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Expert and lay knowledge: A sociological perspective

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LEADING ARTICLE
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
encounters.1
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
face.5
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
4
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
REFERENCES
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2 Crawford R. Health as a meaningful social practice. Health
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3 Lane K. The plasticity of professional boundaries: a case study of
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4 Tousijn W. Beyond decline: consumerism, managerialism and
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5 Springett J, Owen C, Callaghan J. The challenge of combining
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6 Popay J, Williams G. Public health research and lay knowledge.
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10 McMahon AT, Tapsell L, Williams P, Motion J, Jones SC. Food
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11 Macintyre S, Reilly J, Miller D, Eldridge J. Food choice, food
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Leading article
© 2010 The Author
Journal compilation © 2010 Dietitians Association of Australia
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