'Permission to participate?' A qualitative study of participation in patients from differing socio-economic backgrounds.

Participation in health care is an important element of self-management in chronic illness, and policy emphasises patient's choice. Evidence suggests that this may be inequitable and inadequate, since active participation is strongly associated with socio-demographic variables. This qualitative study explores the perceptions of participation in people with differing socio-economic status with themes related to health literacy and relationship with health-care professionals. Patients perceive participation in different ways, related to their prior expectations of a health-care consultation, cultural expectations and social position. Policies aimed at simply improving 'health literacy' and choice will not be successful if these broader disparities are not addressed.