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

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.

The articulation of neoliberalism: narratives of experience of chronic illness management in Bulgaria and the UK

“…In the analysis we aimed to elicit links between people's experiences of CIM and factors operating on macro, meso and micro levels, as well as identifying contextual changes over time (Brannen and Nilsen 2011). Drawing on our earlier analysis of factors identified by stakeholders in the two countries (Rogers et al 2015) we developed a preliminary coding frame which included the funding and adequacy of health care infrastructure, the impact of regulation, access to services, economic, social and cultural resources, the role of drug companies and the type of interventions introduced by primary care.…”

“…Drawing on our earlier analysis of factors identified by stakeholders in the two countries (Rogers et al . ) we developed a preliminary coding frame which included the funding and adequacy of health care infrastructure, the impact of regulation, access to services, economic, social and cultural resources, the role of drug companies and the type of interventions introduced by primary care.…”

“…Bulgaria and the UK offer contrasting examples in their stage of implementing neoliberal reforms, enthusiasm for austerity, adequacy of funding for health care and self-management support. They differ also in the existence and impact of dedicated self-management policies and interventions, the role of drugs companies in the provision of self-management support and the availability of policies and support in tackling social and health inequalities (Rogers et al 2015). This comparison will shed light on the necessary and contingent aspects of neoliberalism while also identifying factors and processes that have an impact on CIM that might remain invisible within single country analysis.…”

Stakeholders in support systems for self‐care for chronic illness: the gap between expectations and reality regarding their identity, roles and relationships

“…The operationalization of this social–ecological SSSC is challenging. While research abounds in terms of how support for self‐care is influenced by individual factors, understanding the impact of environmental influences remains scarce . This makes it difficult to establish which environmental aspects should be prioritized in the design of SSSC and who could and should be involved and held responsible for their management.…”

“…Most relevant findings related to the views expressed by key informants on policy practices and meso-level influences on type 2 diabetes and self-care have been reported elsewhere. 9,11 This paper focuses on reporting the findings related to the views of key informants from six European countries regarding who the main stakeholders are at different levels in the SSSC and how they should ideally participate and interact among one another. Key informants' perspectives on the actual levels of coordination and collaboration between these stakeholders are also examined.…”