Worldviews

Worldview and Self-Fulfilling Prophesy

The construct of worldview examines how beliefs about the self and the world interact to affect behavior. The following are two examples. Individuals with a high sense of self-efficacy may be more likely to engage in preventive behaviors because they believe that their actions will result in reduced harm (the self-controllability dimension). This may be amplified by the belief that the world is inherently just and that misfortune will not come to those who are good, decent, and try hard (the justice world dimension). However, this behavior may be undermined if individuals believe that they are not worthy of receiving good things (the self-deservingness dimension) and/or that bad things arbitrarily befall on people in the world (the randomness world dimension).

This notion is akin to the psychological theory of attribution, which studies individuals' tendency to see the world in a habitual way and how it can lead to habitual behavioral responses. Attribution theory takes this notion one step further to suggest that if one believes the world to be uncontrollable, as in the example above, it is likely that one will actually experience an uncontrollable world, in part due to the self-fulfilling prophesy. One example in medical decision making is the impact of misperception. If individuals hold the view that cancer is a death sentence, they are more likely to abstain from efforts to prevent or treat cancer; therefore, if diagnosed with cancer, it is likely to be at a later stage when overt symptoms develop (such as acute pain, uncontrolled bleeding) and medical treatment becomes necessary. Because the cancer was not caught early, treatment options become limited and the chance of survival dramatically decreases, tragically confirming their initial belief.

Imagine that this misperception was prevalent in a community at high risk for developing cancer, and as a result, community members engaged in little to no prevention. If policy makers failed to identify their worldview, they might assume that low cancer-screening rates were due to structural factors, such as limited access to screening centers. This mismatch in worldviews could lead policy makers to invest their limited healthcare dollars in the development of a screening center easily reached by public transportation rather than the more appropriate, and less costly, intervention aimed at addressing the community's misperceptions.

Therefore, a more informed understanding of how individuals perceive themselves, combined with specific beliefs about the world, may help

(a) identify those at increased vulnerability for experiencing poor health outcomes and (b) inform the development of appropriate, targeted interventions.

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