https://orcid.org/0000-0001-7562-6874
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ABSTRACT
Background: Community-based approaches have been identified as an effective strategy to address the growing burden of noncommunicable diseases (NCDs) worldwide. However, little is known about community as a concept among people living in socioeconomically disadvantaged settings and stakeholders’ interactions and engagement in NCDs prevention and management.
Objective: The aim of this study was to understand; (1) the meaning of community among people living in socioeconomically disadvantaged suburbs in Region Stockholm and (2) how communities interact and engage with stakeholders at local and regional levels for the prevention and management of type 2 diabetes (T2D).
Methods: This qualitative study was conducted in three municipalities in Region Stockholm with a high proportion of migrants. Multiple data collection methods were used, including observations of community activities; interviews with community members, representatives of public authorities and NGOs; and group interviews with healthcare providers. Data were analyzed using content analysis.
Results: Community was perceived as living in close proximity with shared beliefs, values and resources. Although they recognized its social and cultural diversity, community members focused more on the commonalities of living in their neighborhood and less on their differences in country of birth and languages spoken. Several mismatches between awareness of community needs and the available skills and resources among stakeholders for T2D prevention were identified. Stakeholders expressed awareness of T2D risk and interest in addressing it in a culturally appropriate manner.
Conclusion: Interaction between the communities and stakeholders was limited, as was engagement in T2D prevention and management. This highlights barriers in the collaboration between community, healthcare institutions and other stakeholders which consequently affect the implementation of preventive interventions. Innovative ways to link the community to the healthcare sector and other local government institutions are needed to build the capacity of health systems for T2D prevention in socioeconomically disadvantaged communities.
Responsible Editor Maria Emmelin, Umeå University, Sweden
Responsible Editor Maria Emmelin, Umeå University, Sweden
Acknowledgments
We would like to thank the study participants who agreed to take part in this study.
Author contributions
FA, JA, HMA, MD and IN were involved in the conceptualization and design of the study. FA, JA, IN and HMA collected the data and MD supported data analysis. FA compiled the first draft of the manuscript and JA coordinated the overall writing with all other authors of the manuscript. All authors have approved the final manuscript.
Disclosure statement
No potential conflict of interest was reported by the authors.
Ethics and consent
The study was granted formal ethical approval by the Regional Ethics Review Board in Stockholm (Ref. 2015/712-31/1). Permission to conduct the study was obtained from the heads of the participating primary healthcare centers. Participants gave their individual written informed consent prior to participation in the interviews. Voluntary participation and confidentiality were ensured, and the participants were informed of their right to withdraw from the study at any time. For privacy reasons, participants were assured that their place of residence and other sensitive data will not be directly linked to them. This afforded participants the opportunity to speak freely. For this reason, the names of the participants’ areas of residence are not disclosed.
Paper context
T2D care in Sweden has primarily been at health facility level with minimal focus on prevention. Research on the meaning of communities, how they interact and engage with other stakeholders in prevention and management of T2D is scarce. Our findings provide a point of departure for development of community-clinical linkages to improve the capacity of the Swedish healthcare system and municipalities in dealing with the prevention and management of T2D. However, further research on innovative ways to achieve this is required.