Anne
e059c1c7-d6d0-41c8-95e1-95e5273b07f8
Lionis, Christos
458b4c43-ceff-4226-820d-c3db2cc8d08b

Rogers, Anne, Vassilev, Ivaylo, Pumar, Maria J. Jesús, Todorova, Elka, Portillo, Mari Carmen, Foss, Christina, Koetsenruijter, Jan, Ratsika, Nikoleta, Serrano, Manuel, Knutsen, Ingrid A. Ruud, Wensing, Michel, Roukova, Poli, Patelarou, Evridiki, Kennedy, Anne and Lionis, Christos (2015) Meso level influences on long term condition self-management: stakeholder accounts of commonalities and differences across six European countries. BMC Public Health, 15 (622), 1-11. (doi:10.1186/s12889-015-1957-1). (PMID:26152139)

Record type: Article

Abstract

Background

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. 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.

Methods

Ninety 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.

Results

Stakeholders 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.

Conclusions

The 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.

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More information

Accepted/In Press date: 22 June 2015
e-pub ahead of print date: 22 June 2015
Published date: 8 July 2015
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 379515
URI: https://eprints.soton.ac.uk/id/eprint/379515
ISSN: 1471-2458
PURE UUID: 48305265-687c-4b62-93a9-42f4972ff739
ORCID for Mari Carmen Portillo: ORCID iD orcid.org/0000-0003-1583-6612
ORCID for Anne Kennedy: ORCID iD orcid.org/0000-0003-4570-9104

Catalogue record

Date deposited: 03 Aug 2015 15:31
Last modified: 06 Jun 2018 12:28

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Contributors

Author: Anne Rogers
Author: Ivaylo Vassilev
Author: Maria J. Jesús Pumar
Author: Elka Todorova
Author: Christina Foss
Author: Jan Koetsenruijter
Author: Nikoleta Ratsika
Author: Manuel Serrano
Author: Ingrid A. Ruud Knutsen
Author: Michel Wensing
Author: Poli Roukova
Author: Evridiki Patelarou
Author: Anne Kennedy ORCID iD
Author: Christos Lionis

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