What makes advocacy work? Stakeholders' voices and insights from prioritisation of maternal and child health programme in Nigeria.

BACKGROUND: The Nigerian government introduced and implemented a health programme to improve maternal and child health (MCH) called Subsidy Reinvestment and Empowerment programme for MCH (SURE-P/MCH). It ran from 2012 and ended abruptly in 2015 and was followed by increased advocacy for sustaining the MCH (antenatal, delivery, postnatal and immunization) services as a policy priority. Advocacy is important in allowing social voice, facilitating prioritization, and bringing different forces/actors together. Therefore, the study set out to understand how advocacy works - through understanding what effective advocacy implementation processes comprise and what mechanisms are triggered by which contexts to produce the intended outcomes. METHODS: The study used a Realist Evaluation design through a mixed quantitative and qualitative methods case study approach. The programme theory (PT) was developed from three substantive social theories (power politics, media influence communication theory, and the three-streams theory of agenda-setting), data and programme design documentation, and subsequently tested. We report information from 22 key informant interviews including national and State policy and law makers, policy implementers, CSOs, Development partners, NGOs, health professional groups, and media practitioners and review of relevant documents on advocacy events post-SURE-P. RESULTS: Key advocacy organizations and individuals including health professional groups, the media, civil society organizations, powerful individuals, and policymakers were involved in advocacy activities. The nature of their engagement included organizing workshops, symposiums, town hall meetings, individual meetings, press conferences, demonstrations, and engagements with media. Effective advocacy mechanism involved alliance brokering to increase influence, the media supporting and engaging in advocacy, and the use of champions, influencers, and spouses (Leadership and Elite Gendered Power Dynamics). The key contextual influences which determined the effectiveness of advocacy measures for MCH included the political cycle, availability of evidence on the issue, networking with powerful and interested champions, and alliance building in advocacy. All these enhanced the entrenchment of MCH on the political and financial agenda at the State and Federal levels. CONCLUSIONS: Our result suggest that advocacy can be a useful tool to bring together different forces by allowing expression of voices and ensuring accountability of different actors including policymakers. In the context of poor health outcomes, interest from policymakers and politicians in MCH, combined with advocacy from key policy actors armed with evidence, can improve prioritization and sustained implementation of MCH services.

The activist health sciences librarian.

At the remove of 2019, it is hard for many to imagine the sense of apocalypse that was palpable throughout the gay community during the 1980s and much of the 1990s. My professional career was launched at the height of the acquired immunodeficiency syndrome (AIDS) pandemic, and at the time, saving lives through librarianship was my mission. This Janet Doe Lecture presents my personal story of activism and advocacy as a lens through which to consider the larger story of activism around social justice issues for the Medical Library Association, by groups such as the Relevant Issues Section, now the Social Justice Section, and by the work of past Doe Lecturers Rachael K. Anderson, AHIP, FMLA, and Gerald Oppenheimer. It is also the story of an association that has at times been deeply conflicted about the role of such activism in our niche of librarianship. With anchors in poetry and prose, this is a story of hope through justice, conveying a message of the essentialness of our work as librarians and health information professionals to the mission of saving lives.

Domestic violence advocates' HIV prevention practices with women survivors: Frequency and barriers.

There is strong evidence of the association between being a survivor of domestic violence (DV) and the risk of acquiring HIV. Unfortunately, DV advocates often fail to adequately address this risk. Data from an online survey with a national convenience sample of 677 DV advocates from throughout the United States and territories were used to examine current practices and beliefs about HIV and DV. Encouragingly, advocates reported feeling comfortable discussing sex-related topics with their clients and largely rejected stigmatizing attitudes toward people living with HIV. However, only 16% of the advocates reported regularly engaging in at least half of the HIV prevention practices measured. Barriers to such practices were explored. Findings suggest advocates need further training and organizational supports to adequately address HIV with clients. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

A Systematic Review of Advocacy Curricula in Graduate Medical Education.

BACKGROUND: Professionalism standards encourage physicians to participate in public advocacy on behalf of societal health and well-being. While the number of publications of advocacy curricula for GME-level trainees has increased, there has been no formal effort to catalog them. OBJECTIVE: To systematically review the existing literature on curricula for teaching advocacy to GME-level trainees and synthesize the results to provide a resource for programs interested in developing advocacy curricula. METHODS: A systematic literature review was conducted to identify articles published in English that describe advocacy curricula for graduate medical education trainees in the USA and Canada current to September 2017. Two reviewers independently screened titles, abstracts, and full texts to identify articles meeting our inclusion and exclusion criteria, with disagreements resolved by a third reviewer. We abstracted information and themes on curriculum development, implementation, and sustainability. Learning objectives, educational content, teaching methods, and evaluations for each curriculum were also extracted. RESULTS: After reviewing 884 articles, we identified 38 articles meeting our inclusion and exclusion criteria. Curricula were offered across a variety of specialties, with 84% offered in primary care specialties. There was considerable heterogeneity in the educational content of included advocacy curriculum, ranging from community partnership to legislative advocacy. Common facilitators of curriculum implementation included the American Council for Graduate Medical Education requirements, institutional support, and preexisting faculty experience. Common barriers were competing curricular demands, time constraints, and turnover in volunteer faculty and community partners. Formal evaluation revealed that advocacy curricula were acceptable to trainees and improved knowledge, attitudes, and reported self-efficacy around advocacy. DISCUSSION: Our systematic review of the medical education literature identified several advocacy curricula for graduate medical education trainees. These curricula provide templates for integrating advocacy education into GME-level training programs across specialties, but more work needs to be done to define standards and expectations around GME training for this professional activity.

"Provide care for everyone please": engaging community leaders as sexual and reproductive health advocates in North and South Kivu, Democratic Republic of the Congo.

BACKGROUND: Inadequate infrastructure, security threats from ongoing armed conflict, and conservative socio-cultural and gender norms that favour large families and patriarchal power structures contribute to poor sexual and reproductive health (SRH) outcomes in North and South Kivu provinces, Democratic Republic of the Congo (DRC). In order to expand contraceptive and post-abortion care (PAC) access in North and South Kivu, CARE, the International Rescue Committee and Save the Children provided technical support to the Ministry of Health and health facilities in these regions. Partners acknowledged that community leaders, given their power to influence local customs, could play a critical role as agents of change in addressing inequitable gender norms, stigma surrounding SRH service utilization, and topics traditionally considered taboo within Congolese society. As such, partners actively engaged with community leaders through a variety of activities such as community mapping exercises, values clarification and transformation (VCAT) activities, situational analyses, and education. METHODS: This manuscript presents findings from 12 key informant interviews (KIIs) with male political and non-political community leaders conducted in six rural health zones of North and South Kivu, DRC. Transcripts were analysed thematically to explore community leaders' perceptions of their role in addressing the issue of unintended pregnancy in their communities. RESULTS: While community leaders in this study expressed overall positive impressions of contraception and strong support for ensuring access to PAC services following spontaneous and induced abortions, the vast majority held negative beliefs concerning women who had induced abortion. Contrasting with their professed opposition to induced abortion, leaders' commitment to mediating interpersonal conflict arising between community members and women who had abortions was overwhelming. CONCLUSION: Results from this study suggest that when thoughtfully engaged by health interventions, community leaders can be empowered to become advocates for SRH. While study participants were strong supporters of contraception and PAC, they expressed negative perceptions of induced abortion. Given the hypothesized link between the presence of induced abortion stigma and care-avoidance behavior, further engagement and values clarification exercises with leaders must be integrated into community mobilization and engagement activities in order to increase PAC utilization.

Medical Training in the Maelstrom: The Call to Physician Advocacy and Activism in Turbulent Times.

In this Invited Commentary, the author probes current events overlapping with his early medical education for unwritten lessons. Today's generation of trainees studies the careful application of science to suffering in the roiling context of resurgent white supremacy, anti-immigrant hatred, climate disasters, contentious public health epidemics, and attacks on the structures undergirding access to health care for millions. The author reflects on the connections between sociopolitical events and his own experiences, as well as those of his classmates, friends, and family members. These experiences, he argues, have galvanized his and his fellow medical students' commitment to decency, truth, diversity, and equity. He concludes that, in the current climate, the practice of healing is inextricably tied to the social and political context, such that advocacy and activism have become essential to a career in medicine.

Re-Evaluating Expertise: Principles for Food and Nutrition Security Research, Advocacy and Solutions in High-Income Countries.

Drawing on examples from Australia and the United States, we outline the benefits of sharing expertise to identify new approaches to food and nutrition security. While there are many challenges to sharing expertise such as discrimination, academic expectations, siloed thinking, and cultural differences, we identify principles and values that can help food insecurity researchers to improve solutions. These principles are critical consciousness, undoing white privilege, adopting a rights framework, and engaging in co-creation processes. These changes demand a commitment to the following values: acceptance of multiple knowledges, caring relationships, humility, empathy, reciprocity, trust, transparency, accountability, and courage.

School Nurse Advocacy for Student Health, Safety, and School Attendance: Impact of an Educational Activity.

School nurses are expected to advocate for policies and procedures that support student health, safety, and school attendance. An educational activity to improve school nurse advocacy was developed and implemented based on advocacy literature, self-efficacy theory, and continuing education guidelines. A quantitative, repeated measure descriptive project design was used to compare school nurses' advocacy measures before and following an educational activity and 6 weeks after the activity. Immediately after the education, there were significant increases in advocacy knowledge (p < .001), confidence (p < .001), and recalled behaviors (p < .01) for a convenient sample of 51 Massachusetts school nurses. There were no significant differences across pre-, post-, and 6-week survey responses (n = 6); however, advocacy outcomes from immediately after the education were maintained at 6 weeks. More effective school nurse advocacy may improve youth population health, increase safety for students at school, and improve school attendance.

The passage of tobacco control law 174 in Lebanon: reflections on the problem, policies and politics.

Progress in tobacco control policy making has occurred worldwide through advocacy campaigns involving multiple players- civil society groups, activists, academics, media and policymakers. The Framework Convention on Tobacco Control (FCTC)-the first ever global health treaty-outlines evidence-based tobacco control policies. Lebanon ratified the FCTC in 2005, but until 2011, tobacco control policies remained rudimentary and not evidence-based. Beginning in 2009, a concerted advocacy campaign was undertaken by a variety of stakeholders with the aim of accelerating the process of adopting a strong tobacco control policy. The campaign was successful, and Law 174 passed the Lebanese Parliament in August 2011. In this article, we analyse the policy making process that led to the adoption of Law 174 using Kingdon's model. The analysis relies on primary and secondary data sources including historical records of key governmental decisions, documentation of the activities of the concerted advocacy campaign and in-depth interviews with key stakeholders. We describe the opening of a window of opportunity as a result of the alignment of the problem, policy and politics streams. Furthermore, findings revealed that despite the challenge of persistent tobacco industry interference and established power relations between the industry, its allies and policymakers; policy entrepreneurs succeeded in supporting the alignment of the streams, and influencing the passage of the law. Kingdon's multiple stream approach was useful in explaining how tobacco control became an emerging policy issue at the front of the policy agenda in Lebanon.

An open source pharma roadmap.

In an Essay, Matthew Todd and colleagues discuss an open source approach to drug development.

Advocacy coalitions involved in California's menu labeling policy debate: Exploring coalition structure, policy beliefs, resources, and strategies.

Advocacy coalitions often play an important role in the state health policymaking process, yet little is known about their structure, composition, and behavior. In 2008, California became the first state to enact a menu labeling law. Using the advocacy coalition framework, we examine different facets of the coalitions involved in California's menu labeling policy debate. We use a qualitative research approach to identify coalition members and explore their expressed beliefs and policy arguments, resources, and strategies by analyzing legislative documents (n = 87) and newspaper articles (n = 78) produced between 1999 and 2009. Between 2003 and 2008, six menu labeling bills were introduced in the state's legislature. We found the issue received increasing media attention during this period. We identified two advocacy coalitions involved in the debate-a public health (PH) coalition and an industry coalition. State organizations acted as coalition leaders and participated for a longer duration than elected officials. The structure and composition of each coalition varied. PH coalition leadership and membership notably increased compared to the industry coalition. The PH coalition, led by nonprofit PH and health organizations, promoted a clear and consistent message around informed decision making. The industry coalition, led by a state restaurant association, responded with cost and implementation arguments. Each coalition used various resources and strategies to advance desired outcomes. PH coalition leaders were particularly effective at using resources and employing advocacy strategies, which included engaging state legislators as coalition members, using public opinion polls and information, and leveraging media resources to garner support. Policy precedence and a local policy push emerged as important policymaking strategies. Areas for future research on the state health policymaking process are discussed.

Information Literacy Advocates: developing student skills through a peer support approach.

Since 2013/2014, an Information Literacy Advocates (ILA) scheme has been running at the University of Nottingham as an extracurricular module on the Nottingham Advantage Award programme. The Information Literacy Advocates scheme, which recruits medicine and health sciences students in their second year or above, aims to facilitate development of information literacy skills and confidence, as well as communication, organisation and teamwork, through the provision of peer support. Previous research indicates peer assistance effectively enhances such skills and is valued by fellow students who welcome the opportunity to approach more experienced students for help. This article, written by guest writer Ruth Curtis from the University of Nottingham, provides an overview of administering the ILA scheme and explores its impact on the Information Literacy Advocates, peers and librarians, and discusses future developments for taking the scheme forward. H. S.

Tobacco Control and Health Advocacy in the European Union: Understanding Effective Coalition-Building.

INTRODUCTION: Coalitions of supporters of comprehensive tobacco control policy have been crucial in achieving policy success nationally and internationally, but the dynamics of such alliances are not well understood. METHODS: Qualitative semi-structured, narrative interviews with 35 stakeholders involved in developing the European Council Recommendation on smoke-free environments. These were thematically analyzed to examine the dynamics of coalition-building, collaboration and leadership in the alliance of organizations which successfully called for the development of comprehensive European Union (EU) smoke-free policy. RESULTS: An alliance of tobacco control and public health advocacy organizations, scientific institutions, professional bodies, pharmaceutical companies, and other actors shared the goal of fighting the harms caused by second-hand smoke. Alliance members jointly called for comprehensive EU smoke-free policy and the protection of the political debates from tobacco industry interference. The alliance's success was enabled by a core group of national and European actors with long-standing experience in tobacco control, who facilitated consensus-building, mobilized allies and synchronized the actions of policy supporters. Representatives of Brussels-based organizations emerged as crucial strategic leaders. CONCLUSIONS: The insights gained and identification of key enablers of successful tobacco control advocacy highlight the strategic importance of investing into tobacco control at European level. Those interested in effective health policy can apply lessons learned from EU smoke-free policy to build effective alliances in tobacco control and other areas of public health.

Improving tobacco-free advocacy on college campuses: a novel strategy to aid in the understanding of student perceptions about policy proposals.

OBJECTIVE: Tobacco-control policy proposals are usually met with opposition on college campuses. Research to understand students' viewpoints about health-related policy proposals and messaging strategies, however, does not exist. This study investigated students' perceptions about a smoke-free policy proposal to help understand their positions of support and opposition and to inform the development of effective messaging strategies. PARTICIPANTS: In January 2012, 1,266 undergraduate students from a midwestern university completed an online questionnaire about smoke-free campus policies. METHODS: Responses were coded and analyzed using Linguistic Inquiry and Word Count software and chi-square, independent-samples t tests, and binary logistic models. RESULTS: Most students who supported a smoke-free policy considered environmental or aesthetic conditions, whereas most opponents used personal freedom frames of thought. Supporters viewed smoking policies in personal terms, and opponents suggested means-ends policy reasoning. CONCLUSIONS: Taken together, points of reference and emotions about proposed policies provided insight about participants' perspectives to help inform effective policy advocacy efforts.