Co-creating community support strategies for chronic disease management: insights from our experience with two community groups in southern Quito, Ecuador.

Social support plays an important role in the management of type 2 diabetes (T2DM), yet health promotion strategies often focus on individual behavior change while overlooking community structures that sustain supportive environments and facilitate adherence to healthy behaviors. Participatory approaches can help identify locally grounded strategies to strengthen community support networks for chronic disease management. This study aimed to co-create community-based strategies to strengthen social support networks for T2DM management. Between March and September 2024, we conducted a participatory research process with two communities in southern Quito, Ecuador. A core group composed of community leaders and academic representatives facilitated a three-phase process including situational analysis, co-creation of strategies, evaluation, and dissemination. Four community workshops engaged 152 participants. Proposed actions were prioritized through a weighted scoring system assessing feasibility, community ownership, and potential impact on social support networks. Participants generated 15 community-driven proposals. The highest-ranked proposal was the creation of a community health committee responsible for identifying socially isolated individuals, raising family awareness, and facilitating accompaniment to medical appointments. Additional initiatives included nutrition workshops, a community cookbook, and a solidarity-based medication bank. Participants also highlighted strengthened relationships within and between community members and the need for sustainable coordination mechanisms. This study demonstrates the potential of participatory co-creation to generate locally grounded strategies that strengthen social support for chronic disease management. Community governance structures and collective support mechanisms are fundamental in health promotion efforts addressing chronic diseases. Health promotion strategies should integrate community knowledge and participation to enhance their relevance and sustainability.