Weaving community networks for diabetes: co-creation with two community-based groups in Ecuador

Abstract Background Type 2 diabetes (T2DM) affects millions worldwide, requiring sustained efforts to promote healthy behaviours beyond clinical intervention. Strong social support networks are crucial for effective self-management as social interactions improve overall well-being and can help foster adherence to healthy behaviours. This study aims to co-create collaborative strategies that strengthen community-based support for T2DM management. Methods From March to September 2024, we conducted a Participatory Research (PR) project with two communities in southern Quito, led by a Core Group (CG) of three women and four men, representing a patient club, a neighbourhood committee, and a local academic institution. We developed four phases: (1) situation analysis based on prior evidence from an ongoing international research project, (2) co-creation of proposals using participatory tools such as relational flowcharts and problem/solution trees, (3) prioritisation in an open community event, and (4) evaluation with the CG. Results We held four participatory workshops which involved 152 participants and led to the cocreation of 15 community-driven proposals. Seventy participants attended the prioritisation event and voted for their preferred proposals. The proposals were scored using corrective factors as to whether they addressed root causes, were community-led, and strengthened support networks. Key actions included the establishment of a community health committee, local food-based nutrition workshops, a communal recipe initiative, and a medical supplies inventory. The evaluation highlighted strengthened relationships among community actors, increased collaboration, and the need for sustainable planning mechanisms. Conclusions This experience demonstrates the potential of participatory approaches to empower communities, strengthen social support networks, and address structural barriers in chronic disease management. Key messages • Incorporating community perspectives enables contextualised, relevant strategies that address social, psychological, economic and structural barriers in T2DM management. • Participatory methods through collective action are essential to co-create tangible and community-led initiatives that integrate local knowledge to improve chronic disease care.