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Background Multiple Sclerosis (MS) is a chronic, degenerative condition with an estimated UK prevalence of 100 000. Contact with health-care services is frequent and long-term; however, little research has investigated the experiences of health care for MS in the UK. Objective The aim of this systematic narrative review was to critically review qualitative studies reporting patients' experiences of health-care services in the UK. Search strategy EMBASE, CINAHL, Medline, psychINFO and MS Society databases were searched with no date restrictions using search terms denoting ‘Multiple Sclerosis’, ‘health-care services’, ‘patient’, ‘experience’ and ‘qualitative research’. Snowballing and hand searching of journals were used. Inclusion criteria Studies were included if they used qualitative methods of data collection and analysis to investigate adult patient's experiences of health-care services for MS in the UK. Data extraction and synthesis Data were extracted independently and analysed jointly by two reviewers. Studies were appraised for the quality of evidence described using the Critical Appraisal Skills Programme's qualitative tool. Due to the breadth of areas covered, the data were too heterogeneous for a synthesis and are presented as a narrative review. Main results and discussion Five studies were included. Studies primarily investigated diagnosis or palliative care. Themes of importance were the emotional experience of health care, continuity of care and access to services, and support from health-care professionals. Studies were mainly poor quality and focussed on a homogenous sample. Conclusions This study provides the first review of the UK evidence base of experiences of health care for MS. Future research should investigate experiences of care after diagnosis in a more varied sample of participants.

Individual-focused self-management interventions are one response to both an ageing society and the purported increase in chronic conditions. They tend to draw on psychological theories in self-management interventions, but over-reliance on these theories can reinforce a narrow focus on specified attitudinal and behavioural processes, omitting aspects of living with a chronic condition. While advances have been made in health behaviour change theory and practice, scant attention has been paid to the social, with the question of social context remaining under-theorised and under-explored empirically. This is particularly noticeable in trials of behaviour change interventions for self-management. The common sociological critique is that these ignore context and thus no explanation can be given as to why, for whom and under what circumstances a treatment works. Conversely, sociologists are criticised for offering no positive suggestions as to how context can be taken into account and for over-emphasising context with the risk of inhibiting innovation. This article provides an overview of these issues and provides examples of how context can be incorporated into the rigid method of trials of self-management for chronic conditions. We discuss modifications to both trial interventions and design that make constructive use of the concept of context.

Objective A lack of agreement between clinician and patient priorities can impact the clinician–patient relationship, treatment concordance, and potential health outcomes. Studies have suggested that patients with osteoarthritis (OA) may prioritize comorbidities over their OA, but as yet no explicit systematic exploration of OA patients' priorities in relation to comorbidities exists. This study aims to explore how patients prioritize their OA among their conditions, which factors underlie this prioritization, and whether and why these priorities change over time. Methods A secondary analysis of qualitative data was conducted utilizing 4 existing data sets collated from the 3 research centers involved. Purposive sampling provided a sample of 30 participants who all had OA and comorbidities. The research team collectively coded and analyzed the data thematically. Results Three groups of patients emerged from the analysis. The 2 smaller groups had stable priorities (where OA was or was not prioritized) and illustrated the importance of factors, such as personal social context and the specific nature of the comorbid conditions. The third and largest group reported priorities that shifted over time. Shifting appeared to be influenced by the participants' perceptions of control and/or interactions with clinical professionals, and could have important consequences for self-management behavior. Conclusion The various factors underlying patients' priorities among their conditions, and the fluctuating nature of these priorities, highlight the importance of regular assessments during clinician–patient consultations to allow better communication and treatment planning, and ultimately optimize patient outcomes.

Government policy promoting consumerism in healthcare can be seen as offering up certain preferred identities to which its citizens are encouraged to aspire. Whilst many commentators reject the notion that health services users should be conceived of as consumers, this paper outlines the relevance of the concept to our understanding of the ways in which individuals manage their health and service use. The paper examines the identity work undertaken by individuals in relation to decisions about healthcare preferences and assesses the extent to which this is compatible with the identities promoted in Government policy. We suggest that in circumstances where individuals feel both a sense of personal entitlement and a desire to be supportive of the needs of other members of the community, 'doing' ethical consumer can be fraught with discomfort and anxiety. These anxieties are exacerbated in a context where citizenship is increasingly being defined in terms of consumer identities, and making good (health) choices might be seen as distinguishing the civilised from the marginalised.