Connectivity, contest and the ties of self‐management support for type 2 diabetes: a meta‐synthesis of qualitative literature

Abstract

What is known about this topic• Previous research into selfmanagement support tends to focus on individual attitudes and motivations.• The difficulties people have in incorporating self-management into pre-existing life contexts have been conceptualised in terms of concepts such as non-compliance, nonadherence and lack of concordance or difficulties in the regulation of the self.• Existing literature does not problematise the conditions under which diabetes-related experiences unfold. What this paper adds• Peoples' accounts are of themselves located with reference to daily life within a social network and how this network affects their self-management.• Connectivity is an important element of self-management.• Self-management support needs to be targeted to take account of the appropriate context operating at micro-, meso-and macro-levels.Correction added on 12 October 2015, after first online publication: the surname Krennedy has been changed to Kennedy. AbstractThis paper presents a meta-synthesis of the literature on communitybased self-management to support experiences of people diagnosed with type 2 diabetes. The aim was to synthesise findings on both formal and informal self-management support with particular reference to the relevance and influence of the social context operating at different levels. The review forms part of EU-WISE, a project financed through EU's 7th Framework Programme. The review was performed by systematically searching MEDLINE, PubMed, EMBASE, CINAHL, PsycINFO and Web of Science for English language publications between 2005 and 2014 presenting research conducted in Europe on the experiences and perspectives of self-management concerns of patients diagnosed with type 2 diabetes. The search yielded 587 abstracts, which were reduced through search strategy refinement and eligibility and quality criteria to 29 papers that were included in the review. This review highlights the relevance of contextual factors operating at micro-and macro-levels. The synthesis yielded six second-order thematic constructs relating to selfmanagement: sense of agency and identity, the significance and meaning of social networks, minimal disruption of everyday life, economic hardship, the problem of assigning patients' responsibility and structural influences of primary care. Using a line of argument synthesis, these themes were revisited, and a third-order construct, connectivity emerged which refers to how links in daily life are interwoven with peoples' social networks, local communities, economic and ideological conditions in society in a way which support self-management activities. This metasynthesis indicates a need to heed the notion of connectivity as a means of mobilising and supporting the self-management strategies of people with type 2 diabetes in everyday life.

The role of collective efficacy in long‐term condition management: A metasynthesis

“…Bandura's concept has stood the test of time but elaborating it in relation to personal communities makes it relevant to LTCM. The notion of CE offers a link between individual level self‐management processes, such as self‐efficacy, and access to and capacity to mobilise social capital and environmental resources when living with a LTC (Foss et al, ). Specifically, improvements in CE for people with LTCs can be sought where there is low intensity but wide‐ranging support for developing meaningful engagement opportunities dispersed within personal communities (e.g.…”

Moving between ideologies in self‐management support—A qualitative study

“…Previous literature concerned with type 2 diabetes patients and health professionals highlights the distinction of “illness vs life,” where the main conflict between health professionals and diabetes patients is termed “keeping life and disease apart.” In our study, we find that it is lifestyle vs life that has become the apparent category; that is, the notion of “life” is reduced to “lifestyle” based on health professionals’ understanding. The health professionals in our study seem mainly occupied with what they believe “works” for the assessment of a healthier lifestyle, not with what the individuals (patients) themselves see as a better life.…”

Group affiliation in self‐management: support or threat to identity?

“…Earlier literature has focused on identity work regarding challenges related to the self‐management of type 2 diabetes. The differences between health professionals’ ‘disease orientation’ and patients’ ‘life over disease’ approach have been used to explain poor self‐management among type 2 diabetes patients . Joining a group‐based activity for self‐management support may, for some, involve making the disease an important part of their identity.…”

“…The differences between health professionals' 'disease orientation' and patients' 'life over disease' approach have been used to explain poor self-management among type 2 diabetes patients. 4,42 Joining a group-based activity for self-management support may, for some, involve making the disease an important part of their identity. Group affiliation may therefore sound threatening to individuals who do not want to identify with having the disease because they prefer to identify as being independent and managing their health on their own.…”

“…[1][2][3] In line with a wider individualization trend in society, patients as self-managers represent a shift from collective expectations to those of the individual, promoting the logic of moral responsibility and implying a strong normative ethos focused on healthrelated behaviours. [4][5][6] Type 2 diabetes is an increasingly prevalent condition that is largely associated with self-management requirements, including monitoring, diet and exercise. 7 The demands of the self-management of type 2 diabetes are described as challenging, 8 and inadequate health behaviours may induce feelings of shame and guilt in this patient group.…”