Health advocacy: A gulf between instruction and practice.

BACKGROUND: Systematic ways to teach health advocacy, an educational outcome for pharmacy graduates, is lacking. We developed a workshop to facilitate understanding and application of a novel structured framework for health advocacy and explored how pharmacy students enacted opportunities for health advocacy during subsequent outpatient experiential training. EDUCATIONAL ACTIVITY AND SETTING: A two-hour workshop was introduced for year 2 students in 2019. Its content was organized around a health advocacy framework. With patient and faculty facilitators, students worked through examples characterized into the framework's four quadrants: 1) shared advocacy "with patients" at the individual- or 2) systems-level and 3) directed advocacy "for patients" at the individual-or 4) systems-level. We then conducted a longitudinal diary study asking pharmacy students (N = 23) to reflect on opportunities to practice health advocacy skills in community pharmacy practice. A systematic, multi-coder reflexive thematic analysis of diary entries was employed. FINDINGS: Pharmacy students did not express a fulsome view of patient health advocacy and mischaracterized self-reported practice examples into inappropriate categories of the health advocacy framework. Most overemphasized usual pharmacist care as acts of health advocacy. No systems-level activities were undertaken, although isolated episodes of shared advocacy with patients were identified. SUMMARY: Lasting impacts of a health advocacy workshop in our pharmacy curriculum were not widely apparent. While longer training periods in community pharmacy practice may yield more opportunities to develop and enact this role, gaps in student conceptualization of health advocacy and inabilities to practically observe and exercise system-level advocacy are ultimately problematic for patient care.

Community health worker perspectives on advocacy: design-based research to develop a digital advocacy training course.

Introduction: While community health workers (CHWs) are well-positioned as health advocates, they frequently lack support and feel undervalued. Advocacy training may prepare CHWs to support communities better. Methods: This study uses a design-based research approach to (1) explore how participation in curriculum-development workshops for a digital advocacy course influenced CHWs' (n = 25) perceptions of advocacy and (2) describe how CHW involvement shaped course development. Data were collected via five discussion groups and seven surveys over six months. Results: Initially, the CHWs perceived themselves as community-advocates but not as self-advocates. They increasingly reflected on the merits of advocating for better working conditions and aspired to greater involvement in decision-making. CHWs reflected positively on their advisory role in shaping the course to improve content acceptability and validity. Discussion: Training efforts to engage CHWs in advocacy must overcome systemic barriers and norms internalized by CHWs that deter them from reaching their full potential as advocates.

Adopting a WHO Framework Convention on Tobacco Control-Based Tobacco Control Law in Ethiopia: Sustained Transnational Health Advocacy and Multi-Sectoral Institutionalized Support.

OBJECTIVE: The objective of this study was to document how Ethiopia adopted a WHO Framework Convention on Tobacco Control (FCTC)-based tobacco control law. METHODS: We analyzed publicly available documents, including news media articles, advocacy reports, and government documents. We triangulated these findings by interviewing nine key stakeholders. Data were analyzed to construct a historical and thematic narrative and analyzed through a retrospective policy analysis. RESULTS: Local and international health advocacy efforts helped introduce and support WHO FCTC-based legislation by (1) educating policymakers about the WHO FCTC, (2) providing legal assistance in drafting legislation, (3) generating local data to counter industry claims, and (4) producing media advocacy to expose industry activity. Health advocates worked closely with government officials to create a multi-sectoral tobacco committee to institutionalize efforts and insulate tobacco companies from the policymaking process. Japan Tobacco International bought majority shares of the government-owned tobacco company and attempted to participate in the process, using standard industry tactics to undermine legislative efforts. However, with health advocacy assistance, government officials were able to reject these attempts and adopt a WHO FCTC-based law in 2019 that included 100% smoke-free indoor places, a comprehensive ban on tobacco advertising, and large pictorial health warning labels, among other provisions. CONCLUSION: Sustained local health advocacy efforts supported by international technical and financial assistance can help establish WHO FCTC-based tobacco control laws. Applying a standardized multi-sectoral approach can establish coordinating mechanisms to further institutionalize the WHO FCTC as a legal tool to build support with other government sectors and insulate the tobacco industry from the policymaking process.

Exploring the Landscape of Intracranial Aneurysms in South America: A Comprehensive Narrative Review Intracranial Aneurysms in South America.

Exploring the landscape of intracranial aneurysms in South America unravels a complex interplay of epidemiological factors, clinical manifestations, and therapeutic challenges. The study methodically conducts a comprehensive literature review spanning the years 2003 to 2023, focusing on English-language articles obtained from diverse databases to elucidate the multifaceted nature of intracranial aneurysms in the region. Results and discussions categorize outcomes into positive domains, emphasizing successful treatments, favorable recoveries, and high survival rates, while also shedding light on negative aspects such as residual aneurysms and complications. The research illuminates significant gaps in pathological typing of intracranial aneurysms and exposes challenges in healthcare accessibility, notably the disparities in neurosurgical resources. Management challenges, including constrained infrastructure access, a neurosurgeon shortage, and gender disparities, are underscored. Transitioning to future prospects, the study advocates for strategic interventions, proposing expanded neurosurgical training, multidisciplinary approaches, improved funding, enhanced access to care, and fostering international collaborations. The study concludes by emphasizing the pivotal role of collaborative efforts, intensified training programs, and global partnerships in propelling intracranial aneurysm management forward in South America, ultimately contributing to enhanced patient outcomes across the region.

Benefits of a health advocacy intervention intended to improve self-efficacy for self-care in residents of a homeless shelter.

Despite a great need for healthcare, unhoused individuals encounter significant barriers to utilizing public healthcare systems. Given the inequities in access to healthcare, accompanied by disabilities and health risks associated with homelessness, self-efficacy for self-care is particularly critical. As a primary purpose of this article, we describe a self-care intervention (Health Advocacy Behavioral Activation), which was implemented within a long-standing participatory community action research project for homeless shelters, and report evidence of the intervention's effectiveness in enhancing self-efficacy for self-care. Participants included 62 residents of the St. Vincent de Paul Gateway Shelter for Men (Dayton, Ohio). Shelter residents with disabilities and those without disability benefited approximately equally from the intervention and both showed statistically significant pre- to post-intervention improvements in self-efficacy for self-care. Recommendations for future research examining the effectiveness of the intervention are provided. As a secondary (supplementary) purpose, we report preliminary evidence of psychometric validation for a new instrument (Scale of Self-Efficacy for Self-Care), which was developed in service of our primary purpose (i.e., to examine the effects of intervention on self-efficacy for self-care) because a literature search did not identify an appropriate measure. Because this new instrument fills a void in the literature, we anticipate that it will be useful in practice and research, and so we delineate research recommendations for additional psychometric validation of this measure. Because of the barriers that unhoused people encounter with regard to access to healthcare in the community, self-care interventions provided (and evaluated) on-site (e.g., in homeless shelters) are necessary.

Advocacy e condições de trabalho na universidade: Estratégia para o empoderamento do docente de enfermagem / Advocacy and working conditions at the university: A strategy for the empowerment of nursing teachers / Advocacy y condiciones laborales en la universidad: Estrategia para el empoderamiento del profesorado de enfermería

Resumo Enquadramento: No campo da enfermagem a advocacy procura contribuir no direito à saúde, que se insere no campo dos direitos humanos, pois está intrinsecamente relacionado ao direito de todos a uma vida saudável. Objetivo: Analisar a perceção de docentes sobre a advocacy na enfermagem e discutir as estratégias de promoção de advocacy para o trabalhador docente universitário de enfermagem. Metodologia: Estudo descritivo e exploratório, de abordagem qualitativa realizado em duas universidades públicas situadas no município do Rio de Janeiro, Brasil. Os participantes foram 14 docentes de enfermagem. Utilizou-se o grupo focal e os dados foram analisados à luz da técnica de análise de conteúdo. Resultados: Destaca-se a advocacy como atividade imperativa para alcançar a defesa dos interesses da categoria profissional, bem como a utilização das mídias como estratégia de divulgação do trabalho da enfermagem, incluindo os docentes de enfermagem. Conclusão: A advocacy é uma estratégia de promoção e valorização dos docentes de enfermagem em universidades sendo necessário o investimento nessa estratégia como importante recurso para a promoção da valorização profissional.

Abstract Background: In nursing, advocacy seeks to contribute to the right to health, which is intrinsically related to the human right to a healthy life. Objective: To analyze university teachers' perceptions of advocacy in nursing and discuss strategies to promote advocacy for university nursing teachers. Methodology: A descriptive and exploratory study with a qualitative approach was carried out in two public universities in Rio de Janeiro, Brazil. The participants were 14 nursing teachers. A focus group was conducted, and data were analyzed using the content analysis technique. Results: Advocacy stands out as a crucial activity to defend the professional category's interests, using the media as a strategy for disseminating nursing work, including nursing teachers. Conclusion: An investment in advocacy is needed as it is a strategy for valuing university nursing teachers and promoting their professional development.

Resumen Marco contextual: En el ámbito de la enfermería, la advocacy pretende contribuir al derecho a la salud, que se enmarca en el ámbito de los derechos humanos, ya que está intrínsecamente relacionado con el derecho de todos a una vida sana. Objetivo: Analizar la percepción de los profesores sobre la advocacy en la enfermería y debatir estrategias para promover la advocacy para el trabajador docente universitario de enfermería. Metodología: Estudio descriptivo y exploratorio de enfoque cualitativo realizado en dos universidades públicas localizadas en el municipio de Río de Janeiro, Brasil. Los participantes fueron 14 profesores de enfermería. Se utilizó el grupo focal y los datos fueron analizados con la técnica de análisis de contenido. Resultados: Se destaca la advocacy como actividad imprescindible para lograr la defensa de los intereses de la categoría profesional, así como la utilización de los medios de comunicación como estrategia de difusión del trabajo de enfermería, incluidos los docentes de enfermería. Conclusión: La advocacy es una estrategia de promoción y valoración del profesorado de enfermería en las universidades y es necesario invertir en esta estrategia como recurso fundamental para la promoción de la valoración profesional.

Use of Social Media for Health Advocacy for Digital Communities: Descriptive Study.

BACKGROUND: There has been a growth surge in the use of social media among individuals today. The widespread adoption of these platforms, coupled with their engaging features, presents a unique opportunity for the dissemination of health advocacy information. Social media is known as a powerful tool used to share health policy and advocacy efforts and disseminate health information to digital community members and networks. Yet, there is still a gap in the full exploitation of this powerful instrument, among health care professionals, for health advocacy campaigns. OBJECTIVE: This paper aims to describe the process of mobilizing social media platforms such as Twitter (rebranded to X Corp in 2023) for health advocacy of the digital community. Additionally, it aims to share the lessons and insights gained during this digital health advocacy engagement process. METHODS: We performed a comprehensive review of Twitter analytical data to examine the impact of our social media posts. We then consolidated these analytic reports with our meeting logs to describe our systematic, iterative, and collaborative design process to implement social media efforts and generate key lessons learned. RESULTS: Our review of monthly Twitter analytical reports and regular team meeting logs revealed several themes for successful and less successful practices in relation to our social media-based health advocacy efforts. The successful practices noted by the team included using personable, picture-based tweets; using a series of posts on a particular topic rather than an isolated post; leveraging team members' and partners' collaborations in shared posts; incorporating hashtags in tweets; using a balanced mix of texts and graphics in posts; using inclusive (nondestigmatizing) languages in tweeted posts; and use of polls to share tweets. Among the many lessons learned, we also experienced limitations including a lack of comprehensive statistics on Twitter usage for health care-related purposes such as health advocacy and limits in collating the estimates of the actual impact made on the intended digital community members by our posts. CONCLUSIONS: Twitter has been successfully used in promoting health advocacy content, and the social media team aims to explore other social media platforms that have a wider reach than Twitter. We will continue making necessary adjustments in strategies, techniques, and styles to engage the audience as we expand onto new platforms like Instagram and TikTok for health advocacy promotions.

Evaluating the internalisation of the intrinsic role of health advocacy of student pharmacists in a new integrated Bachelor of Pharmacy curriculum: a mixed-methods study.

To keep up with the contemporary health landscape, there is an imperative need for healthcare professionals to practise health advocacy through health promotion on the individual, population, and systems levels. In the Academic Year of 2020/2021, the National University of Singapore (NUS) Department of Pharmacy implemented a new spiral curriculum integrating basic, clinical, and systems sciences with one of its aims to deepen students' health advocacy internalisation and prepare them as future health advocates. A mixed-methods approach was adopted. Questionnaires were disseminated across three time-points to elicit students' levels of internalisation of health advocacy, which were then categorised into levels, and a Mann-Whitney U test was conducted. In comparison with prematriculation, no significant difference was found after students underwent the first year of the curriculum, while a significant difference was found after students underwent two years of the curriculum. Semi-structured interviews were also conducted after each Academic Year to gain deeper insights into the questionnaire results. Thematic analysis of the interviews revealed that curricular integration in the first year was perceived to be lacking. However, with learnt knowledge constantly reinforced and more experiential learning opportunities incorporated throughout the second year, students found the integrated curriculum beneficial in instilling confidence to practise health advocacy. This study offers insights into the prospects of a spiral integrated curriculum in imparting health advocacy, and may even suggest its potential to be applied to other educational settings. Future follow-up studies can also be conducted on the same study population to evaluate long-term impacts and areas for improvement of the curriculum.

What works in advocating for food advertising policy change across an english region - a realist evaluation.

BACKGROUND: With increasing recognition of the role of commercial determinants of health, local areas in England have sought to restrict the advertising of products high in fat, salt and sugar (HFSS) on council-owned spaces, as part of wider strategies to reduce obesity. While there is some evidence of the impact of such policy change on behaviour, little is known about what works in the process of implementing this policy change. METHODS: Guided by a realist evaluation framework that explores the interaction between context, mechanism and outcomes, this study aims to investigate the factors that influence the restriction of outdoor advertising of HFSS products in one region in England. It refines a programme theory co-produced with stakeholders from 14 local authorities within a region and uses multiple data sources from each area with an in-depth examination of four case study sites. Data sources include longitudinal realist interviews, focus groups and surveys with policy advocates and policy stakeholders. Data were analysed retroductively to understand the causal link between context, mechanism and outcomes. RESULTS: Outcomes were driven by five dominant mechanisms: a strategic and staggered approach to stakeholder engagement, gathering intelligence, identifying policy champions, building relationships, reframing the issue; and two secondary mechanisms of amplifying the issue and increasing public will. These led to varied outcomes with no changes in formal policy position within the evaluation period but draft policy guidance in place and changes in political will demonstrated. Dominant context factors influencing change included having a named and resourced policy advocate in place supported by an external Community of Improvement and having existing aligned local objectives. Organisational complexity and change, financial concerns, lack of local examples, ideological positions and the pandemic were also influencing contextual factors. CONCLUSION: Effecting policy change in this area requires the commitment of an extended period and the valuing of short-term policy outcomes, such as increasing political will. The importance of a resourced and well-supported policy advocate to lead this work is fundamental and the commercially sensitive nature of this policy change means that a complex interplay of mechanisms is required which may be dominated by a strategically staggered approach to stakeholder engagement.

Significant Disparity of Access to Stroke Treatment Between the Western Parts and Eastern and Northern Parts of Sydney.

Objective To provide an estimate of access times and distances to an endovascular clot retrieval (ECR) service provider for a typical stroke patient in the western part of Sydney and to compare it with the eastern and northern parts. Methods Incidences of stroke were simulated through a population-weighted randomized selection of addresses in the studied western, eastern, and northern areas of Sydney (100,000 times for each). The access times and distances were calculated from those addresses to the closest ECR hub for the eastern and northern parts and to all five ECR hubs, as well as the Nepean Public Hospital (NPH) for the western part. The access times and distance means were compared statistically using ANOVA. Results In the western areas, the estimated average access times and distances to different ECR hubs varied from 38.5 (+/- 15) to 45 (+/- 15) minutes and from 42 (+/- 15.9) to 46.8 (+/- 16) km in working hours and from 45 (+/- 15) to 64 (+/- 15) minutes and 46.8 (+/- 16) to 69.6 (+/- 16) km in after hours. However, the estimated average access times and distances to the local ECR hub were 12.25 (+/- 6) minutes and 9.1 (+/- 5.6) km for northern and 7.5 (+/- 4) minutes and 4.4 (+/- 2.5) km for the eastern areas. The differences between the estimated average access times and distances for a typical stroke patient to an ECR hub in the western areas in comparison with eastern or northern areas were statistically significant (p<0.0001). The average access times and distances in the western part to NPH were 17 (+/- 16) minutes and 15.6 (+/- 16.6) km. Conclusions The patients in the western part of Sydney had significantly longer access times to ECR hubs than those living in comparable areas of the eastern and northern parts. This study supports the Nepean Public Hospital supplying an ECR service to achieve travel times, and, therefore, treatment times for a typical stroke patient in the western parts, similar to patients in the eastern and northern parts of Sydney.

Pharmacy Students Practicing Health Advocate Competency Roles in Workplace-Based Training.

OBJECTIVE: Health advocacy competency roles are found in the educational outcomes of many health disciplines, yet their development is neglected in the professional curriculum and clinical learning environment. We explored how pharmacy students conceptualize health advocacy through their practice in workplace-based learning and any feedback they receive. METHODS: We conducted a longitudinal diary study of Canadian pharmacy students completing Advanced Pharmacy Practice Experiences in hospital and community practices in their graduating year. At pre-determined intervals, 25 students recorded workplace-based activities they recognized as health advocacy and any feedback they received from supervisors, patients, or other staff. Written diary data from 180 records were analyzed by 5 researchers according to inductive content analysis steps and principles. RESULTS: Pharmacy student records reflecting health advocacy roles were organized into 5 categories including, (1) disease prevention; (2) health promotion; (3) seamless care; (4) usual pharmacist care; and (5) professional advocacy. Although many activities were consistent with current competency role descriptions, they do not reflect educational outcomes associated with patient- or systems-level support necessary to address socio-political determinants of health. Although Advanced Pharmacy Practice Experience in training evaluation reports included scores for items related to health advocacy competency, few students confirmed receiving specific written or verbal feedback. CONCLUSION: Pharmacy students construct health advocacy roles in workplace-based training through biomedical-oriented practices with little direct input offered by supervisors. Pharmacy educational outcomes require contemporary updates to health advocacy competency descriptions which offer examples for practical enactment at system-level and recommendations for feedback and assessment.

The SickKids Caribbean Initiative to improve care for children with cancer and blood disorders.

To improve pediatric hematology and oncology outcomes, there is a recognized potential for partnerships between low- and high-resource institutions within health care systems. The SickKids Caribbean Initiative is a partnership between health care professionals at the Hospital for Sick Children in Toronto, Canada, and seven Caribbean institutions across six countries (Bahamas, Barbados, Jamaica, Saint Lucia, Saint Vincent and the Grenadines, and Trinidad and Tobago). The primary aim of the SickKids Caribbean Initiative has been to improve the outcomes and the quality of life of children in the Caribbean aged <18 years who have cancer and blood disorders. This article describes five key activities undertaken within the SickKids Caribbean Initiative, including providing education and training, assisting with case consultations and diagnostic services, developing local oncology databases, engaging in advocacy and ensuring stakeholder engagement, and coordinating administration and project management.

Las colaboraciones de instituciones de recursos bajos y altos dentro de los sistemas de atención de salud tienen un potencial reconocido para mejorar las respuestas a los tratamientos hematológicos y oncológicos pediátricos. La iniciativa SickKids para el Caribe es una asociación entre profesionales de la salud del Hospital for Sick Children de Toronto (Canadá) y siete instituciones de seis países del Caribe (Bahamas, Barbados, Jamaica, Santa Lucía, San Vicente y las Granadinas y Trinidad y Tabago). El objetivo principal de la iniciativa SickKids para el Caribe ha sido mejorar la respuesta a los tratamientos y la calidad de vida de los menores de 18 años del Caribe con cáncer o trastornos hematológicos. En este artículo se describen cinco actividades clave emprendidas en el marco de la iniciativa SickKids para el Caribe, consistentes en impartir formación y capacitación, prestar asistencia en materia de consultas de pacientes y servicios de diagnóstico, crear bases de datos locales en el área de la oncología, participar en actividades de promoción y garantizar la participación de las partes interesadas, y coordinar la administración y gestión de proyectos.

Há um potencial reconhecido para parcerias entre instituições com poucos e muitos recursos dentro dos sistemas de saúde para melhorar os resultados de hematologia e oncologia pediátricas. A iniciativa SickKids no Caribe é uma parceria entre profissionais de saúde do Hospital for Sick Children em Toronto, Canadá, e sete instituições em seis países do Caribe (Bahamas, Barbados, Jamaica, Santa Lúcia, São Vicente e Granadinas e Trinidad e Tobago). O objetivo principal da iniciativa SickKids no Caribe tem sido melhorar os desfechos e a qualidade de vida das crianças caribenhas com menos de 18 anos que têm câncer e doenças hematológicas. Este artigo descreve cinco atividades principais realizadas no âmbito da iniciativa SickKids no Caribe: oferecimento de educação e capacitação; assistência em consultas de casos e serviços diagnósticos; desenvolvimento de bancos de dados locais em oncologia; promoção da causa, assegurando o envolvimento das partes interessadas; e coordenação da administração e da gestão de projetos.

Pilot implementation of community health advocacy teams to improve the effectiveness of long-lasting insecticide net distribution through both campaigns and continuous channels in Ghana: a qualitative study of opportunities and barriers to implementation.

Introduction: In Ghana, the National Malaria Elimination Programme (NMEP) distributes long-lasting insecticide net (LLIN) to households for free through the periodic point mass distribution (PMD) campaign and continuous distribution to populations most vulnerable to malaria. It is known that the existence of effective and functional community-based groups could influence positive behaviours regarding health interventions promoted through health campaigns. However, there is no evidence of functional community-based groups that aim to improve the effectiveness of LLIN distribution campaigns by transitioning into primary healthcare delivery. This study aimed to explore the opportunities and barriers to the pilot implementation of co-created community health advocacy teams (CHATs) to improve the effectiveness of LLIN distribution through both campaigns and continuous channels in Ghana. Methods: A qualitative research approach was used among 43 CHAT members across six communities in the Eastern and Volta regions of Ghana. The CHAT constitutes significant community actors whose roles are centred on key elements of community/social mobilisation and capacity building, all nested in social and behaviour change communication (SBCC) strategies. The CHATs were pilot implemented in all study communities for 4 months after which we identified opportunities and barriers during implementation. CHAT members participated in six focus group discussions which were audio recorded, transcribed verbatim, and analysed thematically using the NVivo 13. Results: CHATs were instrumental in sensitising community members through SBCC strategies. Moreover, there were changes in the behaviour of community members who were receptive towards and participated in CHAT activities. Community members were accurately informed about malaria (e.g., causes and preventive measures). However, the CHAT experienced barriers during implementation, including a lack of financial support to aid in transportation, organisation of meetings, and outreach activities. Additionally, the level of participation by CHAT members in activities and the medium of communication among members were key areas of concern. Conclusion: The CHATs would be instrumental in promoting LLINs' use during and after PMD campaigns through community outreaches. It is therefore necessary to provide resources to support their operations and a good network to address communication barriers. Finally, continuous capacity strengthening of CHAT members by the NMCP is important.

O empoderamento de indivíduos com deficiência auditiva: revisão de literatura / The empowerment of individuals with hearing impairment: literature review / El empoderamiento de las personas con pérdida auditiva: revisión de la literatura

Introdução: o empoderamento está atrelado à autoadvocacia e a aprendizagem de ambos por pessoas com deficiência é fundamental para que essas conquistem o poder pessoal de gerir seus destinos. Objetivo: elencar as estratégias de intervenção utilizadas para o empoderamento do indivíduo com deficiência auditiva. Metodologia: realizou-se busca nas bases de dados Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS), Public Medicine Library (PubMed) e na ferramenta de buscas Google Acadêmico, por meio do cruzamento de descritores previamente selecionados. Foram incluídos estudos que avaliassem, propusessem estratégias ou discutissem sobre o empoderamento do indivíduo com deficiência auditiva. Resultados: Foram encontrados 186 estudos. Destes, 18 foram lidos na íntegra e 11 foram incluídos nesta revisão. O ano de publicação dos estudos variou de 2011 a 2021. Os estudos incluídos discutem, em algum momento, sobre o empoderamento de indivíduos com deficiência auditiva, porém a minoria propõe e relata resultados de estratégias de intervenção para trabalhar esse aspecto. Os estudos propõem que o empoderamento inicie por meio dos pais, nos centros de intervenção precoce. O empoderamento dos adolescentes com deficiência auditiva faz-se extremamente necessário e estratégias de intervenção em grupo podem ser benéficas para este fim. Somente um estudo brasileiro propôs uma estratégia de intervenção para essa população. Conclusão: O empoderamento deve começar por meio dos pais, logo após o diagnóstico da deficiência auditiva. Adolescentes podem tornar-se modelos para seus pares quanto a esse aspecto e adultos devem ser empoderados antes da adaptação do dispositivo de escuta. (AU)

Introduction: empowerment is linked to self-advocacy and the learning of both by people with disabilities is essential for them to conquer the personal power to manage their destinies. Purpose: to list the intervention strategies used for the empowerment of individuals with hearing impairment. Methodology: a search was carried out in the Latin American and Caribbean Literature in Health Sciences (LILACS), Public Medicine Library (PubMed) databases and in the Google Scholar search engine, by crossing previously selected descriptors. Studies that evaluated, proposed strategies or discussed the empowerment of individuals with hearing impairment were included. Results: 186 studies were found. Of these, 18 were read in full and 11 were included in this review. The year of publication of the studies ranged from 2011 to 2021. The included studies discuss, at some point, the empowerment of individuals with hearing impairment, but the minority proposes and reports results of intervention strategies to work on this aspect. The studies propose that empowerment start through parents, in early intervention centers. The empowerment of adolescents with hearing impairment is extremely necessary and group intervention strategies can be beneficial for this purpose. Only one Brazilian study proposed an intervention strategy for this population. Conclusion: Empowerment must start through the parents, right after the diagnosis of hearing loss. Adolescents can become role models for their peers in this regard and adults must be empowered before adapting the listening device. (AU)

Introducción: el empoderamiento está vinculado a la autogestión y el aprendizaje de ambos por parte de las personas con discapacidad es fundamental para que adquieran el poder personal para gestionar sus destinos. Objetivo: enumerar las estrategias de intervención utilizadas para el empoderamiento de las personas con discapacidad auditiva. Metodología: se realizó una búsqueda en las bases de datos de Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Public Medicine Library(PubMed) y en el buscador Google Scholar, cruzando descriptores previamente seleccionados. Se incluyeron estudios que evaluaron, propusieron estrategias o discutieron el empoderamiento de las personas con discapacidad auditiva. Resultados: Se encontraron 186 estudios. De estos, 18 se leyeron en su totalidad y 11 se incluyeron en esta revisión. El año de publicación de los estudios osciló entre 2011 y 2021. Los estudios incluidos discuten, en algún momento, el empoderamiento de las personas con discapacidad auditiva, pero la minoría propone e informa resultados de estrategias de intervención para trabajar en este aspecto. Los estudios proponen que el empoderamiento comience a través de los padres, en los centros de intervención temprana. El empoderamiento de los adolescentes con discapacidad auditiva es extremadamente necesario y las estrategias de intervención grupal pueden ser beneficiosas para este propósito. Solo un estudio brasileño propuso una estrategia de intervención para esta población. Conclusión: El empoderamiento debe comenzar con los padres, inmediatamente después del diagnóstico de pérdida auditiva. Los adolescentes pueden convertirse en modelos a seguir para sus compañeros en este sentido y los adultos deben empoderarse antes de adaptar el dispositivo de escucha. (AU)

A conceptual framework for culturally appropriate advocacy with racialised groups.

Independent mental health advocacy was introduced in England to protect and promote the rights of people detained under mental health legislation. However, shortcomings in access and delivery to racialised people, raising concerns about equity, were identified by a review of the Mental Health Act. The development of culturally appropriate advocacy was recommended. While the term culturally appropriate may be taken for granted it is poorly defined and limited efforts have conceptualized it in relation to advocacy. Ideally, advocacy operates as a liberatory practice to challenge epistemic injustice, which people experiencing poor mental health are at acute risk of. This is amplified for people from racialised communities through systemic racism. This paper argues that advocacy and culturally appropriate practices are especially relevant to racialised people. It clarifies the importance of culture, race and racism to the role of advocacy, and understanding advocacy through the conceptual lens of epistemic injustice. A central aim of the paper is to draw on and appraise cultural competency models to develop a conceptual framing of cultural appropriate advocacy to promote epistemic justice.

Perceptions of Advocacy in High School Students: A Pilot Study.

Assessing perceptions and attitudes of advocacy in adolescent populations is an important area of research. Previous studies have shown that advocacy programs in high schools are well-received and help promote health advocacy. This pilot study took place at the University of Central Florida College of Medicine Health Leaders Summer Academy hosted by medical students of the Student National Medical Association. A one-hour interactive workshop was administered to high school students interested in the healthcare field. Pre- and post-survey data were collected to assess participants' perceptions, methods, and barriers to engaging in advocacy. A total of 29 students were included in this study. Results indicated that students' definitions of advocacy changed after completing the workshop, as a higher percentage of students indicated that they practiced advocacy (pre-survey, 82.76% versus post-survey, 95.45%). There was a statistically significant difference in perceptions of the importance of advocacy in the student's future career (pre-survey, 3.82 versus post-survey, 4.15, p = .035). Social media was the most effective and common form of advocacy used (post-survey 72.73%). The most common barrier to practicing advocacy was a lack of education on a particular topic (31.82% post-survey). Overall, the workshop increased participants' interest in engaging in advocacy. Future directions include expanding the study to a larger population sample throughout the Orlando community and researching the use of social media as a tool for advocacy.

Health advocacy role performance of nurses in underserved populations: A grounded theory study.

AIM: Nurses' health advocacy (HA) role requires them to speak up for patients, clients, and communities in relation to healthcare. Various studies report the importance of the HA role of the nurse in healthcare. However, nurses' performance in this role is not clear yet. The present study aims to identify and explain how nurses perform their HA role in underserved populations. DESIGN: Qualitative grounded theory by Strauss and Corbin. METHODS: Data were gathered from three regional hospitals in Ghana with 24 registered nurses and midwives as participants through purposive and theoretical sampling techniques. Face-to-face in-depth semi-structured interviews were conducted from August 2019 to February 2020. The data were analysed using Strauss and Corbin's method and Nvivo software. The reporting follows Consolidated Criteria for Reporting Qualitative Research guidelines. FINDINGS: The HA role performance theory emerged from data with role enquiry, role dimension, role context, role influence, role reforms and role performance as building blocks. Data analysis showed that the main concerns of the nurses during their daily practice were mediating, speaking up, and negotiating. Among others, the intervening conditions were clientele influence and interpersonal barriers, whereas the outcome was a balance between role reforms and role performance. CONCLUSION: Although some nurses proactively initiated biopsychosocial assessment and performed the HA role, most of them relied on clients' requests to perform the role. Stakeholders should prioritise critical thinking during training and intensify mentoring programmes in the clinical areas. RELEVANCE FOR CLINICAL PRACTICE: The present study explains the process by which nurses perform their roles as health advocates in their daily activities as nurses. The findings can be used to teach and guide clinical practice for the HA role in nursing and other health care fields. There was no patient or public contribution.

A Wellbeing Index for South Australia.

ISSUE ADDRESSED: Wellbeing SA, an independent South Australian government agency, developed a Wellbeing Index for South Australia across a 12-month period in 2021-2022 to enable the measurement of wellbeing outcomes for the state. METHODS: The development of the Index was a methodical process based on two key emphases-evidence-based action and working in partnership. The steps included a scoping of existing wellbeing measurement frameworks and then working with a broad range of partner agencies to define the purpose, scope and structure for the Index and subsequently the content (indicators, their measures and the most robust data available). RESULTS: A Wellbeing Index for South Australia was launched in June 2022 on the Wellbeing SA website. It is structured against domains of physical, mental, social/community, Aboriginal cultural wellbeing and the underpinning determinants of wellbeing. CONCLUSIONS: The Index communicates the importance and the breadth of wellbeing outcomes addressed by the various health promotion and policy actors in South Australia and provides a sound basis for monitoring the wellbeing of the community over time. SO WHAT?: Measuring wellbeing is identified by proponents of a Wellbeing Economy as one useful mechanism, alongside legislation, policy and funding, for shaping a broader definition of a successful society. The health promotion community, and their partners, have a role to play in promoting the importance of a broad definition of wellbeing, and in identifying robust and meaningful indicators. This paper offers other jurisdictions insights into the process used, and challenges encountered, in creating the Index.

Poverty and Health Inequities in Children Investigated by Child Protective Services.

The objective of our study was to examine the association between poverty and child health outcomes in school-age children referred to child protective services. We conducted a secondary analysis of children aged 5 to 9 years in the Second National Survey of Child and Adolescent Well-Being, a nationally representative longitudinal observational data set of children referred to protective services for maltreatment (2008-2012). We analyzed the association of poverty, defined as family income below the federal poverty level (FPL), with caregiver report of the child's overall health, primary care, and emergency department visits using Pearson's chi-squared test. Children below FPL compared with children above it had poorer overall health (29.8% vs 18.0%, P = .03). We also conducted a longitudinal multivariable logistic regression analysis and found poverty was associated with the child's poorer overall health at 36 months (odds ratios 2.78, 95% confidence interval 1.55-5.01). Future studies and interventions to improve health in this at-risk population should target poverty.