Abstract of Meeting Paper

One-Day Conference on Risk, June 13, 1997, City University, London

Heuristics About How Service Users and Professionals Perceive and Manage Health Risks. Bob Heyman and Mette Henriksen, University of Northumbria

The proposed paper will draw upon a number of qualitative research projects, carried out at the University of Northumbria, which have explored the ways in which service users and professionals understand and manage health risks. The research has been carried out in a range of clinical and service contexts, including general nursing; maternity and diabetes care; and care for the elderly, people with dementia, and people with learning difficulties.

As well as having clinical significance, this work can be used as a source of theoretical insight into risk analysis, the theme of the proposed paper. Health problems, in many cases, can be subjected to inductive, frequentist analysis; raise contentious issues about value priorities, event horizons and time frames; have a two way relationship to risk since they represent both an adversity which has happened and new hazards; and are explained by lay people in terms of a variety of explanatory schema other than risk analysis, e.g. fatalism, personalism, hedonism. The proposer has developed a theoretical analysis of health risk management, based on the above work, which, along with the empirical work, will be published as a book in 1998. The proposed paper will focus on understandings of probability, and will follow through the argument set out below. Each idea will be discussed briefly and illustrated with research data, with the aim of giving listeners an overview of the approach adopted. The argument will run as follows:

1. Probabilistic reasoning based on induction from observed frequencies should be reframed as a heuristic device for reducing uncertainty. Its employment allows the user to gain some predictive knowledge at the price of simplifying acceptance of the ecological fallacy that aggregate properties of a category hold true of the individuals in that category. As with any heuristic, simplification is achieved at the price of systematic error. Heuristics identified in psychological research, such as availability, representativeness and anchoring should be analysed as simplifications of simplifications.
2. The risk which an individual faces can be changed by altering the boundaries of the category into which that person is placed. This apparent absurdity can be explained by treating risk as externalised uncertainty. Professionals and service users may manipulate risk categories in order to achieve risk analysis results which they value a priori through processes of differentiation and generalisation.
3. Similarly, professionals and service users may take strategic decisions about seeking or not seeking knowledge in order to achieve a result which they value a priori.
4. Health risks which have been socially labeled and identified become real and have identifiable personal and organisational consequences. Some of the processes involved can be understood in terms of the idea of therapeutic and anti-therapeutic risk escalators driven by processes of reflexive recursion.
5. Given the role of values in health risk reasoning, and the heuristic basis of probabilistic reasoning, service users may judge risk expertise in terms of personal qualities, e.g. wisdom as much as in terms of technical expertise, and seek to synthesise the two forms of knowledge. The implications of different models of risk expertise for service user/professional relationships will be briefly explored.

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