Purpose: Expressing a desire for surgery already before participating in first-line osteoarthritis (OA) interventions (patient education and exercise therapy) has in previous research shown to contribute to poorer outcomes from the interventions, yet we lack knowledge about patients’ views of health care and self-management of osteoarthritis (OA). This study aimed to explore and describe patients’ perspective of health care and self-management of OA among those expressing a desire for surgery before participating in first-line OA intervention.

Methods: Sixteen patients with hip or knee OA who had expressed a desire to undergo surgery before they participated in a standardized first-line OA intervention program in primary health care in Sweden were included in the study. We used individual semi-structured interviews to collect data, which were then analysed using inductive qualitative content analysis to identify, describe, and categorize patterns detected within the data.

Results: The analysis resulted in one main theme “A multifaceted picture of needs, expectations and individual choices”, which illustrates how the informants expressed a broad range of topics in their perspectives on health care and self-management of OA. Five categories, with its subcategories were identified: (1) lacking control and needing support, consisting of the perspectives; limiting activities due to pain, having difficulties in identifying patterns and finding strategies, feeling frustration and stress, seeing OA as an inevitable deterioration and needing help and being insecure (2) standing alone in an unsupportive environment, comprised of the two subcategories; being left alone and not being taken seriously (3) being passive, which included the subcategories; unstructured self-management, getting used to and adapting to the situation, limited retrieval of information and knowledge and passive health care consumer. (4) having expectations which was divided into the following subcategories: wanting quick help, doubts about the health care provided and expectations based on previous function and experiences and (5) taking ownership, which included trying to stay active or actively adapting to the situation and seeking control and answers (Fig.1).

Conclusions: The patients’ perspectives of expressing a desire for surgery already before participating in a first-line OA intervention program are multifaceted and based on a broad range of aspects, from a passive approach manifested by lack of control, adapting to the situation, being left alone, often resulting in doubts or mistrust regarding provided health care to actively trying to adapt to the situation and striving to maintain in control. Findings from this study strengthen insights on the importance of individualizing OA interventions and can contribute to optimizing the support that physiotherapists provide to patients in daily clinic practice.