Hermes-46-fage-butler.indd

The Discursive Construction of Risk and Trust in Patient Information
Leafl ets
Abstract
There is wide recognition that the communication of risk in Patient Information Leafl ets (PILs) – the instructions that
accompany medications in Europe – problematises the reception of these texts. There is at the same time growing
understanding of the mediating role of trust in risk communication. This paper aims to analyse how risk is discursively
constructed in PILs, and to identify and analyse discourses that are associated with trust-generation. The corpus
(nine PILs chosen from the British online PIL bank, www.medicines.org.uk) is analysed using Foucauldian (1972)
discourse analysis: specifi cally, this involves identifying the functions of the statements that constitute the discourses.
A discourse analysis of the corpus of PILs reveals that the discourse of risk revolves around statements of the potential
harm that may be caused by taking the medication, whilst trust is constructed through three discourses: the discourses
that relate to competence and care, in accordance with the trust theories of Poortinga/Pidgeon (2003) and Earle (2010),
and a third discourse, corporate accountability, which functions to construct an ethical (trustworthy) identity for the
company. This paper contributes to PIL literature in the following ways: it introduces a methodology that has not
been used before in relation to these texts, namely, Foucauldian discourse analysis; it helps to identify the presence of
trust-generating discourses in PILs; and analysing the discourses of risk and trust at statement-level facilitates a better
understanding of how these discourses function in texts that are generally not well-received by the patients for whom
they are intended.
1. Introduction
Patient Information Leafl ets (henceforth PILs) are legally required to accompany medicine avail-
able for purchase in Europe: they inform about side effects and give instructions on how to take
the medication appropriately, information which patients say they want to receive (Kenny et al.
1998, Berry et al. 1997). Somewhat paradoxically, however, research shows that PILs are not
well-regarded by the patients for whom they are written: despite attempts to improve PILs, in-
cluding ongoing research and new EU legislation for compulsory user-testing in 2004, PILs are
considered ‘dysfunctional (…) due to very complex production and reception processes’ (Aske-
have/Zethsen 2008: 171). Patients have criticised PILs for many reasons including a register that
is too complex (Askehave/Zethsen 2000), poor presentation and layout (Berry 2006, Bernardini
et al. 2001, Koo et al. 2003), and lack of user-friendliness (Askehave/Zethsen 2000). As a meas-
ure of how patients ‘do not value the written medicines information they receive’ (Raynor/Dick-
inson 2009: 701), many opt not to read them (Raynor/Britten 2001, Horwitz et al. 2009). The
fact that some patients choose not to read PILs is problematic as the information provided is im-
portant for the health and safety not only of the patient taking the medication, but also for others,
including foetuses (in the case of pregnant women), infants (in the case of breastfeeding moth-
ers), and indeed the general public (where, for example, medication may affect one’s capacity to
drive safely).
PILs have been studied in two main ways: through reception studies, and with focus on the texts themselves. Within the latter stream, Askehave/Zethsen (2000), for example, when analys-ing Danish PILs, found that the complex word-choice and convoluted syntax of these texts made Department of Business Communication Aarhus University, Business and Social Sciences Hermes – Journal of Language and Communication Studies no 46-2011 them diffi cult to understand for the lay receiver; Clerehan/Buchbinder (2006) devised a means of evaluating Australian PILs using the linguistic approaches of Systemic Functional Linguistics (SFL) – it was found in a follow-up reception study (Hirsch et al. 2009) that patients felt that PILs that were revised using the evaluative framework had been improved; Connor et al. (2008) com-pared American and Spanish PILs and found evidence of differences that were ascribable to the effects of two different sets of cultures and institutions. The present paper contributes to this text-oriented stream of research into PILs by focusing on how risk and trust are expressed in these texts. Previous studies of risk in PILs have tended to focus on their reception, examining the effects of the communication of risk in PILs on the pa-tient. It has been shown, for example, that communicating effectively about risk in these leafl ets is diffi cult due to the burden of negative information that risk messages must bear (Berry 2004: 5). Amery (1999: 122) points out that an unbalanced focus on side effects in PILs can lead to ‘rel-atively negative information overload’ and result in texts which patients describe as ‘negative’ (MHRA 2005: 18). A study by Knapp et al. (2010: 270) similarly found evidence that patients tend to over-estimate the risks associated with side effects in PILs. Trust, on the other hand, is a more neglected area of PIL research; it has been investigated more in terms of patients’ mistrust of the sender, the pharmaceutical industry, in reception-oriented studies (see, for example, Con-sumers’ Association 2000).
The regulatory agencies, the bodies that evaluate PILs, have explicitly called for further inves- tigation into how the communication of risk in PILs could be improved. Thomas Lonngren, the former head of EMA (the European Medicines Agency, the body responsible for the regulation of PILs at European level), underlined the need to improve how risk is communicated in PILs, as it has the effect of ‘scaring people’ (Smith 2008) with the unintended result that patients do not take medication appropriately. Similarly, the Medicines and Health Products Regulatory Agency (MHRA 2005), the British government body responsible for regulating PILs, pinpointed the com-munication of risk as one of the areas of greatest weakness in these texts, calling for further re-search in this area. This paper can be considered a response to the problems associated with the communication of risk in PILs identifi ed by patients and researchers alike, and calls by the regu-latory agencies for further research in this area. Both risk and trust have been researched from a psychological perspective: trust has been de- fi ned as a psychological phenomenon, and risk has been defi ned as having psychological impact. The psychologising of risk is evident in PIL research where the emotive effects associated with the communication of risk in PILs are highlighted. In psychological models of risk reception, risk information is seen as input to the brain – especially playing a role in triggering neurological re-actions in the part of the brain called the amygdala, also called the ‘fear module’ (Öhman/Mineka 2001: 483), in a stimulus-response system where risk information is the ‘stimulus’ and the receiv-er ‘responds’ physiologically. Functional magnetic resonance imagery experiments conducted by Isenberg et al. (1999) demonstrated that the amygdala is activated by ‘linguistic threat’ – in other words, risk ‘input’ can consist of words that are read by the receiver, which is a relevant fi nding for any risk communication that depends on text. In psychological models of risk reception, risk information is portrayed as having the potential to overwhelm or engulf ‘normal’ cognitive pro-cesses, revealing the limits of human rationality. As risk ‘may frighten and frustrate the public’ (Slovic 2000: 184-185), risk messages are often accompanied by messages designed to engender trust. Trust has been considered a psychological state (Rousseau et al. 1998: 395); Giddens (1990: 92-100) defi nes it as an emotional state of onto-logical security. Trust can be considered a social lubricant (Luhmann 1988), reducing complexity and uncertainty, hence the aptness of its service to the mediation of risk communication where, again using the psychological perspective, complexity and uncertainty abound (Kasperson et al. 1992). Moreover, the nature of the relationship between risk and trust has been theorised from a psychological perspective. Eiser et al. (2002) postulated two models: the causal model in which the trust one has, or invests, (in a product, institution, company etc.) determines one’s perceptions of risks and the acceptability of those risks; and the associationist model in which the acceptabil-ity of perceived risks determines trust. A study by Poortinga/Pidgeon (2005), which focused on the British public’s perceptions of genetically modifi ed food, provides evidence that supports the associationist model. Risk has not only been theorised from a psychological perspective, however. Writers such as Lupton (1999, 1993), Turner/Tennant (2009) and McKay (2006), working within a social con-structionist paradigm, posit that risks are discursively constructed. In this conceptualisation, risks are ‘viewed as assemblages of meanings, logics and beliefs cohering around material phenomena, giving the phenomena form and substance’ (Lupton 1999: 30). The description of risk as forms of meaning that constitute phenomena is reminiscent of Foucault’s (1972: 49) defi nition of a dis-course as ‘practices that systematically form the objects of which they speak’. As risk within a so-cial constructionist paradigm can be considered to be discursively constructed, it follows that risk is amenable to discourse analysis. When it comes to trust, more ‘translation’ of framework (from psychological to discursive) is required than in the case of risk. This has something to do with the different ontic natures of
risk and trust: risk is considered something that is external to individuals, whilst trust tends to be
viewed as a state of mind. How then can trust be analysed discursively? The approach that is tak-
en here is to examine how trust is generated. Trust has been conceptualised as the by-product of
‘solidarity’ and ‘accuracy’ (Earle 2010: 570). ‘Solidarity’ relates to the relationship between send-
er and receiver where the truster is assured that the trustees have his/her best interests at heart;
‘accuracy’ relates to the trustees appearing knowledgeable in their fi eld of expertise. Poortinga/
Pidgeon (2003: 962) describe these facets of trust generation in the similar, related terms of ‘com-
petence’ and ‘care’, where one is more likely to trust, say, an institution if it appears to be expert
and knowledgeable in its fi eld, and if it is perceived to be showing genuine interest in the well-
being of at-risk individuals or groups. Characterising trust in terms of these two parameters (com-
petence/accuracy and care/solidarity) facilitates the necessary translation from a psychological
framework to a discursive one, as discourses that are associated with competence and care may
be identifi ed. Hence, the discourse analysis undertaken here relates to identifying discourses as-
sociated with trust-generation rather than trust itself. Of course, the fact that discourses that are
associated with the generation of trust may be present in PILs does not imply that individual pa-
tients will ‘trust’ PILs: other methods, such as interviews, would be required to investigate that
issue. What discourse analysis offers is a means of identifying whether risk and trust-generating
discourses are present and what their salient features are.
The question that this paper pursues is: How are risk and trust discursively constructed in
PILs? It engages in discourse analysis from the social constructionist point of view that language
does not simply refl ect reality but creates it. The purpose is to understand the functioning of these
texts better, given that the ‘reality’ that they create is often rejected by the patients for whom they
are intended.
2. Methods
2.1. Corpus
The corpus under investigation consists of the nine PILs that went online on www.medicines.org.
uk on the 22nd March 2010. The reason for choosing this site is that it provides up-to-date PILs
that have been validated either by the MHRA or EMA (in other words, a fair cross-section of PILs
that the British public would be using, as PILs in Britain are validated either nationally by the
MHRA or at European level by EMA). A random approach is more characteristic of quantitative
research, but a ‘random purposeful’ selection has its place in qualitative research (Patton 2002:
240-241) where a snapshot of a very large corpus is required; the random approach also helps to
add ‘credibility’ (Patton 2002: 241) in an explorative study such as this where a ‘window’ on the
genre is required. The corpus consists of the following texts (see Table 1).
Medication
Pharmaceutical
Main purpose
manufacturer
Antireteroviral medicine, used to control HIV infection 2.2. Foucauldian Discourse Analysis
Foucault’s (1972) approach to discourse as outlined in The Archaeology of Knowledge forms
the basis of the analytic approach used here. His intention was to provide ‘a method of analysis’
(1972: 16) that was not about examining structure or subjectivity (structuralism and phenomenol-
ogy are research paradigms which he rejects) but rather the discourses that constitute our under-
standing of the world, which mediate our access to the world. As individuals, we are ‘subject’ to
these discourses as they tend to be taken-for-granted, defi ning what can be done and said (and
not), as well as determining the limits of knowledge itself. Foucauldian analysis involves exam-
ining text closely, though Foucault insists that one must not confl ate discourse analysis with lin-
guistic analysis (1972: 48). Language for Foucault represents the ‘exteriority’ of discourse (1972:
140). When language is examined in Foucauldian discourse analysis, it is in order that discourses
may be scrutinised through the substance of language.
Key concepts in Foucauldian analysis are discursive formations (Foucault’s word for ‘dis-
course’ as a structured body of knowledge), and the statement (énoncé) which is the smallest in-
divisible building block or ‘atom’ of a discursive formation (Foucault 1972: 80). The statement
is roughly equivalent to a sentence, but it is discursive rather than linguistic in identity, pointing
backwards towards the rule of formation that generated it, rather than to objects in the world, as
a sentence would. Moreover, as Foucault (1972: 49) considers discourses to be ‘practices’, a state-
ment should be analysed in relation to its function – the discursive work it performs. In analysing
the function of statements, Foucault (1972: 27) usefully provides the following question: ‘how
is it that one particular statement appeared rather than another?’ This involves questioning what
is ‘special’ about the function of the statement, and, as discourses in Foucault’s discourse theory
are linked to institutions (Foucault 1972: 41-42), such a functional approach to the statement also
provokes the question of whose interests a statement serves.
This emphasis on the statement’s function has an impact on the presentation of the analysis. The end-point of Foucauldian discourse analysis is a better understanding of discourses; it is not concerned with the linguistic expression of the statements in the discursive formations, or the fre-quency of the occurrence of similar statements in texts. In depicting the discourses of risk and trust generation, it is thus not necessary to include in the analysis all of the statements that relate to the same function, as this would lead to redundancy in the analysis. To illustrate this point, the statements: ‘Like all medicines, Neurontin can cause side effects, although not everybody gets them’ in the PIL for Neurontin, and ‘Most people can use this medicine without any problems but sometimes you may notice some side effects’ taken from the PIL for Boots Nic-Assist Fruit Fresh Gum, would be considered from a Foucauldian perspective to have the same function, namely, ‘To inform about the possibility of side effects with the medication’. Thus, one example only of the statements that refl ect this function is included in the analysis (see Statement Nr. 3 in the Analysis section). Foucauldian discourse analysis is, as I have argued, a means of uncovering and describing the discourses that underlie and motivate texts, rather than having the language of the texts as the focus of analysis. The methodology of Foucauldian (1972) discourse analysis presents the analyst with two main advantages. First of all, it examines and describes discursive formations on the basis of the indi-vidual statements in texts. The method is simple and elegant, in that a picture of discursive forma-tions emerges on the basis of statements that have been spoken or are written down that relate to a particular fi eld (such as ‘scientifi c expertise’). Unlike Critical Discourse Analysis (CDA), Fou-cauldian discourse analysis does not consider it necessary to bring the optic of social theories or linguistic tools to bear on the analysis (see Fairclough 2003: 2-3): for Foucault, the elements of discourse are present in the statements; a functional analysis of statements allows the discourse analyst to ‘describe’ (Foucault 1972: 38) discursive formations. Besides its descriptive powers, Foucauldian discourse analysis provides a second advantage: an identifi cation of the functions of statements in a discursive formation facilitates the introduction of normative and evaluative stances. This is because after one has analysed the functions, one can then consider whether the rules of formation that generate the statements are fair and reasonable, or need to be challenged. Foucault (1972: 25-26) expresses this as follows: ‘we must show that they [pre-existing forms of continuity] do not come about by themselves, but are always the result of a construction the rules of which must be known, and the justifi cations of which must be scrutinized’. The purpose of this paper is to map out the discourse of risk and the discourses associated with trust-generation – this relates to the fi rst advantage of Foucauldian discourse analysis (its descriptive/ analytical powers) outlined above. The results of this paper could, however, be taken and interfaced with communi-cation theory or the fi ndings of best practice in PILs research (such as results from reception stud-ies) for a more critical perspective. A wide diversity of discourse methodologies characterises the study of health communication, giving rise to what Sarangi (2010: 413) describes as ‘analytical eclecticism’ in the fi eld. Arribas-Ayllon et al. (2011, forthcoming), for example, advocate the application of ‘rhetorical discourse analysis’ when investigating the negotiation of genetic knowledge in health settings. Måseide (2003) marries a Foucauldian approach (the idea of ‘order of discourse’) with Goffman’s concepts of ‘framing’ and ‘footing’ when examining moral discourses in medical collaborative settings. Roberts/Sarangi (2005) propose a multi-method approach called ‘theme-oriented discourse anal-ysis’ to examine how language is used strategically to construct professional practice. Taylor et al. (2011, forthcoming) link their narrative approach to the ‘discursive turn’ in the study of medi-cine and healthcare. As already noted, the aim of this paper is to chart the discursive landscape of PILs, specifi cally examining how risk and trust are discursively constructed in these texts. For this task, Foucault’s descriptive approaches and his focus on discourses as they appear in texts make Foucauldian discourse analysis seem an appropriate and obvious choice. Analysis
What follows are the fi ndings from a Foucauldian discourse analysis of the risk and trust gener-ating discourses in the corpus of PILs. Foucauldian discourse analysis is utilized to unpack these discourses; it employs the concept of the ‘statement’ to reveal the functional components of these discourses. 3.1. Risk Discourse
Source text
Statement
Function
Boots Nic-Assist Read all of this leafl et carefully for you. Do not pass it on to others.
Ask your pharmacist how to dispose To warn of the risks to the of medicines no longer required. Table 2. Foucauldian analysis of the risk discourse The risk discourse revolves around the need for care due to the potential harm that the medication can cause. A Foucauldian discourse analysis of the statements in the risk discourse reveals that the patient is constructed as needing to take responsibility to ensure the safety of the product, as patients are urged to exercise caution with the medication (1), to act responsibly (2), as the medi-cation can have dangerous side effects (3). The person most affected by the potential risks of the medication is the patient him/herself, but the medication may also be toxic for others, such as in-fants through breastmilk (4); others through the inappropriate sharing of medication (5); nature through inappropriate disposal of the medication (6).
What emerges is a view of risk as polluting (to self, others, environment) that is reminiscent of Mary Douglas’s (2002 [1996]) identifi cation of danger with impurity. And whilst Foucauldian discourse analysis is more concerned with isolating the main functions of the statements in the discourses rather than with indicating the frequency of certain statements, it should also be noted that the discourse of risk dominates the communication in PILs as the risk discourse appears in four of the six sections of a standard PIL, namely, Before you take X, How to take X, Possible Side Effects, How to Store X; the two sections not directly concerned with risk are What X is and what it is used for, and Further Information.
3.2. Trust Discourses
As noted earlier, risk messages tend to rely on trust, where the truster invests trust in the trustee:
it can be considered a kind of relinquishing of the truster’s autonomy to the trustee, even a leap
of blind faith (Kierkegaard 1985 [1843]: 85). What follows is a discursive analysis of a range of
discourses that refl ect Earle’s (2010) and Poortinga/Pidgeon’s (2003) conceptualisation of trust as
relating to two qualities which the trustee should be seen by the truster as possessing: competence
(accuracy) and care (solidarity). The inclusion of these trust discourses in PILs appears strategic –
even ‘rhetorical’ (Foucault 1972: 59) – to make the prevailing risk messages more palatable. The
main trust discourses that were identifi ed in PILs were the following: science/expertise (which
relates to competence, and to some extent care); empathy (which relates to care); and corporate
accountability (this relates to to the discursive construction of the ethical credentials of the phar-
maceutical company).
3.2.1. Science/Expertise Discourse
The science/expertise discourse relates to the notion of competence, which, as noted earlier, has
been recognised as being important in instilling trust. Findings from the analysis are presented in
the following table (Table 3):
Quote Source
Statement
Function
classifi ed as follows: very com-
mon: affects more than 1 user in
Cozaar has been studied in children. To underline that the pharmaceutical company has conducted the necessary clinical trials.
Table 3. Foucauldian analysis of the science/expertise discourse In the present corpus, the science/expertise discourse is built on the basis of four statements that relate to biomedical and pharmacological knowledge (7), knowledge of the statistical likelihood of side-effects and their nature (8), evidence of clinical trials (9), as well as accounting for the benefi ts that patients can expect from the product (10). The science/expertise discourse contrib-utes to the generation of trust as it projects the image of a professional company capable of pro-ducing a scientifi cally sound and effi cacious product – in other words, a trusted company that can produce a trustworthy product. By including statement (10) which revolves around the promise or hope of a treatment/cure of the patient’s illness, the science/expertise discourse reminds the patient why they might want to trust the medication (take it despite possible side-effects), that the pharmaceutical company and the patient share a common goal of the patient’s improved wellbeing and health: in other words, that the pharmaceutical company operates with the patient’s interests at heart. This reveals one of the strategic functions of the statements of benefi t – to offset the negatives of the risk discourse. This statement relating to the benefi ts of taking the medication can furthermore be considered to bring together the trust-engendering elements of expertise and care, as it constructs scientifi c ex-pertise as improving the condition of the patient, which in turn suggests the company’s concern for the wellbeing of the patient. However, as noted earlier, the risk discourse dominates the dis-cursive terrain of PILs. Statements associated with the scientifi c benefi ts of taking the medication appear in only one section of the PIL – entitled ‘What X is and what it is used for’, whereas the risk discourse appears in four. 3.2.2. The Empathy Discourse
The empathy discourse focuses on the emotional needs of the patient and is used communicative-
ly to establish an empathetic relationship with the patient as a means of engendering trust. This
relates to the notion of the pharmaceutical company as provider of care (see Table 4):
Quote Source
Statement
Function
it is diffi cult for the patient and refl ect their intention to encourage the patient.
also help to treat these conditions.
patients are different and may benefi t from different types of treatment You may fi nd it useful to tell a friend or To remind patients of the relative about your condition, and read taking this medicine will not experience company’s awareness of any problems.
patients’ concerns about risks and remind them not to be unduly worried.
Table 4. Foucauldian analysis of the empathy discourse The empathy discourse is expressed along two main trajectories in the present corpus. The fi rst
has to do with the psychological effects of the condition in question. Both nicotine-addiction
(Boots Nic-Assist Fresh Fruit Gum) (11) and depression (Fluoxetine) (12-13) have a psychologi-
cal profi le – one must be motivated to overcome nicotine addiction, and there is a need for emo-
tional support in relation to depression. However, the empathy discourse is not present in all the
PILs in the sample: in the PILs for chronic illnesses (heart disease and HIV infection) represented
in the corpus, it may be considered conspicuously absent, as research shows that chronic illness
has a major emotional impact on patients and relatives (see Rolland 1984).
The second aspect of the empathy discourse is refl ected in the statement that relates to concerns about taking the medication (14). An explicit recognition of patients’ anxieties about the possible
effects of the medicine is represented in only two of the nine PILs in the corpus. This particular
statement is interesting as it constructs and communicates the company’s awareness that damage
may be caused (in terms of undue anxiety) by the risk discourse that dominates the communica-tion in PILs. 3.2.3. The Corporate Accountability Discourse
Discourse analysis reveals the presence of a third discourse (besides competence and care) that
can be considered to generate trust, namely the discourse of corporate accountability, which serves
to construct the ethical credentials of corporations. Despite the fact that PILs are highly regulat-
ed, standardised texts, some corporate self-consciousness is present, where a company’s desire to
create a positive impression of corporate accountability and reliability is evident. The discourse
of corporate accountability has a Janus-faced quality, positioning itself both in relation to the trust
needs of the patients (here, ‘consumers’) and instrumental in the construction of its own positive
self-image. Christensen (1997: 197) argues that marketing is a form of ‘self-referential commu-
nication practices through which the organization recognizes and confi rms its own images, values
and assumptions; in short, its own culture.’ We can therefore see in the corporate accountability
discourse of PILs the construction of a looking-glass image of self that speaks both to the phar-
maceutical companies themselves as well as to their audience. Analysis of the statements of the
discourse of corporate accountability is presented in Table 5 (below):
Quote Source
Statement
To represent the contractual relationship between the patient as consumer and the pharmaceutical company.
Boots Nic-Assist To request a copy of this leafl et in Fruit Fresh Gum Braille, large print or audio please call, company’s awareness that their This medicinal product is authorised in To indicate authorisation to sell the Member States of the EEA under Table 5. Foucauldian analysis of the corporate accountability discourse Of the nine PILs in this corpus, four employ a company icon such as in (15) – a sort of badge of identity of the pharmaceutical company, underlining the source of the medication and suggestive of some corporate pride. It is relevant to note here that for Foucault (1972: 84-86), statements were not necessarily lexical items: they could take other semiotic forms too. A commitment to ac-cessibility for blind or partially-sighted patients is underlined in (16), which emphasises the com-pany’s ethical credentials. Another example of this strategy is the exhortation to dispose of the medicine responsibly to protect the environment (17) which eight out of the nine PILs in the cor-pus included. The fact that regulation is mentioned (18) emphasises that the product meets legal standards; transparency is underlined in (19).
The perceived trustworthiness of the sender is an important element in risk judgements. So be- sides the discourses associated with competence and care (identifi ed by Poortinga/Pidgeon 2003; Earle 2010), another discourse used to generate trust is present in the corpus, namely, the ‘corpo-rate accountability’ discourse, whose function is to construct discursively the ethical credentials of the company. Discussion and Conclusion
In this paper, I have used Foucauldian discourse analysis to investigate the discursive construc-tion of risk and trust in PILs. The aim of the analysis was to reveal how these discourses worked by examining the function of the statements that constitute these discourses.
This paper has contributed to research into PILs in a number of ways. Methodologically, it
brings a new optic, Foucauldian discourse analysis, to bear on PILs, and as such may be consid-ered a response to Payne (2002: 177) who called for greater use of discursive approaches to writ-ten health materials, particularly ‘the deconstruction of text used in leafl ets using methods such as discourse analysis’. The descriptive advantages and evaluative potential of the Foucauldian ap-proach to discourse have been described in this paper.
The study has also contributed to the fi eld empirically by conducting an examination of the
statements within the discourses of risk and trust. Whilst there has been an understanding that risk problematised communication in PILs, no study prior to this has focused on examining what risk in these texts might be considered to ‘consist of’. The discourse analysis conducted here anato-mises the risk discourse in a corpus of PILs, at the same time as it identifi es trust as being con-structed through discourses that relate to competence and care, in accordance with the trust theo-ries of Poortinga/Pidgeon (2003) and Earle (2010), and reveals a third discourse, corporate ac-countability, which also contributes to the generation of trust. Indeed, one of the advantages of discourse analysis is that it has helped to uncover the less obvious discourses related to trust gen-eration that are present in these texts and may have some impact on reception. This is important as there has been little investigation of trust as an aspect of PILs. There is, moreover, a growing interest in trust as a discursive phenomenon (see Candlin 2010): studying the discursive construc-tion of trust in a variety of different settings and in written texts should contribute to a better un-derstanding of this phenomenon.
Thirdly, this paper makes a theoretical contribution in its attempt to theorise how trust may
be ‘discursifi ed’. It is useful that the various discourses of trust-generation are understood better given the importance of trust in society (we recall Bachmann/Zaheer’s (2006) characterisation of the ‘trust society’ and Löfstedt’s (2008) description of our world as ‘post-trust’). There is no doubt scope for the theorisation of trust to be developed further, hand-in-hand with more analysis, as well as different objects of analysis.
This paper has its limitations: it is mainly explorative, introducing a new methodology to a well-recognised problem (the poor communication of risk in PILs), investigating at the same time the affordances of Foucauldian (1972) discourse analysis. It will be recalled that Foucauldian dis-course analysis can be used for descriptive and evaluative purposes. This paper undertook the de-scriptive analysis of discourse only, as it was outside the scope of this paper to introduce the sec-ond layer of Foucauldian discourse analysis, namely, evaluation. This one could do by critically examining the fi ndings of the descriptive analysis (conducted here) in relation to a health com-munication model, or research into best practice in document-writing of this kind. A follow-up re-ception study would no doubt also be valuable, where the results of the discourse analysis could, for example, provide questions or topics for a focal group study. In any case, before the discours-es of risk and trust may be evaluated, they need to be anatomised and described. It is hoped that the present paper can engender debate and interest by showing the value of bringing Foucault’s (1972) descriptive approach to discourse analysis to bear on a genre that has been recognised by so many different parties as being problematic. This paper is positioned at the intersection between discourse and communication: its funda- mental presupposition is that discourse analysis can contribute to communication research as it al-lows one to go ‘backstage’ on the basic presuppositions of discourses that may problematise com-munication which otherwise might seem beyond scrutiny. Not all communication problems are discourse problems, of course. Discourse analysts wishing to contribute to a fi eld such as commu-nication need fi rst to establish that the problem they wish to investigate is amenable to discourse analysis. To conclude, this paper offers a number of insights into what can be achieved using the Fou- cauldian approach of employing statements to analyse discourse. What emerges from the analysis conducted here is a better understanding of how the discourses of risk and trust-generation (sci-ence, care and corporate responsibility) operate in the corpus of PILs in question at the micro-level of statements. Describing the constituent components of discourses also provides a means of challenging them as it makes underlying assumptions amenable to scrutiny and evaluation. In the case of texts that are considered not to meet the expectations or needs of those for whom they are intended, such analytical and evaluative perspectives are very valuable, as, by understanding better how these texts work discursively, it may be possible to derive arguments and strategies for their improvement.
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