University of Delaware, 325 Smith Hall, Newark, DE 19716, USA.
Soc Sci Med. 2014 Aug;114:66-72. doi: 10.1016/j.socscimed.2014.05.036. Epub 2014 May 24.
Existing literature characterizes fatalism as a passive reaction to health in the face of powerlessness and constructs agency as a more activist perspective based in self-efficacy and control. Frequently studied together, researchers extol agency as the appropriate approach to decision-making around health, while discouraging fatalistic outlooks. Despite associating such beliefs with social classes-agency with high socioeconomic status (SES) groups and fatalism with low SES groups-there is little research that compares health beliefs across class groups. By examining the medicalized condition of infertility among women of both high and low SES, this study examines how social class shapes reactions to health and illness. Through 58 in-depth interviews with infertile women in the U.S., we reveal the complexity of fatalism and agency and the reasons behind that complexity. We first examine the commonalities among SES groups and their mutual use of fatalism. We then demonstrate the nuance and continuity between the health beliefs themselves-fatalism can be agentic and agency can be achieved through fatalism. In other words, we disrupt the binary construction of health beliefs, their conflation with social class, and the static application of health beliefs as psychological attributes, ultimately exposing the classist basis of the concepts. Doing so can result in improved patient care and reduced health inequalities.
现有文献将宿命论描述为在无能为力的情况下对健康的一种消极反应，并将能动性构建为一种更积极主动的观点，其基础是自我效能感和控制感。研究人员经常一起研究能动性，称赞其是健康决策的适当方法，同时不鼓励宿命论观点。尽管将这些信念与社会阶层联系起来——能动性与高社会经济地位（SES）群体相关，宿命论与低 SES 群体相关，但几乎没有研究比较不同社会阶层群体的健康信念。本研究通过考察 SES 高低不同的女性的不孕这一医学化状况，研究了社会阶层如何影响对健康和疾病的反应。通过对美国 58 名不孕女性的深入访谈，我们揭示了宿命论和能动性的复杂性及其背后的原因。我们首先考察了 SES 群体之间的共同点及其对宿命论的共同使用。然后，我们展示了健康信念本身之间的细微差别和连续性——宿命论可以是能动的，能动性可以通过宿命论来实现。换句话说，我们打破了健康信念的二元结构、它们与社会阶层的混淆以及健康信念作为心理属性的静态应用，最终揭示了这些概念的阶级主义基础。这样做可以改善患者护理并减少健康不平等。
