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Glob Health Action. 2019;12(1):1609313. doi: 10.1080/16549716.2019.1609313.

Community and stakeholders' engagement in the prevention and management of Type 2 diabetes: a qualitative study in socioeconomically disadvantaged suburbs in region Stockholm.

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a Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden.
b Department of Food Studies, Nutrition, and Dietetics , Uppsala University , Uppsala , Sweden.
c School of Public Health , University of the Western Cape , Bellville , South Africa.
d Chronic Disease Initiative for Africa , University of Cape Town , Rondebosch , South Africa.
e Department of Biostatistics and Epidemiology , Makerere University College of Health Sciences, School of Public Health , Kampala , Uganda.
f Department of Molecular Medicine and Surgery, Diabetes and Endocrinology Unit , Karolinska Institutet , Stockholm , Sweden.
g Department of Women's and Children's Health , International Maternal and Child Health, Uppsala University , Uppsala , Sweden.


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.


Community; NCD prevention; Type 2 diabetes; health promotion; qualitative studies

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