Health Advocacy

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Mike Daube - One of the best experts on this subject based on the ideXlab platform.

Jennifer L. David - One of the best experts on this subject based on the ideXlab platform.

Maria Hubinette - One of the best experts on this subject based on the ideXlab platform.

  • Health Advocacy.
    Medical teacher, 2016
    Co-Authors: Maria Hubinette, Sarah Dobson, Ian Scott, Jonathan Sherbino
    Abstract:

    In the medical profession, activities related to ensuring access to care, navigating the system, mobilizing resources, addressing Health inequities, influencing Health policy and creating system change are known as Health Advocacy. Foundational concepts in Health Advocacy include social determinants of Health and Health inequities. The social determinants of Health (i.e. the conditions in which people live and work) account for a significant proportion of an individual's and a population's Health outcomes. Health inequities are disparities in Health between populations, perpetuated by economic, social, and political forces. Although it is clear that efforts to improve the Health of an individual or population must consider "upstream" factors, how this is operationalized in medicine and medical education is controversial. There is a lack of clarity around how Health Advocacy is delineated, how physicians' scope of responsibility is defined and how teaching and assessment is conceptualized and enacted. Numerous curricular interventions have been described in the literature; however, regardless of the success of isolated interventions, understanding Health Advocacy instruction, assessment and evaluation will require a broader examination of processes, practices and values throughout medicine and medical education. To support the instruction, assessment and evaluation of Health Advocacy, a novel framework for Health Advocacy is introduced. This framework was developed for several purposes: defining and delineating different types and approaches to Advocacy, generating a "roadmap" of possible Advocacy activities, establishing shared language and meaning to support communication and collaboration across disciplines and providing a tool for the assessment of learners and for the evaluation of teaching and programs. Current approaches to teaching and assessment of Health Advocacy are outlined, as well as suggestions for future directions and considerations.

  • Not just ‘for’ but ‘with’: Health Advocacy as a partnership process
    Medical education, 2015
    Co-Authors: Maria Hubinette, Sarah Dobson, Glenn Regehr
    Abstract:

    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.

  • Shifts in the interpretation of Health Advocacy: a textual analysis.
    Medical education, 2014
    Co-Authors: Maria Hubinette, Sarah Dobson, Angela Towle, Cynthia Whitehead
    Abstract:

    Context Health Advocacy is widely accepted as a key element of competency-based education. We examined shifts in the language and description of the role of the Health advocate and what these reveal about its interpretation and enactment within the context of medical education. Methods We conducted a textual analysis of three key documents that provide sequential depictions of the role of the Health advocate in medical education frameworks: Educating Future Physicians for Ontario (1993), CanMEDS 2000 and CanMEDS 2005. We used a series of questions to examine shifts in the emphasis, focus and application of the role between documents. Theoretically, we drew upon Carlisle's conceptual framework to identify different approaches to Advocacy. Results We identified three major shifts in the language associated with the role of Health advocate across our textual documents. Firstly, activities and behaviours that were initially positioned as being the responsibility of the profession as a whole came to be described instead as competencies required of every physician. Secondly, the initial focus on Health Advocacy as representing collective action towards public policy and systems-level change was altered to a primary focus on individual patients and doctors. Thirdly, we observed a progression away from descriptions of concrete actions and behaviours. Conclusions This study uncovers shifts in the language of physician Advocacy that affect the discourse of Health Advocacy and expectations placed on physicians and trainees. Being explicit about expectations of the medical profession and individual practitioners may require renewed examination of societal needs. Although this study uses the CanMEDS role of Health Advocate as a specific example, it has implications for the conceptualisation of Health Advocacy in medicine and medical education globally.

  • we not i Health Advocacy is a team sport
    Medical Education, 2014
    Co-Authors: Maria Hubinette, Sarah Dobson, Stephane Voyer, Glenn Regehr
    Abstract:

    Context Health Advocacy, although recognised as a professional responsibility, is often seen as overwhelming, perhaps because it is framed conceptually as an activity that each physician should undertake alone rather than as a collaborative process. In the context of a study exploring how effective physician Health advocates conceptualise their roles and their activities related to Health Advocacy, we uncovered data that speak directly of the issue of whether the activities of Health advocates are enacted as individual or collective pursuits. Methods We interviewed ten physicians, identified by others as effective Health advocates, regarding their Advocacy activities. We collected and analysed data in an iterative process, informed by constructivist grounded theory, continuously refining the interview framework and examining evolving themes. The final coding scheme was applied to all transcripts. Results Health Advocacy was viewed by these physicians as a collective activity. This collective construction of Advocacy presented in three ways: (i) as teamwork by interprofessional teams of individuals with clearly defined roles and functional, task-oriented goals; (ii) as a process involving networks of resources or people that can be accessed for both support and reinforcement, and (iii) as a process involving collaborative think-tanks in which members contribute different perspectives to enact collective problem solving at a conceptual level. Conclusions Effective Health advocates do not conceptualise themselves as stand-alone experts who must do everything themselves. Their collective approach makes it possible for these physicians to incorporate Health Advocacy into their clinical practice. However, although conceptualising Health Advocacy as a collective activity may make it less daunting, this way of understanding Health Advocacy is not compatible with current formal descriptions of the associated competencies.

  • ‘We’ not ‘I’: Health Advocacy is a team sport
    Medical education, 2014
    Co-Authors: Maria Hubinette, Sarah Dobson, Stephane Voyer, Glenn Regehr
    Abstract:

    Context Health Advocacy, although recognised as a professional responsibility, is often seen as overwhelming, perhaps because it is framed conceptually as an activity that each physician should undertake alone rather than as a collaborative process. In the context of a study exploring how effective physician Health advocates conceptualise their roles and their activities related to Health Advocacy, we uncovered data that speak directly of the issue of whether the activities of Health advocates are enacted as individual or collective pursuits. Methods We interviewed ten physicians, identified by others as effective Health advocates, regarding their Advocacy activities. We collected and analysed data in an iterative process, informed by constructivist grounded theory, continuously refining the interview framework and examining evolving themes. The final coding scheme was applied to all transcripts. Results Health Advocacy was viewed by these physicians as a collective activity. This collective construction of Advocacy presented in three ways: (i) as teamwork by interprofessional teams of individuals with clearly defined roles and functional, task-oriented goals; (ii) as a process involving networks of resources or people that can be accessed for both support and reinforcement, and (iii) as a process involving collaborative think-tanks in which members contribute different perspectives to enact collective problem solving at a conceptual level. Conclusions Effective Health advocates do not conceptualise themselves as stand-alone experts who must do everything themselves. Their collective approach makes it possible for these physicians to incorporate Health Advocacy into their clinical practice. However, although conceptualising Health Advocacy as a collective activity may make it less daunting, this way of understanding Health Advocacy is not compatible with current formal descriptions of the associated competencies.

Samantha L. Thomas - One of the best experts on this subject based on the ideXlab platform.

Melanie J Randle - One of the best experts on this subject based on the ideXlab platform.

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