Diabetes self-management arrangements in Europe: a realist review to facilitate a project implemented in six countries View Full Text


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Article Info

DATE

2014-10-02

AUTHORS

Antonis A Kousoulis, Evridiki Patelarou, Sue Shea, Christina Foss, Ingrid A Ruud Knutsen, Elka Todorova, Poli Roukova, Mari Carmen Portillo, María J Pumar-Méndez, Agurtzane Mujika, Anne Rogers, Ivaylo Vassilev, Manuel Serrano-Gil, Christos Lionis

ABSTRACT

BACKGROUND: Self-management of long term conditions can promote quality of life whilst delivering benefits to the financing of health care systems. However, rarely are the meso-level influences, likely to be of direct relevance to these desired outcomes, systematically explored. No specific international guidelines exist suggesting the features of the most appropriate structure and organisation of health care systems within which to situate self-management approaches and practices. This review aimed to identify the quantitative literature with regard to diabetes self-management arrangements currently in place within the health care systems of six countries (The United Kingdom, The Netherlands, Norway, Spain, Bulgaria, and Greece) and explore how these are integrated into the broader health care and welfare systems in each country. METHODS: The methodology for a realist review was followed. Publications of interest dating from 2000 to 2013 were identified through appropriate MeSH terms by a systematic search in six bibliographic databases. A search diary was maintained and the studies were assessed for their quality and risk of bias. RESULTS: Following the multi-step search strategy, 56 studies were included in the final review (the majority from the UK) reporting design methods and findings on 21 interventions and programmes for diabetes and chronic disease self-management. Most (11/21, 52%) of the interventions were designed to fit within the context of primary care. The majority (11/21, 52%) highlighted behavioural change as an important goal. Finally, some (5/21, 24%) referred explicitly to Internet-based tools. CONCLUSIONS: This review is based on results which are derived from a total of at least 5,500 individuals residing in the six participating countries. It indicates a policy shift towards patient-centred self-management of diabetes in a primary care context. The professional role of diabetes specialist nurses, the need for multidisciplinary approaches and a focus on patient education emerge as fundamental principles in the design of relevant programmes. Socio-economic circumstances are relevant to the capacity to self-manage and suggest that any gains and progress will be hard to maintain during economic austerity. This realist review should be interpreted within the wider context of a whole systems approach regarding self-care support and chronic illness management. More... »

PAGES

453

References to SciGraph publications

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  • 2008-10-17. The emotional context of self-management in chronic illness: A qualitative study of the role of health professional support in the self-management of type 2 diabetes in BMC HEALTH SERVICES RESEARCH
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    http://scigraph.springernature.com/pub.10.1186/1472-6963-14-453

    DOI

    http://dx.doi.org/10.1186/1472-6963-14-453

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1030475927

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/25278037


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