title: Implementing a social network intervention designed to enhance and diversify support for people with long-term conditions. A qualitative study.
abstract: BACKGROUND
  For people with long-term conditions, social networks provide a potentially central means of mobilising, mediating and accessing support for health and well-being. Few interventions address the implementation of improving engagement with and through social networks. This paper describes the development and implementation of a web-based tool which comprises: network mapping, user-centred preference elicitation and need assessment and facilitated engagement with resources. The study aimed to determine whether the intervention was acceptable, implementable and acted to enhance support and to add to theory concerning social networks and engagement with resources and activities.
  
  
  METHODS
  A longitudinal design with 15 case studies used ethnographic methods comprising video, non-participant observation of intervention delivery and qualitative interviews (baseline, 6 and 12 months). Participants were people with type 2 diabetes living in a marginalised island community. Facilitators were local health trainers and care navigators. Analysis applied concepts concerning implementation of technology for self-management support to explain how new practices of work were operationalised and how the technology impacted on relationships fit with everyday life and allowed for visual feedback.
  
  
  RESULTS
  Most participants reported identifying and taking up new activities as a result of using the tool. Thematic analysis suggested that workability of the tool was predicated on disruption and reconstruction of networks, challenging/supportive facilitation and change and reflection over time concerning network support. Visualisation of the network enabled people to mobilise support and engage in new activities. The tool aligned synergistically with the facilitators' role of linking people to local resources.
  
  
  CONCLUSIONS
  The social network tool works through a process of initiating positive disruption of established self-management practice through mapping and reflection on personal network membership and support. This opens up possibilities for reconstructing self-management differently from current practice. Key facets of successful implementation were: the visual maps of networks and support options; facilitation characterised by a perceived lack of status difference which assisted engagement and constructive discussion of support and preferences for activities; and background work (a reliable database, tailored preferences, option reduction) for facilitator and user ease of use.
authors.affiliation: NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK. a.kennedy@soton.ac.uk.
authors.forename: Anne
authors.initials: A
authors.lastname: Kennedy
authors.affiliation: NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK. I.I.vassilev@soton.ac.uk.
authors.forename: Ivaylo
authors.initials: I
authors.lastname: Vassilev
authors.affiliation: NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK. ej1q07@soton.ac.uk.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: James
authors.affiliation: NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK. a.e.rogers@soton.ac.uk.
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000523:psychology*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016730:Program Development; D036301:Qualitative Research; D012648:Self Care; D012944:Social Support