Xuxi Zhang

negative association with both physical and mental HRQoL. The associations between social frailty and both physical and mental HRQoL remained significant when controlling for physical and psychological frailty. In Chapter 3 , the longitudinal association between frequency of moderate physical activity and overall, physical, psychological and social frailty as well as the association between a 12 ‐ month change in frequency of moderate physical activity and frailty were studied. Our results showed that both maintaining a regular frequency of physical activity and increasing to a regular frequency of physical activity are associated with maintaining or improving the level of frailty, not only in the physical domain, but also in the psychological and social domains of frailty. In Chapter 4 , the reliability and validity of the full TFI and its three domains were assessed. Our study supported the reliability and validity of the full TFI and physical domain. The TFI may be applied as an instrument to measure frailty in community ‐ dwelling older adults for large ‐ scale population studies on frailty in the five European countries In Chapter 5 , process components of the implementation of the UHCE approach were evaluated using the Steckler and Linnan framework. The findings indicate that people in poor health might have enrolled less often and that care activities requiring transport or a higher level of activity might not reach older people who are limited in their functioning. Finally, mistrust towards unfamiliar care providers and lack of confidence to engage in certain care activities were observed to be main barriers towards engagement in care among older people. In Chapter 6 , the effects of peer support on glycemic control for patients with T2DM and the important characteristics among providers, types, intervention duration and effect duration were studied through a meta ‐ analysis among relevant randomized control trials (RCTs). Peer support was found to achieve modest but statistically significant benefits on glycemic control for patients with T2DM. Peer support provided by patients themselves as a group or provided by nonprofessionals like community workers may have significantly better effect. In Chapter 7 , the effects of interventions targeting modifiable risk factors of diabetic retinopathy (blood glucose, blood pressure, lipid, dietary, physical activity and smoking) as well as the important characteristics of effective interventions were studied through a meta ‐ analysis among relevant RCTs. A multifactorial intervention with an individualized approach and communication between health professionals and patients was more effective than other interventions in the prevention and control of diabetic retinopathy. In Chapter 8 , the evaluation design of the SEFAC project was described. The SEFAC project aimed to improve the self ‐ management of citizens at risk of or with T2DM and/or CVD in four European countries using the SEFAC intervention. The intervention combines the concepts of mindfulness, social engagement and ICT support. The evaluation design includes the effects of the SEFAC intervention on self ‐ management, healthy lifestyle behaviors, social support, 240 Chapter 10