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.

Interprofessional Education: Reaching Health Professionals With an Interactive Professional Virtual/Online Event on Advocacy and Policy.

Competencies in health policy and advocacy should be developed by all health professionals to effectively advance their professions but also effectively collaborate in interprofessional teams to improve public health. However, the COVID-19 epidemic presents a challenge to reaching students of health professions through face-to-face offerings. To meet this need, the University of South Florida College of Public Health developed asynchronous and synchronous online health policy and advocacy modules delivered to an interprofessional group of students pursuing health careers. After learning policy and advocacy material individually through a self-paced online curriculum, faculty gathered the students for a synchronous online event where they formed collaborative groups. In interprofessional teams, students prepared and presented advocacy briefs that were critiqued by the faculty. Post-event evaluation results showed that most students strongly agreed that the interprofessional event was very effective, and they all would recommend the program to other students. Universities and colleges educating students of health professions can take advantage of the technologies employed to keep students safe in the COVID-19 pandemic and still reach students effectively with interprofessional health policy and advocacy content.

La educación ante el consumo de riesgo de bebidas alcohólicas: propuesta de actuación multidisciplinar desde el profesional de la salud / Education facing risk consumption of alcoholic beverages - A proposal for multidisciplinary action from the health care professionals

Educar y sensibilizar al consumidor para moderar el consumo de alcohol es clave para potenciar un estilo de vida saludable. Los profesionales de la salud (PS) en general, y los farmacéuticos comunitarios o los médicos y enfermeros de Atención Primaria (AP) en particular, son influenciadores clave en la educación para prevenir conductas de riesgo. El desconocimiento por parte del consumidor de conceptos como la unidad de bebida estándar, las recomendaciones de consumo, o las equivalencias de alcohol en las bebidas consumidas, puede generar consumos de riesgo alto, dado que el alcohol es alcohol y no depende de la bebida que lo contiene. Asimismo, los PS no suelen estar familiarizados con estos conceptos y con el uso de herramientas para la detección precoz, como puede ser el cuestionario AUDIT (Alcohol Use Disorders Identification Test). Proponemos un abordaje multidisciplinar (médicos y enfermeros de AP, farmacia comunitaria, dietistas-nutricionistas) para educar al consumidor sobre el riesgo asociado al consumo de alcohol, sustentado en la elaboración de un protocolo de actuación consensuado entre las sociedades científicas de estos colectivos profesionales, cuyo objetivo fundamental es contribuir a la formación óptima y actualizada de los PS. Este protocolo de actuación pretende, por tanto, prevenir conductas de riesgo mediante la educación del consumidor y la detección de hábitos de consumo de alto riesgo. Asimismo, este abordaje multidisciplinar y coordinado debe servir para impulsar la comunicación entre los distintos colectivos a la hora de proporcionar información relevante para abordar el consumo de riesgo desde la AP de Salud

Educating and increasing awareness in the consumer to achieve a moderate alcohol consumption is key to promote a healthy lifestyle. Health care professionals (HCP), in particular community pharmacists and Primary Care (PC) physicians and nurses, are key influencers in the education to prevent risk behaviors. A consumer's poor knowledge of concepts such as standard unit, the recommendations on alcohol use, or the alcohol equivalence in the drinks consumed, can lead to a high-risk use, since "alcohol is alcohol" no matter what beverage contains it. Moreover, HCPs are usually not familiar with these concepts and with early detection tools such as the AUDIT (Alcohol Use Disorders Identification Test). We propose a multidisciplinary approach (PC physicians and nurses, community pharmacy, dietists-nutritionists) to educate consumers on the risks associated with the use of alcohol, supported by the development of a protocol of action subscribed by the scientific societies of these professional groups, with the main objective of contributing to optimal and updated training for HCPs. Thus, this protocol of action aims to prevent risk behaviors through consumer education, and to detect high-risk alcohol use. Moreover, this multidisciplinary and coordinated approach should help to boost communication between the different collectives involved when providing relevant information to tackle risky alcohol use from PC

Systems thinking: advancing health advocacy training; a perspective from junior family physicians in the Middle East.

Healthcare systems are becoming increasingly complex. Physicians are expected to be agents of change to meet the growing health needs. In the Middle East, young family doctors are subtly creating a space for advocacy. Recognising the need for compulsory advocacy training in undergraduate medical curricula, allows health workers and students a concrete exposure to social determinants of health by carrying out clinical encounters from the hospital setting to outpatient dispensaries in underprivileged areas. At the community level, they organise mobile clinics and engage in collaborative initiatives to provide primary healthcare services to vulnerable populations. To be successful, advocacy practice and training should move towards systems thinking. Family doctors need to engage and collaborate with other stakeholders within the healthcare system and understand the dynamics of the relationships between them. This empowers their role in national health agendas, especially those related to universal health coverage (UHC). Future physicians and all members of primary care teams need to partner with people outside their discipline; the idea of interdisciplinary and interprofessional collaboration should be integrated into their schooling and all forms of vocational training.

Teaching Health Advocacy: A Systematic Review of Educational Interventions for Postgraduate Medical Trainees.

PURPOSE: A systematic review was undertaken to characterize the training approaches that are currently being implemented in postgraduate medical education to teach residents advocacy skills. METHOD: An initial search was conducted in MEDLINE, PubMed, Embase, ERIC, and PsycINFO in November 2016 (updated in December 2017) for articles discussing postgraduate medical education interventions covering advocacy. Articles published between 1995 and 2017 were included. Two authors independently reviewed titles and abstracts (and, if needed, the full text) for inclusion; disagreements were resolved by consensus. Data were extracted from studies to characterize the content and pedagogy of the interventions by mapping them to the CanMEDS health advocate core competencies and key concepts. RESULTS: A total of 3,027 unique abstracts were retrieved; 2,864 were excluded upon title and abstract review, and another 85 were excluded upon full-text review. Seventy-eight total articles were included. More studies involved residents from pediatrics, psychiatry, primary care or preventative medicine, or internal medicine than from emergency medicine, surgery, obstetrics and gynecology, or neurology. Published interventions varied widely by pedagogical approach and assessment method. CONCLUSIONS: Using the CanMEDS framework, this review maps the breadth and nature of postgraduate medical education interventions in health advocacy, with applicability to community organizations, program directors, educators, and administrators working to develop advocacy training interventions. Areas of focus included adapting practice to respond to the needs of or advocacy in partnership with patients, communities, or populations served; determinants of health; health promotion; mobilizing resources as needed; and social accountability.

Post-Graduation Effects of an Advocacy Engagement Project on Alumni of a Dental Hygiene Program.

The aim of this study was to investigate advocacy actions of dental hygiene program alumni who had completed a Legislative Advocacy Project (LAP) when they were students in the undergraduate or graduate program. Five variables were assessed: participation, frequency, perceived barriers, engagement, and mentorship. Alumni of the undergraduate and graduate programs were compared regarding frequency of and barriers encountered to legislative advocacy actions. A descriptive-comparative research design was used with quantitative and qualitative analysis. A convenience sample of 157 alumni who had completed a seven-week LAP at Idaho State University between 2008 and 2013 were invited to complete a 52-item author-designed online questionnaire in 2015. The response rate was 41.4%. The results showed a significant difference for participation prior to and after the LAP (df=12, X2=28.28, p=0.005). Most respondents, however, did not participate in legislative actions. There was a significant difference between the two groups for two frequency items: subscribing to online listservs (p=0.001) and contacting political representatives or staff (p=0.003). The three greatest barriers were time, financial resources, and testifying. The analysis found a significant difference between the two groups for the barrier of interest in advocating (p=0.05). In the qualitative analysis, themes emerged about engagement factors (collective efforts and advocacy commitment) and mentorship (mentoring experiences). Advocacy actions after graduation improved, but implementation of actions was challenging due to competing barriers. The results of this study may be useful in identifying key components of advocacy education that should be part of training programs.

From Private Practice to Academia: Integrating social and political advocacy into every MFT Identity.

While advocacy was essential to establishing the field of marriage and family therapy, at present a social and political advocacy skill set is lacking for the typical marriage and family therapist (MFT). This article reviews the importance of being active in social and political advocacy and highlights the attributes of MFTs' professional identity that uniquely position us for success in these areas. Other mental health fields' pedagogical approaches to training and education are explored, and recommendations are made for how MFTs can begin to increase their competency in advocacy. Ideas for incorporating advocacy into a professional identity are presented for MFTs at every level of professional experience. Finally, the concept self-of-the-advocate is introduced and discussed.

Using a digital storytelling assignment to teach public health advocacy.

The need and expectation for advocacy is central to public health nursing practice. Advocacy efforts that effectively call attention to population health threats and promote the well-being of communities rely on strategies that deliver influential messaging. The digital story is a lay method to capture meaningful, impactful stories that can be used to advocate for public health concerns. Readily available, user-friendly digital technologies allow engagement in digital media production to create digital stories. This paper describes how digital story making can be utilized as an academic assignment to teach public health advocacy within an undergraduate nursing curriculum. Providing nursing students this artistic outlet can facilitate meeting academic learning goals, while also equipping them with creative skills that can be applied in future professional practice. Nursing educators can take advantage of institutional resources and campus culture to support the use of novel digital media assignments that facilitate application of advocacy concepts.

Shifting the Culture Around Public Health Advocacy: Training Future Public Health Professionals to Be Effective Agents of Change.

There is a critical need to build the capacity of our current and future public health workforce and the communities we serve to engage in public health advocacy. Advocacy should be an integral piece of our intervention strategies and public health discourse. Incorporating public health advocacy into public health training, practice, and research serves as a long-term investment for the public's health. Advocacy can achieve systemic change by addressing the social determinants of health. We developed an advocacy training program that embeds students in community-based organizations (CBOs) for 9 months, providing students with experiential education through the application of advocacy skills and CBOs with opportunities to expand and broaden their advocacy efforts. We have three priority populations: graduate students, CBOs serving Los Angeles County, and the broader Los Angeles County community, focusing on vulnerable populations. Our multifaceted approach addresses the necessity of public health advocacy among the health professions. Through changing how we train students and how communities and universities collaborate, we can strengthen the public health workforce and build healthier communities.

Increasing Awareness on Health Care Access in Florida: A Community-Based Medical-Legal Practicum Project.

PROBLEM: Service learning and experiential coursework has become a requirement for medical students and law students. Advocacy for the underinsured and uninsured is of ethical importance to both the practice of law and medicine, however engaging professional students in meaningful advocacy work with community partners can be challenging. PURPOSE: The article describes a partnership between medical and law students in a community-based service learning project to promote health care access. KEY POINTS: Law and medical students at Florida International University partnered with community members and Florida Legal Services to collect patient narratives, disseminate information on Medicaid expansion to community members, and present patient stories to state lawmakers. CONCLUSIONS: The medical and law students learned about each other's professional roles and gained skills in interviewing, and legislative and policy advocacy through this service learning project by providing legislative testimony to key stakeholders and community education on Medicaid expansion.

Developing a comprehensive curriculum for public health advocacy.

There is a substantial gap in public health school curricula regarding advocacy. Development of such a curriculum faces three challenges: faculty lack advocacy skills and experience; the public health literature on effective advocacy is limited; and yet a successful curriculum must be scalable to meet the needs of approximately 9,000 public health students graduating each year. To meet these challenges, we propose a 100-hour interactive online curriculum in five sections: campaigning and organizing, policy making and lobbying, campaign communications, new media, and fund-raising. We outline the content for individual modules in each of these sections, describe how the curriculum would build on existing interactive learning and social media technologies, and provide readers the opportunity to "test-drive" excerpts of a module on "grasstops" organizing. Developing advocacy skills and expertise is critical to meeting the challenges of public health today, and we provide a blueprint for how such training might be brought to scale in the field.

Activist emotions: gay radicalism and melancholic attachments.

It has been argued recently that Australian historians have overlooked histories of emotion. In this article, through the life-history analysis of two long-standing Sydney gay activists, I trace the emotional currents of radical gay activism and suggest these histories point to a wider story of Left melancholy in the closing decades of the twentieth century. I argue that their melancholia is not a trauma-like despair but surprisingly is tinged with a sustaining hope.

Working with and for: student advocates' experience of relationship-centered advocacy with low-income women.

This study describes a qualitative study of student advocates' experiences of their work with low-income women struggling with symptoms of depression. Using an advocacy model called Relationship-Centered Advocacy, these 1st-year counseling psychology graduate students worked intensively with their "partners" for 9 months. Advocate-partner teams met together each week, developing collaborative relationships and addressing the women's emotional and material needs in integrated ways. Using qualitative content analysis of participant interviews and journal entries, this study describes emergent themes involving negotiating the advocacy relationship, insider-outsider dynamics, responding to perceptions of privilege and disparity, and gaining professional and personal insights. It concludes with a discussion of the practice and research implications, highlighting the possibilities of Relationship-Centered Advocacy as a new training tool.

Practice-based teaching for health policy action and advocacy.

The Institute of Medicine has issued numerous reports calling for the public health workforce to be adept in policy-making, communication, science translation, and other advocacy skills. Public health competencies include advocacy capabilities, but few public health graduate institutions provide systematic training for translating public health science into policy action. Specialized health-advocacy training is needed to provide future leaders with policy-making knowledge and skills in generating public support, policy-maker communications, and policy campaign operations that could lead to improvements in the outcomes of public health initiatives. Advocacy training should draw on nonprofit and government practitioners who have a range of advocacy experiences and skills. This article describes a potential model curriculum for introductory health-advocacy theory and skills based on the course, Health Advocacy, a winner of the Delta Omega Innovative Public Health Curriculum Award, at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.

Fundamental components of a curriculum for residents in health advocacy.

PURPOSE: To develop components of a curriculum for teaching and evaluating Residents as health advocates. METHOD: Modeled on the Delphi technique, the first step involved a multidisciplinary panel of 10 Queen's University health care providers with expertize in education and patient advocacy. In the context of four Advocacy questions: What is it?, Who does it?, How to teach it?, and How to evaluate it?, they discussed a curriculum framework including graded education, scholarly activity, role modeling, and case examples. In the second step, 24 faculty experts addressed two goals: (1) to identify attributes discussed by the expert panel in step 1 and corresponding measurable behaviours and (2) to refine the curriculum framework proposed in step 1 with emphasis on content and evaluation. RESULTS: Six attributes of a health advocate were identified; knowledgeable, altruistic, honest, assertive, resourceful, and up-to date. Behaviours that reflect these attributes were identified as desirable or undesirable and means of teaching were matched to the attributes. For most residents, skills would be developed in a graded fashion, progressing from advocating for the individual to society as a whole. CONCLUSIONS: This study provides a general framework from which specialty-specific curriculums for training health advocates can be developed.