Not just 'for' but 'with': health advocacy as a partnership process.

CONTEXT: Health advocacy is often framed as an activity that physicians do for others. A physician uses her expertise to identify and address the health needs of patients or communities on their behalves. As part of a larger study, we uncovered data to suggest that effective health advocates work not just for but often with others to understand and address their health needs. OBJECTIVES: This paper explores and elaborates the important distinction between advocating with and for others. METHODS: We interviewed 10 physicians, identified by others as successful health advocates, about their advocacy activities. Informed by constructivist grounded theory, we gathered and evaluated data iteratively, continually revising the interview outline and concurrently refining our evolving themes. Once it had stabilised, the coding scheme was applied to the full set of transcripts. RESULTS: Health advocacy was framed by participants as an activity that was more often done with others, than for others. This manifested in two ways: (i) joining other voices: rather than always feeling a need to plan and act alone, our participants often described making efforts to find and join existing initiatives and to work collaboratively, and (ii) amplifying other voices: rather than authoritatively determining needs and enacting solutions on behalf of others, our participants often described making efforts to empower others to find their own voices, thereby fostering autonomy rather than reliance. Participants described factors and mechanisms that enabled them to approach advocacy in this manner. CONCLUSIONS: Successful health advocates often enact health advocacy with others, rather than exclusively for them. This partnership-based facilitative approach enables them to better appreciate the needs of those requiring support, and to ask: 'How can I help?' If this approach were more effectively reflected in formal constructions of the process, health advocacy might not only be practised more effectively, but might also be perceived as more achievable by trainees and physicians.