How do newly diagnosed hypertensives understand 'risk'? Narratives used in coping with risk

In many clinical settings, there are concerns about communicating risk effectively in the absence of a clear understanding of what risk means to individuals.

To explore the ways in which individuals think about risk in the context of a recent diagnosis of hypertension.

A qualitative interview study of 11 recently diagnosed hypertensive patients recruited from general practice.

Participants presented a 'narrative' about their relationship to risk. Two general types of risk narrative were evident: 'denial' narratives and 'acceptance' narratives (though some examples fall along the spectrum in between). The 'deniers' described risk as something they do not think about, or as applying to others but not themselves. The 'acceptors' described risk as an unavoidable part of everyday life. The use of a 'denial' or 'acceptance' narrative appeared to be independent of the level of understanding of evidence-based hypertension medical risks. Some participants who used a denial narrative also described taking a variety of risk-reducing actions in relation to the new diagnosis. For some people the distancing of risk achieved by the narrative seems to be an important way of coping.

Participants described risk by way of a personal narrative, which functioned as a coping position. The coping position adopted did not presuppose either levels of knowledge, or health-related behaviour. In communicating information about risk, practitioners need to be aware of the use of coping narratives; 'denial' does not necessarily imply lack of understanding or unwillingness to take medically appropriate health-related actions.