Public health practitioners as policy advocates: skills, attributes and development needs

Effecting policy change is a key strategy in tackling wider determinants of health. In England, public health sits within Local Authorities (LAs) and responsibility for ensuring health is considered across directorates increasingly falls to public health practitioners. While international professional standards expect competence in understanding policy processes, the advocacy role has been under-explored. This paper explores the professional skills, role characteristics and learning needs of practitioners advocating for the restriction of advertising high-fat, salt and sugar products in a region of England. A series of three interviews were conducted at three time points over 10 months with policy advocates leading this policy change from four LAs. Three focus groups were also held with 12 public health advocates from 10 LAs at the end of the 10-month period of data collection. Data were transcribed and analysed retroductively. Data showed that practitioners felt inexperienced as policy advocates and saw this work as different from other public health approaches. Successful advocates required interpersonal skills, knowledge of policy-making and local governance, determination, resilience, confidence, belief in their work's value and leadership. These skills were difficult to acquire through formal education, but advocacy training, mentorship and role modelling were seen as important for professional development. To successfully implement a Health in all Policies approach and address wider determinants of health, public health practitioners need to be equipped and supported as policy advocates. The advocacy role and the complex skills required need to be more fully understood by the public health profession and prioritized within workforce development at both local and national levels.

Teaching Strategies for Health Advocacy for Undergraduate Nursing Students: A Scoping Review

AIM

The goal of this study was to identify strategies for teaching health advocacy for undergraduate nursing students.

BACKGROUND

Although health advocacy is a core skill of professional nursing practice, there are challenges in the health advocacy approach in nursing education.

METHOD

The databases LILACS, IBECS, BDENF, Medline, Web of Science, CINAHL, and the Cochrane Library were searched, without limit of time and language, for this scoping review; 11 articles were included. Data were analyzed and synthesized in a narrative form.

RESULTS

The following teaching strategies emerged: theoretical exposition and supervised clinical internship, technology-enhanced simulation, clinical experience, experiential learning, simulated social experiences, digital story making, and narrative pedagogy. The topic was taught according to several themes: economic disparity, health legislation, LGBTQ+ population, elder health, mental health, health policies, concept of advocacy, and nontechnical skills.

CONCLUSION

Teaching strategies for health advocacy should be based on constructivist education linked to social reality.

Introducing dental students to dental public health: An analysis of US predoctoral course syllabi

Dental public health competencies in predoctoral dental education ensure that students have the skills to succeed in an increasingly complex professional environment. This study examined existing public health curricula in US dental education and their alignment with national recommendations from the American Association of Public Health Dentistry (AAPHD) and guidance from the Healthy People Curriculum Task Force for health professions education programs. We contacted all US dental schools (N = 66) in November 2020-January 202 and requested syllabi for schools' first course with dental public health content. We received 34 syllabi, which provided textual data for content analysis. The authors used an initial content analysis tool to extract descriptive course characteristics. Then, direct and emergent coding was performed to summarize course content. Direct codes included the 23 dental public health topics specified by AAPHD recommendations. Uncategorized content was coded using an inductive approach to identify emergent course themes. Frequently covered topics included principles of dental public health (79% of syllabi) and access to care (79%). "Health disparities" was the most common emergent theme, with 50% of courses including related content. There was little consistency in how courses approached each topic. For example, the topic "access to care" covered healthcare delivery systems, determinants of health, legislative reform, and advocacy. Dental public health was often taught alongside unrelated content. Recommendations for dental public health competencies should be updated to include new educational priorities, align with current national recommendations, and align with Commission on Dental Accreditation Standards more clearly.

Evidence attack in public health: Diverse actors' experiences with translating controversial or misrepresented evidence in health policy and systems research

Bringing evidence into policy and practice discussions is political; more so when evidence from health studies or programme data are deemed controversial or unexpected, or when results are manipulated and misrepresented. Furthermore, opinion and misinformation in recent years has challenged our notions about how to achieve evidence-informed decision-making (EIDM). Health policy and systems (HPS) researchers and practitioners are battling misrepresentation that only serves to detract from important health issues or, worse, benefit powerful interests. This paper describes cases of politically and socially controversial evidence presented by researchers, practitioners and journalists during the Health Systems Research Symposium 2020. These cases cut across global contexts and range from public debates on vaccination, comprehensive sexual education, and tobacco to more inward debates around performance-based financing and EIDM in refugee policy. The consequences of engaging in controversial research include threats to commercial profit, perceived assaults on moral beliefs, censorship, fear of reprisal, and infodemics. Consequences for public health include research(er) hesitancy, contribution to corruption and leakage, researcher reflexivity, and ethical concerns within the HPS research and EIDM fields. Recommendations for supporting researchers, practitioners and advocates include better training and support structures for responding to controversy, safe spaces for sharing experiences, and modifying incentive structures.

Prevalence and characteristics of advocacy curricula in Australian public health degrees

BACKGROUND

Public health advocacy is a fundamental part of health promotion practice. Advocacy efforts can lead to healthier public policies and positive impacts on society. Public health educators are responsible for equipping graduates with cross-cutting advocacy competencies to address current and future public health challenges.

PROBLEM

Knowledge of the extent to which students are taught public health advocacy is limited. To determine whether advocacy teaching within public health degrees matches industry needs, knowledge of pedagogical approaches to advocacy curricula is required. This study sought to understand the extent to which advocacy is taught and assessed within Australian public health degrees.

METHODOLOGY

Australian public health Bachelor's and Master's degrees were identified using the CRICOS database. Open-source online unit guides were reviewed to determine where and how advocacy was included within core and elective units (in title, unit description or learning outcomes). Degree directors and convenors of identified units were surveyed to further garner information about advocacy in the curriculum.

RESULTS

Of 65 identified degrees, 17 of 26 (65%) undergraduate degrees and 24 of 39 (62%) postgraduate degrees included advocacy within the core curriculum, while 6 of 26 (23%) undergraduate and 8 of 39 (21%) postgraduate offered no advocacy curriculum.

IMPLICATIONS

Australian and international public health competency frameworks indicate advocacy curriculum should be included in all degrees. This research suggests advocacy competencies are not ubiquitous within Australian public health curricula. The findings support the need to advance public health advocacy teaching efforts further.

"Private and personal": Corporate political activity, informal governance, and the undermining of marketing regulation in Brazil

Few studies have investigated corporate political activity by unhealthy commodity industries in low- and middle-income countries, and the significance of social and political context has been largely neglected. This study aimed to explore the stalled development of marketing restriction policies in Brazil with an analysis of strategies used to undermine the Legal Framework for Early Childhood. Using a constructivist approach based on a typology of corporate political strategies, decision-making processes were assessed to understand interference by food companies in the Legal Framework, and how this was perceived by policy actors. Semi-structured interviews were conducted with public health advocates, academics and legislature officials. Three broad strategies that contributed to the stalling of marketing restrictions in the Legal Framework were identified: relational approaches to policy influence; collective participation in formal decision-making; and specific strategy choices (information and financial incentives). Key opportunities for policy influence through informal social networks in the 'backstage' of policy making are found to privilege commercial sector actors. Informal policy making may have a critical function in obstructing the development of health-focused regulation in Brazil. This highlights the need for a better understanding of non-codified and hidden corporate efforts to shape the policy environment.

Evidence-based Training to Improve Communication between Health Advocates and State Policymakers

Persuading state policymakers to adopt effective child health policies requires effective communication from health advocates. This study examined the effectiveness of evidence-based communication training among child obesity advocates and their state legislators. A health advocacy group conducted training using evidence-based strategies and health-related policy updates in one Midwestern State Capitol building in January 2020. Twenty-three health professionals participated in the training prior to meetings with their legislators to discuss child obesity policies. An 18-item, pre- and post-questionnaire assessed training effects on knowledge, confidence, competence, importance of communicating, and future intentions to communicate with state policymakers. Satisfaction with the training was also assessed. Knowledge, confidence, importance, and future intentions to deliver child health messages to Missouri legislators all improved as a result of the training. Participants significantly increased their competence to speak with legislators on child health issues (Mann-Whitney U = 99.5; p = .039). Participants were very satisfied with the training and enjoyed receiving health-related policy updates and learning policymakers' preferred message frames related to child health. Evidence-based training and in-person practice can significantly improve the competence of health advocates for communicating with their policymakers. This in-person training is one feasible strategy for developing impactful child health policies and informing health education efforts.

Advocacy, activism, and lobbying: How variations in interpretation affects ability for academia to engage with public policy

Research and teaching are considered core-responsibilities for academic researchers. "Practice" activities however are viewed as ancillary, despite university emphasis on their importance. As funders, governments, and academia address the role of research in social impact, the deliberations on researcher activism, advocacy and lobbying have seen a resurgence. This study explores the perceptions of 52 faculty and 24 government decisionmakers on the roles, responsibilities, and restrictions of an academic to proactively engage in efforts that can be interpreted under these three terms. Data was coded through inductive thematic analysis using Atlas.Ti and a framework approach. We found that discordant perceptions about how much activism, advocacy and lobbying faculty should be engaging in, results from how each term is defined, interpreted, supported and reported by the individuals, the School of Public Health (SPH), and government agencies. Influential faculty factors included: seniority, previous experiences, position within the institution, and being embedded in a research center with an advocacy focus. Faculty views on support for advocacy were often divergent. We surmise therefore, that for effective and mutually beneficial collaboration to occur, academic institutions need to align rhetoric with reality with respect to encouraging modes and support for government engagement. Similarly, government agencies need to provide more flexible modes of engagement. This will contribute to alleviating confusion as well as tension leading to more effective engagement and consequently opportunity for evidence-informed decision making in public health globally.

The Important Role for Physicians as Advocates for Firearm and Road Traffic Injury Prevention

The purpose of this article is to discuss the important role for physicians in advocating for the prevention of road traffic and firearm injuries. Physicians have shown to be effective advocates for a variety of injuries, and this needs to continue and be enhanced for these injury categories. Road traffic and firearm injuries are among the leading causes of death across the lifespan. The influence and credibility of physicians enhance the messages they provide in advocacy efforts. It is important that physicians educate and counsel patients in a variety of healthcare settings along with joining advocacy efforts of professional associations. Recommendations are provided for advocacy components related to these injuries. Also, it is very important that physicians receive training in medical school and/or residency about injuries and how to successfully advocate for evidence-based injury prevention strategies.

Embracing challenging complexity: exploring handwashing behavior from a combined socioecological and intersectional perspective in Sierra Leone

Background

Handwashing with soap is a cost-effective, efficient health behavior to prevent various diseases. Despite its immense health benefits, the lowest prevalence of handwashing is found in low-income countries. Here, its practice is not only determined by individual behavior, but also heavily shaped by deprivations in the social and structural ecology. Moreover, handwashing barriers are not equally experienced as overlapping social identities (e.g., age and gender) intersect and create inequities between members of different social groups. To embrace the complexities of handwashing beyond individual-level behavior and singular social identities, a combined socioecological and intersectional perspective is employed. This multi-level approach with regards to intersecting privileges and disadvantages serves as a basis to promote this highly important health behavior.

Methods

This study used a qualitative, theory-based approach and combined data from two samples: experts in health promotion (n = 22) and local citizens stratified by gender and rural/urban location (n = 56). Data was collected in face-to-face interviews in Sierra Leone between November 2018 and January 2019 and analyzed using thematic analysis and typology of the qualitative data.

Results

The conceptualization of multi-level determinants of handwashing within a socioecological model showed the high relevance of inhibiting social and structural factors for handwashing practice. By establishing seven distinguishing social identity dimensions, data demonstrates that individuals within the same social setting yet with distinct social identities experience strikingly differing degrees of power and privileges to enact handwashing. While a local leader is influential and may also change structural-level determinants, a young, rural wife experiences multiple social and structural constraints to perform handwashing with soap, even if she has high handwashing intentions.

Conclusion

This study provides a holistic analytical framework for the identification of determinants on multiple levels and accumulating intersections of socially produced inequalities for handwashing and is applicable to other health topics. As the exploration of handwashing was approached from a solution-focused instead of a problem-focused perspective, the analysis can guide multi-level intervention approaches (e.g., using low-cost, participatory activities at the community level to make use of the available social capital).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11923-1.

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.

Employee Perceptions About Public Health Agencies' Desired Involvement in Impacting Health Equity and Other Social Determinants of Health

CONTEXT

Despite a growing consensus in public health to address health inequities and leverage social determinants of health (SDoH), the level of public health practitioners' readiness to become the agents of change in promoting health equity and shaping SDoH is not well researched.

OBJECTIVES

To examine (1) the level of public health agency employees' perceived desirability for impacting health equity and SDoH, and (2) the impact of employee characteristics such as a (PH WINS) public health degree and awareness of health in all policies on such desirability.

METHODS

Data from the 2017 Public Health Workforce Interests and Needs Survey were used in examining the sense of desirability among agency employees for affecting health equity and SDoH in the agency jurisdictions.

RESULTS

Fifty-seven percent of health agency employees believed that their agencies should be very involved in affecting health equity in their jurisdictions. Fairly smaller proportions of employees believed in the desirability of affecting SDoH, and the proportions who believed that the agency should be very involved in affecting specific SDoH were 17.8% for affecting the quality of transportation, 18.5% for affecting the economy, 22.2% for quality of housing, 22.4% for quality of the built environment, 25.4% for K-12 education system, and 34.5% for impacting the quality of social support systems. Agency employees without a public health degree had significantly lower odds (P < .05) of believing that the agency should be very involved in affecting health equity.

CONCLUSIONS

With increasing efforts to reduce health inequities and leverage SDoH for improved population health, gaps exist in the public health workforce's perceived desirability for their agencies to be involved in such efforts. These gaps exist among employees regardless of their demographic characteristics, length of tenure, or agency setting. Policy and practice initiatives aimed to improve health equity might benefit from our findings positing a need for education regarding SDoH and health equity. Our study findings imply the need for interventions for improving alignment between employee beliefs and organizational priorities for an effective transformation to Public Health 3.0. Fostering cross-sector partnerships with a focus on Health in All Policies (HiAP), SDoH, and health equity must be a high priority for public health agencies, which can be formalized through organizational strategic plans.

Empowering Students and Influencing Policy Change Through Experiential Public Health Advocacy Education

BACKGROUND

Public health advocacy is central to the work of many health professionals, including nurses. Although deemed to be a core competency for public health practitioners, courses described in the literature often lack a focus on experiential learning, which is an essential component to acquiring public health advocacy skills.

METHOD

This article describes an innovative, 12-week graduate course that provides students with a combination of theory and experiential learning through an opportunity to engage in political advocacy, community mobilization, and media engagement on a current public health issue.

RESULTS

An advocacy campaign undertaken by students to increase community access to the overdose reversal medication naloxone is described in light of the current North American overdose epidemic. Key considerations for teaching public health advocacy to facilitate development of nursing courses elsewhere are highlighted.

CONCLUSION

Public health advocacy education is important and needs to be expanded both within the nursing profession and across all disciplines. [J Nurs Educ. 2019;58(12):698-703.].

Advocacy and Public Policy Perceptions and Involvement of College Health Promotion Students

Understanding the advocacy and public policy training needs of our future health promotion workforce is crucial if we are to prepare them to meet their professional responsibilities. The purpose of this study was to examine health promotion students' advocacy/public policy involvement, training, and perceptions. Electronic surveys were disseminated nationwide to college students in health education and closely related programs. Of 477 student respondents, the most frequently indicated advocacy/public policy activity engaged in was voting (56%). The greatest benefit to advocacy was indicated as creating public awareness, while the most prevalent barrier reported was lack of familiarity with the legislation process. Less than one third of students reported receiving any training; however, training and the number of training sources were associated with greater involvement (p < .05). Comparisons by academic classification indicated that graduate students participated in more advocacy activities and reported significantly more benefits, barriers, knowledge, and self-efficacy compared with undergraduates. Regression analysis indicated that knowledge, self-efficacy, perceived benefits, and total number of training sources were significant predictors of advocacy involvement in both graduate and undergraduate student models, with age also contributing significantly to the graduate student model. Findings emphasize the need for increased training at earlier education levels to increase knowledge, self-efficacy, and advocacy/public policy involvement.

Health Advocacy for Busy Professionals: Effective Advocacy With Little Time

Health advocacy is a central responsibility for health educators and public health practitioners, as documented clearly in our professional competencies. Professional organizations such as the Society for Public Health Education and the American Public Health Association undertake frequent advocacy initiatives and strive to engage their members in advocacy strategies on a regular basis. Despite this understanding and advocacy training requirements in academic preparation programs for public health professionals, students and emerging professionals often lack advocacy experience. In this article, we provide descriptions of multiple effective health advocacy strategies spread across the time intensity spectrum, in order of least time intensive to most. Advocates may select the best strategy based on the needs of their target audience, the amount of time and energy they have for the task, and the level of confidence they have in practicing the strategy itself.

Building Advocacy Capacity and Skills Through a Statehouse Advocacy Day: Indiana SOPHE Experience

The purpose of this article is to provide public health organizations and practitioners a guide for organizing an advocacy summit to develop and practice advocacy skills. Further development of advocacy skills in current and prospective public health practitioners is vital in improving health outcomes among communities creating sustainable change. Though many approaches are available to help students and professionals acquire advocacy skills, an engaging real-life event such as the advocacy summit described within this commentary can be highly beneficial for both novice and seasoned advocates. The feedback obtained from summit participants showed that participants are interested in similar opportunities and believe that such events help further hone their advocacy skills. The essential steps to plan a successful advocacy summit are provided in the article, as well as a sample planning timeline, making it easier for public health advocates in other states to successfully plan similar events.

Ethnic Differences for Public Health Knowledge, Health Advocacy Skills, and Health Information Seeking Among High School Students: Community Agents of Change

Although adult health advocacy programs have been examined in communities, little is known about integrated adolescent health advocacy programs in high schools. The purpose of this study was to examine the health advocacy program impact and ethnic differences among high school students. Using a cross-sectional study, high school students participating in the school-based program completed evaluation surveys. The program domains included upstream causes of health, community assets, and public health advocacy. Bivariate analyses were conducted to examine ethnic differences for public health knowledge, health advocacy skills, and health information seeking behaviors. Using thematic analysis, open-ended survey item responses were coded to identify themes for students' perceptions of community health. Non-Hispanic (n = 72) and Hispanic high school students (n = 182) in ten classes reported owning smartphones (95%) and laptops (76%). Most students (72%) reported seeking online health information. Non-Hispanic students reported significantly higher health advocacy skills for speaking with the class about health issues, identifying community services, or creating health awareness at school than Hispanic students. Non-Hispanic students were more likely to seek health information from fathers and television than Hispanic students. Hispanic students were more likely to seek health information from hospital or clinic staff than non-Hispanic students. Emergent themes included health advocacy skills, community awareness, and individual and community health changes. High schools benefit from integrating health advocacy programs into the core curriculum. Adolescents gain important skills to improve their individual health and engage in changing community health.