Qualitative Research Perceived Risk

Journal of Risk Research Vol. 11, No.
5, July 2008, 617643
A characterisation of the methodology of qualitative research on the nature of perceived risk: trends and omissions
Gillian Hawkes* and Gene Rowe
Institute of Food Research, Norwich Research Park, Norwich, UK The issue of how risk is perceived is one of significant research interest and immense practical importance. In spite of this wide interest, however, it is probably fair to say that most emerging risk crises whether related to natural or technological phenomena come as a surprise to researchers and to society as a whole. Prediction of human responses to novel potential hazards (or novel manifestations of old hazards) is neither reliable nor complete; strategies to ameliorate inappropriate concerns when they arise (or to make realistic inappropriate absences of concern) do not appear totally effective. It therefore seems apt to ask the question: just what have we learned about risk perception? In this paper we conduct a structured review of qualitative research on perceived risk to be followed by a subsequent analysis of quantitative research in a later paper focusing upon methodological issues. Qualitative research often precedes quantitative research, and ideally informs it; it seeks depth and meaning from few subjects rather than identifying patterns within larger samples and populations. Without adequate qualitative research, quantitative research risks misanalysis of the target phenomenon, at the very least by the omission of relevant factors and inclusion of irrelevant ones. Our analysis here of qualitative studies conducted across a range of disciplines, not all of which will be familiar to the readers of this journal suggests that this research suffers from an incomplete coverage of the risk perception universe, typified by a focus on atypical hazards and study samples. We summarise the results of this research, while pointing out its limitations, and draw conclusions about future priorities for research of this type. Keywords: risk perception; qualitative research; structured review; risk communication
Introduction The issue of how risk is perceived is one of significant research interest and immense practical importance, particularly with regard to the setting of social policies in almost every domain, from health to finance, and transport to the environment. Published research on risk perception has accumulated with increasing speed over the last few decades, largely following from the seminal work of Paul Slovic and colleagues in the late 1970s and onwards (e.g., Slovic, Fischhoff, and Lichtenstein 1979a, 1979b). In that time, research has led to a number of significant findings. For example, it is now generally recognised that laypersons perceive risk in a more complex, multi-dimensional way than do risk assessors, who base their assessments of risk on the likelihood of human harm (we hesitate to say than experts, given methodological difficulties with much of the research comparing laypersons to experts, e.g., see Rowe and Wright 2001; Sjoberg 2002). It has also been found that certain demographic and socio-economic factors are related to
*Corresponding author. Email: gillian.hawkes@bbsrc.ac.uk
ISSN 1366-9877 print/ISSN 1466-4461 online # 2008 Taylor & Francis DOI: 10.1080/13669870701875776 http://www.informaworld.com
618 G. Hawkes and G. Rowe quantitative (if not qualitative) differences in risk perception: for example, males tend to rate the risks associated with (various/most) hazards as lower than do females. A variety of studies have also identified factors related to risk perception that have proven quite consistent across hazards and experimental samples for example, the factor of novelty/knowledge/uncertainty (howsoever this is phrased, e.g., Slovic, Fischhoff, and Lichtenstein 1980; Sparks and Shepherd 1994). In spite of the great research interest in this area, however, it is probably fair to say that most emerging risk crises whether related to natural or technological phenomena come as a surprise to researchers and to society as a whole. Prediction of human responses to novel potential hazards (or novel manifestations of old hazards) is neither reliable nor complete; strategies to ameliorate inappropriate concerns when they arise (or to make realistic inappropriate absences of concern) do not appear totally effective (e.g., for a critique of risk communication research, see Bier 2001). It is notable, for example, that there is no widely accepted model of risk perception that indicates what factors are related to risk perception, and in what way, and there is no theory that might help researchers and policy makers predict public responses to novel potential hazards. Among the unresolved issues is whether risk perception is fundamentally or primarily cognitive or emotional/affective. It is also unclear how risk perceptions are formed and develop, and to what extent aspects such as culture and the nature of the hazard itself influence how (qualitatively and quantitatively) risks are perceived. Furthermore, it is pertinent to observe that research on the issue of risk perception has taken place in a variety of academic domains not all of which are known to researchers in the risk domain which has generally focused on risks associated with ecological and technological hazards. In medical disciplines, for example, there has been considerable research interest in the perceived risks related to HIV infection and cancer as will be shown later. In the face of all this uncertainty, it would seem warranted to address the various literatures in detail in order to understand the state of play for the risk perception research community. This article is the first part of such a process: in this paper, we consider qualitative research, and in a future paper we will turn to address quantitative research. We have made this division as our main interest here is methodological, going beyond what research has found, to consider how it has been found. Our analysis and critique not only summarises what we do and do not know, but whether research is, and has been, conducted in such a way as to allow research questions like those indicated above to be addressed. As qualitative research often precedes quantitative work as well as being a standalone research approach it was considered useful to consider this body of work prior to tackling the larger body of quantitative research. It is often the case that qualitative research will precede quantitative research, mapping out the domain of interest in a relatively unconstrained and comprehensive manner. Such research is generally non-experimental; its aim from one perspective is to provide the raw material that may inform subsequent quantitative designs. (It is important to note, however, that qualitative researchers often see their work as an end in itself rather than as a precursor to quantitative research, its aim being to uncover a richness of processes that, they might argue, cannot be addressed adequately by simplistic quantitative methods.) In the risk perception field, however,
Journal of Risk Research
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quantitative research (a term used here in a largely interchangeable way with experimental research) has often taken place without preliminary qualitative studies the designs being informed instead by theoretical (by which we often mean, in this domain, intuitive) insights. As a case in point, much of Slovic et al.s early psychometric work, which asked subjects to complete questionnaires rating different hazards on a number of different risk characteristics, was based upon the researchers assumptions about which risk characteristics might be relevant (e.g., Slovic, Fischhoff, and Lichtenstein 1980). Subsequent work using a similar research paradigm, but informing choice of questionnaire items by qualitative findings, has revealed other factors related to risk perception not uncovered in the earlier work. For example, Fife-Schaw and Rowe (1996 2000) used focus groups to establish the kinds of risk characteristics that subjects thought might be important regarding food risks, and their subsequent analysis suggested there might be a naturalness dimension to risk perception not uncovered previously. Such a dimension has more clearly emerged from subsequent work by Sjoberg (e.g. 2002). In essence, a study can only find relationships between factors that are somehow included within its design, and it is important to be sure that research addresses the whole domain set and not a selective subset of issues if we are fully to understand the phenomenon being studied. In this paper we provide a structured review of qualitative studies of risk perception. By structured review we mean that we have used a detailed search approach to identify relevant papers (as will be described), and we characterise the nature of this research. In particular, we consider the extent to which research has addressed different facets (the whole domain set) of risk perception, discuss methodological deficiencies, and generally comment upon the comprehensiveness, validity and usefulness of qualitative research in this area. In our next article we will tackle the larger domain of quantitative studies. Method of review In this paper, we identify and critique qualitative studies carried out in the field of risk perception. The aim is to provide an overview of the field, but also to indicate methodological and theoretical improvements that can be made. Relevant papers were identified in November 2006 through searches in the internet-based databases Web of Knowledge, Science Direct, and Ingenta Connect. The search terms used were risk perception, risk communication, mental models and perceived risk. We then searched the references in these papers to identify other relevant papers that our searches may have missed, for example, ones that may have appeared in journals not included in the databases examined. A total of 2807 papers were identified by our searches. A number of criteria were devised to select a smaller sample of the most directly relevant papers for our current aims. That is, the papers had to be in English, they had to present the findings of empirical studies (therefore review articles, commentaries and book reviews were excluded), they had to deal with risk perception (rather than with risk analysis or some other aspect of risk), and the research methods used had to be qualitative in nature (or to include a qualitative in addition to quantitative component). Through a careful reading of the abstracts using the criteria discussed, this was reduced to 67 qualitative studies of direct relevance, including 13 studies that utilised both qualitative and quantitative research methods. Our analysis of the references
620 G. Hawkes and G. Rowe within the larger set of papers did not identify any further relevant papers. The quantitative studies uncovered in our searches will be considered in a future paper. The selected papers were then interrogated using the following questions:
N N N N
What hazards were studied? What research methods were used? How were research questions framed (i.e., what questions were asked of subjects)? What sampling methods were employed?
A sample of the 67 papers was cross-checked for consistency of interpretation by at least two researchers. In order to save words and provide concise tables, Table 1 provides a code of the different risk perception studies identified. In all subsequent tables, the numeric label of these studies is used, and this table should be referred to in order to identify the appropriate papers. Methodological characteristics of the qualitative risk perception studies Hazards studied In Table 2, the hazards studied by the different papers are identified (see Table 1 for coding of these papers). This table reveals that most studies have focused on a single hazard or type of hazard, with only three studies comparing a variety of hazard types (Lion, Meertens, and Bot 2002; Lupton and Tulloch 2002; and Rodham et al. 2006). These latter studies asked people generally what they were worried about. Most of the 64 remaining studies might be broadly categorised into those that either addressed health-related hazards (by which we mean diseases and medical interventions) or food-related hazards, with a number of other studies addressing various technological and lifestyle hazards. Most of the studies (39) were concerned with health-related hazards, with HIV/ AIDS the most frequently studied (by 11, e.g., Connors 1992 and Go et al. 2006). Of the others in this category, nine considered breast cancer (e.g., Bond et al. 2002 and Foster et al. 2002); three addressed cardiovascular disease (e.g., Goldman et al. 2006); two considered intravenous drug use (Dear 1995 and Miller 2005), and two focused on the vaccination of infants (Benin et al. 2006 and Raithatha et al. 2003). Other conditions were only addressed by single studies, e.g., SARS (Cava et al. 2005), pregnancy (Chapman 2003), smoking (Hay et al. 2002), and cystic fibrosis (Lowton 2004). As will be discussed in a later section, most of these studies took place in the developed world. Therefore, in order to gain some insight into the relative risk posed by these different hazards, we considered data on the main causes of death in the United Kingdom (recognising that there are, of course, differences in relative disease and mortality prevalence across developed countries). These figures reveal that circulatory diseases (which include cardiovascular diseases and stroke) had the highest death rate throughout the period from 19712004 (despite a fall of 58% since 1971). The second most common cause of death was respiratory diseases (which include pneumonia and bronchitis), and the third most common cause of death was cancers (of which lung cancer was the most common overall and breast cancer the most common in women) (Office of National Statistics 2006). According to the

Table 1. The risk perception papers and their numerical identifiers. Paper Aldoory and Van Dyke (2006) Beehler, McGuinness, and Vena (2001) Beehler, McGuinness, and Vena (2003) Benin et al. (2006) Bond et al. (2002) Bostrom et al. (1994) Brown and Ping (2003) Burger, Staine, and Gochfeld (1993) Carroll et al. (2003) Cava et al. (2005) Chapman (2003) Connors (1992) Dear (1995) Denberg, Wong, and Beattie (2005) Dokova et al. (2005) Fife-Schaw and Rowe (1996) Flint and Haynes (2006) Foster et al. (2002) Gaskell et al. (2004) Go et al. (2006) Goldman et al. (2006) Gorin and Albert (2003) Hallowell et al. (2004) Hay et al. (2002) Heyman et al. (2006) Holm and Kildevang (1996) Jensen et al. (2005) Jones and Haynes (2006) Katapodi et al. (2005) Kenen, Ardern-Jones, and Eeles (2003a) Langford et al. (2000) Lion, Meertens, and Bot (2002) Lofstedt (2003) Lowton (2004) Luginaah et al. (2002) Code 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 Paper Lupton and Tulloch (2002) Marrazzo, Coffey, and Bingham (2005) McAllister (2003) Mgalla and Pool (1997) Miles and Frewer (2001) Miller (2005) Moffatt and Pless-Mulloli (2003) Nelkin and Brown (1984) Ott et al. (2003) Poortinga et al. (2004) Quinn, Thomas, and McAllister (2005) Raithatha et al. (2003) Ramos, Shain, and Johnson (1995) Rodham et al. (2006) Royak-Schaler et al. (2004) Salant et al. (2006) Salazar et al. (2004) Skidmore and Hayter (2000) Slachtova et al. (1998) Smith et al. (2002) Sobo (1993) Sobo (2005) Stanley (2005) Thirlaway and Heggs (2005) Tolley et al. (2006) Trenoweth (2003) van Steenkiste et al. (2004) Wakefield and Elliott (2000) Wakefield and Elliott (2003) Walter et al. (2004) Weegels and Kanis (2000) Wright, Tompkins, and Jones (2005)
621
Code 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67
World Health Organisation data, this is broadly in line with the most common causes of death in developed countries (WHO 2003). Other causes of death are far less common, such as HIV/AIDS. For example, in 2000 in the United Kingdom, 208 people died of HIV/AIDS, while 14,478 did so in the US. Compare this to fatalities, in the same period, of 553,091 from cancer and 941,524 from circulatory diseases in the US; and 151,186 from cancer and 236,723 from circulatory diseases in the UK (WHO 2003). It would seem that there is a disjunction between the kind of hazards/risks chosen for study and the most severe hazards/risks faced by people in everyday life. That is,
622 G. Hawkes and G. Rowe
Table 2. Hazards studied. Health Total: 41 Hazard HIV/AIDS/STD Studies 12; 20; 28; 37; 39; 44; 48; 53; 56; 58; 60 5; 18; 22; 23; 29; 30; 50; 51; 59 9; 21; 62 13; 41 N 11 Food Total: 12 Hazard General food risks Studies 16; 26; 40 N 3 Environmental Total: 13 Hazard Climate change Studies 6 N 1 Other Total: 3 Hazards General risks Studies N 36 1
Breast cancer (and ovarian cancer) Cardiovascular disease Intra-venous drug use
3 2
Fishing and 2; 3; 8 fish consumption GM food 7; 19; 32* Bioterrorism 1
Forest disturbance by Spruce Bark beetles Polluted coastal bathing waters Radon concentrations in houses, dioxin emissions by incinerators, electromagnetic fields Mars Sample Return programme Petroleum refinery
17
Adolescents risks Household goods
49
3 1
31 32*
1 1
66
Vaccination of infants SARS
4; 47
10
Zoonotic risks (BSE and vCJD) Foot and Mouth Disease
27
33
45
35
Pregnancy Cancer Stroke Smoking Chromosomal abnormalities Cystic fibrosis
11 14 15 24 25 34
1 1 1 1 1 1
Opencast coal mining Hazardous chemicals Anthrax attacks Exposure to pesticides Heavy air pollution Noxious land uses
42 43 46 52 54 63
1 1 1 1 1 1
Table 2. (Continued.) Health Total: 41 Hazard Colon cancer Huntingdons disease Day surgery Violence in mental health inpatients HRT Hepatitis C Anti-blood clotting medication 38 55 57 61 65 67 32* Studies N 1 1 1 1 1 1 1 Food Total: 12 Hazard Studies N Environmental Total: 13 Hazard Non-hazardous industrial waste landfill Studies 64 N 1 Other Total: 3 Hazards Studies N
Note: * signifies study which examined hazards from more than one of the categories and thus appears more than once in the table.
623
624 G. Hawkes and G. Rowe nearly one third of those studies concerning health issues addressed a relatively minor hazard (AIDS/HIV) (although one of these was conducted in Tanzania, where the disease is much more prevalent), whereas only three considered some form of cancer, two considered circulatory diseases, and none considered respiratory diseases. Indeed, a recent study by the British Heart Foundation found that although the number of people dying of circulatory diseases has fallen over the past decade, there are now many more people living with these diseases (British Heart Foundation 2004). It is therefore notable that one of the biggest health hazards has, at least in qualitative research, been largely overlooked. More generally, there arises the issue as to whether our understanding of how people perceive risks is biased by a focus on unusual and arguably, media highlighted hazards, and undermined by a lack of interest in hazards that have other, less media-worthy characteristics. The proportion of studies addressing the specific hazards within other researched categories may also speak to this observation. If we now consider the studies on food-related hazards (of which there were 12), several of these compared a variety of hazards. Fife-Schaw and Rowe (1996) compared a total of 22 hazards, which ranged from campylobacter and colourings, to pesticide residues and heavy metal residues; Miles and Frewer (2001) looked at five hazards, namely, BSE, GM foods, high-fat foods, pesticides and salmonella food poisoning; and Holm and Kildevang (1996) asked subjects to consider food-related risks in general. Of the other single-hazard studies, three focused upon genetically modified foods (e.g., Brown and Ping 2003), and three considered fishing and fish consumption (with reference to heavy metal residues and pollution) (e.g., Beehler, McGuinness, and Vena 2003), while other hazards were considered by just a single study, i.e., zoonotic food risks (Jensen et al. 2005), Foot and Mouth disease (with some reference to possible risks to food) (Poortinga et al. 2004), and a bioterrorist attack on the food supply chain (Aldoory and Van Dyke 2006). If we consider which food-related hazards cause the most illness and death in the developed world (all the studies noted above took place in developed countries), using the UK as a general guide, we find that poor nutrition (the lack of healthy foods, and the over-indulgence in unhealthy ones such as those high in saturated fats) is likely the major cause of ill health and premature death (Department of Health 2005). As noted previously, cancer and cardiovascular diseases (including heart disease and stroke) are the major causes of death in the UK, accounting together for almost 60% of premature deaths. Notably, about one third of cancers can be attributed to poor nutrition (Department of Health 2000) and recall that there were over 150,000 cancer deaths in the UK in 2000 (noted previously). Increasing the consumption of fruit and vegetables can significantly reduce the risk of many chronic diseases (WHO 2003). In fact, it has been estimated that eating at least five portions of fruit and vegetables a day can reduce the risk of death from these chronic diseases by up to 20% (Department of Health 2000). Unhealthy diets (together with physical inactivity) have contributed to the growth in obesity in the UK, which is responsible for an estimated 9000 premature deaths per year, and thus accounts for 6% of all deaths (compared to 10% for smoking) (National Audit Office 2001). Of the qualitative studies on food hazards, however, only two (Fife-Schaw and Rowe 1996, and Miles and Frewer 2001) considered dietary aspects (high fat foods), and even then these were part of a suite of considered hazards.
625
Other hazards have attracted greater research interest. For example, the bacterial causes of food poisoning have been addressed by four studies (Fife-Schaw and Rowe 1996; Jensen et al. 2005; Holm and Kildevang 1996; Miles and Frewer 2001). While it is true that salmonella, Campylobacter, E.coli 0157, Listeria monocytogenes and Clostridium perfringens, taken together, account for the majority of cases of foodborne illness in our example developed country, the UK (e.g., 81,280 cases of food-borne illnesses in 2000: FSA 2002), they only cause a relatively few deaths (e.g., 718 deaths in England and Wales in 2002 see Rocourt et al. 2003). Though these bacteria are a major cause of illness and death in the developing world (Rocourt et al. 2003), no studies have used samples from such locations (see later section on study samples). The same four studies that considered bacterial sources of food poisoning also considered BSE. This is a very high visibility hazard that has also caused relatively few illnesses and fatalities (as of 2006, there were 161 probable cases of vCJD in the UK, with 156 deaths) (The National Creutzfeldt-Jacob Disease Surveillance Unit 2006). It is also notable that five of the studies considered genetically modified foods a highly contentious issue (whose risks are theoretical in nature) with high media coverage, but one that has not led to any definite cases of illness or death (FSA 2002). The study looking at Foot and Mouth disease (Poortinga et al. 2004) also reflected concern with a high profile hazard event, as did the study which focused on a possible bioterrorist attack on the food supply chain (Aldoory and Van Dyke 2006). We will return shortly to the implications of this focus of research. Other qualitative studies have considered a range of environmental, technological and lifestyle hazards, including those related to climate change (Bostrom et al. 1994); Anthrax attacks (Quinn, Thomas, and McAllister 2005) and polluted coastal bathing waters (Langford et al. 2000) to name a few. Though this is a small sample of studies to comment upon, it is worth considering how these hazards compare to others in terms of potential severity. For example, it is clear that much more mundane, though arguably less dramatic hazards are de facto riskier than some of the big issue hazards studied. To demonstrate this, we considered the main causes of accidental death in the United Kingdom. The highest number of fatalities in 2005/6 occurred in accidents in and around the home (3541) followed closely by road accidents (3201), although the highest number of casualties (non-fatal injuries) occurred in the home and during leisure activities (5,577,661) (ROSPA 2007). Other main causes of fatalities are on the railways (for example, railway employees, passengers, trespassers and suicides) (313), and in the work place (212, including deaths through trespass). However, when we compare this to the non-health and non-food related hazards studied, we see a very different picture emerging. Only one study focused on accidents sustained through the use of household goods. The others have focused on hazards that do not appear in the accident statistics, and which therefore, on a year-by-year basis, cause fewer fatalities and injuries than the more day-to-day hazards that can be found in and around the home or on the road. The main issue we have attempted to raise in this analysis is the extent to which the universe of potential hazards has been addressed by research studies, since the omission of consideration of particular types of hazard might lead to a gap in our understanding of why people perceive some hazards as risky and others as not, and might miss the identification of important factors related to perceptions (or non-perceptions!) of risk. We have suggested that, for example, the studies on
626 G. Hawkes and G. Rowe health-related hazards have largely omitted consideration of the most risky hazards, as have those on food-related risks and (tentatively) those related to accidental hazards in all cases there being a preponderant research interest in the populist, with omission of concern for lower profile and perhaps less dramatic and visual hazards. There is, of course, no reason not to study high visibility hazards: our aim is not to criticise the researchers studying these, but rather, to draw attention to other hazard types that research has neglected, findings about which might arguably have greater implications for human health and risk communication. Types of method used Tables 3, 4 and 5 identify the research techniques employed in the qualitative studies (refer to Table 1 for the key to identify the noted papers). In this section we discuss the types of method used; in the next section we discuss the nature of the samples used and other details from these tables. The most commonly used method was the individual interview, used as the sole qualitative method in 40 studies, while focus groups were used as the sole qualitative method in 16 studies. Table 3 records details of the interview studies, and includes details on a further nine studies that used interviews along with other qualitative methods, such as focus groups and ethnographic research. Table 4 details the focus group studies and includes information on seven additional studies that used this method along with another qualitative method (in each case, this being interviews). Five further studies are described in Table 5: these employed other qualitative methods, including two that used qualitative (open-ended) questionnaires (Lofstedt 2003; Thirlaway and Heggs 2005); two that used ethnographic research (Connors 1992; Ramos, Shain, and Johnson 1995); and one that used video reconstructions (Weegels and Kanis 2000). Across these three types of qualitative study, a total of 18 combined both a qualitative and a quantitative element, though for the purposes of this review, only the qualitative elements of the studies are discussed (those involving a quantitative aspect are indicated with an asterisk in Tables 3, 4 and 5). It is important to note here that the sample size figures in these tables refer solely to the number of participants studied using the particular method detailed in each table, and not necessarily the total sample sizes within the noted studies per se. Regarding the interview studies (Table 3), these were mostly semi-structured, that is, researchers reported being roughly guided by a number of questions about particular topics of interest to them (e.g., Katapodi et al. 2005; Raithatha et al. 2003), although some interviews were less-structured (e.g., Lupton and Tulloch 2002 simply asked participants what they were worried about, and the interview proceeded from there). A number of the other interview studies used slightly more involved methods. For example, Miles and Frewer (2001) used the laddering technique in order to delve down to the values underlying participants responses (laddering requires the interviewer to constantly repeat the question: and why is that important to you? to get beyond superficial answers and attempt to find the core values underlying these e.g., see Miles and Rowe 2004). Other studies used a mental models approach to elicit information from participants (e.g., Bostrom et al. 1994), in which beliefs are elicited by allowing participants to give their own structure to the interview. Another interesting variation was used by Weegels and Kanis (2000), who showed video recordings of initial interviews to participants to

Table 3. Details of the interview studies. Study Sample size Type of interview 4 Semi-structured Total 33 Type Purposive Sample characteristics Country USA
627
Comments on make-up
6* 8
Mental models Semi-structured
100 154
9 10 11* 12*# 13 14 15 17* 18 20 22* 23 24 25 26 27 29 30 34 35
Semi-structured Semi-structured Unstructured Semi-structured Unstructured Semi-structured Structured Semi-structured Semi-structured Semi-structured Semi-structured Semi-structured Semi-structured Semi-structured Semi-structured Semi-structured Semi-structured Semi-structured Semi-structured Semi-structured
20 21 83 42 ? 24 635 115 15 22 26 30 15 54 20 24 11 21 31 29
36 38 39 40* 41 42*
Unstructured Semi-structured Semi-structured Laddering Semi-structured Semi-structured
74 29 53 130 60 31
43
Semi-structured
75
All women, interviewed 1-3 days post-partum and again 3-6 months later Convenience USA 3 different studies Convenience USA Majority AfricanAmerican, Hispanic and unemployed Purposive UK All had type 2 diabetes Random Canada 7 were healthcare workers Snowball Mozambique All women, all pregnant Purposive USA All IDUs, a further 66 took part in questionnaire Convenience Australia All IDUs Purposive USA Socio-economically diverse Random Bulgaria Convenience USA Random UK All women with history of breast/ovarian cancer Snowball Vietnam Purposive USA All women with close relative with breast cancer Purposive UK All women who had undergone genetic testing Purposive USA All were smokers Purposive UK Multiple interviews: pre-and post-screening Convenience Denmark Majority women Purposive Denmark 11 lay people and 13 experts Convenience USA All women with abnormal breast symptoms Purposive UK All women from high-risk families Purposive UK All cystic fibrosis sufferers Convenience USA Recruited after earlier questionnaire (indicated willingness) Convenience Australia Convenience UK All from high-risk families Random Tanzania 33 bar workers and 20 male visitors Convenience UK Majority women Purposive Australia All IDUs Purposive UK Recruited after earlier questionnaire (based on results) ? USA

Table 3. (Continued.) Study Sample size Type of interview 44 46 Semi-structured Semi-structured Total 21 65 Type Sample characteristics Country Comments on make-up Majority AfricanAmerican, all postal workers Majority women (1 male) Recruited through field research All women, majority African-American
Convenience USA Snowball USA
47 48# 51* 53 54* 55 56 57 58 60* 61 62 63 64 65 66# 67
Semi-structured Unstructured Semi-structured Unstructured Semi-structured Semi-structured Semi-structured Semi-structured Semi-structured Semi-structured Semi-structured Semi-structured Semi-structured Semi-structured Semi-structured Structured Semi-structured
15 102 33 50 7 5 13 35 126 30 10 22 36 23 4 42 17
Convenience UK Purposive USA Convenience USA Convenience UK Purposive Czech Republic Convenience UK Purposive USA Convenience USA Purposive UK
All women at high risk
Parents and health professionals Purposive India All women, 14 high risk, 16 low risk Purposive UK All nurses Convenience Netherlands Majority male Convenience Canada Purposive Canada Random UK All women Random Netherlands Also included video reconstructions Purposive UK All IDUs with Hepatitis C
*: interviews and quantitative component : interviews and focus groups #: interviews and other methods (e.g. field research, video reconstructions)
stimulate further discussion about the topic of concern (accidents that had caused the participants to visit an Accident and Emergency department). The total sample size in these studies ranged from 4 to 635, with the majority of studies interviewing 2050 participants. Focus groups were used in 23 studies in total (see Table 4). The number of focus groups held per study varied from 3 to 40, while the number of participants per focus group ranged from 4 to 15. Consequently, the total sample sizes ranged from 23 to 341. It is significant to note, however, that a large number of studies did not record full details about these important methodological features. While on the topic of missing data, we should also note a widespread absence of key details in many studies concerning the questions asked of participants. For example, only 20 studies recorded the questions asked (2, 4, 6, 8, 9, 12, 15, 16, 21, 26, 29, 31, 32, 33, 38, 40, 44, 51, 57, 59 see Table 1 for identification). Naturally, if the aim of a study is to be as open and flexible in data acquisition as possible, then there

Table 4. Details of the focus group studies. Study Sample size N of N in focus groups focus groups 1 2 3 5* 7* 11* 16* 19* 21 28* 6 4 4 7 4 ? 9 40 7 8 ? ? ? ? ? ? ? 5-8 ? 4-15 Total Type Sample characteristics Country
629
Comments on make-up
62 37 33 30 100 83 ? ? 50 ?
Convenience Convenience Snowball Purposive Random Snowball Convenience Convenience Random Convenience
USA
31*
108
Purposive
32* 37 45*
9 ? ?
? ? ?
57 23 35
Convenience Convenience Convenience
46
65
Snowball
48 49 50
? ? ?
? ? ?
150 24 42
Purposive Convenience Purposive
52 54* 56 58 65
? ? 3 63 ?
? ? 9 ? ?
33 ? 27 341 36
Purposive Purposive Purposive Convenience Random
Most assoc with university USA Majority AfricanAmerican USA All Latinos USA All women with breast cancer USA Majority female (82%) Mozambique All pregnant women UK 10 EU countries USA Recruited topic blind UK Recruited via earlier questionnaire (indicated willingness) UK Recruited via earlier questionnaire (based on results) Netherlands Canada All lesbian and bisexual women UK Recruited via earlier questionnaire (indicated willingness) USA Majority AfricanAmerican postal workers USA Recruited through field research UK Majority female (16) USA All women and all African-American or Hispanic USA Aged between 13-16 Czech Unknown number took Republic part in focus groups USA Majority female and all African-American UK UK All women (additional 4 were interviewed)
*: focus group and quantitative component : focus group and interviews #: focus group and other qualitative method (e.g., field research)

Table 5. Details of other qualitative studies. Study Sample size Type of method 33* 59 12 48 66 Open-ended questionnaires Open-ended questionnaire Field (or ethnographic) research Field (or ethnographic) research Video reconstructions Total 70 176 42 252 42 Type Convenience Convenience Convenience Purposive Random Sample characteristics Country USA UK USA USA Comments on make-up Recruited outside museum All women All IDUs
Field research used to recruit participants Netherlands Video reconstructions of accidents
*: with quantitative element : with interviews and focus groups
may be no precise formulation of an interview question. Thus, some studies preferred to leave the questioning open, asking participants indirect questions and allowing concerns about hazards to surface unprompted (e.g., Holm and Kildevang 1996), while others were interested in exploring peoples risk perception about a very specific topic and therefore questioned participants in a more direct and controlled manner (e.g., Dokova et al. 2005). It is apparent, however, that in many cases, interview schedules and question wordings may have existed but not been reported. These are important issues to consider as the usage of specific terms such as risk or worry has the ability to frame the question and lead the questioning in a particular way (it is important that the question posed allows study participants to understand what is being asked of them, while not being too leading). Thus, we know that a number of studies explicitly used the word risk in their interrogations (e.g., Sobo 2005; Goldman et al. 2006), but we are unclear whether this phrasing was common. Little research has been conducted on differences or biases due to the differential framing of questions about risk: absence of methodological details in many studies prevents us saying more on this subject here, save to suggest that future studies ought to be more comprehensive in the descriptions of their methods. As has been discussed above, a majority of studies used either interviews (particularly semi-structured) as their data collection method, or focus groups. Because all data collection methods have strengths and weaknesses, by focusing on one particular method, weaknesses cannot be ameliorated. For example, interviews can suffer from a number of difficulties, such as the views of the interviewer biasing/ influencing the interviewee, although the method allows for the interviewer to probe for greater detail or elicit further information than methods such as questionnaires. In contrast, focus groups have other problems, such as group consensus inhibiting original, unorthodox, or minority views although this method allows for interactive discussion, where a greater range of opinions can be sought. An approach using different but complimentary methods may thus be a more effective way to study a problem (Arhinful et al. 1996, 24). From this perspective, it is worth
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discussing in more detail the nine studies that used multiple methods. Five of these used focus groups and interviews; two used interviews, questionnaires and focus groups; one used interviews, questionnaires and ethnographic research; and one used interviews in combination with video reconstructions (Weegels and Kanis 2000). Some of these studies specifically sought to combine methods in a beneficial manner. For example, in Chapman (2003), 83 women took part in individual interviews, filled out questionnaires, and were part of a series of focus groups. Because of the cultural beliefs surrounding pregnancy in Mozambique, it was felt that the female participants here would likely disclose different levels of information in individual interviews than in group discussions, and so the same sample took part in all the different aspects of the study. Similarly, in the study by Sobo (1993), focus groups and interviews were conducted on the same sample here, the focus groups being followed by individual interviews with 13 of the women who had taken part in these. In this case it was felt that, because the group discussions were on a sensitive topic (sexual activity and HIV/AIDS), it was important to also interview participants on a one-to-one basis, and that this was best done after the women had become familiar with the researchers during the group process so that accrued trust might encourage a greater level of disclosure. In the case of the study conducted by Stanley (2005), there was a deliberate decision to use group discussions and individual interviews with different groups of people to allow for different views to come out, and to take advantage of the different methods. Although it was clear that bravado and embarrassment play a role in group discussions about sexual activity (the focus of the study), it was nonetheless considered useful to acknowledge this in the research process, and hence focus groups were used as well as interviews. Quinn, Thomas, and McAllister (2005) also used different participants in each of several methods, conducting interviews with key informants and following these with both focus groups and individual interviews with rank-and-file postal workers. In this study, participants were allowed to select the interview format that they were most comfortable with, and researchers were then able to explore key questions through both individual discussions and more interactive group ones (a total of 65 people took part in this study: 36 in focus groups, 20 in interviews, and 9 in key informant interviews). Walter et al. (2004) also used both focus groups and interviews with different participants, being directed here by pragmatic considerations i.e., using interviews for participants who could not take part in the focus group discussion. An interesting additional element to qualitative research is found in Ramos, Shain, and Johnson (1995), who used both focus groups and interviews but also used an ethnographic research approach in order to recruit participants and help with the interviewing technique. That is, the interviews were conducted in a naturalistic setting and the language (slang) of the participants was used by the interviewers. In this study, it is unclear if a separate sample took part in the focus groups and in the interviews, though the methods in combination served to elicit generalised views on risks and how participants view these (focus groups) and how participants dealt with these risks on a daily basis (individual interviews). The ethnographic element was important to establish rapport and trust with the participants and also to shape and frame the way the interviews were conducted. Taking a more naturalistic approach to qualitative research is arguably like using multiple methods a beneficial approach (though arguably this is less so in
632 G. Hawkes and G. Rowe quantitative or experimental research, where greater control over the research environment is needed). That is, most studies have operated in somewhat sterile academic environments that remove relevant environmental cues to thoughts and behaviour, and may invoke particular frames of responding (i.e., participants being framed as experimental subjects, who may experience needs for socially desirable responding). We might learn more about what hazards truly concern people, and in what way, by taking our studies outside the laboratory. Aside from Ramos, Shain, and Johnson (1995), the study of Connors (1992) is notable in this regard, using interviews preceded by field research, in which the participants risk exposure and behaviour were observed. We suggest that the risk perception domain might benefit from more ethnographic research. Several other studies were interesting for combining a qualitative and quantitative component. In some cases qualitative research preceded and thus informed later quantitative work (e.g., Fife-Schaw and Rowe 1996); in other cases (e.g., Poortinga et al. 2004; Jones and Haynes 2006; and Langford et al. 2000) participants in the focus groups were recruited after having taken part in a previous quantitative study. In the case of Poortinga et al. (2004) and Jones and Haynes (2006), recruitment was done on the basis of participants showing willingness to take part in a further element of the study, whereas in Langford et al. (2000), focus group participants were specifically selected on the basis of responses from a previous quantitative study. Finally, it is worth noting that most of the studies discussed here focused on perceptions of risk at a particular moment in time: there is little that most of these studies can truly contribute to our knowledge of how perceptions emerge and change through time. Although some studies (see above) did use consecutive methods (e.g., focus groups followed by interviews), there were only a few that specifically did this to explore change over time (e.g., Heyman et al. 2006 and Benin et al. 2006). In the study carried out by Heyman et al. (2006), women were interviewed immediately after they received the news that their unborn babies might be at higher risk of chromosomal abnormalities. The same group of women was interviewed after they had received further confirmation of their high risk status (or not). The aim of the study was thus to try and understand how women respond to being placed in a higher risk category and what effect this has on their lives. The later interviews were useful in gaining further insight in how women responded to their increased risk status, even when they had been given the all-clear. Benin et al. (2006) also interviewed mothers at different time intervals: the first series of interviews was conducted 13 days post-partum and the second series once the baby was aged between three and six months. The focus of this study was mothers risk perceptions of vaccinations, and how these changed over time and in what way, and it also looked at the sources of information different mothers used at different times to inform their decision-making process. Poortinga et al. (2004) also used a two-stage approach, with questionnaires initially used to assess views on a particular highprofile topic, followed by focus groups some time later. This allowed some commentary on how views might have changed in the intervening period, though the samples in the two stages were different. In conclusion, we would recommend that more longitudinal research is conducted in order to improve our understanding of the development and life-course of risk perceptions.
Journal of Risk Research Study samples
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The first aspect worthy of note concerns the locations in which the studies were carried out. These details are recorded in Tables 35, and are summarised in Figure 1. As can be seen in the figure, most studies were either carried out in North America (USA and Canada) (30 in total) or the UK (22). Of the rest, eight took place in other European countries, and three in Australia, with only four in developing countries. Given that one of our selection criteria was publication in English, the English-speaking-world bias is perhaps unsurprising. And given global variations in research funding opportunities, it is also unsurprising that almost all of the other studies have taken place in developed countries. However, if culture plays a role in how people perceive risks, there is a danger that our knowledge of the extent of this factors role will be undermined by the relatively narrow focus of research on Western civilisation. It is also possible that the role and importance of socioeconomic characteristics may be underestimated by our focus on relatively wealthy samples. Research results as will be suggested in the final section of this paper do indeed suggest that cultural and socio-economic aspects are important factors in explaining how and whether people perceive something as risky (see Connors 1992; Chapman 2003; Sobo 1993; Tolley et al. 2006). Tables 3, 4 and 5 also detail the characteristics of the samples used in the various studies. If we look further at the sampling details, we find that most of the studies used convenience samples by which we mean participants were chosen on the basis of their availability rather than their representativeness of any particular population though a fairly high number instead involved purposive sampling (attaining participants of particular types). Relatively few studies claimed to attain random samples (by which we essentially mean samples that roughly took into account or controlled for major socio-demographic differences, such as roughly even splits of males/females). A few studies employed snowball sampling (participants effectively helping to recruit other participants). Though convenience sampling is a method often used in qualitative research, and reflects difficulties in sample recruitment, the method should only really be used when more sophisticated recruitment methods are utterly unfeasible. Certainly, it is difficult to generalise to the wider population from such studies, and though the researchers themselves may take care not to
Figure 1. Number of studies by country.
634 G. Hawkes and G. Rowe over-generalise, we tentatively suggest that others citing their works may be less careful in repeating the necessary caveats in their summaries (a hypothesis we invite others to test). Convenience sampling would be more valid if aspects such as socioeconomics, demographics, and culture played no role in risk perception, but if they do, then studies using this approach are likely to miss the collection of important perspectives from unsampled population subsets and potentially claim to ascertain general trends that are not the case. It is worth noting at this point that many studies failed to record demographic characteristics of their samples, suggesting that the researchers were unaware how important such factors might be for explaining their results (it is mainly for this reason that we limit commentary on precise sample characteristics, in Tables 35, to the final column, where we make some general remarks on this aspect only). There are a number of other sampling trends that are worthy of note. In particular, it is clear that studies may be divided into either those that have sought to sample members of the general population (or a convenience sample thereof) with no particular engagement with the hazard in question, or they have sampled people or groups that have some particular interest in the hazard/s studied. Table 6 reveals how we have classified studies in this respect. Only about one-third of studies comprised the first type, and these mainly addressed food hazards (e.g., Fife-Schaw and Rowe 1996) or the more general topic of what people perceive as risky (e.g., Lupton and Tulloch 2002; Rodham et al. 2006). It should be noted, however, that unless people are recruited to a study topic-blind, one might argue that they are likely to have some special interest in or knowledge of the topic, or else why would they respond to recruitment requests? Again, research details in many of the published studies do not allow us to ascertain the exact information used to entice respondents to take part in the studies, although we suspect few, if any, were completely topic blind (though some undoubtedly were fairly vague in informing subjects what their research was about in order to address this potential source of bias e.g., Holm and Kildevang (1996) deliberately avoided using the terms food risk and food safety, instead phrasing their study as just being about food). Of those studies that sampled people with some particular interest in the hazard/s in question, some focused on those with a high risk of hazard exposure, while others focused on those with particular hazard knowledge (not necessarily experts, but perhaps informed citizens or people related to others who had suffered from a hazard). Note that we have classified some of these studies in Tables 35 as having employed convenience samples, because although their participants may have been recruited (conveniently) due to their membership of the group of interest, they were
Table 6. Different types of samples used (refer to Table 1 for coding). Types of samples used General population Studies Number of studies 21 21 25
1; 6; 7; 15; 16; 19; 21; 26; 27; 28; 31; 32; 33; 36; 40; 45; 49; 50; 53; 58; 59 Directly at risk 2; 3; 8; 9; 10; 11; 12; 13; 20; 25; 34; 38; 39; 41; 43; 48; 51; 55; 61; 62; 67 Special interest in risk 4; 5; 14; 17; 18; 22; 23; 24; 29; 30; 35; 37; 42; 44; 46; 47; 52; 54; 56; 57; 60; 63; 64; 65; 66
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recruited without deliberate consideration of other (e.g., socio-economic) factors beyond the main selection criterion. There were 21 studies whose participants were selected for being at high risk of, or with (relatively) high knowledge about the particular hazard in question. A number involved participants who voluntarily engaged with the hazard, such as fishermen (Burger, Staine, and Gochfeld 1993) and intra-venous drug users (Connors 1992; Miller 2005), while others focused on those who were involuntarily at risk from the hazard, such as people with a genetic predisposition to a particular disease (Smith et al. 2002) and people exposed to pollution (e.g., Wakefield and Elliott 2000 looked at the risk perception of people who lived in the immediate area of a proposed landfill site as well as people who visited the area on a regular basis). Twenty-five studies sampled people with a special interest in, or knowledge about, the hazard in question, such as adolescents who were taking part in an education programme about HIV (Ott et al. 2003), parents who had chosen to vaccinate their children (Raithatha et al. 2003), and parents whose children had undergone day surgery (Sobo 2005). Two of these studies, however, compared people with a special interest in the hazard to other samples that did not have such a strong association with the hazard: Poortinga et al. (2004) considered samples that were more or less affected by a Foot and Mouth disease outbreak; and Jensen et al. (2005) compared expert and lay perspectives on zoonotic risks. Generally, the former studies potentially give us important insights into risk-taking and how people accommodate the risks they face (e.g., they indicate collectively how the voluntariness of hazard exposure is an important factor in risk perception), though they say little about the general population at large. The latter two studies, however, found some differences in their samples responses to the hazards of concern, indicating the importance of exposure/ knowledge factors to risk perception, and also indicating the limits of generalising findings from studies using specialist samples to the population at large. In summary, sampling is a key issue. A majority of the studies noted have employed convenience samples from developed world countries, often with a particular interest in, or exposure to, the hazard/s of interest to the researchers. Individually, most of these studies provide valuable insights into aspects of risk perception, but as a whole we would argue that particularly in the light of factors discovered to be important in understanding risk perception they do not adequately cover the issue universe. Some results of the qualitative studies The focus of this paper is predominantly methodological. However, it might seem somewhat odd to review an area of research and not give any details of what has been found. Our analysis of the chosen qualitative papers has included consideration of results, but we will not discuss these in detail here, first, because this would detract from our methodological critique; second, because the results of the 67 studies are extensive, and to detail them in a way that would do them justice would not allow this paper to remain within acceptable word limits; and third, because it is more apt to combine a discussion of the results from the qualitative risk perception work with that from the quantitative research (of which there are more studies), in order to avoid a partial and unbalanced analysis of the factors related to risk perception. Thus, it is our intent to follow this paper with another considering the methodology
636 G. Hawkes and G. Rowe of quantitative research, and then a further paper summarising all that we have found from research on risk perception across all methods. Nevertheless, we will present a broad overview of some of the main result trends here, particularly where the nature of results speak to some of the methodological points we have been making throughout. It is notable that across the qualitative studies a number of key findings recur, hinting at the kinds of factors that appear to be related in some manner to risk perception, in terms of level of perceived risk, and the thought processes related to the concept. For example, several studies associate low levels of trust in an appropriate body with high levels of perceived risk and vice versa (e.g., Aldoory and van Dyke 2006; Brown and Ping 2003; Slachtova et al. 1998; Wakefield and Elliott 2000; Walter et al. 2004), while high perceived control over a hazard/activity is associated with lower perceived risk, and lower control, or high powerlessness, is associated with higher perceived risk (e.g., Kenen, Ardern Jones, and Eeles 2003; Mgalla and Pool 1997; Miles and Frewer 2001; Miller 2005; Rodham et al. 2006; Salazar et al. 2004). The voluntariness with which a hazard is engaged is also found important: typically, if voluntariness is high, then risk perception is low (e.g., Connors 1992; Miller 2005). Absence of perceived benefits is also associated with heightened risk perception, or vice versa (e.g., Brown and Ping 2003; Gaskell et al. 2004). Aspects such as knowledge and familiarity come through as important factors related to risk perception in a number of studies. Generally, it seems as though familiarity/high knowledge (expertise) reduces perceived risk (e.g., Burger, Staine, and Gochfeld 1993; Beehler, McGuinness, and Vena 2003), though this is not a straightforward relationship. For example, Benin et al. (2006) found that mothers with the highest level of medical knowledge were the most concerned about the risks of vaccinating their children (here, the concern may have led them to seek out the knowledge in the first place). Indeed, others have suggested that low levels of knowledge are related to lower perceived risk (e.g., Dokova et al. 2005), and further, that people may deliberately refrain from finding things out in order to avoid scaring themselves (Aldoory and van Dyke 2006; Lion, Meertens, and Bot 2002; Salant 2006). The problem across all of these studies is in establishing a benchmark for knowledge levels. Perhaps both low knowledge and high knowledge (and familiarity) are related to lower perceived risk and, as is popularly said, it is a little knowledge (i.e., an intermediate state of knowledge) that is a dangerous thing? This would seem a topic worthy of future research, but for our present purposes, this uncertainty about the significance of familiarity/knowledge levels emphasises the point we previously made about the importance of measuring and recording precise aspects of ones sample. Relatedly, demographic aspects such as age and sex were indicated as important for risk perception by some studies (e.g., Gaskell et al. 2004; Lupton and Tulloch 2002; van Steenkiste et al. 2004). Earlier we commented on the importance of culture and its influence on risk perception. One nice example of this comes from Chapman (2003), who looked at the perceptions of pregnant women in Mozambique. Chapman found that women here purposefully avoid ante-natal care, not because they dont appreciate childbirth risks, nor because they do not want help, but rather, because they believe that public knowledge of their condition could lead to their being cursed by jealous neighbours! Sobo (1993) also showed, in a study carried out in the USA, but which focused on poor African-American women, how it is important not to assume that the risks
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associated with a particular hazard will be perceived the same way by everyone. In this case, sex educators perceived the risks of not practising safe sex to be contracting HIV/ AIDS or other sexually transmitted infections, but for the participants, the risks associated with practising safe sex were greater such as abandonment by their partners, public stigma, and loss of face and status (i.e., risk is more than just a health concept). In terms of the kinds of mental processes associated with risk perception, various studies have interesting things to say. One theme that occurs is how aspects of human judgment and decision making can impact on perceived risk. For example, optimistic bias (perceiving oneself less at risk than a comparable other) is reported in several studies (Luginaah et al. 2002; Royak-Schalter et al. 2004; Weegels and Kanis 2000). Other biases in perception have been linked to lay people having difficulties in understanding risk figures, in using frequencies, and in using numerical scales (e.g., Jensen et al. 2005; Hay et al. 2002), while Bostrom et al. (1994) described misconceptions held within lay mental models, and Katapodi et al. (2005) suggested that cognitive heuristics lead to predictable biases in peoples risk assessments. The acquisition of risk perceptions has also been related to personal theories of inheritance (e.g., people most likely to fall victim to a disease being those looking most like, or sharing certain traits with, others who had had the disease) (McAllister 2003), and being based on prevailing views within a community (Marrazzo, Coffey, and Bingham 2005) the latter, once more, emphasising a link with culture. Conclusions In summary, our analysis of the qualitative risk perception studies suggests the following:
N N
Most of the hazards studied have been somewhat unusual, typified by high contemporary (e.g., media) interest and public concern, but relatively low risk. Significantly, few of the hazards studied have been major causes of death in the countries in which they were studied, and hence, we have relatively little knowledge about perceptions of low concern/high risk hazards or the process by which hazards change from being perceived as low to high risk (and vice versa). Most of the studies have relied on one method of data collection, i.e., interviews. Collectively, it would be useful if there was more research using other qualitative methods in order to correct biases inherent in any one research technique. Research using combinations of techniques may be useful. We also suggest there is a need for more ethnographic research. Most studies present generally a static one-off picture of perceptions, rather than a longitudinal one. Most studies do not record the specific details of, for example, wording/ phrasing used, making it difficult to judge the effectiveness and consistency of their research questioning. Can we therefore be sure that differences identified in risk perceptions (e.g., between lay people and experts, see Jensen et al. 2005) are due to the differences between the people being questioned, or differences in the framing of the questions posed? The vast majority of studies have taken place in developed countries. More research needs to be conducted in other cultures involving a wider variation of demographic and socio-economic characteristics.
Most studies have focused on the perspectives of samples with an exposure to, or interest in, a particular hazard (as opposed to the more general population). There is perhaps also a need for more topic blind recruitment to address the problem of over-sampling the interested. Most studies have effectively used convenience samples, suggesting a lack of awareness by researchers of the importance of certain demographic/socioeconomic factors for risk perception.
Though we have raised a number of concerns about specific problems with individual papers (largely in terms of a lack of adequate reporting of methodological details on the research processes used and sample characteristics), our main concern is that, collectively, there is a bias in terms of what precisely has been studied, and how, meaning that we have a view of only a part of the risk perception universe. It is likely that this bias has arisen because researchers have sought to use their limited resources to address the most interesting and fundable! research topics available, and hence to study, for example, the most high profile emerging hazards. Though individual researchers cannot be blamed for their rational interests, as a discipline, as a whole, we need a broader, more coherent, more inclusive research programme on the risk perception topic, one that considers every manner of hazard and population with all manner of research methods, at all points in time, and across all possible contexts. With hope, this review may at least stimulate some to address some of the gaps in research that we have identified. Acknowledgements
The authors would like to acknowledge funding for this research from a Core Strategic Grant of the UK Biotechnology and Biological Sciences Research Council. We would also like to thank Julie Houghton for help in cross-checking our analysis of the reviewed studies, and for insightful comments on the paper.
References
Aldoory, L., and M.A. Van Dyke. 2006. The roles of perceived shared involvement and information overload in understanding how audiences make meaning of news about bioterrorism. Journalism & Mass Communication Quarterly 83: 34661. Arhinful, D.K., A.M. Das, J.P. Haidyono, K. Heggenhougen, N. Higginbotham, F.B. Iyun, J. Quick, and D. Ross-Degnan. 1996. How to use applied qualitative methods to design drug use interventions. http://www.inrud.org/documents/How_to_Use_Applied_ Qualitative_Methods.pdf. Beehler, G.P., B.M. McGuinness, and J.E. Vena. 2001. Polluted fish, sources of knowledge, and the perception of risk: Contextualizing African American anglers sport fishing practices. Human Organization 60: 28897. . 2003. Characterizing Latino anglers environmental risk perceptions, sport fish consumption, and advisory awareness. Medical Anthropology Quarterly 17: 99116. Benin, A.L., D.J. Wisler-Scher, E. Colson, E.D. Shapiro, and E.S. Holmboe. 2006. Qualitative analysis of mothers decision-making about vaccines for infants: The importance of trust. Pediatrics 117: 153241. Bier, V.M. 2001. On the state of the art: Risk communication to the public. Reliability Engineering and System Safety 71: 13950.
639
Bond, B., L. Hirota, J. Fortin, and N. Col. 2002. Women like me: Reflections on health and hormones from women treated for breast cancer. Journal of Psychosocial Oncology 20: 3956. Bostrom, A., M.G. Morgan, B. Fischhoff, and D. Read. 1994. What do people know about global climate change? 1. Mental models. Risk Analysis 14: 95970. British Heart Foundation. 2004. Coronary Heart Disease Statistics Book 2004. http:// www.bhf.org.uk/publications/uploaded/fact_sheet2.pdf. Brown, J.L., and Y.C. Ping. 2003. Consumer perception of risk associated with eating genetically engineered soybeans is less in the presence of a perceived consumer benefit. Journal of the American Dietetic Association 103: 20814. Burger, J., K. Staine, and M. Gochfeld. 1993. Fishing in contaminated waters: Knowledge and risk perception of hazards by fishermen in New York City. Journal of Toxicology and Environmental Health 39: 95105. Carroll, C., E. Naylor, P. Marsden, and T. Dornan. 2003. How do people with Type 2 diabetes perceive and respond to cardiovascular risk? Diabetic Medicine 20: 35560. Cava, M.A., K.E. Fay, H.J. Beanlands, E.A. Mccay, and R. Wignall. 2005. Risk perception and compliance with quarantine during the SARS outbreak. Journal of Nursing Scholarship 37: 3437. Chapman, R.R. 2003. Endangering safe motherhood in Mozambique: Prenatal care as pregnancy risk. Social Science & Medicine 57: 35574. Connors, M.M. 1992. Risk perception, risk taking and risk management among intravenous drug users: Implications for AIDS prevention. Social Science and Medicine 34: 591601. Dear, L. 1995. Negotiated safety: What you dont know wont hurt it, or will it? Drug and Alcohol Review 14: 3239. Denberg, T.D., S. Wong, and A. Beattie. 2005. Womens misconceptions about cancer screening: Implications for informed decision-making. Patient Education and Counseling 57: 28085. Department of Health. 1998. Nutritional aspects of the development of cancer. Report on Health and Social Subjects No. 48. London: HMSO. . 2000. The NHS plan. London: HMSO. . 2005. Choosing a better diet: A food and health action plan. London: HMSO. Dokova, K.G., K.J. Stoeva, P.I. Kirov, N.G. Feschieva, S.P. Petrova, and J.W. Powles. 2005. Public understanding of the causes of high stroke risk in northeast Bulgaria. European Journal of Public Health 15: 31316. Fife-Schaw, C., and G. Rowe. 1996. Public perceptions of everyday food hazards: A psychometric study. Risk Analysis 16: 487500. . 2000. Extending the application of the psychometric approach for assessing public perceptions of food risk: Some methodological considerations. Journal of Risk Research 3: 16779. Fischhoff, B., S. Lichtenstein, P. Slovic, S.L. Derby, and R.L. Keeney. 1984. Acceptable risk: A critical guide. Cambridge: Cambridge University Press. Flint, C.G., and R. Haynes. 2006. Managing forest disturbances and community responses: Lessons from the Kenai Peninsula, Alaska. Journal of Forestry 104: 26975. Food Standards Agency. 2002. Measuring foodborne illness levels. http://www.food.gov.uk/ safereating/microbiology.58736. Foster, C., M. Watson, C. Moynihan, A. Ardern-Jones, and R. Eeles. 2002. Genetic testing for breast and ovarian cancer predisposition: Cancer burden and responsibility. Journal of Health Psychology 7: 46984. Gaskell, G., N. Allum, W. Wagner, N. Kronberger, H. Torgersen, J. Hampel, and J. Bardes. 2004. GM foods and the misperception of risk perception. Risk Analysis 24: 18594.

Go, V.F., V.M. Quan, C. Voytek, et al. 2006. Intra-couple communication dynamics of HIV risk behavior among injecting drug users and their sexual partners in northern Vietnam. Drug and Alcohol Dependence 84: 6976. Goldman, R.E., D.R. Parker, E.B. Charles, J.M. Borkan, R. Gramling, R.T. Cover, and D.K. Ahern. 2006. Patients perceptions of cholesterol, cardiovascular disease risk, and risk communication strategies. Annals of Family Medicine 4: 20510. Gorin, S.S., and S.M. Albert. 2003. The meaning of risk to first degree relatives of women with breast cancer. Women and Health 37: 97117. Hallowell, N., C. Foster, R. Eeles, A. Ardern-Jones, and M. Watson. 2004. Accommodating risk: Responses to BRCA1/2 genetic testing of women who have had cancer. Social Science and Medicine 59: 55365. Hansen, J., L. Holm, L. Frewer, P. Robinson, and P. Sande. 2003. Beyond the knowledge deficit: Recent Research into lay and expert attitudes to food risks. Appetite 41: 11121. Hay, J.L., J.S. Ostroff, G.D. Cruz, R.Z. LeGeros, H. Kenigsberg, and D.M. Franklin. 2002. Oral cancer risk perception among participants in an oral cancer screening program. Cancer Epidemiology Biomarkers and Prevention 11: 1558. Heyman, B., G. Hundt, J. Sandall, K. Spencer, C. Williams, R. Grellier, and L. Pitson. 2006. On being at higher risk: A qualitative study of prenatal screening for chromosomal anomalies. Social Science and Medicine 62: 236072. Holm, L., and H. Kildevang. 1996. Consumers views on food quality: A qualitative interview study. Appetite 27: 114. Jensen, K.K., J. Lassen, P. Robinson, and P. Sande. 2005. Lay and expert perceptions of zoonotic risks: Understanding conflicting perspectives in the light of moral theory. International Journal of Food Microbiology 99: 24555. Jones, N.R., and R. Haynes. 2006. The association between young peoples knowledge of sexually transmitted diseases and their behaviour: A mixed methods study. Health, Risk and Society 8: 293303. Juniper, E.F., P.M. OByrne, P.J. Ferrie, D.R. King, and J.N. Roberts. 2000. Measuring asthma control clinic questionnaire or daily diary? American Journal of Respiratory and Critical Care Medicine 162: 133034. Katapodi, M.C., N.C. Facione, J.C. Humphreys, and M.J. Dodd. 2005. Perceived breast cancer risk: Heuristic reasoning and search for a dominance structure. Social Science and Medicine 60: 42132. Keleher, H.M., and G.K. Verrinder. 2003. Health diaries in a rural Australian study. Qualitative Health Research 13: 43543. Kenen, R., A. Ardern-Jones, and R. Eeles. 2003. Living with chronic risk: Healthy women with a family history of breast/ovarian cancer. Health, Risk and Society 5: 31531. Langford, I., S. Georgiou, I.J. Bateman, R.J. Day, and R.K. Turner. 2000. Public perceptions of health risks from polluted coastal bathing waters: A mixed methodology analysis using cultural theory. Risk Analysis 20: 691704. Lion, R., R.M. Meertens, and I. Bot. 2002. Priorities in information desire about unknown risks. Risk Analysis 22: 76576. Lofstedt, R.E. 2003. Public perceptions of the Mars sample return program. Space Policy 19: 28392. Lowton, K. 2004. Only when I cough? Adults disclosure of cystic fibrosis. Qualitative Health Research 14: 16786. Luginaah, I.N., S.M. Taylor, S.J. Elliott, and J.D. Eyles. 2002. Community responses and coping strategies in the vicinity of a petroleum refinery in Oakville, Ontario. Health and Place 8: 17790. Lupton, D., and J. Tulloch. 2002. Risk is part of your life: Risk epistemologies among a group of Australians. Sociology 36: 31734.
641
Marrazzo, J.M., P. Coffey, and A. Bingham. 2005. Sexual practices, risk perception and knowledge of sexually transmitted disease risk among lesbian and bisexual women. Perspectives on Sexual and Reproductive Health 37: 612. McAllister, M. 2003. Personal theories of inheritance, coping strategies, risk perception and engagement in hereditary non-polyposis colon cancer families offered genetic testing. Clinical Genetics 64: 17989. Mgalla, Z., and R. Pool. 1997. Sexual relationships, condom use and risk perception among female bar workers in north-west Tanzania. AIDS Care 9: 40716. Miles, S., and L.J. Frewer. 2001. Investigating specific concerns about different food hazards. Food Quality and Preference 12: 4761. Miles, S., and G. Rowe. 2004. The laddering technique. In Doing social psychology research, ed. G. Breakwell, 30543. Oxford: BPS Blackwell. Miller, P.G. 2005. Scapegoating, self-confidence and risk comparison: The functionality of risk neutralisation and lay epidemiology by injecting drug users. International Journal of Drug Policy 16: 24653. Moffatt, S., and T. Pless-Mulloli. 2003. It wasnt the plague we expected. Parents perceptions of the health and environmental impact of opencast coal mining. Social Science and Medicine 57: 43751. Musil, C.M., S. Ahn, M. Haug, C. Warner, D. Morris, and E. Duffy. 1998. Health problems and health actions among community-dwelling older adults: Results of a health diary study. Applied Nursing Research 11: 13847. Neal, R.D., G. Wickenden, D. Cottrell, J. Mason, J. Rugiano, P. Clarkson, and A. Bearpark. 2001. The use of primary, secondary, community and social care by families who frequently consult their general practitioner. Health & Social Care in the Community 9: 37582. Nelkin, D., and M. Brown. 1984. Observations on workers perceptions of risk in dangerous trades. Science, Technology and Human Values 9: 310. Office of National Statistics. 2006. Health Statistics Quarterly. No. 30, Summer. http:// www.statistics.gov.uk/downloads/theme_health/HSQ30.pdf. Ott, M.A., N.L. Evans, B.L. Halpern-Felsher, and S.L. Eyre. 2003. Differences in altruistic roles and HIV risk perception among staff, peer educators, and students in an adolescent peer education program. AIDS Education and Prevention 15: 15971. Poortinga, W., K. Bickerstaff, I. Langford, J. Niewohner, and N. Pidgeon. 2004. The British Foot and Mouth crisis: A comparative study of public risk perceptions, trust and beliefs about government policy in two communities. Journal of Risk Research 7: 7390. Quinn, S.C., T. Thomas, and C. McAllister. 2005. Postal workers perspectives on communication during the anthrax attack. Biosecurity and Bioterrorism-Biodefense Strategy Practice and Science 3: 20715. Raithatha, N., R. Holland, S. Gerrard, and I. Harvey. 2003. A qualitative investigation of vaccine risk perception amongst parents who immunize their children: A matter of public health concern. Journal of Public Health Medicine 25: 1614. Ramos, R., R.N. Shain, and L. Johnson. 1995. Men I mess with dont have anything to do with AIDS: Using ethno-theory to understand sexual risk perception. The Sociological Quarterly 36: 483504. Rocourt, J., G. Moy, K. Vierk, and J. Schlundt. 2003. The present state of foodborne diseases in OECD countries. World Health Organisation. http://www.who.int/foodsafety/publications/ foodborne_disease/oecd_fbd.pdf. Rodham, K., H. Brewer, W. Mistral, and P. Stallard. 2006. Adolescents perception of risk and challenge: A qualitative study. Journal of Adolescence 29: 26172. Rowe, G., and G. Wright. 2001. Differences in expert and lay judgments of risk: Myth or reality? Risk Analysis 21: 34156.

Royak-Schaler, R., D.E. Blocker, A.M. Yali, et al. 2004. Breast and colorectal cancer risk communication approaches with low-income African-American and Hispanic women: Implications for healthcare providers. Journal of the National Medical Association 96: 598608. Royal Society for the Prevention of Accidents. 2005. Accident statistics: Brief overview. www.rospa.org.uk/factsheets/accidents_overview.pdf. Salant, T., P.S. Ganschow, O.I. Olopade, and D.S. Lauderdale. 2006. Why take it if you dont have anything? Breast cancer risk perceptions and prevention choices at a public hospital. Journal of General Internal Medicine 21: 77985. Salazar, M.K., M. Napolitano, J.A. Scherer, and L.A. McCauley. 2004. Hispanic adolescent farmworkers perceptions associated with pesticide exposure. Western Journal of Nursing Research 26: 14666. Sjoberg, L. 1996. A discussion of the limitations of the psychometric and cultural theory approaches to risk perception. Radiation Protection Dosimetry 68: 21925. . 2002. The allegedly simple structure of experts risk perception: An urban legend in risk research. Science, Technology and Human Values 27: 44359. Skidmore, D., and E. Hayter. 2000. Risk and sex: Ego-centricity and sexual behaviour in young adults. Health, Risk and Society 2: 2332. Slachtova, H., I. Tomasek, K. Jones, B. Vasina, and J. Volf. 1998. Risk perception in the framework of PHARE/CESAR study Central European study on air pollution and respiratory health: Risk perception, the environment, and communication strategies in the CESAR project: Results from the Czech Republic. Journal of Hazardous Materials 61: 31317. Slovic, P. 1993. Perceived risk, trust and democracy. Risk Analysis 13: 67582. Slovic, P., B. Fischhoff, and S. Lichtenstein. 1979a. Rating the risks. Environment 21: 1420, 3639. . 1979b. Characterizing perceived risk. In Managing the hazards of technology, ed. R.W. Kates, C. Hohenemser, and J.X. Kasperson, 91125. Boulder, CO: University of Colorado. . 1980. Facts and fears: Understanding perceived risk. In Societal risk assessment: How safe is safe enough?, ed. R. Schwing and W.A. Albers, 181225. New York: Kluwer. Smith, J.A., S. Michie, M. Stephenson, and O. Quarrell. 2002. Risk perception and decisionmaking processes in candidates for genetic testing for Huntingtons Disease: An interpretative phenomenological analysis. Journal of Health Psychology 7: 13144. Sobo, E.J. 1993. Inner-city women and AIDS: The psycho-social benefits of unsafe sex. Culture, Medicine and Psychiatry 17: 45585. . 2005. Parents perceptions of pediatric day surgery risks: Unforeseeable complications, or avoidable mistakes? Social Science and Medicine 60: 234150. Sparks, P., and R. Shepherd. 1994. Public perceptions of the hazards associated with food production and food consumption: An empirical study. Risk Analysis 14: 7986. Stanley, N. 2005. Thrills and spills: Young peoples sexual behaviour and attitudes in seaside and rural areas. Health, Risk and Society 7: 33748. The National Audit Office. 2001. Tackling obesity in England. London: HMSO. The National Creutzfeldt-Jacob Disease Surveillance Unit. 2006. http://www.cjd.ed.ac.uk/ index.htm. Thirlaway, K.J., and D.A. Heggs. 2005. Interpreting risk messages: Womens responses to a health story. Health Risk and Society 7: 10721. Tolley, E.E., E. Eng, R. Kohli, M.E. Bentley, S. Mehendale, A. Bunce, and L.J. Severy. 2006. Examining the context of microbicide acceptability among married women and men in India. Culture, Health and Sexuality 8: 35169. Trenoweth, S. 2003. Perceiving risk in dangerous situations: Risks of violence among mental health inpatients. Journal of Advanced Nursing 42: 27887.
643
Tversky, A., and D. Kahneman. 1974. Judgment under uncertainty: Heuristics and biases. Science 185: 112430. van Steenkiste, B., T. van der Weijden, D. Timmermans, J. Vaes, J. Stoffers, and R. Grol. 2004. Patients ideas, fears and expectations of their coronary risk: Barriers for primary prevention. Patient Education and Counselling 55: 3017. Wakefield, S., and S.J. Elliott. 2000. Environmental risk perception and well-being: Effects of the landfill siting process in two southern Ontario communities. Social Science and Medicine 50: 113954. . 2003. Constructing the news: The role of local newspapers in environmental risk communication. Professional Geographer 55: 21626. Walter, F.M., J.D. Emery, M. Rogers, and N. Britten. 2004. Womens views of optimal risk communication and decision making in general practice consultations about the menopause and hormone replacement therapy. Patient Education and Counseling 53: 1218. Weegels, M.F., and H. Kanis. 2000. Risk perception in consumer product use. Accident Analysis and Prevention 32: 36570. Weinstein, N.D. 1984. Why it wont happen to me: Perceptions of risk factors and susceptibility. Health Psychology 3: 43157. World Health Organisation. 2000. Country statistics. http://www3.who.int/whosis/mort/ table1.cfm?path5whosis,mort,mort_table1&language5english. . 2003. Diet, nutrition and the prevention of chronic diseases. London: World Health Organisation. Wright, N.M.J., C.N.E. Tompkins, and L. Jones. 2005. Exploring risk perception and behaviour of homeless injecting drug users diagnosed with Hepatitis C. Health and Social Care in the Community 13: 7583.

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Journal of Risk Research Vol. 11, No.

5, July 2008, 617643

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622 G. Hawkes and G. Rowe

Fishing and 2; 3; 8 fish consumption GM food 7; 19; 32* Bioterrorism 1

Adolescents risks Household goods

Vaccination of infants SARS

Zoonotic risks (BSE and vCJD) Foot and Mouth Disease

Pregnancy Cancer Stroke Smoking Chromosomal abnormalities Cystic fibrosis

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Mental models Semi-structured

9 10 11* 12*# 13 14 15 17* 18 20 22* 23 24 25 26 27 29 30 34 35

Unstructured Semi-structured Semi-structured Laddering Semi-structured Semi-structured

628 G. Hawkes and G. Rowe

Convenience USA Snowball USA

47 48# 51* 53 54* 55 56 57 58 60* 61 62 63 64 65 66# 67

All women at high risk

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Convenience Convenience Convenience

Purposive Convenience Purposive

Purposive Purposive Purposive Convenience Random

630 G. Hawkes and G. Rowe

Field research used to recruit participants Netherlands Video reconstructions of accidents

*: with quantitative element : with interviews and focus groups

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Journal of Risk Research Study samples

Figure 1. Number of studies by country.

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638 G. Hawkes and G. Rowe

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640 G. Hawkes and G. Rowe

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642 G. Hawkes and G. Rowe

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