Advocacy Role Research Articles

Women as Change Agent for Sustainable Development in the 21st Century in Nigeria

This study investigated women as change agent for sustainable development in the 21st century Nigeria. Two research questions guided the study; why are women the change agent in the 21st century in Nigeria for sustainable development? What are the hindrances that negate their active participation in sustainable development in Nigeria? descriptive survey research design was adopted for the study. The population consists of 5.6 million women in South-East Nigeria. The sample size was 400 women. The sampling technique adopted was multi stage sampling and simple random sampling. Data collected were analyzed using mean. The findings of the study showed that women in 21st century Nigeria are change agents for sustainable development because they posses characteristics such as community advocacy roles, promotion and grassroots mobilizations to achieve different change that could rob off on the socio-economic life of the people , contribution to the economy through business both at retail, wholesale and production level, care for the family, nurture and play a significant role in community building, mobilization skills, teaching skills , disciplinarian skills, disburser and manager of funds in the home, caregivers, educators, teacher, organizer, and home making. It was concluded among others that the role of women as agents of sustainable development seems to be more potent, effective and holds the possibilities of fostering a positive change that span the different areas for sustainable development . From the foregoing evidences, it is safe to deduce that through the use of women as agents for sustainable development, it is easier and gives a better result in the 21st century Nigeria that is battling with a lot of cultural, religious and political inclinations against women.

Are we there yet? A guide to achieving endemic status for COVID‐19 and variants

To clarify factors that support a policy change from pandemic to endemic status and to examine options for non-medical responses to reduce COVID-19 transmission. Critical factors to be considered in pandemic response decisions are not limited to medical options or public health orders, although these are important. All evidence drawn from publicly available sources is presented through the lens of the authors' nursing, management, education, policy and research experience. As COVID-19 variants cause infections to surge nurses and other health practitioners, who are the de facto implementers of public and health policy, need to consider the evidence supporting a pandemic policy change to endemic status. Non-medical options for reducing transmission and variant mutations are needed to enable at-risk populations to avoid infection. Public policy that shifts infection risks onto the general population requires close scrutiny of the evidence base for such decisions and warrants open debate and review. If people are to manage risks arising from policy decisions, they need access to non-medical virus detection options as well as access to effective medicines and treatment. Nurses have an extension to their advocacy role when policy changes about infectious disease status are declared. Evaluation of policy in terms of validity, equity and scientific basis is part of nursing's public responsibility. Policies that fail to reflect what is happening at the patient care level need to be questioned and modified where necessary. Only policies deemed 'good' policy by nurses should be implemented without challenge. Access to devices for environmental detection of the virus would enable real-time estimation of infection risks and inform individual decisions about the real risk of participating in work or other activities. Policy decisions to transition from pandemic to endemic status must be evidence based. Clear messaging about risks and options assists policy implementation. Terminologies describing stages of infectious disease spread from 'outbreak, epidemic, endemic and pandemic' are not interchangeable, although they will expand and contract across the range in response to interventions such as public health safety measures (PHSM), quarantine, vaccinations, antivirals and fatalities that alter the case count in defined locations for those who avoid or survive an infection.

USE OF MOTIVATIONAL INTERVIEWING IN THE CONTEXT OF ELDER ABUSE INTERVENTION: THE RISE PROJECT

Abstract Despite the increasing number of elder abuse (EA) cases, many EA victims are reluctant to engage with formal support services, such as Adult Protective Services (APS). For EA interventions to be effective, it is important to overcome this client reluctance. This study examined the use of motivational interviewing (MI) by elder advocates, as a component of a larger EA intervention model, RISE (Repair Harm, Inspire Change, Support Connection, Empower Choice), developed in partnership with Maine APS and the Elder Abuse Institute of Maine. The advocate role was developed, in part, to increase service acceptance/utilization among EA victims. Advocates are trained in MI, a collaborative, client-centered approach designed to help individuals explore and resolve ambivalence around making a change. This study conducted qualitative interviews and a focus group interview with all advocates (n = 4) working within the RISE model to understand how MI is applied in the context of an EA intervention. Three domains were identified: (1) therapeutic relationship, which describes the importance of foundational relationship building to support EA victims; (2) techniques, which refers to the MI strategies that advocates apply and adapt in the context of EA intervention; and (3) implementation challenges, which discusses the difficulties that advocates encounter when using MI with victims of EA. Overall, the experiences of advocates suggest MI is a beneficial and amenable approach to help EA victims navigate feelings of ambivalence and explore their motivation for change. This study represents the first in-depth exploration of MI in the context of EA intervention.

Why Partner with a Zoo or Garden? Selected Lessons from Seventy Years of Regional Conservation Partnerships at the Arizona-Sonora Desert Museum

Zoos and botanical gardens (ZBGs) play a variety of roles in regional conservation partnerships, including their most common role as the ex situ managers of rare plant and animal populations. Using case studies from a 70-year history of conservation work at the Arizona-Sonora Desert Museum in Tucson, Arizona, USA, this paper illustrates these roles and the characteristics of ZBGs that make them versatile and effective regional conservation partners. ZBGs commonly play the role of conservation advocates, as discussed in the context of the establishment of protected islands in the Gulf of California. ZBGs also conduct field research, including the collection of long-term datasets, as exemplified by the establishment of the Ironwood Forest National Monument and a 40-year Sonoran Desert phenology database. ZBGs can be effective conveners of communities and conservation partners in regional-scale efforts, such as the Sonoran Desert Conservation Plan and Cooperative Weed Management Areas. The paper also explores the challenges faced by ZBGs in sustaining their conservation work.

‘Mainstreaming’ Meets ‘Choice and Control’: Unsettling Neoliberal Imaginaries of Service Choice

‘Mainstreaming’ and ‘Choice and control’ agendas have played a dominant role in shaping disability policy and advocacy in many countries since the 1970s, however scholarship is yet to critically explore the tensions and synergies between the two. ‘Mainstreaming’ is the aspiration to move people with disability out of ‘specialist’ spaces designed specifically for them, and into ‘mainstream’ spaces open to people of all abilities. ‘Choice and control’ concerns efforts to enhance autonomy and self-determination for people with disability. In this paper we interrogate the relationship between ‘choice and control’ and ‘mainstreaming’, both conceptually and through empirical examination of choices made by people with intellectual disability about use of mainstream services in four Australian cities. Our analysis shows their ability to choose is severely constrained by excessive control practiced by supporters, funding restrictions, affordability constraints, and exclusionary practices in mainstream services. We argue that the potential for both ‘choice and control’ and ‘mainstreaming’ has been constrained by neoliberal socio-spatial imaginaries in which they have been framed.

Students as policymakers and policy advocates: Role-playing evidence-based health policies

Background Role playing has been increasingly utilized as a teaching strategy in the health discipline. However, the utilization of role playing within the field of health policy and systems research, while imperative, remains limited. Thus, this study documented and described a role playing activity and explored students’ experiences within the context of evidence-based health policy. Method The role playing activity was conducted as part of a course assessment – evidence-based health policy brief at a university in Saudi Arabia. Six graduate level students who were enrolled in the course participated in the activity. Through a mixed method approach, the study collected data from different sources including assessment forms, surveys, written reflections, and observational notes, to explore students experiences with the role playing activity. Data analysis included descriptive statistics for quantitative data and content analysis for qualitative data. Results Students reported an overall positive experience with the role playing activity. The activity provided them with an experience mimicking real scenarios, while playing roles of policy advocates and policymakers. Additionally, the activity contributed to students’ knowledge acquisition and expansion as well as skills development relevant to policymaking. Conclusion The study’s findings contribute to the current literature on the utilization of simulation within the health discipline, with valuable contribution to the field of health policy and systems research. Implications of the study require attention from respective policymakers, practitioners, and academicians.

Measurement of Unmet Need for Contraception: A Counterfactual Approach.

Unmet need plays a critical role in reproductive health research, evaluation, and advocacy. Although conceptually straightforward, its estimation suffers from a number of methodological limitations, most notably its reliance on biased measures of women's stated fertility preferences. We propose a counterfactual-based approach to measuring unmet need at the population level. Using data from 56 countries, we calculate unmet need in a population as the difference between: (1) the observed contraceptive prevalence in the population; and (2) the calculated contraceptive prevalence in a subsample of women who are identified to be from "ideal" family planning environments. Women from "ideal" environments are selected on characteristics that signal their contraceptive autonomy and decision-making over family planning. We find significant differences between our approach and existing methods to calculating unmet need, and we observe variation across countries when comparing indicators. We argue that our indicator of unmet need is preferable to existing population-level indicators due to its independence from biases that are generated from the use of reported preference measures, the simplicity with which it can be derived, and its relevance for cross-country comparisons as well as context-specific analyses.

Promoting Deaf-Adults' Participation in Early Care and Education of Deaf Children.

Few studies exist on the early care and education (ECE) of children who are deaf in low-to-middle-income countries, and none examine the roles of deaf adults in such provision. A research base is needed to inform contextually sensitive "deaf-infused" models of ECE in such contexts that build on indigenous deaf community experience, knowledge, and local expertise. This paper discusses the development of ECE in Ghana in sub-Saharan Africa focusing specifically on the perspectives of deaf adults on their roles in ECE support and leadership. Seventeen deaf adults with different leadership and advocacy roles in Ghana were interviewed about their perceptions of ECE priorities in this context, and the role of deaf adults in the development and delivery of early support. The participants expressed diverse views on ECE for the children and their families and suggested ways of building capacity and leadership among deaf adults to support ECE for the children and their families.

P094Sexual and reproductive health advocacy successes, failures, and needs in the US: Perspectives from key stakeholders

<h3>Objectives</h3> Despite active advocacy for access to sexual and reproductive health (SRH) services in the US, persistent restrictions have created barriers to care. We sought the perspectives of key stakeholders on what makes for an effective SRH physician advocate and thoughts about the successes, failures, and needs of the abortion advocacy movement. <h3>Methods</h3> We interviewed 15 SRH key informants (KIs) in sectors with expertise in organizational policy and advocacy (n=6); clinical leadership and education (n=3); media (n=3); and reproductive justice (n=3) as part of a mixed-methods evaluation of a physician advocacy training program. The analytic team coded repeating ideas and conducted a thematic analysis, organizing findings within KI perspectives on the role of physician advocates; successes, failures, and needs in SRH advocacy; and recommendations on the composition and components of an ideal advocacy training program. <h3>Results</h3> KIs felt successes included mandated access to contraception under the Affordable Care Act and the application of reproductive justice and storytelling to abortion advocacy. Failures included misplaced political focus and increased abortion bans. Participants highlighted the importance of building community across disciplines and diminishing silos. Skill-building related to communication, developing relationships with changemakers, and understanding political systems was thought to be critical for effective advocacy. They felt clinician advocacy training programs should include providers other than physicians and be designed for trainees to build relationships with one another over time. <h3>Conclusions</h3> KI perspectives can be valuable in informing advocacy training programs and for contributing strategic approaches to increasing equitable and widespread access to SRH services.

Health Care as a Partner in Federal Nutrition Programs: Call for Advocacy.

Health Care as a Partner in Federal Nutrition Programs: Call for Advocacy.

MIND THE GAP: THE POTENTIAL OF PROFESSIONAL YOUTH WORK FOR CIVIC EMPOWERMENT AND ENGAGEMENT OF YOUTH AT SOCIAL RISK

Youth work is often regarded as a fruitful place for the creation of democratic citizens and is thus a favoured space for civic educational activities. Despite these efforts, there is a growing concern on the civic empowerment gap: the difference that can still be found across various domains of civic outcomes between disadvantaged groups and those from dominant and socio-economically advantaged backgrounds. From a democratic point of view, the civic empowerment gap is deeply problematic. Various efforts exist to include excluded or so-called ‘nonparticipating’ youngsters, albeit often with a socialization or disciplinarian discourse. The presented study challenges such approach and builds on the concept of political subjectification to offer an alternative approach to remedy the civic empowerment gap? To do so, a case study has been conducted with a youth social organization in Molenbeek, Brussels. The findings emphasize the importance of the explicit and implicit role of advocacy by the organization and the importance of the fragile pedagogical and political relationship between youth workers and youngsters to enable meaningful participation.

An HCI Research Agenda for Online Science Communication

Social media, blogs, podcasts, and other computer-mediated communication technology have become an integral way for the public to access and engage with research. However, despite the evolving challenges researchers face navigating these platforms, and the high stakes of online science communication, relatively little HCI research has focused on understanding and supporting online science communication through these participatory platforms. Through a review of the literature and a set of interviews with HCI researchers (n = 24), we identify challenges currently facing researchers who try to engage with the public about their work, and establish a research agenda for HCI to study, design, and evaluate technology to support science communication. Specifically, we advocate for the design of tools to support audience analytics, automated summary and outreach workflows, and providing quantitative and qualitative feedback about online outreach efforts, as well as additional research to elucidate the impacts of self-directed science communication efforts and the evolving roles of scientists on the participatory web. With shifting online platforms placing researchers in the role of advocates and participants in science communication, understanding and supporting these interactions is now more important than ever.

10.C. Round table: Is public health just science?

Abstract Politicians and policy makers often assert that they are following the science and the evidence in their decision making. Public health is proud of its rigorous scientific and evidence-based approaches and providing the numbers and facts. It is clear though that such numbers and facts, as during the pandemic, have resulted in diverse policies in different countries. Some commentators have noted that public health has lost its way, arguing that its leadership is failing, lacks courage and not sufficiently concerned with issues about social reform and political accountability and change. Is providing facts and the science sufficient to fulfil our mandate and obligations in public health? What should be our role in advocacy and engagement in politics and policy-making to promote and protect the public's health and tackle health inequalities? The purpose of the roundtable is to explore questions of whether public health is “just science”: is it built merely on a scientific skillset; or is it about justice-promoting science? This question goes to the heart of public health's mandate, with direct implications for public health practice. The questions will be considered largely from the perspective and evidence from the Covid pandemic. There will be presentations by senior distinguished academics and public health practitioners and leaders who have been researching and advising policy makers on wide range of public health issues. They will share their research and experience in particular from membership of the UK Independent Scientific Advisory Group (Indie_ SAGE) for the pandemic and on the Pandemic Ethics Accelerator, as well as other groups advising the government and public organisations on the analysis and implementation of policy options during the pandemic. This will be followed by reflections and discussion with the workshop participants and their reflections and insights on these critical questions. Key messages • Public health is not merely a technical, scientific discipline; it incorporates norms and values, and operates in a political environment where value-judgments are fundamental to decision making. • Public health practitioners and leaders need to consider advocacy and engagement, and the moral foundations of public health, as key to their mandate and professional obligations. Speakers/Panellists John Coggon University of Bristol, Bristol, UK Martin McKee LSHTM, London, UK Marleen Bekker Wageningen University &amp; Research, Wageningen, Netherlands Farhang Tahzib Faculty of Public Health, Haywards Heath, UK

Advocates’ perspectives on the Canadian prison mother child program

AimsOver twenty years ago, Correctional Services Canada launched the Mother Child Program (MCP) to mitigate harms of separating incarcerated mothers from their babies. It has never been subjected to internal evaluation or independent study. The aim of the qualitative study was to explore the experiences of advocates employed by Elizabeth Fry Societies (EFS), community organizations dedicated to the support of incarcerated women, with respect to supporting people who were pregnant or had young children while federally incarcerated and did or did not participate in the MCP. DesignThis study uses a qualitative design, rooted in abolition feminism. MethodsData were collected between 2020 and 2021 through semi-structured interviews with twelve people employed by EFS in advocacy roles. Data were analyzed using thematic analysis. ResultsRespondents described supporting clients who experience the trauma of repeated separation from their children, increased vulnerability to child protection services, inadequate health care, and the conflict between addressing immediate harms and resisting prison expansion. ConclusionAdvocates working for EFS have an in-depth understanding of the complex factors underlying client participation in the MCP. Findings point to the urgent need to address the inadequacy of the MCP as a solution to parental incarceration. ImpactAlthough we make recommendations related to recognizing the impact of maternal incarceration on children and families, improving access to perinatal care, and collecting data on the number of children affected by parental incarceration, our overarching recommendation is to question if expanding the MCP is the best possible recourse to the trauma of maternal criminalization. Patient or public contributionThis study was designed in consultation with advocates working for Elizabeth Fry Societies with experience supporting people who had been pregnant or parenting while federally incarcerated, and people with lived experience of being pregnant or parenting while federally incarcerated.

9.G. Workshop: Health in all Policies: key driver for better health still awaiting of greater governing stewardship

Abstract Healthy public policies are those that take accountability of all possible health impacts, acknowledging the causal pathways resulting from the modification of upstream health determinants (e.g. transport strategies, etc.), and related risk factors downstream (e.g. air pollutants). The strategy of Health in All Policies (HiAP), promoted by the World Health Organization (WHO) and adopted by the European Union (EU) in 2006, reinforced the need to reduce inequalities and improve health and wellbeing as essential pillars for a sustainable economic development. Central to HiAP is the notion that health is not only the responsibility of the health sector, but also a shared responsibility with many other sectors. In this context, Health impact Assessment (HIA) was proposed as the combination of methods to support HiAP implementation by providing scientific evidence on the positive and negative effects that any new proposal may have on health and health equity. The COVID-19 pandemic, and the climate change threat, are two of the main challenges that emphasise the need of integrated responses across many sectors to mitigate not only effects on health and inequalities, but also in the economy. However, HiAP and HIA implementation remains almost at a conceptual level, with a few remarkable exceptions in Europe. One of the most relevant reported barriers contributing to this uneven HiAP implementation is the lack of political stewardship and commitment. The difficulties in applying the guiding principles of HiAP (and consequently of HIA) at local, regional, or national governance level are in many cases linked to a conflict between the right to work and mobilization of the economy, with the right to health and reduction of inequities. This is where the role and drive of public health actors comes across, as HiAP requires public health professionals to build partnerships and engage meaningfully with the sectors affecting the social determinants of health and health equity, external to the health sector. A good proxy example to HiAP implementation, facilitating local and regional initiatives with communities, is the WHO initiative of Healthy Cities. The present panel discussion intends to analyse, from different perspectives, why HiAP has not gained a meaningful place within governing contexts, the current and future status of the intersectoral approach, and the advocacy role of public health in this context. The session is scheduled with a first overview presentation followed by a debate framed around the following aspects: – Different perceptions regarding the concrete implementation of HiAP at all political levels. – Perceived barriers or trade-offs for a broader implementation of HiAP. – Role of public health actors in the implementation of HiAP at a strategic, policy level, and how it could gain a more prominent role. – Level of understanding and awareness of the utility of HIA for HiAP implementation by public health actors. Key messages • HiAP, a recognised approach requiring all sectors to address decisions’ health and equity implications for reaching better global health, has not yet been implemented with an overarching vision. • Public Health actors can disentangle political and technical aspects, seeking for synergisms, and clarifying to non-health sectors the complexity and interrelatedness of social health determinants.

Five mechanisms for tackling the risks to NEEThood: introducing a pathway to change to guide educators’ support strategies

ABSTRACT Tackling NEEThood remains a major UK policy focus, with numbers of young people not in education, employment or training (NEET) stubbornly high and the COVID-19 Pandemic exacerbating school disengagement and widening inequalities. Drawing on rich qualitative data from a three-year study evaluating educational interventions tackling NEEThood, this paper explores such interventions were successful from the perspectives of the young people and their educators. We introduce five mechanisms underpinning effective support strategies, arguing that these enable a pathway to change for young people. We distinguish between foundational mechanisms, essential at the outset of work with young people, facilitating mechanisms which build on these foundations, and outcome-generating mechanisms which lead to education and work goals. These findings underscore the importance of tackling the social aspects of educational disengagement, as well as the critical role of advocacy and support from an adult who can unpick the complex barriers to engagement and learning.

Professional autonomy and patient advocacy in nurses

BackgroundDevelopments in the field of health care require nurses to have professional autonomy and to fulfil contemporary nursing roles including patient advocacy. AimIn this study, it was aimed to determine the levels of professional autonomy and patient advocacy of nurses and to examine the relationship between them. MethodsThe descriptive and cross-sectional study was conducted with nurses working in inpatient clinics of a public hospital (n = 212). The data of the study were collected using a questionnaire consisting of questions to determine the socio-demographic and professional characteristics of nurses, the Nurses’ Attitude Towards Professional Autonomy Scale, and the Patient Advocacy Scale for Nurses. FindingsThe mean age of the nurses participating in the study was 29.60 ± 6.72, 92% were females and 71.7% hold a bachelor's degree. The mean score of the Nurses’ Attitude Towards Professional Autonomy Scale was 78.74 ± 8.56, and the total mean score of the Patient Advocacy Scale for Nurses was 165.91 ± 20.31. It was determined that there was a positive and significant correlation between the total mean score of the Nurses’ Attitude Towards Professional Autonomy Scale and the mean score of the Patient Advocacy Scale for Nurses (p < 0.05). It was found that the mean total scores of the Nurses’ Attitude Towards Professional Autonomy Scale of nurses working in intensive care and holding a postgraduate degree were statistically higher (p < 0.05). ConclusionNurses' professional autonomy was high, and the practice of patient advocacy roles was above average. As professional autonomy increases, the practice of patient advocacy roles also increases.

“Not just the asthma”: Understanding the acute asthma experiences of adult women with asthma presenting to the emergency department through photovoice

Rationale: Asthma is a common reason for emergency department (ED) presentation. Few studies have explored the experiences of adults during asthma exacerbation, particularly those that necessitate ED care. Objectives: This study explored adults experiences during asthma exacerbation. Methods: A photovoice study was conducted. ED patients presenting for asthma care between the ages of 17-55 years were eligible for the study and recruited in the ED. Participants had 3-4 weeks to take photographs and subsequently completed a one-on-one photo-elicitation interview. Interviews were audio recorded, transcribed and thematically analyzed. Measurements and Main Results: Six patients agreed to participate; 2 were lost to follow-up. One primary theme emerged. Specifically, the role of hope and fear, including the tension between them, in their experience of their condition. Hope and fear permeated all aspects of experience, including the following subthemes: 1) participants adopting the roles of advocate and expert, 2) frustration with their health state, 3) loss of freedom and subsequent feelings of failure, 4) barriers to accessing health care, and 5) “good” and “bad” ED care. Asthma was an ever-present consideration in participants lives during times of “good asthma control” and times of exacerbation. Conclusions: Participants’ focus on the roles of hope and fear, both in the ED and beyond, suggests that openly acknowledging and addressing these emotional aspects as a part of the ED interaction could result in a better care experience for some patients. Seeing the whole person as more than their symptoms and sharing decision-making may help clinicians to provide care that supports hopefulness.

Expanding the advocacy lens: using photo-elicitation to capture patients' and physicians' perspectives about health advocacy.

Heath advocacy (HA) remains a difficult competency to train and assess, in part because practicing physicians and learners carry uncertainty about what HA means and we are missing patients' perspectives about the role HA plays in their care. Visual methods are useful tools for exploring nebulous topics in health professions education; using these participatory approaches with physicians and patients might counteract the identified training challenges around HA and more importantly, remedy the exclusion of patient perspectives. In this paper we share the verbal and visual reflections of patients and physicians regarding their conceptualizations of, and engagement in 'everyday' advocacy. In doing so, we reveal some of HA's hidden dimensions and what their images uncovered about the role of advocacy in patient care. Constructivist grounded theory guided data collection and analysis. Data was collected through semi-structured interviews and photo-elicitation, a visual research method that uses participant generated photographs to elicit participants knowledge and experiences around a particular topic. We invited patients living with chronic health conditions (n = 10) and physicians from diverse medical and surgicalspecialties (n = 14) to self-select photographs representing their experiences navigating HA in their personal and professional lives. Both groups found taking photographs useful for revealing the nuanced and circumstantial factors that either enabled or challenged their engagement in HA. While patients' photos highlighted their embodiment of HA, physicians' photos depicted HA as something quite elusive or as a complicated and daunting task. Photo-elicitation was a powerful tool in eliciting a diversity of perspectives that exist around the HA role and the work advocates perform; training programs might consider using visuals to augment teaching for this challenging competency.

Shared Decision Making and Peer Support: New Directions for Research and Practice.

Shared Decision Making and Peer Support: New Directions for Research and Practice.