title: Institutional logic in self-management support: coexistence and diversity.
abstract: The prevalence of chronic conditions in Europe has been the subject of health-political reforms that have increasingly targeted collaboration between public, private and voluntary organisations for the purpose of supporting self-management of long-term diseases. The international literature describes collaboration across sectors as challenging, which implies that their respective logics are conflicting or incompatible. In line with the European context, recent Norwegian health policy advocates inter-sectorial partnerships. The aim of this policy is to create networks supporting better self-management for people with chronic conditions. The purpose of our qualitative study was to map different understandings of self-management support in private for-profit, volunteer and public organisations. These organisations are seen as potential self-management support networks for individuals with chronic conditions in Norway. From December 2012 to April 2013, we conducted 50 semi-structured interviews with representatives from relevant health and well-being organisations in different parts of Norway. According to the theoretical framework of institutional logic, representatives' statements are embedded with organisational understandings. In the analysis, we systematically assessed the representatives' different understandings of self-management support. The institutional logic we identified revealed traits of organisational historical backgrounds, and transitions in understanding. We found that the merging of individualism and fellowship in contemporary health policy generates different types of logic in different organisational contexts. The private for-profit organisations were concerned with the logic of a healthy appearance and mindset, whereas the private non-profit organisations emphasised fellowship and moral responsibility. Finally, the public, illness-oriented organisations tended to highlight individual conditions for illness management. Different types of logic may attract different users, and simultaneously, a diversity of logic types may challenge collaboration at the user's expense. Moral implications embed institutional logic implying a change towards individual responsibility for disease. Policy makers ought to consider complexities of logic in order to tailor the different needs of users.
authors.affiliation: Norwegian National Advisory Unit on Learning and Mastery in Health NKLMH, Universitetssykehus HF, Aker Sykehus, Oslo, Norway. dagmara.bossy@medisin.uio.no.|Department of Nursing Science, Faculty of Medicine, University of Oslo, Oslo, Norway. dagmara.bossy@medisin.uio.no.
authors.forename: Dagmara
authors.initials: D
authors.lastname: Bossy
authors.affiliation: Department of Nursing Science, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Ingrid Ruud
authors.initials: IR
authors.lastname: Knutsen
authors.affiliation: NIHR CLAHRC Wessex, Faculty of Health Sciences, University of Southampton, Hampshire, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
authors.affiliation: Department of Nursing Science, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Christina
authors.initials: C
authors.lastname: Foss
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D006801:Humans; D008128:Logic; D009664:Norway; D036301:Qualitative Research; D000073278:Self-Management
keywords: chronic conditions; community health; institutional logic; organisational collaboration; self-management support; type 2 diabetes