The borderland between care and self-care

Abstract: The aim of this thesis was to examine different approaches to support the self-care of persons with Type 2 diabetes, with special reference to practical, social, and sexual aspects of women's self-management. The methods to elucidate this comprised: evaluating a new model for diabetes patient education; designing a model to analyse the role of social networks in women's diabetes; conducting individual and focus group interviews for deeper understanding of the social and sexual aspects of diabetes; and collecting questionnaire data as a complement to the above.The experience-based educational program led by pharmacists was found to improve participants' subjective control over diabetes and to provide important emotional support and encouragement to continue self-care. Metabolic control as measured by HbA1c temporarily improved. The social network model elucidated potential mechanism leading to conflict of disease and social demands in women's diabetes. Qualitative analysis of the focus group interviews pointed to the role of guilt, shame, and social taboo in connection with the women's diabetes and sexuality.Borderland is the metaphor I have chosen to describe the space between the traditional health care system and the everyday self-care of people with chronic disease. Using Borderland as a framework, a future model for diabetes management, anchored in our own and other's findings, is outlined and the concept of "Disease Manager Role" is introduced. The vision of a self-care support center in Borderland addresses such issues as accessibility, continuity, equitable provider-user relations, shared care plans, and strengthening social support.