Social Support and Health in Diabetes Patients: An Observational Study in Six European Countries in an Era of Austerity

Abstract

IntroductionSupport from individual social networks, community organizations and neighborhoods is associated with better self-management and health outcomes. This international study examined the relative impact of different types of support on health and health-related behaviors in patients with type 2 diabetes.MethodsObservational study (using interviews and questionnaires) in a sample of 1,692 type 2 diabetes patients with 5,433 connections from Bulgaria, Greece, Netherlands, Norway, Spain, and the United Kingdom. Outcomes were patient-reported health status (SF-12), physical exercise (RAPA), diet and smoking (SDCSCA). Random coefficient regression models were used to examine linkages with individual networks, community organizations, and neighborhood type (deprived rural, deprived urban, or affluent urban).ResultsPatients had a median of 3 support connections and 34.6% participated in community organizations. Controlled for patients’ age, sex, education, income and comorbidities, large emotional support networks were associated with decrease of non-smoking (OR = 0.87). Large practical support networks were associated with worse physical and mental health (B = -0.46 and -0.27 respectively) and less physical activity (OR = 0.90). Participation in community organizations was associated with better physical and mental health (B = 1.39 and 1.22, respectively) and, in patients with low income, with more physical activity (OR = 1.53).DiscussionParticipation in community organizations was most consistently related to better health status. Many diabetes patients have individual support networks, but this study did not provide evidence to increase their size as a public health strategy. The consistent association between participation in community organizations and health status provides a clear target for interventions and policies.

Preferring to manage by myself: A qualitative study of the perspectives of hardly reached people with type 2 diabetes on social support for diabetes management

“…Social support is increasingly perceived to be cornerstone in diabetes management (Koetsenruijter et al, 2016(Koetsenruijter et al, , 2015Stopford, Winkley, & Ismail, 2013). Studies have shown that lack of social support is associated with higher levels of HbA1c and diabetes distress (Baek, Tanenbaum, & Gonzarlez, 2014;Mayberry, Egede, Wagner, & Osborn, 2015;Stopford et al, 2013).…”

“…Informal support comes from friends, family and close colleagues and formal support from health professionals, community organisations and local neighbourhoods (Koetsenruijter et al, 2015).…”

“…Social support is provided by members of a person's social network and can influence disease management both positively and negatively (Cohen & Syme, ; Stopford et al, ). Informal support comes from friends, family and close colleagues and formal support from health professionals, community organisations and local neighbourhoods (Koetsenruijter et al, ).…”

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

“…The involvement of network members in illness management forms an aspect of a collective network process, effort and change placing emphasis on collective agency rather than individual self‐efficacy. Recent findings highlight how social involvement with a diverse range of people, activities and groups provides social and psychological opportunities and resources which contribute to self‐management support (SMS) and physical and mental well‐being (Koetsenruijter et al, ; Reeves et al, ). This more recent focus has highlighted a need to better understand how people engage with social capital, support and resources in a way that is acceptable and meaningful to them and members of their networks when managing and living with a long‐term condition.…”

Factors associated with subsequent diabetes‐related self‐care activities: The role of social support and optimism

“…People's efforts to maintain DRSCA are often implemented in a social context and in interaction with family and social environment (Rintala, Jaatinen, Paavilainen, & Astedt‐Kurki, ). For people with chronic diseases, social support has been defined as assistance from family, friends, neighbours or community organizations (Koetsenruijter et al, ), comprising an important environmental support resource. Therefore, understanding how it relates to DRSCA has crucial implications for health policy and practice (Miller & Dimatteo, ).…”