title: Social Support and Health in Diabetes Patients: An Observational Study in Six European Countries in an Era of Austerity.
abstract: BACKGROUND
  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).
  
  
  CONCLUSIONS
  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.
authors: Radboud university medical center, Radboud Institute for Health Sciences, Department of IQ healthcare, Nijmegen, The Netherlands.
authors: Jan
authors: J
authors: Koetsenruijter
authors: Radboud university medical center, Radboud Institute for Health Sciences, Department of IQ healthcare, Nijmegen, The Netherlands.
authors: Jan
authors: J
authors: van Lieshout
authors: Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
authors: Christos
authors: C
authors: Lionis
authors: School of Nursing, University of Navarra, Pamplona, Spain.
authors: Maria Carmen
authors: MC
authors: Portillo
authors: NIHR Wessex CLAHRC, Faculty of Health Sciences, University of Southampton, Hampshire, United Kingdom.
authors: Ivo
authors: I
authors: Vassilev
authors: Department of Economic Sociology, University of National and World Economy, Sofia, Bulgaria.
authors: Elka
authors: E
authors: Todorova
authors: University of Oslo, Institute for Health and Society, Oslo, Norway.
authors: Christina
authors: C
authors: Foss
authors: Education, Health and Society Foundation, Murcia, Spain.
authors: Manuel Serrano
authors: MS
authors: Gil
authors: University of Oslo, Institute for Health and Society, Oslo, Norway.
authors: Ingrid Ruud
authors: IR
authors: Knutsen
authors: Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
authors: Agapi
authors: A
authors: Angelaki
authors: School of Nursing, University of Navarra, Pamplona, Spain.
authors: Agurtzane
authors: A
authors: Mujika
authors: University of Oslo, Institute for Health and Society, Oslo, Norway.
authors: Poli
authors: P
authors: Roukova
authors: NIHR Wessex CLAHRC, Faculty of Health Sciences, University of Southampton, Hampshire, United Kingdom.
authors: Anne
authors: A
authors: Kennedy
authors: NIHR Wessex CLAHRC, Faculty of Health Sciences, University of Southampton, Hampshire, United Kingdom.
authors: Anne
authors: A
authors: Rogers
authors: Radboud university medical center, Radboud Institute for Health Sciences, Department of IQ healthcare, Nijmegen, The Netherlands.
authors: Michel
authors: M
authors: Wensing
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005060:Europe; D005260:Female; D006304:Health Status; D006801:Humans; D008019:Life Style; D016014:Linear Models; D008297:Male; D012944:Social Support