title: The influence of social networks on self-management support: a metasynthesis.
abstract: BACKGROUND
  There is increasing recognition that chronic illness management (CIM) is not just an individual but a collective process where social networks can potentially make a considerable contribution to improving health outcomes for people with chronic illness. However, the mechanisms (processes, activities) taking place within social networks are insufficiently understood. The aim of this review was to focus on identifying the mechanisms linking social networks with CIM. Here we consider network mechanisms as located within a broader social context that shapes practices, behaviours, and the multiplicity of functions and roles that network members fulfil.
  
  
  METHODS
  A systematic search of qualitative studies was undertaken on Medline, Embase, and Web for papers published between 1st January 2002 and 1st December 2013. Eligible for inclusion were studies dealing with diabetes, and with conditions or health behaviours relevant for diabetes management; and studies exploring the relationship between social networks, self-management, and deprivation. 25 papers met the inclusion criteria. A qualitative metasynthesis was undertaken and the review followed a line of argument synthesis.
  
  
  RESULTS
  The main themes identified were: 1) sharing knowledge and experiences in a personal community; 2) accessing and mediation of resources; 3) self-management support requires awareness of and ability to deal with network relationships. These translated into line of argument synthesis in which three network mechanisms were identified. These were network navigation (identifying and connecting with relevant existing resources in a network), negotiation within networks (re-shaping relationships, roles, expectations, means of engagement and communication between network members), and collective efficacy (developing a shared perception and capacity to successfully perform behaviour through shared effort, beliefs, influence, perseverance, and objectives). These network mechanisms bring to the fore the close interdependence between social and psychological processes in CIM, and the intertwining of practical and moral dilemmas in identifying, offering, accepting, and rejecting support.
  
  
  CONCLUSIONS
  CIM policy and interventions could be extended towards: raising awareness about the structure and organisation of personal communities; building individual and network capacity for navigating and negotiating relationships and CIM environments; maximising the possibilities for social engagement as a way of increasing the effectiveness of individual and network efforts for CIM.
authors.affiliation: NIHR CLAHRC Wessex, Faculty of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK. I.I.Vassilev@soton.ac.uk.
authors.forename: Ivaylo
authors.initials: I
authors.lastname: Vassilev
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
authors.forename: Anne
authors.initials: A
authors.lastname: Kennedy
authors.forename: Jan
authors.initials: J
authors.lastname: Koetsenruijter
mesh_terms: D002908:Chronic Disease / Q000517:prevention & control; D003142:Communication; D003153:Community Health Services; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D019468:Disease Management; D006801:Humans; D012648:Self Care; D060756:Social Networking