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An interplay of complex issues influence opportunities to gain paid work for people living with long-term conditions, but there are patterns that traverse the various contexts. Synthesising findings across qualitative studies can inform vocational rehabilitation approaches. Public consultation and PRISMA guidelines were used to develop a protocol and comprehensive search strategy. Seven databases were searched and results screened against inclusion criteria. Included studies investigated either lived experiences of gaining paid work while living with a long-term condition or the socio-cultural factors affecting opportunities for paid work. Findings were extracted from included studies and then analysed using thematic synthesis. Sixty-two studies met inclusion criteria. Identified themes demonstrate that people living with long-term conditions need access to support through the different stages of gaining paid work. This can include considering the benefits and risks of having paid work and negotiating needs in the workplace prior to and during employment. Positive experiences for workers and employers were influential in changing attitudes about the work-ability of people living with long-term conditions. Findings emphasise the interplay between socio-cultural norms and the constraints experienced in trying to gain work. Appropriately targeted support can unlock possibilities that are otherwise hindered by these norms.IMPLICATIONS FOR REHABILITATIONPositive experiences of paid work for people living with long-term conditions and those who employ them are important for stimulating future opportunities.“Informal” or alternative routes into paid work are experienced as more successful in contending with discrimination.Job seekers living with long-term conditions need access to pre-placement advocacy, support to negotiate work-related needs, and support to negotiate difficulties that arise in the job.Vocational rehabilitation initiatives need to have good collaboration with other health services to ensure consistent messages about seeking and managing work. Positive experiences of paid work for people living with long-term conditions and those who employ them are important for stimulating future opportunities. “Informal” or alternative routes into paid work are experienced as more successful in contending with discrimination. Job seekers living with long-term conditions need access to pre-placement advocacy, support to negotiate work-related needs, and support to negotiate difficulties that arise in the job. Vocational rehabilitation initiatives need to have good collaboration with other health services to ensure consistent messages about seeking and managing work.

Living with a long-term health condition and seeking paid work: qualitative systematic review and thematic synthesis