How the Market Influences Formal and Patient Systems of Support for Long Term Condition Management: Stakeholder Accounts of Commonalities and Differences Across Six European Countries

The challenges of increasing provision of resources delivered by the market  and how it influences influences  long term condition management is a relatively under-analysed area.  European countries policies and health care systems are increasingly adopting policies for the prevention and management of long term conditions which focus on enhancing individual, competencies, skills, behaviour and lifestyle changes. How the broader market influences relevant policy and practice such as those related to food production, distribution and consumption and the structural aspects and economics relating to physical exercise and governance of health care delivery systems  are implicated in the populations ability to self- manage. This study aimed to identify key informants operating with knowledge of both policy and practice in order to explore how these influences are seen to impact on the self-management support environment.

Ninety semi-structured interviews were conducted with key stakeholder informants in Bulgaria, Spain, Greece, Norway, Netherlands and UK. Interviews were transcribed and analysed using thematic and textual analysis.

 The infrastructure and culture for supporting self- management practice  was viewed as driven by political decision-makers, the socio-economic and policy environment, and the ethos and delivery of financially incentivised formal health care systems. Three key themes emerged 1) social environmental influences on self-management 2) reluctance or inability of policy makers to regulate processes and environments related to chronic illness management 3) the focus of healthcare system governance and gaps in provision of self-management support (SMS). Nuances in the salience of themes between countries related to the presence and articulation of dedicated self- management policies, drug company involvement and the impact of measures resulting from economic crises and public spending on shaping illness management.

There is a need to acknowledge meso level influences and the private market and economic and policy challenges in addressing  people's capacity to undertake self-care activities.