Social Support and Health in Diabetes Patients: An Observational Study in Six European Countries in an Era of Austerity.

INTRODUCTION: Support from individual social networks, community organizations and neighborhoods is associated with better self-management and health outcomes. This international study examined the relative impact of different types of support on health and health-related behaviors in patients with type 2 diabetes. METHODS: Observational study (using interviews and questionnaires) in a sample of 1,692 type 2 diabetes patients with 5,433 connections from Bulgaria, Greece, Netherlands, Norway, Spain, and the United Kingdom. Outcomes were patient-reported health status (SF-12), physical exercise (RAPA), diet and smoking (SDCSCA). Random coefficient regression models were used to examine linkages with individual networks, community organizations, and neighborhood type (deprived rural, deprived urban, or affluent urban). RESULTS: Patients had a median of 3 support connections and 34.6% participated in community organizations. Controlled for patients' age, sex, education, income and comorbidities, large emotional support networks were associated with decrease of non-smoking (OR = 0.87). Large practical support networks were associated with worse physical and mental health (B = -0.46 and -0.27 respectively) and less physical activity (OR = 0.90). Participation in community organizations was associated with better physical and mental health (B = 1.39 and 1.22, respectively) and, in patients with low income, with more physical activity (OR = 1.53). DISCUSSION: Participation in community organizations was most consistently related to better health status. Many diabetes patients have individual support networks, but this study did not provide evidence to increase their size as a public health strategy. The consistent association between participation in community organizations and health status provides a clear target for interventions and policies.

Voluntary Organizations and Community Groups as New Partners in Diabetes Self-management and Education: A Critical Interpretative Synthesis.

PURPOSE: The purpose of this study is to critically review the literature on the role and work of voluntary organizations and community groups and volunteers in diabetes self-management programs. It seeks to explain how these organizations are located and could be integrated further within a broader system of support. METHODS: A critical interpretative synthesis of the literature was undertaken as part of the conceptual development of a European research project. Evidence (2000-November 2014) was searched in databases, with the use of key terms, and limited to the languages of the participating countries. This was supplemented by an additional hand search and snowballing technique. A total of 21 articles were included in the review. RESULTS: Evidence regarding the involvement of voluntary organizations in diabetes self-management programs mainly related to: the nature and remit of their work, responsibilities, and attributes; key strategies of programs accounting for success; motivations/barriers for engaging in volunteering participation; relationships between volunteers and users; and connections/tensions with formal services. CONCLUSIONS: This review has uncovered a range of facets of voluntary organizations and community groups relevant for supporting diabetes self-management such as the context within which they act and the nature of relationships developed with community and health services. The principles of "assistance, support, sharing, and link" seem essential for this voluntary initiative in self-management to establish effective reciprocal collaboration with health professionals.

Empowerment and bariatric surgery: negotiations of credibility and control.

Today obesity is understood as a chronic illness. Programs developed to deal with obesity often build on an explicit aim to "empower" patients to take increased responsibility for their health, in line with contemporary neoliberal discourses. There is little empirically based knowledge about this so-called empowering process. In this article we focus on how an empowering program for patients diagnosed as morbidly obese worked on individuals' identity. The program encompassed a course in lifestyle change, bariatric surgery, and aftercare. We conducted qualitative interviews with 9 individuals at different stages of their treatment process and applied discourse analysis to interpret their constructions and negotiations as they progressed through the program. We found that dimensions of control and credibility framed the respondents' identity work. Based on the findings we suggest that contemporary discourses of empowerment as practice might leave the participants "trapped" within the ambivalence of freedom and control.

Morbidly obese patients and lifestyle change: constructing ethical selves.

Morbidly obese patients and lifestyle change: constructing ethical selves In contemporary societies, bodily size is an important part of individuals' self-representation. As the number of persons clinically diagnosed as morbidly obese increases, programmes are developed to make people reduce weight by changing their lifestyle, and for some, by bariatric surgery. This article presents findings from interviews with 12 participants undergoing a prerequisite course prior to bariatric surgery that is intended both as a preparation for further (surgical) treatment and as a tool to empower individuals regarding lifestyle changes. In this study, we investigate how power operates by looking at how the participants position themselves throughout the course. Findings reveal how participants construct their ability to act in line with norms of lifestyle change. They do this by positioning themselves as both included group members and as 'morally' acceptable individuals. Despite some resistance, the participants tend to glide into the role of 'good patients' acting in compliance with the aims of the course in their hope and striving for new positions as 'normal-sized'. The intention in the course is to empower individuals towards lifestyle changes. The findings provide a basis to question whether these kinds of courses create new forms of compliance and dependency.