Negotiating Diet in Networks: A Cross-European Study of the Experiences of Managing Type 2 Diabetes

Social networks, perceived social support, and HbA1c in individuals with type 2 diabetes mellitus in urban Ghana

OBJECTIVES

Although links between social relationships and health are well established, few studies have concurrently examined the effects of compositional, structural, and functional dimensions of social networks on glycemic (HbA1c) control in low- and middle-income countries such as Ghana. In these settings where informal social relationships are critical for access to resources, evaluating the links between social network characteristics, social support, and glycemic control may provide clarity about important relationships that facilitate the well-being of individuals with type 2 diabetes mellitus (T2DM).

DESIGN

In 2018, we conducted a hospital-based, cross-sectional survey of noninstitutionalized adults with T2DM in Ghana. Using data from 247 study participants, multivariable linear regression models were used to estimate associations between: 1) HbA1c and three social network characteristics (kin composition, household composition, and network density); 2) social support and the three social network characteristics; and 3) HbA1c and social support. We also examined gender differences in these associations and applied mediation techniques to determine if network characteristics operated through social support to affect HbA1c.

RESULTS

Findings indicated that higher kin composition and higher household composition were each significantly associated with increased social support. Neither social support nor social network characteristics were significantly related to HbA1c, and there were no gender differences in any of these associations.

CONCLUSION

Although family and household members were identified as important sources of social support for diabetes management, the ways in which they influence HbA1c control among Ghanaians require further investigation. Future studies can examine whether changes in social support over time, social support satisfaction, or other dimensions of social relationships improve T2DM outcomes in countries like Ghana.

The influence of social relationships and activities on the health of adults with obesity: A qualitative study

Background

Obesity in adults is a leading health challenge that causes millions of deaths worldwide and represents a risk factor for developing long‐term conditions. Social relationships are one of the multiple drivers shaping obesity and obesity‐related practices. However, there is still little evidence as to the processes by which relationships influence the adoption of positive and negative obesity health‐related practices—eating, physical activity and alcohol intake. This study aims first to identify the types of relationships relevant to the adoption of practices in adults with obesity and, second, to explore the type of activities these relationships engage with or promote to produce those practices and their potential health consequences.

Methods

Nineteen adults who have or had a history of obesity living in the United Kingdom were interviewed between May 2020 and March 2021. Experiences were explored through semi‐structured interviews and network mapping via videoconferencing. Data were analysed using a hermeneutic phenomenology informed thematic analysis.

Results

Three main themes were identified: (1) everyday familial routines matter, (2) chasing healthier lifestyles: comparing, modelling and connecting emotionally with friends and (3) healthcare professionals as negative influencers.

Discussion and Conclusions

Findings show how different types of relationships might shape the risk of developing and losing weight. They uncover the power of informal networks (family and friends) and highlight the potentially negative impact of formal ones (healthcare professionals). Our exploration could add to arguments about the need for stakeholders confronting obesity to be aware of the relevance of everyday social relationships in health and well‐being strategies for tackling the issue, in creating collective and individual person‐centred long‐term sustainable actions.

Patient and Public Contribution

Feedback on the tone/content of the interview questions was provided by the two first participants. The results were checked and received feedback from one of the interviewees.

Effects of Transmission Delay on Client Participation in Video-Mediated Group Health Counseling

In face-to-face group counseling, active client participation contributes to the counseling agenda by a variety of social processes, but little is known about how video mediation shapes client participation. In this article, we use conversation analysis to investigate how transmission delay affects client participation in video-mediated group counseling through shaping the resolution of overlapping talk. Data are video recordings from three video-mediated group health counseling sessions recorded simultaneously in the two participating locations. The delay changes the timing of the overlapping turns and pauses at each end of the mediated counseling, making it difficult to interpret who should take the turn after the overlap. This may pose obstacles to client participation. While mediated counseling services can increase access to services and thus improve client participation at a macro level, transmission delay can pose threats to active client participation at the micro level of interaction.

Eating Alone or Together among Community-Living Older People-A Scoping Review

Research on healthy aging commonly concerns problems related to loneliness and food intake. These are not independent aspects of health since eating, beyond its biological necessity, is a central part of social life. This scoping review aimed to map scientific articles on eating alone or together among community-living older people, and to identify relevant research gaps. Four databases were searched, 989 articles were identified and 98 fulfilled the inclusion criteria. In the first theme, eating alone or together are treated as central topics of interest, isolated from adjoining, broader concepts such as social participation. In the second, eating alone or together are one aspect of the findings, e.g., one of several risk factors for malnutrition. Findings confirm the significance of commensality in older peoples' life. We recommend future research designs allowing identification of causal relationships, using refined ways of measuring meals alone or together, and qualitative methods adding complexity.

Diabetes self-management: what role does the family play?

Purpose

This paper aims to explicate one of the major findings of a research study seeking to understand how Indonesian people with diabetes learn about their disease. The one key finding discussed in this paper is how families influence the learning and self-management processes adopted by Indonesian people with diabetes.

Design/methodology/approach

A grounded theory methodology was adopted to investigate how Indonesian people with diabetes learn about their disease. Twenty-eight semi-structured interviews were undertaken with Indonesian people living with diabetes, families of people living with diabetes, healthcare professionals and other healthcare providers. Data was analysed by using constant comparative analysis during three coding stages.

Findings

The study explicated the basic social process of how people with diabetes in Indonesia learn about their disease through a generated theory “Learning, choosing, and acting: self-management of diabetes in Indonesia”. This study found family engagement was integral to Indonesian people living with diabetes who were self-managing their disease. Families assisted with seeking information, providing recommendations, selecting and implementing actions, appraising implemented actions, and informing others about their experiences. By acknowledging that family is involved in this process, the healthcare professional can adequately provide health education to both the person with diabetes and their families. Involving families in health education is crucial as family can influence decision making made by people with diabetes in a proper or improper way. Thus, clinicians need to also skilfully recognise difficulties these people encounter by monitoring their self-management progress and by working closely with them and their family members.

Originality/value

This is the first study conducted in Indonesia that specifically investigates the process of how people with diabetes learn about their disease. The involvement of families in this process is a central finding of the study. Families can enhance the overall health and well-being of the person with diabetes, aid in early recognition of aberration to health status and trigger the initiation of interventions to re-establish homeostasis if they are actively engaged and supported by health professionals.

Social network influences and the adoption of obesity-related behaviours in adults: a critical interpretative synthesis review

BACKGROUND

Obesity is a key risk factor for developing a long-term condition and a leading cause of mortality globally. The limited evidence associated with interventions that currently target obesity-related behaviours demand new approaches to tackle this problem. Given the evidence that social ties are implicated in the gaining and reduction of weight, the use of social networks in interventions is potentially a novel and useful means of tackling this health issue. There is a specific gap in the literature regarding what and how social network properties and processes together with environmental and individual factors influence the adoption of positive and negative obesity-related behaviours in adults.

METHODS

To address this gap in developing an integrated and holistic conceptual approach, a critical interpretative synthesis was undertaken following a line of argument synthesis as an analytical strategy.

RESULTS

Twenty-four studies were included. The data-driven themes meso-micro network processes, contextual and individual factors, and types of ties and properties were identified individually as components and causes of different health scenarios. Nevertheless, these drivers do not act on their own. As a consequence, developing multi-agent coalitions considering cross-level influences between the data-driven themes are two mechanisms that are created to understand more in-depth how social networks and the environment influence the adoption of obesity-related behaviours. These two new constructs point to a dynamic multilevel set of influences between multiple constructs, developing scenarios where positive and negative health results are identified.

CONCLUSIONS

This critical interpretative synthesis offers a new means of exploring the application of social network properties and mechanisms in the 'obesity' field. The synthesizing argument created during the analysis process might be considered by health policy-makers, who might need to contemplate the wider open system of socially connected individuals and harness these forces to design new interventions where social networks and other contextual and individual factors operate together in a complex multilevel environment influencing obesity-related behaviours and practices.

"We Were Totally Supportive, of Course": How People Talk About Supporting a Significant Other to Stop or Reduce Their Drinking

Despite the strong influence our significant others have on health behaviors such as alcohol consumption, little is known about when they are willing to provide support for changing such behaviors. We conducted interviews with 13 Australian adults who had a partner, friend, or family member who stopped or significantly reduced their alcohol consumption within the past 2 years, to understand how these significant others accounted for providing support for this behavior change as reasonable. Through thematic discourse analysis, we identified three types of accounts: (a) deontological, referring to duty or obligation to support others; (b) consequentialist, where costs for providing support were minimized or balanced; and (c) relational, attending to the importance of maintaining relationships. By identifying the principles people draw on to justify supporting a significant other who changes their alcohol consumption, this study enhances our understanding about when significant others are likely to support health behavior changes.

Family Support and Diabetes: Patient's Experiences From a Public Hospital in Peru

Family support is crucial for managing chronic conditions but it is often overlooked when designing behavioral interventions in type 2 diabetes mellitus (T2DM). As part of the formative phase of a feasibility randomized control trial (RCT), we conducted 20 semistructured interviews with people with T2DM from Lima, Peru. Based on such results, we describe the support people with T2DM receive from their families and the role that such support has in their efforts to implement diabetes management practices. We learned that participants receive support from family members, but mostly from their spouses and children. Their relatives encourage them and motivate them to fight for their health, they also provide instrumental support by preparing healthy meals, reminding them to take medications, and sharing physical activity. Participants also reported controlling actions which were not always "well received." Thus, any intervention supporting self-management practices need to work with key family members. We support the literature that suggests that interventions should target family members to ensure improved T2DM self-management practices.

Methodological and Practical Issues in Cross-National Qualitative Research: Lessons From the Literature and a Comparative Study of the Experiences of People Receiving a Diagnosis of Cancer

Social science and health services research have much to gain from cross-national qualitative research, yet the logistics involved in setting up such studies, especially where different languages and health systems are involved, can seem daunting. In this article, we highlight issues to consider and suggest some solutions, drawing both on the literature and examples from our own cross-national research. We highlight the issues involved with synchronizing staffing and funding, ensuring comparable methods, project management, and communication between research groups, the consequences of the different criteria for ethical approval for recruitment, the challenge of working with multiple languages, teams involving different disciplines and skill sets, and coordinating and timing data collection and analysis. The aim of this article is to draw on the literature, which includes several useful insights, as well as reflections from our own cross-national research, to highlight considerations for cross-national qualitative research teams. Our approach is to highlight and discuss potential challenges and suggest potential solutions, using the format of an illustrated literature review.

The articulation of neoliberalism: narratives of experience of chronic illness management in Bulgaria and the UK

The shift from social democratic to a neoliberal consensus in modern welfare capitalist states is characterised by an emphasis on individual responsibility, consumer choice, market rationality and growing social inequalities. There has been little exploration of how neoliberalism has shaped the environment within which chronic illness is experienced and managed. This article explores the different articulations of neoliberalism manifest in the arena of personal illness management in Bulgaria and the UK. People with type 2 diabetes discussed their experiences in terms of struggling with diet, diabetes as a personal failure, integrating illness management and valued activities, and the trustworthiness of the healthcare system. The UK narratives were framed within an individual responsibility discourse while in Bulgaria lack of resources dominated discussions, which were framed as structurally generated and unrelated to individual capabilities and choices. Respondents faced personal management challenges related to consumer and healthcare market failures in both countries. Differences in market regulation and emerging stakeholder and interest coalitions influenced users' expectations and their navigation and adaption to market failures in managing their everyday illnesses. The UK and Bulgarian articulations of neoliberalism can be described differently: the first as a logic of managed choice and the second as a logic of unmanaged consumerism.

Social Network Type and Long-Term Condition Management Support: A Cross-Sectional Study in Six European Countries

Background

Network types and characteristics have been linked to the capacity of inter-personal environments to mobilise and share resources. The aim of this paper is to examine personal network types in relation to long-term condition management in order to identify the properties of network types most likely to provide support for those with a long-term condition.

Method

A cross-sectional observational survey of people with type 2 diabetes using interviews and questionnaires was conducted between April and October 2013 in six European countries: Greece, Spain, Bulgaria, Norway, United Kingdom, and Netherlands. 1862 people with predominantly lower socio-economic status were recruited from each country. We used k-means clustering analysis to derive the network types, and one-way analysis of variance and multivariate logistic regression analysis to explore the relationship between network type socio-economic characteristics, self-management monitoring and skills, well-being, and network member work.

Results

Five network types of people with long-term conditions were identified: restricted, minimal family, family, weak ties, and diverse. Restricted network types represented those with the poorest self-management skills and were associated with limited support from social network members. Restricted networks were associated with poor indicators across self-management capacity, network support, and well-being. Diverse networks were associated with more enhanced self-management skills amongst those with a long-term condition and high level of emotional support. It was the three network types which had a large number of network members (diverse, weak ties, and family) where healthcare utilisation was most likely to correspond to existing health needs.

Discussion

Our findings suggest that type of increased social involvement is linked to greater self-management capacity and potentially lower formal health care costs indicating that diverse networks constitute the optimal network type as a policy in terms of the design of LTCM interventions and building support for people with LTCs.

Implementing a social network intervention designed to enhance and diversify support for people with long-term conditions. A qualitative study

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.