From the Clinic to the Community

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Abstract
Purpose The integration of health advocacy activities into medical training has been controversial and challenging from theoretical and practical standpoints. In part, this may be because it is unclear how such activities could be incorporated into the everyday practices of most physicians. This study explored the breadth of advocacy activities described by physicians engaged in health advocacy in order to articulate a set of activities that might be enacted regularly by all physicians. Method From October 2012 to June 2013, 10 physician advocates from British Columbia were interviewed. Using transcriptions from semistructured interviews, the authors identified all advocacy activities described by participants. Employing an iterative process of individual and group analysis, the authors developed conceptual categories building on previously developed frameworks to represent the types of activities participants articulated. Results Physician participants identified five main categories of advocacy activities: clinical agency, paraclinical agency, practice quality improvement, activism, and knowledge exchange. These were enacted at one of three levels: individual patient, practice, and community/system. They also identified a wide range of abilities and perspectives that they employed across all levels and activities. Conclusions Most activities described by health advocates at the patient and practice level (clinical agency, paraclinical agency, practice quality improvement) might reasonably be incorporated into the professional lives of all physicians if training incorporated some reorientation of perspective. Many activities at the system level (activism and knowledge exchange) perhaps require more elaborate skill development and support, which could be provided for those interested in pursuing further advocacy training.

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