title: Social support systems as determinants of self-management and quality of life of people with diabetes across Europe: study protocol for an observational study.
abstract: BACKGROUND
  Long-term conditions pose major challenges for healthcare systems. Optimizing self-management of people with long-term conditions is an important strategy to improve quality of life, health outcomes, patient experiences in healthcare, and the sustainability of healthcare systems. Much research on self-management focuses on individual competencies, while the social systems of support that facilitate self-management are underexplored. The presented study aims to explore the role of social systems of support for self-management and quality of life, focusing on the social networks of people with diabetes and community organisations that serve them.
  
  
  METHODS
  The protocol concerns a cross-sectional study in 18 geographic areas in six European countries, involving a total of 1800 individuals with diabetes and 900 representatives of community organisations. In each country, we include a deprived rural area, a deprived urban area, and an affluent urban area. Individuals are recruited through healthcare practices in the targeted areas. A patient questionnaire comprises measures for quality of life, self-management behaviours, social network and social support, as well as individual characteristics. A community organisations' survey maps out interconnections between community and voluntary organisations that support patients with chronic illness and documents the scope of work of the different types of organisations. We first explore the structure of social networks of individuals and of community organisations. Then linkages between these social networks, self-management and quality of life will be examined, taking deprivation and other factors into account.
  
  
  CONCLUSIONS
  This study will provide insight into determinants of self-management and quality of life in individuals with diabetes, focusing on the role of social networks and community organisations.
authors.affiliation: Radboud University Medical Centre, Scientific Institute for Quality in Healthcare, Nijmegen, The Netherlands. jan.koetsenruijter@radboudumc.nl.
authors.forename: Jan
authors.initials: J
authors.lastname: Koetsenruijter
authors.forename: Jan
authors.initials: J
authors.lastname: van Lieshout
authors.forename: Ivaylo
authors.initials: I
authors.lastname: Vassilev
authors.forename: Mari Carmen
authors.initials: MC
authors.lastname: Portillo
authors.forename: Manuel
authors.initials: M
authors.lastname: Serrano
authors.forename: Ingrid
authors.initials: I
authors.lastname: Knutsen
authors.forename: Poli
authors.initials: P
authors.lastname: Roukova
authors.forename: Christos
authors.initials: C
authors.lastname: Lionis
authors.forename: Elka
authors.initials: E
authors.lastname: Todorova
authors.forename: Christina
authors.initials: C
authors.lastname: Foss
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
mesh_terms: D000328:Adult; D002031:Bulgaria / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000628:therapy; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D009664:Norway / Q000453:epidemiology; D011788:Quality of Life / Q000523:psychology*; D012424:Rural Population / Q000706:statistics & numerical data; D012648:Self Care / Q000523:psychology* / Q000706:statistics & numerical data; D012944:Social Support; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data