The lay perspective
Introd uction The professional construction of compliance and the development of EBM devel oped from within the culture of mainstream biomedical research and practice . Running in parallel to this from the 1 970s onwards, a growing body of sociological work started to reveal the existence and complexity of lay concepts of health underlying illness behaviour (Backett 1 992; Blaxter 1 982; Cornwell 1 985 ; Craw ford 1 984; Herzlich 1 973 ; Pill & Stott 1 982; Pollock 1 99 3 ) . The development of 'grounded theory' was a powerful tool of qualitative research which involved an intensive scrutiny of respondents' verbatim accounts . The aim was to develop concepts inductively, and build theory from 'the ground up' ( Strauss & Corbin 1 998 ) . This contrasted with the hypothetico-deductive method ( ' top down' approach) characteristic of conventional scientific research, which proceeded through the systematic formulation and testing of predetermined hypotheses. Sociological interest at this time extended from the analysis of medical systems and formal health care to an investigation of the experience of health and illness in everyday life, and the illness behaviour of individual patients (Anderson & Bury 1 988; Stimson & Webb 1 97 5; Wadsworth & Robinson 1 97 6 ) . One of the striking findings was not only the high prevalence of symptoms among the population at any time, but also how infrequently these prompted visits to the doctor (Dunnell & Cartwright 1 972; Hannay 1 979; Wadsworth, Butterfield & Blaney 1 9 7 1 ) . Dunnell and Cartwright ( 1 972 ) found that 9 1 % of adult respondents had experienced symptoms during the preceding fortnight and each reported an average of 3 . 9 symptoms . Wadsworth, Butterfield & Blaney ( 1 97 1 ) found that 9 5 % o f 2 1 5 3 respondents reported health complaints but less than a third of those reporting at least one painful or clistressing symptom had contacted their doctor during this time . Hannay ( 1 979 ) found not only that most people did not consult about most of their symptoms ( especially mental problems) but that nearly a quarter of people reporting symptoms they considered to be severe or serious did not seek medical advice. He called this phenomenon 'the symptom iceberg' .