Table 3.

Key themes and sub-themes from respondent narratives

	BG	GR	SP	UK	NO	NL
Social environmental influences on diabetes self-management	+	+	+	+	+	+
Social inequalities impact on resources for SM				+	+	+
Public stigma and impact of portrayal of behavioural dispositions	+	+		+	+
Media and the portrayal of stigma	+	+	+	+	+
Diabetogenic food environment	+	+		+	+
Inability of policy to regulate processes and environments related to chronic illness management	+	+	+	+	+	+
Lack of governments capacity to regulate the food supply chain	+			+	+
Growing responsibility of localities stakeholders in a context of financial uncertainty			+	+	+	+
Challenges associated with the coordination, funding, and implementation of local commissioning of services				+	+	+
Extending the scope of voluntary and community groups and private provider involvement in SMS				+	+
Few welfare resources and impact of austerity on local supply and demand for SMS	+	+		+
Bio-medical tendencies and incentives in primary care	+	+	+	+	+	+
Gap between SMS policy and implementation within health services	+	+	+	+	+
Inconsistent support for shift in healthcare provision towards better SMS		+	+	+
Prevention/ public health interventions have a role in SMS	+	+	+	+	+	+
Insufficient policy level commitment to implementing SMS policies	+	+	+	+	+
Lack of incentives for SMS		+		+
Insufficient SMS tools and infrastructure in the health service	+	+	+	+	+	+
Drugs companies interests as barrier to implementing SMS	+	+	+	+	+
Professionals interests as barrier to implementing SMS	+		+	+
Growing involvement of patient groups			+		+	+
Financial crisis as an opportunity for changes in the healthcare system		+	+	+
System level crisis as a dominant policy concern	+	+
Drug companies providing SMS in the absence of state capacity	+	+	+