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Expert and lay knowledge: A sociological perspective

Expert and lay knowledge: A sociological perspectivendi_
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The role of lay knowledge and its relationship to expert
scientific knowledge is an issue that has been frequently
explored by public health and health sociology scholars in
the last 20 years. A number of emerging trends impact upon
this relationship. On one hand diminishing trust in medical
and scientific expertise and greater access to alternate health
information sources have democratised clinical decision-
making.1Sociologists argue for greater personal responsibil-
ity for the management of health risks with health service
users positioned in health policy as active and ‘knowing
consumers’ of health services.2,3 The construction of service
users as knowing consumers challenges the traditional rela-
tionship between the expert practitioner and patient leading
to greater patient expectations for information and involve-
ment in decision-making around treatment.4Prior argues
that this contributes to a patient-centred medicine with
increasing accountability for lay perspectives in clinical
On the other hand, the development of evidence-based
practice privileges generalisable, scientific knowledge over
experiential knowledge.5Sociologists argue that evidence-
based practice may result in disease being treated objectively
in isolation from the individual’s experience of their every-
day life.6Furthermore, the use of epidemiological techniques
to identify risk factors for the development of health prob-
lems atomises experience, through emphasising discrete lif-
estyle behaviours.5,7 Springett et al. argue that the separating
out and management of lifestyle behaviours in isolation pre-
vents exploration of how these factors interrelate potentially
leading to a failure to deal with the ‘real’ issues that people
As health services move towards long-term management
of chronic disease and disability the meanings that people
attach to health behaviours become more important to care
provision.6Popay and Williams identify three ways in which
lay knowledge can inform practice.6First, awareness of lay
knowledge can provide a more nuanced understanding of
the factors contributing to health-damaging behaviours. The
adoption of unhealthy behaviours is often associated in
public health literature with knowledge deficit. This concept
is captured by a ‘public understanding of science’ that privi-
leges scientific knowledge, contrasting pure scientific knowl-
edge with devalued popularised, lay knowledge about
health. From this perspective the public are uninformed
recipients and passive consumers of health information, and
a failure to comply with the advice of health professionals is
understood as arising from poor understanding of this infor-
mation.8,9 Popay et al. argue instead, for exploring unhealthy
behaviours within their social context; for incorporating the
subjective lived experience of individuals and for recognition
of the impact of structural restrictions such as poor housing,
poverty and disempowerment into understandings of behav-
iours which diminish health.7
Second, the incorporation of lay knowledge can contrib-
ute to understanding of lay theories of disease causation by
highlighting the opinions that people hold about causes of
illness.6McMahon et al. in this issue demonstrate that lay
interpretation of food marketing messages differs from
expert opinion, particularly in relation to understanding of
‘lay’ keywords. Furthermore, acceptance of and trust in ‘sci-
entific’ messages depends upon regular exposure to these
terms.10 Given the divergence between lay and expert
opinion, awareness of lay beliefs around disease causation
may allow for better tailoring of health promotion strategies.6
It may also provide insight into the behaviours adopted to
avoid or manage illness.6Macintyre et al. for example found
that media reporting of food scares had more impact upon
the consumption of beef and eggs by British participants
than information about the guidelines for preventing coro-
nary heart disease. They conclude that official advice is
received with some skepticism resulting in participants
relying on ‘commonsense’ in making food decisions.11
A final consideration is that of predicting the future.
Popay and Williams note that when subjective experiences
of ill health are not confirmed by more objective measures
such as clinical examination, that the medical definition of
health and illness is privileged over the experiences of the
patient.6This may have a negative impact upon health. Gun-
narson and Hyden in a study of parental responses to child-
hood allergies found that the diffuse symptoms of food
allergies in conjunction with limited diagnostic tools delay
help-seeking behaviour. Parents adopt preventative strate-
gies and only seek medical advice when these fail.12 The
privileging of clinical diagnosis may also result in a failure to
identify early symptoms of illness. Popay and Williams argue
that experience of poor health in the absence of identifiable
pathology may be an indication of future illness. Taken
together, these factors lead them to conclude that subjective
experiences of illness should be taken seriously.6
Despite arguments for lay expertise, there are critiques of
the extent of this expertise. Prior questions whether it is
possible to have lay expertise, arguing that the term in itself
is an oxymoron.1Lay expertise, by definition is partial and
based upon experience acquired in everyday life.1,13 In the
health arena this involves personal experience of illness and
disease. While this knowledge is valuable in understanding
Nutrition & Dietetics 2010; 67: 4–5 DOI: 10.1111/j.1747-0080.2010.01409.x
© 2010 The Author
Journal compilation © 2010 Dietitians Association of Australia
individual experiences it is idiosyncratic insofar as it reflects
the experiences of one person only.1Furthermore, lay
knowledge does not usually involve skills in diagnosis and
management of illness. Patients are likely to have less knowl-
edge of the technical aspects of disease causation and prog-
nosis of conditions. These factors lead Prior to call for
recognition of the limitations of a lay contribution to
medicine and to clinical practice.1
In summary, changes in the delivery of health care have
resulted in greater expectations of, and a greater role for
inclusion of the experiences of the patients in the consulta-
tion process. While some sociologists view lay expertise as a
valuable adjunct to expert knowledge others question the
extent to which this knowledge can be generalised beyond
the experiences of a given individual. Nevertheless, in privi-
leging expert, scientific knowledge over lay knowledge,
health professionals risk misunderstanding the manner in
which the experiences and belief of their clients’ impact
health-seeking behaviour and in doing potentially under-
mine clinical practice.
Julie Henderson, BA (Hons), PhD
Research Fellow, Discipline of Public Health
Flinders University
Adelaide, South Australia, Australia
1 Prior L. Belief, knowledge and expertise: the emergence of the
lay expert in medical sociology. Sociol Health Ill 2003; 25:
2 Crawford R. Health as a meaningful social practice. Health
2006; 10: 401–20.
3 Lane K. The plasticity of professional boundaries: a case study of
collaborative care in maternity services. Health Soc Rev 2006;
15: 341–52.
4 Tousijn W. Beyond decline: consumerism, managerialism and
the need for a new medical professionalism. Health Soc Rev
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5 Springett J, Owen C, Callaghan J. The challenge of combining
‘lay’ knowledge with ‘evidence-based’ practice in health promo-
tion: Fag End Smoking Cessation Service. Crit Public Health
2007; 17: 229–42.
6 Popay J, Williams G. Public health research and lay knowledge.
Soc Sci Med 1996; 42: 759–68.
7 Popay J, William G, Thomas C, Gatrell A. Theorising inequali-
ties in health: the place of lay knowledge. Soc Health Ill 1998;
20: 619–44.
8 Wilcox S. Cultural context and the conventions of science jour-
nalism: drama and contradiction in media coverage of biological
ideas about sexuality. Cult Stud Media Commun 2003; 10: 225–
9 Hansen J, Holm L, Frewer L, Robinson P, Sandoe P. Beyond the
knowledge deficit: recent research into lay and expert attitudes
to food risks. Appetite 2003; 41: 111–21.
10 McMahon AT, Tapsell L, Williams P, Motion J, Jones SC. Food
advertisements containing ‘scientific’ and ‘lay person’ keywords:
responses from a sample of female Australian consumers.
Nutr Diet 2010; 67: 6–12.
11 Macintyre S, Reilly J, Miller D, Eldridge J. Food choice, food
scares and health: the role of the media. In: Murcott A, ed. The
Nation’s Diet: The Social Science of Food Choice. New York:
Addison Wesley Longman, 1998; 228–49.
12 Gunnarson N, Hyden L. Organizing allergy and being a ‘good’
parent: parents’ narratives about their children’s emerging prob-
lems. Health 2009; 13: 157–74.
13 Evan R, Plows A. Listening without prejudice? Re-discovering
the value of disinterested citizens. Soc Stud Sci 2007; 37: 827–
Leading article
© 2010 The Author
Journal compilation © 2010 Dietitians Association of Australia
... In users of complementary and alternative medicine (CAM) for example, a survey found that CAM users reported better health outcomes from the treatments that are suggested by both professionals and friends/family/co-workers, compared to those treatments recommended by only professionals or only friends/family/co-workers [68]. Regarding healthy eating, the individual's lay knowledge generated in society plays an important role in influencing their food choices [69]. Macintyre et al. for example, discovered that media reporting of food contamination scares had more influence on the consumption of eggs and beef in British people than the U.K. national guidelines for preventing coronary heart disease [69]. ...
... Regarding healthy eating, the individual's lay knowledge generated in society plays an important role in influencing their food choices [69]. Macintyre et al. for example, discovered that media reporting of food contamination scares had more influence on the consumption of eggs and beef in British people than the U.K. national guidelines for preventing coronary heart disease [69]. Therefore, health professionals should be aware of people's lay knowledge and find appropriate ways to address it. ...
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... Thus, TPP recalls the methodological proposals of Paulo Freire, who proposes listening deeply to the needs of the community, creating a dialogue for people to critically evaluate and delve into the problems of the community, promoting actions for people to change their living conditions, and permanent reflection on their actions [32]. In other words, it involves recognising lay knowledge, e.g. the role of people's everyday life experiences [33]. Along these lines, it is interesting to note what feminist epistemologies propose, specifically Donna Haraway's with "situated knowledge". ...
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... Lay people are "increasingly coming to frame their problems in professional terms" (Williams 2000: 58). Dieting is a professional terminology that may not always be overseen by clinicians but requires regulated and routinized practice of eating food to maintain, increase, or decrease body weight; to treat and prevent illness such as diabetes; or to improve health (Balfe 2007;Henderson 2010). Dieting was central to HIV management in the Nigerian context, as HIV-positive people in this study framed dieting as the solution to the problem of a low CD4 count (or, in lay terms, low immunity). ...
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Today the risks and uncertainties of scientific knowledge are much debated and science is criticized for its supposed inability to handle problems of the “real world”. In this context, we ask how lay knowledge can complement science. Focusing on healthcare projects, we show how laypeople cooperate with scientists to improve scientific knowledge. We conclude that while science remains logically autonomous, in a complex world it is simultaneously closely interlinked with lay knowledge.
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This book contains 6 chapters that aims to: (i) explore what health promotion is and be critical of it; (ii) set out key ideas in health promotion and explore the discourse surrounding it; (iii) introduce key thinkers in the field and discuss the relevance and application of their ideas; (iv) provide a theoretical basis for health promotion practice; (v) ask some challenging questions and encourage our readers to do the same; and lastly (vi) comment on the state of academic health promotion.
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Public participation in technological decision-making is increasingly seen as de rigueur, but the limits and purpose of such participation remain open to debate. In this paper we explore the tension between different rationales for widening participation and examine their implications for its practice. Taking debates about medical genomics in the UK as an illustrative example, we argue that more heterogeneous participation and debate have the potential to improve the scrutiny and accountability of science within representative democracies. In doing so we also argue that it is necessary to replace the language of 'lay expertise' with a more systematic and rigorous treatment of the expertise or its absence that characterizes different participants. Drawing on the theoretical work of Collins & Evans ( 2002), we distinguish between those processes where expert knowledge is required and debate is conducted within the public domain, rather than by the public itself, and those where the views of non-expert lay citizens are needed and valued. The effect of adopting this approach is to permit a more inclusive treatment of the 'technical' while also providing a positive role for non-expert citizens in the democratic control and oversight of science.
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Recent biological research into homosexuality has been heavily publicized in the media and has been central to intense political and cultural debates over sexuality. This paper presents an analysis of how biological ideas about sexuality have been represented in the media, and of the role that the media have played in circulating ideas about biology and sexuality throughout society. The content of media coverage of scientific research on homosexuality is influenced by the conventions of scientfic Journalism, which require discussion of the scientific context of particular studies and qualfied statements about the conclusions that can be drawn from the research. The coverage is deeply contradictory, however. Biology is popularly understood as biological determinism and in terms of a dichotomy between being born gay and choosing to be gay. The idea that being gay is a choice is prominent in the political agenda of the religious right, but the role of the right as political actor in debates over sexuality is not included in most media coverage of specific scientific studies. Instead, only the claims of gay people are presented as self-interested and political, and science is presented as an arbiter that will grant or deny legitimacy to these claims.
‘Lay’ knowledge is important for developing socially appropriate health-promotion practices. However, the current emphasis on evidence-based practice privileges expert and experimental knowledge over experiential and local. In practice, the integration of the two forms of knowledge is a negotiated process. A process evaluation of ‘Fag Ends’, a smoking cessation service, provides a case study of how lay advisers tried to integrate National Health Service requirements with both clients and their own knowledge about what works while remaining true to the values of the self-help group from which it originated. Its flexible, customer-orientated approach used a wide range of strategies to support quitters and a particular kind of adviser–client interaction, the essence of which is similar to motivational interviewing. The Fag Ends experience demonstrates how at the heart of UK public health lies a tension between the conflicting ideologies of medical science discourse and community/consumer driven health promotion implicit in the introduction of health advisers in the new public health strategy.
This paper contributes to the development of theory and research on inequalities in health. Our central premise is that these are currently limited because they fail adequately to address the relationship between agency and structure, and that lay knowledge in the form of narrative has a significant contribution to make to this endeavour. The paper is divided into three sections. In the first section we briefly review the existing, largely quantitative research on inequalities in health. We then move on to consider some of the most significant critiques of this body of work highlighting three issues: the pursuit of overly simple unidimensional explanations within ‘risk factor’ epidemiology and the (probably inevitable) inability of this research tradition to encompass the full complexity of social processes; the failure to consider the social context of individual behaviour and, in particular, the possibility for, and determinants of, creative human agency; and, thirdly, the need for ‘place’ and ‘time’ (both historical and biographical) to be given greater theoretical prominence. In the final section of the paper the potential theoretical significance of ‘place’ and ‘lay knowledge’, and the relationship between these concepts, in inequalities research is explored. Here we suggest three developments as a necessary condition for a more adequate theoretical framework in this field. We consider first the need for the conceptualisation and measurement of ‘place’ within a historical context, as the location in which macro social structures impact on people’s lives. Second, we argue for a re-conceptualisation of lay knowledge about everyday life in general and the nature and causes of health and illness in particular, as narratives which have embedded within them explanations for what people do and why – and which, in turn, shape social action. Finally, we suggest that this narrative knowledge is also the medium through which people locate themselves within the places they inhabit and determine how to act within and upon them. Lay knowledge therefore offers a vitally important but neglected perspective on the relationship between social context and the experience of health and illness at the individual and population level.
Aim:  To describe female consumer responses to food advertisements containing nutrition messages differentiated by use of ‘scientific’ and ‘lay person’ keywords. Method:  ‘Lay person’ and ‘scientific’ keywords were identified in advertisements from an audit of Australia's 30 top circulation magazines by people with or without formal scientific training in nutrition. Eight sample print advertisements were selected for consideration in focus group interviews. Four semistructured qualitative focus group interviews were conducted (women 25–63 years, n = 25 participants in total). Each group discussed four advertisements (two with ‘lay person’ and two with ‘scientific’ nutrition keywords). Thematic content analysis, including constant comparison and consensus, was driven by identifying types of responses and attributed meanings of keywords. Results:  Participants' responses to the sample advertisements ranged from giving an immediate judgement, attributing meaning to keywords, responding to the keyword's novelty, describing the process of information analysis and addressing tangential issues such as photographic cues. The diversity in response occurred whether the advertisement contained ‘scientific’ or ‘lay person’ keywords and reflected the influence of multiple discourses on perceptions of the credibility and persuasiveness of nutrition messages Conclusions:  Consumers' responses to keywords in advertisements are complex. Communications research that tests the message in its total context is needed to ensure the meaning of nutrition messages are being conveyed as is intended.
The article focuses on the early and problem-solving phases of the child's illness trajectory and on how child allergies are constructed and organized by the parents in a moral everyday context. The parents' narratives were reconstructed as narratives, describing the pathways parents take before they decide to seek professional medical aid as well as showing how they construct themselves as responsible parents. Before consulting health professionals the parents have often tried a range of different ways to define, control and manage their children's various problems. Allergy problems were interpreted and responded to differently, depending on the way they emerged in everyday life. Acute reactions quickly led to an illness definition and a diagnosis. Gradual and diffuse problems were not so easily defined. They were at first interpreted and responded to as normal infant problems, but, through the parents' readiness and various situational and temporal clues, they were organized as symptoms of illness. Parents seek medical aid when their own strategies fail or do not fully work, but their decisions are also formed within a pre-problem context of their moral accountability as parents.
Social science research into the social patterning of health and illness is extensive. One important aspect of this has been work on lay knowledge about health and illness. In this paper we develop three main arguments. First, we suggest that recent developments in social science understanding of the nature and significance of lay knowledge should be more widely recognized within the social sciences themselves. Second, we argue that if public health research, whatever the disciplinary perspective, is to provide an understanding of contemporary health problems that is simultaneously more robust and more holistic, it must incorporate and develop the theoretical and conceptual insights offered by this recent work on lay knowledge and with lay people. Finally, we argue that in order to accomplish this it will be necessary to construct research questions in such a way that the conventional distinctions between science and non-science, and the methodological wrangles associated with this distinction, become marginal to the research process. This will inevitably involve conflicts between members of different professional groups. These conflicts provide the opportunity for open debate on the science and politics of public health research and represent a challenge for the many disciplines involved in this field.
The paper has three main aims. First, to trace--through the pages of Sociology of Health and Illness--the changing ways in which lay understandings of health and illness have been represented during the 1979-2002 period. Second, to say something about the limits of lay knowledge (and particularly lay expertise) in matters of health and medicine. Third, to call for a re-assessment of what lay people can offer to a democratised and customer-sensitive system of health care and to attempt to draw a boundary around the domain of expertise. In following through on those aims, the author calls upon data derived from three current projects. These latter concern the diagnosis of Alzheimer's disease in people with Down's syndrome; the development of an outcome measure for people who have suffered a traumatic brain injury; and a study of why older people might reject annual influenza vaccinations.