Research has indicated that individuals can use some
combination of two modes of thinking: an intuitive and an analytical mode in
making decisions (Slovic
et al.,
2004; Rusou
et al., 2013; Ayal
et al., 2015). Decisions are made
intuitively when they are made quickly, and may rely mostly on heuristics, or
mental shortcuts, which sometimes leads to biassed decisions. Conversely, the
analytical mode tends to be favoured when an individual has time to analyse
data, and assess available options for the best decision.
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Using these two modes of thinking, one can infer that women
of childbearing age from the general public, who have limited time, expertise
and, resources to evaluate a maternal health risk assessment may rely upon an
intuitive mode of decision-making. Conversely, policy makers, maternal health
experts and professionals equipped with the necessary resources to conduct a
risk assessment, and logically make their decisions ought to favour the
analytical mode of thinking. However, care must be taken in perceiving that
people, whether experts or lay individuals, rely solely on the analytical or
the intuitive way of thinking when making judgements and taking decisions. As
Slovic
et al. (2004) expressed,
rationality is not only a product of the analytical mind but the intuitive mind
as well.
Psychology provides one framework for understanding how
different people may perceive and react to risks, but sociology has offered
another approach for understanding individual risk perception and risk attitudes.
The variety of risk perspectives of women of childbearing age may be due to
their different worldviews as identified in cultural theory literature (Dake,
1991; Oltedal et al., 2004; Tsouhou et al., 2006).
Cultural theorists make a
distinction between worldviews (shared mental representations, values and
general social, cultural and political attitudes held by a group of
individuals) and social relations (patterns of social interaction between
people and or social organisation) (Wildavsky and Dake, 1990). Studies (Peters
and Slovic, 1996; Oltedal et al.,
2004; Tsouhou et al., 2006) have
summarised a range of ‘ideal type’ worldviews categories as follows:
Heirarchists: These
individuals place an emphasis on the natural order of society, and preservation,
and the perseverance of this order.
Egalitarians: This group of people fear
any development that may increase inequalities amongst people.
Individualists:
They fear things that have the potential to hinder their individual freedom.
Fatalists: They
take a minor part in social life, are resigned to tight controls on their behaviour
and have a “why bother’ attitude toward risks
Thus, hierarchists, egalitarians, individualists, and
fatalists may each respond differently to evidence of the risk of maternal
mortality and act accordingly:
“…an understanding of who fears what and why requires serious
attention to the political, historical, and social context in which risks are
framed and debated...mental models of risk are not solely matters of individual
cognition, but also correspond to worldviews entailing deeply held beliefs and
values regarding society, its functioning, and its potential fate” (Dake, 1991,
p62).
Understanding the perception of stakeholders (lay citizens
and experts) of maternal health is essential to an improvement of health
services and women’s acceptability of intervention programmes. In the context
of the laywomen, a cultural theory understanding of their worldview
could be interpreted using the following ideal types: that hierarchists tend to
trust experts, doctors, and those in authority. They should support and trust
hospitals and health centres, as long as the government appropriately
legitimises them. Egalitarians should most likely display distrust to the
experts and be concerned/wary of interventions of experts, especially if there
is a sense of inequality. Individualists should be most concerned about
impositions of constraining regulations (e.g. ban on traditional health
practices and cultural practices like female genital mutilation). Finally, the
fatalists would possess a “Que sera sera” or ‘why bother’ attitude about their
maternal health, hence leaving their health outcome to fate.
This theory, could have important implications for maternal
health policymaking and risk communication, revealing that ‘one-size-fits-all’
universal policies and interventions may fail. In summary, the psychological
and sociological perspectives on risk perception suggest that lay citizens
interpret a particular risk and make decisions towards that risk using several
intuitive and analytical processes. The psychometric paradigm points to
cognitive factors as the causes of differences in perceptions and attitudes
exhibited by stakeholders, and the preferred remedy is, not surprisingly,
public education through risk communication (Slovic, 1986). The importance of
social relations, either involving individuals or social organisations has been
highlighted, indicating the importance of communication. Igboanugo and Martin
(2011) recommended that providing critical information to women on how to identify
risk factors during pregnancy was important. They also considered that health
ministers responsible for maternity service provision should be encouraged to
hear the voices of the people they represent. Overall, communication plays a
vital role in addressing the individual/ community perception and worldviews.
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