title: Interventions and working relationships of voluntary organisations for diabetes self-management: A cross-national study.
abstract: BACKGROUND
  Diabetes has become a challenging health priority globally. Given the tensions of financially burdened health systems in Europe the mobilisation of community resources like voluntary organisations and community groups is seen as a health policy strategy to sustain the management of long-term conditions like diabetes. However, little is known about how this is happening in practice in Europe.
  
  
  OBJECTIVE
  To explore diabetes self-management interventions undertaken or promoted by voluntary organisations and community groups in Europe; and describe the types of working relationships between these organisations, European health systems and users when implementing diabetes self-management programmes in different areas.
  
  
  METHODS
  A mixed method study (survey/qualitative interviews) was undertaken. This research formed part of a European project (7th Framework programme of the European Commission) exploring the link between resources, like community organisations, and peoples' capacities to manage long-term conditions.
  
  
  METHODS
  Six European countries (Bulgaria, Greece, Norway, Spain, the Netherlands and the United Kingdom) participated in the study. Three areas: deprived urban area, a relatively affluent urban area and a deprived rural area were purposefully selected.
  
  
  METHODS
  Through a purposeful sample and bottom up strategies 749 representatives of voluntary organisations and community groups were recruited from the geographical areas above. Organisations with at least three members, existing for at least one year that could provide information or other type of support directly or indirectly relevant to patients with diabetes were included.
  
  
  METHODS
  Participants completed a 15 item questionnaire for the survey (n=749) and a voice recorded semi structured interview (n=300). Data collection focused on the type of activities and roles developed to promote health, and relationships and communication channels between organisations, health services and users. Descriptive and comparative statistical and qualitative content analyses were used.
  
  
  RESULTS
  Participants perceived they had better reach of people with health needs than health providers, filled the administration gaps left in their capacity to deal with basic diabetes practical needs, humanized care, and acted as mediators between services and communities. There were significant differences between countries in relation to the types of activities (p-value<0.001), roles (p-value<0.001) and funding sources (p-value<0.001) of organisations concerning diabetes self-management. In non-affluent countries organisations tend to promote social activities twice more often.
  
  
  CONCLUSIONS
  Community and voluntary organisations provide complimentary and on-going support in diabetes management. This involves a shift from focusing on the illness to also longing for social cohesion, sense of community and wellbeing in diabetes health practices and policies.
authors.affiliation: Faculty of Health Sciences, NIHR Wessex CLAHRC, University of Southampton, Hampshire, UK. Electronic address: M.C.Portillo-Vega@soton.ac.uk.
authors.forename: Mari Carmen
authors.initials: MC
authors.lastname: Portillo
authors.affiliation: Faculty of Health Sciences, NIHR Wessex CLAHRC, University of Southampton, Hampshire, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Kennedy
authors.affiliation: Department of Sociology, University of National and World Economy, Sofia, Bulgaria.
authors.forename: Elka
authors.initials: E
authors.lastname: Todorova
authors.affiliation: Quality Department, University Clinic of Navarra, Pamplona, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Regaira
authors.affiliation: Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.affiliation: Institute of Health and Society, University of Oslo, Norway.
authors.forename: Christina
authors.initials: C
authors.lastname: Foss
authors.affiliation: Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Crete, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Lionis
authors.affiliation: Faculty of Health Sciences, NIHR Wessex CLAHRC, University of Southampton, Hampshire, UK.
authors.forename: Ivaylo
authors.initials: I
authors.lastname: Vassilev
authors.affiliation: Department of Statistics, University of National and World Economy, Sofia, Bulgaria.
authors.forename: Valentin
authors.initials: V
authors.lastname: Goev
authors.affiliation: Faculty of Health Sciences, NIHR Wessex CLAHRC, University of Southampton, Hampshire, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Rogers
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005060:Europe; D006801:Humans; D012648:Self Care
keywords: Diabetes mellitus; Europe;; Financial crisis; Health services; Mixed methods; Self-management; Voluntary organisations and community groups