Advocacy Competencies Research Articles

Advocacy Skill Development in Public Health Education Curriculum: A Pilot Study.

The National Commission for Health Education Credentialing (NCHEC) released updated Responsibilities and Competencies for Health Education Specialists based on the 2020 HESPA II. For the first time, advocacy is a standalone area of responsibility (Area V: Advocacy) for health education specialists. Although this is exciting for the field of health education, there is limited consensus on how to effectively teach advocacy or what content and skills to include. Furthermore, while the HESPA II was updated, the Council on Education for Public Health (CEPH) criteria for advocacy have not been. This pilot study examined how CEPH-accredited programs in the United States are addressing the profession-wide advocacy competency in their health education curricula. A cross-sectional research design with single-point data collection was used to assess how CEPH-accredited university programs (including Standalone Baccalaureate Programs, Public Health Programs, and Schools of Public Health) are preparing health education students to meet the national advocacy responsibility. The survey included items from the Advocacy Area of Responsibility and potential barriers for faculty teaching advocacy. Results indicate that most programs are teaching something about advocacy, but there is no program teaching all listed sub-competencies. Barriers to including all components of the advocacy responsibility were largely related to faculty motivation, knowledge, and time. With a full responsibility area devoted to advocacy, it is reasonable to expect that programs will adjust with the profession. However, program administrators must be catalysts for these changes in their individual programs.

Middle Level Teacher Development for Advocacy: A Systematic Review of the Literature

In the realm of middle level education, advocacy is an integral aspect of school culture and community. Advocacy helps to foster a school environment characterized by a sense of respect and value for young adolescents and should take up an awareness of the social and cognitive characteristics of young adolescents. Advocacy competency is also a necessary teacher disposition to foster socially just and successful middle school cultures and climates. We conducted a systematic review of the literature guided by the following driving question: What does the research say about middle level teacher development and advocacy? Our review yielded 38 relevant sources and key thematic ideas across four thematic categories. We anticipate this review of the literature will be of interest to and inform middle level educators and researchers around equity- and justice-oriented middle level teacher development.

Assessing resident experience of a new experiential learning health advocacy curriculum: a mixed methods study

BackgroundHealth Advocacy is considered one of the most difficult skills to teach. Many medical learners feel ill-equipped in social competencies and identify it as a significant gap in their medical training. Experiential learning has recently been emerging as a more effective method to teach health advocacy. The Post Graduate Medical Education (PGME) Health Advocacy Day is a new experiential learning curriculum designed to teach important competencies of health advocacy and social accountability to post-graduate medical residents at the University of Ottawa in Ottawa, Canada. The objective of this mixed-methods study was to assess resident experiences.MethodsSecond-year trainees from all adult residency programs attended the Advocacy Day as part of a mandatory academic day. All participants completed a mandatory pre-and post-session quiz to assess knowledge of key topics before and after the course. We also distributed a voluntary survey to all participants and invited residents to participate in semi-structured interviews to provide feedback on the course. We used descriptive statistics to analyze quiz scores and survey results and conducted a paired t-test of pre and post-test quiz scores. We also performed a thematic analysis of qualitative feedback, specifically survey comments and semi-structured interviews.ResultsOne hundred and eighty-three residents participated in the Advocacy Day and 112 (61.2%) completed the post-course survey. Ten residents volunteered to be interviewed. Respondents were generally satisfied by the session and felt it was of good quality. Most residents felt the course enhanced their ability to advocate for individual patients or communities (N = 80; 71.5%) and understand patients and families’ lived experience with illness (N = 87; 77.5%). Most residents also felt the course improved their knowledge of the impact of social determinants of health (N = 91; 81.2%) and increased their awareness of local resources that can support patients and their families (N = 88; 78.3%). Visiting community sites in-person and meeting persons with lived experiences were highlighted as the most valuable components of the course.ConclusionExperiential learning can be integrated within post-graduate medical curricula to teach health advocacy competencies. Future studies should examine the longitudinal impact of the curricula, to determine whether shifts in perspectives persist over time.

Relationship of sustainable development goals, holistic nursing competence, and social justice advocacy role in public health nurses.

This study was conducted to examine the relationship between public health nurses' holistic nursing and social justice advocacy competencies in terms of their attitudes toward sustainable development goals. Cross-sectional survey. The study sample consisted of 384 public health nurses. Data were collected with the personal information form, the Attitudes toward Sustainable Development Scale, the Holistic Nursing Competence Scale, and the Social Justice Advocacy Scale. The sub-dimensions of environment, public, education, and economy were found to significantly affect social justice advocacy, and the indirect effects of 0.191, 0.222, 0.205, and 0.201 were found to be statistically significant with the inclusion of holistic nursing competence in the model, respectively. It was found to explain 32%, 30%, 29%, and 22% of the total effect, respectively. It supports the claim that developing public health nurses' holistic nursing competence and social justice advocacy skills is an important criterion for achieving sustainable development goals.

Students encouraging other students' learning: Leadership shared metacognition in practice.

This article discusses the conceptual bridges between the leadership learning framework; specifically, its emphasis on metacognition and social justice advocacy, and explores how leadership education might be revamped. The focus of the article is practicing socially shared metacognition using the American Counseling Association's (ACA) advocacy competencies model. The purpose of the ACA advocacy model is to offer comprehensive advocacy-at individual, group, and community dimensions-with interventions aimed at systematic change. The model stresses creating alliances and working with the community. The article concludes with the practical implications of applying metacognition in leadership education and additional resources. A case example (Kai) is used throughout this article.

The Effect of Counselor's Multicultural Sensitivity and Critical Consciousness on Social Justice Advocacy Competence

The Effect of Counselor's Multicultural Sensitivity and Critical Consciousness on Social Justice Advocacy Competence

Development of an Online Nursing Leadership Program for Global Health in the Western Pacific Region.

Global health highlights the transnational determinants, issues, and possible solutions for improving health outcomes. Addressing global health issues requires population-based approaches coupled with individualized healthcare across settings, including strategies for achieving health equity. Designing and implementing global health solutions requires competent nurse leaders who can facilitate multi-disciplinary collaborations, engage in policy development, and lead advocacies that support the global health agenda. Thus, this paper examined the stakeholder perspectives that informed the development of a leadership program on global health for nurse leaders in the Western Pacific Region (WPR). The study used a descriptive qualitative approach to generate key recommendations for a context-appropriate, multi-country capacity-building program for nurse leaders on global health. The Analysis Design, Development, Implementation, and Evaluation (ADDIE) model and reflexive approach were employed to guide the development of the training design. Twenty-five nurse leaders from World Health Organization Collaborating Centers (WHO-CC) in the Western Pacific participated. Qualitative data were collected from participant feedback and post-activity sessions throughout program implementation. Thematic analysis of stakeholder data revealed that the program (1) capitalized on equipping nurse leaders with the concepts related to global health and developing competencies in leadership, policy engagement, and advocacy; (2) ensured learning strategies by having participants from varied contexts and experiences; and (3) reflected on the strengths and limitations of the use of the online platform. This paper contributed to the growing literature on global health and programs that support addressing global health issues. The findings underscored the urgent need to capacitate nurses in leadership positions who contribute to addressing emerging issues in global health. The paper recommended improvements in the design and implementation of the Global Health Nursing Leadership Program to engage more nurse leaders across the region and enhance content and delivery.

Counselors as Social Justice Advocates: Experiences Addressing Systemic Marginalization

A phenomenological study was conducted to determine how counselors are experiencing engagement in social justice advocacy. Participants included seven (N = 7) licensed clinical counselors in the United States. Several themes emerged from the data: social justice advocacy as part of counselor professional identity, experiences of emotional discomfort and gratification, advocacy in action on a micro-, mezzo-, and macro-level, skills utilized to be effective advocates, identity impacting advocacy efforts, challenges faced, and advocacy successes. Results highlighted advocacy action steps that counselors can take to support clients. Skills needed to effective advocates included gaining a knowledge of systems, self-awareness of bias and privilege, intentionality and strategy with advocacy actions, and use of common counseling skills such as compassion and managing challenging responses. Four main elements are identified for potential training implications: (1) establishing a clear professional identity/role around social justice advocacy, (2) teaching advocacy competencies, (3) education about what advocacy practice looks like, and (4) building skills frequently utilized in advocacy practice.

Physician engagement in reproductive health advocacy: findings from a mixed methods evaluation of a leadership and advocacy program

BackgroundMedical curricula include advocacy competencies, but how much physicians engage in advocacy and what enables this engagement is not well characterized. The authors assessed facilitators and barriers to advocacy identified by physician alumni of a reproductive health advocacy training program.MethodsThe authors present secondary results from a mixed methods program evaluation from 2018 to 2020, using alumni data from a cross-sectional survey (n = 231) and in-depth interviews (IDIs, n = 36). The survey measured engagement in policy, media, professional organization, and medical education advocacy and the value placed on the community fostered by the program (eight questions, Cronbach’s alpha = 0.81). The authors estimated the association of community value score with advocacy engagement using multivariable Poisson regression to estimate prevalence ratios and analyzed IDI data inductively.ResultsOver one third of alumni were highly engaged in legislative policy (n = 90, 39%), professional organizations (n = 98, 42%), or medical education (n = 89, 39%), with fewer highly active in media-based advocacy (n = 54, 23%) in the year prior to the survey. Survey and IDI data demonstrated that passion, sense of urgency, confidence in skills, and the program’s emphasis on different forms of advocacy facilitated engagement in advocacy, while insufficient time, safety concerns, and sense of effort redundancies were barriers. The program community was also an important facilitator, especially for “out loud” efforts and for those working in environments perceived as hostile to abortion care (e.g., alumni in hostile environments with high community value scores were 1.8 times [95% CI 1.3, 2.6] as likely to report medium/high levels of media advocacy compared to those with low scores after adjusting for age, gender, and clinical specialty).ConclusionPhysician advocacy training curricula should include both skills- and community-building and identify a full range of forms of advocacy. Community-building is especially important for physician advocacy for reproductive health services such as abortion care.

Charting the Advocacy Landscape: A Qualitative Content Analysis of Syllabi in Public Health Graduate Education.

Addressing public health challenges necessitates policy approaches, but concerns persist about public health graduates' preparedness to advocate. This qualitative study sought to assess advocacy content and skills taught to Master of Public Health students enrolled in US accredited schools and programs of public health (SPPHs) by analyzing 98 course syllabi submitted to the Council on Education for Public Health (CEPH) between 2019 and 2021. Syllabi were submitted by SPPHs during their (re)accreditation process to demonstrate compliance with CEPH's advocacy competency requirement. Qualitative content analysis study. Syllabi were analyzed using MAXQDA Qualitative Data Analysis Software using a 2-coder approach. SPPHs accredited by CEPH. Ninety-eight syllabi submitted to CEPH by 22 schools of public health and 54 programs of public health. Exemplary language from advocacy courses and assignments and aggregate frequency of syllabi advocacy content and skills. Most advocacy courses (61%) were survey, health policy, or health care delivery courses, covering policy (66%), policy communication (46%), coalition-building (45%), lobbying (36%), community organizing (33%), and media advocacy (24%) skills. Only 7% prioritized advocacy skill instruction, and 10% addressed how to advocate in an equitable way. Defining public health advocacy and essential skills is crucial. Issuing competency guidelines, supporting advocacy faculty, offering standardized training, and expanding experiential learning are important first steps. More research is needed on how academic institutions are incorporating equity skill training into courses, whether separate from or combined with advocacy skills.

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

ObjectiveHealth 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. MethodsWe 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. ResultsPharmacy 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. ConclusionPharmacy 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.

Dietitians as change agents for promoting healthy and sustainable food systems

Dietitians as change agents for promoting healthy and sustainable food systems

Grappling with key questions about assessment of the Health Advocate role.

Although the CanMEDS framework sets the standard for Canadian training, health advocacy competence does not appear to factor heavily into high stakes assessment decisions. Without forces motivating uptake, there is little movement by educational programs to integrate robust advocacy teaching and assessment practices. However, by adopting CanMEDS, the Canadian medical education community endorses that advocacy is required for competent medical practice. It's time to back up that endorsement with meaningful action. Our purpose was to aid this work by answering the key questions that continue to challenge training for this intrinsic physician role. We used a critical review methodology to both examine literature relevant to the complexities impeding robust advocacy assessment, and develop recommendations. Our review moved iteratively through five phases: focusing the question, searching the literature, appraising and selecting sources, and analyzing results. Improving advocacy training relies, in part, on the medical education community developing a shared vision of the Health Advocate (HA) role, designing, implementing, and integrating developmentally appropriate curricula, and considering ethical implications of assessing a role that may be risky to enact. Changes to assessment could be a key driver of curricular change for the HA role, provided implementation timelines and resources are sufficient to make necessary changes meaningful. To truly be meaningful, however, advocacy first needs to be perceived as valuable. Our recommendations are intended as a roadmap for transforming advocacy from a theoretical and aspirational value into one viewed as having both practical relevance and consequential implications.

Advocacy for mental health of Asian international college students

ABSTRACT Asian international college students (AICS) deserve advocacy given their individual, organizational, and societal level of barriers. Those barriers have detrimental impacts on wellbeing of AICS. However, seldom discussed are the strategies to advocate for AICS mental health. The authors reviewed the multiple layers of barriers preventing access to mental health services among AICS – namely, individual, community/school, and public arena. Additionally, we provided AICS advocacy strategies based on ACA Advocacy Competency to college counselors.

Advocacy and Creativity in Community: A Social Justice Project for Counseling Students

The proven effective teaching of social justice advocacy competencies while recognized as important by the counseling profession and counselor education programs, remains somewhat nascent in its implementation. Evidence suggests that experiential and constructivist approaches to the teaching of multicultural and social justice counseling competencies represent a worthwhile pedagogical foundation and set of tools in furthering multicultural and social justice counseling competencies in counseling students. The author relates, in detail, the implementation of an experiential, client/community-based, social justice and mental health advocacy project, the Advocacy and Creativity in Community (ACC) Project as a final class assignment in the last term prior to graduation within a CACREP-accredited clinical mental health counseling program in the Northwest region of the United States. Descriptions of student projects, the multitude of benefits for clients/participants and students as elicited from student reflections, and the author’s reflection after three years of implementing this project are presented. This project exemplifies the benefits within the literature of taking an experiential and constructivist approach to social justice advocacy training in counselor education programs.

Situated Cognition and Self-Directed Learning: Pedagogical Approaches to Developing Skills in Advocacy

Advocacy for clients and the profession are important aspects of occupational therapy practice. Accreditation requirements for educational programs demand students are taught about advocacy. However, effective methods of teaching advocacy to future occupational therapy practitioners have not been widely studied. This article aims to highlight the use of situated cognition and self-directed learning in developing advocacy skills among occupational therapy students. Pre and post-test scores of the Advocacy Competencies Self-Assessment Survey obtained from 39 students were examined for changes in perception of personal advocacy skills and beliefs associated with a required advocacy course. Statistically significant improvement was noted across all items and domains. To facilitate this change, students applied the principles of situated cognition to a project in which they advocated for a real issue important to the profession of occupational therapy. Students also applied the principles of self-directed learning as they worked through the advocacy process toward anticipated outcomes. Situated cognition and self-directed learning theories support authentic learning and transformation around advocacy.

Impact of Service-Learning on Student Counselors’ Self-Reported Measures of Program Evaluation, Counselor Advocacy, and Interprofessional Education

Academic service-learning encompasses a reciprocal relationship among university and community partners. Service-learning can familiarize student counselors with future client populations, community resources, and other service providers. Service-learning pedagogy is flexible and may be particularly useful to promote development in counselor competencies more abstractly related to day-to-day client services, including program evaluation and professional advocacy. Interprofessional education serves as a means of enhancing interprofessional collaboration and, in turn, the well-being of individuals seeking healthcare services. Service-learning may provide a vehicle to promote interprofessional education, however, researchers have not yet explored this connection. This quantitative research project evaluates pre- and post- changes of 18 participants using the Effective Practices Survey, Advocacy Competencies Self-Assessment scale to measure experiences in program evaluation, counselor advocacy, and interprofessional education. Results indicate that student counselor scores significantly increased for each of the three variables of interest, with the largest changes observed for counselor advocacy. What is the public significance of this article? Academic service-learning leverages relationships between university and community partners. Service-learning may be a particularly effective pedagogical strategy to promote applied and potentially abstract concepts. This article explores the impact of engagement in an experiential service-learning project on 18 student counselors’ learning outcomes related to program evaluation, counselor advocacy, and perceptions of interprofessional education.

Counselor advocacy against gun violence: a systemic perspective with advocacy and wellness competencies

ABSTRACT Gun violence within the United States has become a public health crisis, negatively impacting the wellness of individuals and communities. While professional counseling associations have called upon members to advocate against gun violence, the literature remains sparse. Furthermore, activism can impede counselor wellness, thus, increased self-care and wellness promotion practices are needed. For these reasons, we propose the combined use of the ACA Advocacy Competencies and CSI Wellness Competencies for counselors advocating against gun violence.

Assessing effectiveness of a self-guided training program for oncology financial advocates.

271 Background: Financial toxicity can be a devastating side effect for patients with cancer and their families, and may impact access to and delivery of care, treatment compliance, and outcomes. Financial advocates mitigate financial toxicity for patients and their families, liaise between payers/providers/pharmacies/patients, support shared decision-making and care planning processes through provision of cost and coverage information, and mitigate institutional financial toxicity. Training on effective financial navigation interventions, financial health literacy, patient engagement, oncology fundamentals, and measurement of impact is critical for advocates. Methods: The Association of Community Cancer Centers (ACCC) Financial Advocacy Boot Camp is a self-paced eLearning program consisting of 9 modules designed to build knowledge and skills of financial advocates. Users interact with education across two levels within the ACCC Learning Management System. To evaluate effectiveness of this content, pre- and post-assessments and evaluation forms for registered learners from 1/1/2020 to 12/31/20 were exported and exploratory analysis was performed on this data set of 538 participants. Results: 51% of respondents are oncology financial advocates; 7% are industry representatives; and the remaining 42% are a mix of patient navigators, nurse navigators, social workers, pharmacists, APPs, and nurses. 363 participants fully completed at least one of two levels. Most participants agreed or strongly agreed that each of the modules improved their knowledge and skills: 94% increased their ability to incorporate effective screening methods to identify patients at risk of financial toxicity, 95% are better able to review the evolving landscape of health insurance provided by public and private payers, and 97% both increased their ability to find patient assistance programs and resources for patients and can describe how to guide patients through the process of improving insurance coverage. 79% identified specific examples of what they will do differently after the training, including implementing screening and follow-up protocols, adjusting communication approaches with patients, proposing quality improvement projects, and accessing resources. Conclusions: Training, such as the Financial Advocacy Boot Camp, that builds knowledge and skills in financial screening, communication, and navigation can help cancer programs improve staffs’ ability to mitigate patient and institutional financial toxicity. Future research efforts should further define financial advocacy competencies, measure patient and institutional impact of financial navigation interventions, and assess effective practices for implementation of financial advocacy training in cancer programs.

Crisis Counseling for Black Lives Matter Protests

The resurgence of the Black Lives Matter movement in response to the killings of George Floyd, Breonna Taylor, and other Black individuals during the summer of 2020 was accompanied by widespread public demonstration and protest. Despite the peaceful nature of most demonstrations, data indicate that protesters experienced police violence at a disproportionate rate compared to demonstrations associated with other movements. Due to the crisis and unrest that undue police violence toward Black communities can cause, it is imperative that counselors identify ways to support communities in their collective acts toward resistance and liberation. This article reviews how counselors can integrate the Multicultural and Social Justice Counseling Competencies and the American Counseling Association’s Advocacy Competencies into crisis counseling responses that support protesters of the Black Lives Matter movement.