|
Article Excerpt
The current review outlines the implications of mesosystem measurement for ecological research and models of collaborative care. Existing approaches to single and multiple mesosystem measurement emphasizing adolescent and family ecological literature are described and critiqued. Ways in which collaborative health care relationships can be assessed across mesosystem dimensions are illustrated, and relevant measurement strategies from multiple disciplines are considered. Coordinated efforts are called for to preserve the integrity of the construct and to systematically develop mesosystem measures emphasizing theory, grounded research, sound test construction, and cultural considerations.
Keywords: ecological, measurement, mesosystem, systems of care, collaborative health care
**********
The momentum gained by various conceptual frameworks, particularly the biospsychosocial model (Biderman, Yeheskel, & Herman, 2005; Engle, 1977) and the ecological model (Bronfenbrenner, 1979) over the past few decades has brought systems thinking to the forefront of health care. This paper demonstrates the complementary nature of these models, and the potential of a uniquely explicit element of the ecological model--that of mesosystems--to productively sharpen the focus of researchers and providers interested in the relationship between the settings that influence health and mental health outcomes. While the ubiquity of the ecological model may prompt readers to question "so what's new?" what we consider here is the translation of mesosystem concepts into practical measurement strategies--both the state of the art and future directions. Our point of entry into the arena of families, systems, and health is our research with adolescents, thus many of our examples come from the child, adolescent, and family psychological literature. However, in an attempt to demonstrate the vast potential of mesosystem measurement, we incorporate numerous collaborative health examples, as well as examples from other disciplines.
As systems frameworks, both the biopsychosocial model and the ecological model consider the interactional nature of individual (biological and psychological) and environmental (natural and social) influences on human outcomes. Traditionally, the social component of the biopsychosocial model has been understudied in health care research relative to the within-person biological and psychological aspects. This has been due in large part to the impracticality of obtaining detailed social data during time limited patient episodes (Weston, 2005), and to practitioners feeling at a loss with respect to applying the social aspect of the model (Biderman et al., 2005; Weston, 2005). There are also remnants of the perspective that social considerations are the purview of social work rather than medicine (Biderman et al,, 2005). The ecological model, on the other hand, evolved in the opposite direction, with greater emphasis on the social components until the revised bioecological model (Bronfenbrenner & Ceci, 1994) elaborated genetic contributions. As the biospychosocial model is customized to suit the practicalities of clinical care and research (e.g., the patient-centered model, Weston, 2005) and translated into collaborative systems of service delivery (Seaburn, 2005) the ecological model can inform practical application, including assessment, of the social domain.
Bronfenbrenner's ecological model (1979) is a carefully articulated, powerful conceptual tool for understanding social influences on development. In order to be maximally useful, however, effective measurement of this construct is crucial. Misapplication of the mesosystem construct has inhibited the progression of the literature on mesosystemic influences. Beginning with Bronfenbrenner's definition of the mesosystem and related processes, and a consideration of the potential impact of this construct on ecological research and collaborative interventions, this article will examine how the mesosystem has been measured and what future development of mesosystem measurement should achieve.
BRONFENBRENNER'S DEFINITIONS RELATING TO THE MESOSYSTEM
As a concept gains popularity and people begin to use it intuitively, it becomes subject to varied interpretations. Consequently, many research studies that purport to address mesosystem components have done so inconsistently, sometimes miscategorizing mesosystem influences (e.g., Corcoran, Franklin, & Bennett, 2000; Rausch, Lovett, & Walker, 2003). Therefore, it makes sense to start with Bronfenbrenner's original definitions, which he laid out with considerable detail and precision, before considering measurement strategies. As the authors acknowledge their own perspectives in the elaboration of the definitions, the reader is encouraged to focus principally on the content within the quotation marks to draw conclusions.
The Mesosystem
Bronfenbrenner defines the mesosystem as "a set of interrelations between two or more settings in which the developing person actively participates (e.g., for a child, the relations among home, school, and neighborhood peer group; for an adult, among family, work, and social life"; Bronfenbrenner, 1979, p. 25). According to Bronfenbrenner, the most basic form of a mesosystem originates "when the developing person first enters a new setting" (1979, p. 210). The developing person becomes the primary link between the settings. Although primary links establish the existence of the mesosystem, the more common focus of mesosystem research appears to be the participation of significant others across settings. These significant others are referred to as supplementary links. For example, a mental health provider who consults with an adolescent's primary care physician becomes a supplementary link, as does an adolescent's mother when she visits his school.
Beyond the basic criteria needed to form a mesosystem, related phenomena can be behavioral, cognitive, or affective in nature. Interactive behaviors have been most widely examined in the psychology literature on mesosystems (e.g., Hirsch et al., 1990; Hickman et al., 1995; Sartor & Youniss, 2002). However, cognitive representations also represent bona fide mesosystem experiences. Bronfenbrenner notes, "If a person in a given setting speaks about her own activities in some other setting, either in the past or in the future, she is exhibiting the ability to create a 'mental mesosystem'" (1979). Weisskirch and Alva (2002) exemplify this in their measure about bilingual youths' attitudes about translating for monolingual parents in English speaking settings. The item "I think my parents learned English slower because I translated for them" (italics added) clearly requires the respondent to access cognition relating to the experience of being an intermediary between parental and social contexts. Although affective mesosystem phenomena are often difficult to locate in the empirical literature, the same measure contains two examples: "I feel embarrassed when I translate for others" and "I feel good about myself when I translate for others" (italics added). Adapted to a health care context, items could tap patients' subjective thoughts and emotions about collaboration with the practitioner, as exemplified in Engel's (1988) characterization of the patient's perspective:
Do my doctors know who I am, who I have been, who I still want to be? Do they understand what I am going through, my suffering, my pain, my distress? Do they understand my hopes and aspirations, my fears and shames, my vulnerabilities and strengths, my needs and obligations and my values? Above all, do they sense my personhood and my individuality? Do they acknowledge my humanity? Do they care?
A final dimension of Bronfenbrenner's (1979) definition delineates four mechanisms by which mesosystem interrelations can be expressed. Cross setting relationships can occur directly through "multisetting participation"--a person's physical participation in two or more settings. Second, they can occur indirectly through a third party facilitating "indirect linkage" of settings. Third, indirect "intersetting communication" (e.g., via phone call or letter) can take place between the settings. Finally, interrelationships can take the form of "intersetting knowledge"--information about one setting available to members of another setting. The act of gaining information about a setting from a website is a contemporary example of the intersetting knowledge mechanism. As pointed out by authors such as Weingarten (2000), mesosystemic Internet resources of this kind have enormous potential to build social support for individuals experiencing chronic illnesses and to provide information about their health status to family and friends.
In summary, Bronfenbrenner's conceptualization of the mesosystem is multidimensional, comprising primary and supplementary links as well as behavioral, cognitive, and affective components. In addition, there are multiple social mechanisms of mesosystem interaction. Each of these dimensions represents a potential area of mesosystem measurement that can be useful to researchers and practitioners.
IMPLICATIONS OF THE MESOSYSTEM FOR RESEARCH AND INTERVENTION
Effective measurement strategies are developed in service of carefully planned research or application, and the utility of a measure relates to its ability to capture the variables that are central to the planned work. The following examples of research and applied goals provide a basis for evaluating the utility of measurement approaches reviewed in this paper.
Research: Theory-based and Exploratory Agendas
Research specifically addressing the mesosystem often posits quantitative mechanisms of influence. Bronfenbrenner (1979) hypothesizes that "Development is enhanced as a direct function of the number of structurally different settings in which the developing person participates" (1979, italics added). This assertion that the effects of participation across meaningful settings are additive implies that the mesosystem provides influence beyond that of any individual microsystem. An illustration of this approach is Thompson, Heinberg, Altabe, and Tantleff-Dunn's (1999) Tripartite model, which states that parents, peers, and the media together shape adolescent body image. Within the collaborative health care literature, the mesosystem is prominently addressed by the widespread acceptance of the importance of strong partnerships between service providers and consumers as well as the families of consumers (Campbell...
|
