title: Group affiliation in self-management: support or threat to identity?
abstract: Self-management is considered important in chronic illness, and contemporary health policy recommends participation in support groups for individuals with chronic conditions. Although withdrawal from or non-participation in support groups is an important problem, there is limited knowledge about individuals' own motivation for participation in or withdrawal from self-management support groups.
  
  
  
  To investigate how individuals with type 2 diabetes perceive participation in group-based self-management support.
  
  
  
  This is a qualitative focus group study using a semi-structured interview guide.
  
  
  
  Sixteen participants diagnosed with type 2 diabetes were included in the study. Individuals with and without group affiliations were mixed in three focus groups to trigger discussions. In the analysis, reoccurring themes of engagement and discussions between participants were focused within a theoretical frame of institutional logic. The focus groups are seen as social spaces where participants construct identity.
  
  
  
  Both participation and non-participation in group-based self-management support are associated with dealing with the stigma of having type 2 diabetes. Negotiations contribute to constructing an illness dignity as a response to the logic of moral responsibility for the disease.
  
  
  
  Contemporary policy contributes to societal understandings of individuals with type 2 diabetes as morally inadequate. Our study shows that group-based self-management support may counteract blame and contribute in negotiations of identity for individuals with type 2 diabetes. This mechanism makes participation in groups beneficial for some but stigma inducing for others.
authors: Norwegian National Advisory Unit on Learning and Mastery in Health, Aker Sykehus, Universitetssykehus HF, Oslo, Norway.|Department of Nursing Science, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors: Dagmara
authors: D
authors: Bossy
authors: Department of Nursing Science, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors: Ingrid Ruud
authors: IR
authors: Knutsen
authors: NIHR CLAHRC Wessex, Faculty of Health Sciences, University of Southampton, Hampshire, UK.
authors: Anne
authors: A
authors: Rogers
authors: Department of Nursing Science, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors: Christina
authors: C
authors: Foss
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012657:Self-Help Groups; D000073278:Self-Management; D012933:Social Identification
keywords: group-based self-management support; institutional logic; self-management; type 2 diabetes