Joint interviewing has been frequently used in health research, and is the subject of a growing methodological literature. We review this literature, and build on it by drawing on a case study of how people make decisions about taking statins. This highlights two ways in which a dyadic approach to joint interviewing can add analytic value compared with individual interviewing. First, the analysis of interaction within joint interviews can help to explicate tacit knowledge and to illuminate the range of often hard-to-access resources that are drawn upon in making decisions. Second, joint interviews mitigate some of the weaknesses of interviewing as a method for studying practices; we offer a cautious defense of the often-tacit assumption that the "naturalness" of joint interviews strengthens their credibility as the basis for analytic inferences. We suggest that joint interviews are a particularly appropriate method for studying complex shared practices such as making health decisions.

Focus on creating a shared narrative not recording choices

No abstract

In an interview study of decision-making about statins, many participants said they took pills regularly, yet described themselves as 'not really pill-takers'. This paper explores this paradox and its implications. The practice of pill-taking itself can constitute a challenge to the presentation of moral adequacy, beyond the potential for rendering stigmatised illnesses visible. Meeting this challenge involves a complex process of calibrating often-conflicting moral imperatives: to be concerned, but not too concerned, over one's health; to be informed, but not over-informed; and deferential but not over-deferential to medical expertise. This calibration reflects a broader tension between rival tropes: embracing medical progress and resisting medicalisation. Participants who take statins present them as unquestionably necessary; 'needing' pills, as opposed to choosing to take them, serves as a defence against the devalued identity of being a pill-taker. However, needing to take statins offers an additional threat to identity, because taking statins is widely perceived to be an alternative strategy to 'choosing a healthy lifestyle'. This perception underpins a responsibilising health promotion discourse that shapes and complicates the work participants do to avoid presenting themselves as 'pill-takers'. The salience of this discourse should be acknowledged where discussions of medicalisation use statins as an example. ' (Smeeth and Hemingway, 2012) Smeeth and Hemingway's comment, written in response to a recommendation (Mihaylova and al, 2012) that statins should be offered at a lower threshold of cardiovascular risk than before, indicates a distaste for the idea of widespread pill-taking. Such distaste has become a trope over several decades, yet during these same decades people have come to take more pills than ever. This apparent paradox is explored in the study reported here, which looks at how participants talk about statin decisions. Many participants say they take pills regularly but also say they are not 'pill-takers'. This article explores what people mean by 'being a pilltaker', how they avoid presenting themselves in this implicitly undesirable way, and why it is particularly hard to legitimate statin-taking.

Preventive medications such as statins are recommended to an increasingly large number of people. To those who make these recommendations, prevention is synonymous with risk reduction; the clinical task of helping people decide about preventive medication is therefore widely framed as one of risk communication. In this article, I explore the role of risk and uncertainty in accounts of medication decisions, drawing on qualitative data from interviews carried out between 2011 and 2013 in the east of England with people who had been offered statins. I found that very few participants mentioned risk or likelihood, or described weighing benefits against harms, the process central to the risk communication project. Instead, those who had decided to take statins described their certainty that statins were needed to treat current problems. This certainty was informed by knowledge about the present or the past; information about possible future harms was presented solely as contributing to concern about current problems. In contrast, those who had decided not to take statins explained their decisions in terms of the inherent uncertainty of information about the future, presenting this uncertainty as a reason to decline medication. This asymmetry between explanations for accepting and for declining statins is rooted in differences between the ways past, present and future information are handled. These findings challenge the assumption that decisions about statins are construed as decisions about risk by those offered them, and raise questions about the usefulness of using risk and uncertainty as key concepts for theoretical accounts of what is going on when people consider taking preventive medication.