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Brownlie, J., Greene, A. and Howson, A. Researching Trust and Health , 2008 , Abingdon : Routledge x+221 pp . £60 ISBN: 978-0-415-95851-6 (hbk)

Amidst a heightened awareness of, and sensitivity to, the uncertainty and limitations of late-modern healthcare (in spite of its achievements and refinements), trust has been held to be of the utmost significance. Policy-makers and researchers alike have become increasingly interested in the concept, especially over the last decade. Yet in spite of this ongoing and mounting scrutiny, trust remains a nebulous concept to investigate. Theoretical and empirical research has struggled with its multi-dimensionality and its paradoxes – hence the multiplicity of conceptualisations and muddled distinctions which clarify and confuse in roughly equal measure.

It is in this context that Researching Trust and Health has been put together, and whilst openly acknowledging the impossibility of tidying up the field, it nevertheless makes significant strides in bringing together an array of approaches, empirical contexts and a significant literature into a neat volume which is required reading for graduate students and researchers in this domain. The book is essentially an edited volume of empirical studies, topped and tailed with more theoretical accounts which both ‘take stock’ and point towards future possibilities. It begins with a foreword by Guido Möllering which is most useful – in that Möllering is able to bring a conceptual precision to the topic which is arguably unsurpassed – as well as apt, in that the first few chapters draw heavily on his work.

The application of Möllering's theory is both positive, in its sure foundations and use within pertinent research contexts, and negative, in the relatively unreflexive manner in which his conceptualisations are applied. A range of settings such as these provided the possibility for further refinement and a pushing of the boundaries of theoretical understanding. On occasions there is an almost blind trust placed by the authors in the concepts and theory they are applying – rather than a more challenging, questioning approach (a notable exception to this assessment is Law's critique of Putnam). However, this book is after all more concerned with the application of theory within specific empirical environments and hence a level of trust in concepts is (in a Luhmannian sense) therefore crucial as a means of complexity reduction –‘explaining away’ certain aspects due to the need to focus on others.

In this sense this book does much to further understandings of how trust functions within certain healthcare settings. Parr and Davidson's chapter on trust in ‘virtual’ environments emphasises the importance of space for trust and the corresponding variables of uncertainty, risk and vulnerability. Sheach Leith's and Greene and colleagues’ studies open up for the reader the fascinating notions of reciprocity, altruism and obligation in terms of the ‘gift relationship’ in the respective contexts of organ donation and diabetes management. Alongside further explorations of patient trust in relation to mammography screening and general practice, there is Huby's illuminating account of inter-professional trust within healthcare teams and the dialectical relationship between accountability and (mis)communication – control and trust – which has arisen within recent policy frameworks and the demands they place on professionals.

Within a less ‘health-services’ context, Haddow and Cunningham-Burley explore public perceptions of the development of a genetic database. Significant within their findings, and a theme which appears elswhere, is the concomitant existence of trust and mistrust alongside one another. The number of sources of knowledge which trustees drew upon, the relative strengths and impacts of these in the consciousness, and the complexities and futuristic projections which had to be accounted for underlines the messiness of trust – and at the same time its teleology in the way that levels of trust facilitate action even in the parallel presence of mistrust.

Improved communication and consultation represents one means of overcoming such mistrust, though the question remains as to whether such public involvement and enfranchisement is as much about attenuating community mistrust as it is about the construction of legitimation. In a thought-provoking chapter entitled ‘The Elixir of Social Trust’, Law points to similar questions around the politicisation of ‘social capital’ and whether in fact attempts to mobilise social trust represent an overly romanticised notion of communities helping themselves, as a means of legitimating a diminished responsibility of the state for human and societal morbidities.

In contrast to the qualitative research which, quite appropriately, dominates the exploration of this nuanced and subjective concept in the rest of the book, the final chapter reviews the literature around trust and its connections with healthcare outcomes, incorporating a range of largely quantitative approaches. Though the ‘measurement’ of trust, as inferred above, is difficult and verging on the elusive, the importance of developing robust means of providing evidence for the significance of trust to patients (in an accurately conceived sense) is essential if policy-makers are to successfully attend to its facilitation.

This book undoubtedly has much to contribute in furthering the data collection and understandings of trust in relation to healthcare, both in itself – as a collection of pertinent, well-researched and insightful studies – and through its utility in informing future research of the methods, approaches and literature necessary for enhancing the analysis of this complex, subtle yet vital concept. As a reader, the one thing that seemed missing was a more serious attempt at theorising the relationship between institutional and inter-personal trust. Whilst the problem is referred to in the introduction, and these two levels of trust are explored empirically by Sheach Leith and others, there was a lack of theoretical analysis to this end.

One explanation of this omission, both within this volume and indeed more widely, is the lack of empirical research carried out into trust which is informed by, and grounded in, grander forms of social theory. Thus applying Möllering and others in certain situations helps inform analysis of these specific environments, but is limited, in itself, in elucidating how these relate to wider social and organisational structures. More dynamic attempts need to be made to go back to the social theory that Möllering himself uses (Luhmann, Simmel and Giddens amongst others) – or critical theory or phenomenology – and applying these frameworks as a means of refining our understandings of how the different dimensions of trust influence and relate to one another.