Time-framing and health risks

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.

Section: Discussionmentioning

confidence: 99%

Current conditions or future risks: certainty and uncertainty in decisions about statins

Polak

2016

“…However, the notion that risk can be objectively measurable is untenable in a context where the idea itself has variable meanings (Slovic et al 2004, Zinn 2008, Brown et al 2013). In addition, as opposed to being formulated and located within discrete individuals, understandings of risk are shared, collective, and embedded in social context (Lupton 2013).…”

Section: Introductionmentioning

confidence: 98%

‘At risk by fact of birth’: perceptions and concerns about medical male circumcision for HIV prevention in northern Malawi

Mkandawire¹,

Dixon²,

Luginaah³

et al. 2014

In this article, we draw on critical approaches to risk to examine varied and interlaced perceptions of personal risk for HIV which young men in an area of traditionally low male circumcision have to Malawi government's new policy of medical male circumcision for HIV prevention, locally known as mdulidwe. In this article, we draw on data from in-depth interviews (n = 29) and focus groups (n = 24) with young men aged 18-24 years undertaken in 2013 in an area with traditionally low rates of circumcision, Livingstonia in the northern region district of Malawi. Our findings show that the push for medical male circumcision in this region has given rise to a perception that the penile foreskin is an inborn anomaly that leads to excessive risk for HIV provoking anxiety, confusion, uncertainty, fatalistic views, and waning faith in national response to the epidemic. Our analysis of the data indicates that medical male circumcision has ushered in a layered and sometimes conflicting understanding of risk for HIV/AIDS where established ideas grounded in sexual propriety and risk-taking are being reevaluated and reinterpreted within an emerging worldview coloured with sensibilities pertaining to notions of bodily normalcy. This indicates that the men in our study had a nuanced understanding of risk for HIV that incorporated notions of sexual risk-taking with corporeal impropriety, necessitating appropriate public risk communication about HIV/AIDS and policy responses for its prevention.

“…He advises both increased research and policy attention to the use of these 'in between' strategies of trust, intuition and emotion in managing uncertainty, otherwise 'individuals will disregard …advice or absorb and transform it within their own beliefs about responses to risk' (p. 447), for example, pregnant women who transformed alcohol abstinence advice into 'red wine is good for you' in order to continue drinking during pregnancy (Thirlaway & Hegg, 2005). The temporal dimension and biographical experience have also reframed both understandings of risk and the risk subject (Heyman, 2013, Brown et al, 2013a. Space precludes a full discussion (see Zinn, 2010a), but in brief, 'individual experiences during the course of one's life significantly impact on one's experience and response to risk' (Zinn, 2010a, p. 7).…”

Section: Health Risk and Society 407mentioning

confidence: 95%

“…In the intervening years since the 1992 Royal Society Report, the objective-subjective divide has seen a number of reframings and characterisations, with the broadly defined interpretivist paradigm growing in significance (see Brown, Heyman, & Alaszewski, 2013a). Differing epistemological and theoretical clashes have taken place, between positivism and constructivism, rational and irrational responses to risk; and latterly as differences between formal rational and non-rational understandings of risk rooted in intuition, affect and emotion (Zinn, 2008).…”

Section: Policy and Risk Rationalitiesmentioning

confidence: 97%

Conflicting rationalities of risk: disputing risk in social policy – reflecting on 35 years of researching risk

Kemshall

2014

This article considers how the concept of risk has been variously defined and deployed within research and UK social policy since the 1980s. The article does not present an in-depth historical narrative, but rather presents key trends over this period. The article begins with a short review of policy and risk rationalities from the 1980s onwards with a specific focus on the research 'discovery' of the 'rationality mistake' by the early 1990s. A short case study from the author's own research is then presented to illustrate the 'rationality mistake' in a particular arena of UK government policy on the management of sexual offenders. The paper concludes by briefly considering actual and potential developments in risk research and relevant recent theorising, and finally the likelihood of social policy understanding the risk subject more fully.