Ethics code: IR.YAZD.REC.1403.006
1- Faculty of Social Sciences, Yazd University, Yazd, Iran
2- Research Center of Shiraz University of Medical Sciences, Shiraz, Iran
2- Research Center of Shiraz University of Medical Sciences, Shiraz, Iran
Abstract: (31 Views)
Objective(s): patients are considered a vulnerable group within various sectors of the healthcare system and therefore require protection and advocacy. “Health advocacy” and the concept of the “physician advocate” are legal in nature and have been introduced into various fields, including medical education, over the past two decades. While these concepts aim to protect patients’ rights, they also grant substantial authority and responsibilities to physician advocates. This research aims to reviewing the scope of studies and Explaining the conceptual field of health advocacy and the role of the health advocate physician has been done.
Methods: A Scoping review for study background and a conceptual review for the typology was done.
The tool of collection was taking note of written documents that by searching for the keywords – health advocacy, physician advocacy, role of advocate, physician advocate - in search engines and scientific databases and a cumulative search based on the references of available documents was done. The selection of documents was based on criteria-oriented purposeful method (1.matching the title, 2.matching the keywords, 3.more valid, more indexed, more cited, 4.more relevant, more meaningful). Finally, 29 full-text documents were selected and reviewed.
Results: The research scope of the subject was recorded. In the typology, 2 levels of advocacy were identified, including micro advocacy and macro advocacy. Also, 5 types of advocacy and their related advocate roles were identified: Patient right and autonomy (Patient right and autonomy advocate), representational advocacy (patient representative), Empowerment and Facilitation (empower and facilitator), social activism (social activist) and Policy activism (social reformer and Policy activist) was identified.
Conclusion: Playing the role of advocate in health advocacy, is a process which includes advocacy at the smallest (Patients Self-determination advocacy) and the largest (reforming Health-social policies) level. This research, while determining the study scope; presented a typology and conceptual model of this new subject, which can be used as a suggested in medical education.
Methods: A Scoping review for study background and a conceptual review for the typology was done.
The tool of collection was taking note of written documents that by searching for the keywords – health advocacy, physician advocacy, role of advocate, physician advocate - in search engines and scientific databases and a cumulative search based on the references of available documents was done. The selection of documents was based on criteria-oriented purposeful method (1.matching the title, 2.matching the keywords, 3.more valid, more indexed, more cited, 4.more relevant, more meaningful). Finally, 29 full-text documents were selected and reviewed.
Results: The research scope of the subject was recorded. In the typology, 2 levels of advocacy were identified, including micro advocacy and macro advocacy. Also, 5 types of advocacy and their related advocate roles were identified: Patient right and autonomy (Patient right and autonomy advocate), representational advocacy (patient representative), Empowerment and Facilitation (empower and facilitator), social activism (social activist) and Policy activism (social reformer and Policy activist) was identified.
Conclusion: Playing the role of advocate in health advocacy, is a process which includes advocacy at the smallest (Patients Self-determination advocacy) and the largest (reforming Health-social policies) level. This research, while determining the study scope; presented a typology and conceptual model of this new subject, which can be used as a suggested in medical education.
type of study: Systematic Reviw |
Subject:
Sicial Medicine
Received: 2024/09/30 | Accepted: 2025/08/16 | ePublished ahead of print: 2026/01/28
Received: 2024/09/30 | Accepted: 2025/08/16 | ePublished ahead of print: 2026/01/28
References
1. Mohseni M. Medical sociology. 1st Edition, Tahuri: Tehran, 1977 [Persian]
2. Wegar K, Sociology in American medical education since the 1960s: the rhetoric of reform. Social Science & Medicine 1992; 35: 959-965 [DOI:10.1016/0277-9536(92)90235-I]
3. Smith T, Smith C. From Courtroom to Clinic: Child Advocacy in Action. Missouri Medicine 2022; 119: 533-535
4. Rappaport L, Burns B, Brown S, Sheridan D, Hansen M, Warden C. Advocacy for emergency medical services for children: education, practice, and Policy implications. Clinical Pediatric Emergency Medicine 2014; 15: 104-113 [DOI:10.1016/j.cpem.2014.01.004]
5. DeGrazia Jr, Ogunwole S, Lorigiano T, Bienstock J, Pollack C. What are the attitudes of medical students and housestaff towards health advocacy? A physician-led voter registration initiative and health advocacy survey. American Journal of Medicine Open 2022; 8: 100023 [DOI:10.1016/j.ajmo.2022.100023]
6. Earnest M, Wong S, Federico S. Physician advocacy: What is it and how do we do it? Academic Medicine 2010; 85: 63-67 [DOI:10.1097/ACM.0b013e3181c40d40]
7. Luft L. The essential role of physician as advocate: how and why we pass it on. Canadian Medical Education Journal 2017; 8: 109-116 [DOI:10.36834/cmej.36925]
8. Li J. The physician as advocate. In Mayo Clinic Proceedings 1998; 73:1022-1024 [DOI:10.4065/73.10.1022]
9. Stafford S, Sedlak T, Fok M, Wong R. Evaluation of resident attitudes and self-reported competencies in health advocacy. BMC Medical Education 2010; 10: 1-7 [DOI:10.1186/1472-6920-10-82]
10. Poulton A, Rose H. The importance of health advocacy in Canadian postgraduate medical education: current attitudes and issues. Canadian Medical Education Journal 2015; 6: 54 [DOI:10.36834/cmej.36665]
11. Pak-Gorstein S, Batra M, Johnston B, Grow H, Grant A, Shugerman R, et al. Training pediatricians to address health disparities: an innovative residency track combining global health with community pediatrics and advocacy. Academic Medicine 2018; 93: 1315-1320 [DOI:10.1097/ACM.0000000000002304]
12. McDonald M, Lavelle C, Wen M, Sherbino J, Hulme J. The state of health advocacy training in postgraduate medical education: a scoping review. Medical Education 2019; 53: 1209-1220 [DOI:10.1111/medu.13929]
13. Boroumand S, Stein M, Jay M, Shen J, Hirsh M, Dharamsi S. Addressing the health advocate role in medical education. BMC Medical Education 2020; 20: 1-5 [DOI:10.1186/s12909-020-1938-7]
14. Waterston T. Advocacy and the paediatrician. Paediatrics and Child Health 2020; 30: 155-161 [DOI:10.1016/j.paed.2020.02.001]
15. Chimonas S, Mamoor M, Kaltenboeck A, Korenstein D. The future of physician advocacy: a survey of US medical students. BMC Medical Education 2021; 21: 1-9 [DOI:10.1186/s12909-021-02830-5]
16. Kahlke R, Scott I, van Der Goes T, Hubinette M. Health advocacy among medical learners: unpacking contextual barriers and affordances. Medical Education 2023; 57: 658-667 [DOI:10.1111/medu.15001]
17. Flynn L, Verma S. Fundamental components of a curriculum for residents in health advocacy. Medical Teacher 2008; 30: 178-e183 [DOI:10.1080/01421590802139757]
18. Arksey H, O'malley L. Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology 2005; 8: 19-32 [DOI:10.1080/1364557032000119616]
19. Peters M, Godfrey C, Khalil H, McInerney P, Parker D, Soares C. Guidance for conducting systematic scoping reviews. JBI Evidence Implementation 2015; 13: 141-146 [DOI:10.1097/XEB.0000000000000050]
20. Pham M, Rajić A, Greig J, Sargeant J, Papadopoulos A, McEwen S. A scoping review of scoping reviews: advancing the approach and enhancing the consistency. Research Synthesis Methods 2014; 5: 371-385 [DOI:10.1002/jrsm.1123]
21. Peterson J, Pearce P, Ferguson L, Langford C. Understanding scoping reviews: Definition, purpose, and process. Journal of the American Association of Nurse Practitioners 2017; 29: 12-16 [DOI:10.1002/2327-6924.12380]
22. Munn Z, Peters M, Stern, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review?guidance for authors when choosing between a systematic or scoping review Approach. BMC Medical Research Methodology 2018; 18:1-7 [DOI:10.1186/s12874-018-0611-x]
23. Peters M, Godfrey C, McInerney P, Baldini Soares C, Khalil H, Parker D. Chapter 11: Scoping Reviews. In: Aromataris E, Munn Z (Editors). Joanna Briggs Institute Reviewer's Manual. The Joanna Briggs Institute, 2017; 1-24
24. Imanifar N, Vagharseyyedin S. Protective nursing advocacy: an evaluation of the beliefs and actions of nurses in educational hospitals affiliated to Birjand University of Medical Sciences during 2014. Iranian Journal of Medical Ethics and History of Medicine 2015; 7: 69-78 [Persian]
25. Baker E, Bouldin N, Durham M, Lowell M, Gonzalez M, Jodaitis N, Adams S. The latino health advocacy program: a collaborative lay health advisor approach. Health Education & Behavior 1997; 24: 495-509 [DOI:10.1177/109019819702400408]
26. Altun I, Ersoy N. Undertaking the role of patient advocate: a longitudinal study of nursing students. Nursing Ethics 2003; 10: 462-471 [DOI:10.1191/0969733003ne628oa]
27. Verma S, Flynn L, Seguin R. Faculty's and residents' perceptions of teaching and evaluating the role of health advocate: a study at one Canadian university. Academic Medicine 2005; 80: 103-108 [DOI:10.1097/00001888-200501000-00024]
28. Bu X, Jezewski M. Developing a mid‐range theory of patient advocacy through concept analysis. Journal of Advanced Nursing 2007; 57: 101-110 [DOI:10.1111/j.1365-2648.2006.04096.x]
29. Hanks R. Development and testing of an instrument to measure protective nursing advocacy. Nursing Ethics 2010; 17: 255-267 [DOI:10.1177/0969733009352070]
30. Shah S, Brumberg H. Advocating for advocacy in pediatrics: supporting lifelong career trajectories. Pediatrics 2014; 134: 1523-e1527 [DOI:10.1542/peds.2014-0211]
31. Jansson B, Nyamathi A, Duan L, Kaplan C, Heidemann G, Ananias D. Validation of the patient advocacy engagement scale for health professionals. Research in Nursing & Health 2015; 38: 162-172 [DOI:10.1002/nur.21638]
32. Law M, Leung P, Veinot P, Miller D, Mylopoulos M. A qualitative study of the experiences and factors that led physicians to be lifelong health advocates. Academic Medicine 2016; 91: 1392 [DOI:10.1097/ACM.0000000000001316]
33. Basu G, Pels R, Stark R, Jain P, Bor D, McCormick D. Training internal medicine residents in social medicine and research-based health advocacy: a novel, in-depth curriculum. Academic Medicine 2017; 92: 515-520 [DOI:10.1097/ACM.0000000000001580]
34. Soklaridis S, Bernard C, Ferguson G, Andermann L, Fefergrad M, Fung K, Whitehead C. Understanding health advocacy in family medicine and psychiatry curricula and practice: a qualitative study. PLoS One 2018; 13: 0197590 [DOI:10.1371/journal.pone.0197590]
35. Nerlinger A, Shah A, Beck A, Beers L, Wong S, Chamberlain L, Keller D. The advocacy portfolio: a standardized tool for documenting physician advocacy. Academic Medicine 2018; 93: 860-868 [DOI:10.1097/ACM.0000000000002122]
36. Howell B, Kristal R, Whitmire L, Gentry M, Rabin T, Rosenbaum J. A systematic review of advocacy curricula in graduate medical education. Journal of General Internal Medicine 2019; 34: 2592-2601 [DOI:10.1007/s11606-019-05184-3]
37. Ying Y, Seabrook C. Health advocacy competency: Integrating social outreach into surgical education. Journal of Surgical Education 2019; 76: 756-761 [DOI:10.1016/j.jsurg.2018.11.006]
38. Marsh M, Supples S, McLaurin-Jiang S, Brown C, Linton J. Introducing the concepts of advocacy and social determinants of health within the pediatric clerkship. MedEdPortal 2019; 15: 10798 [DOI:10.15766/mep_2374-8265.10798]
39. Vance M, Bui E, Shtasel D, Borba C. Health advocacy among resident physicians. MedEdPublish 2019; 8: 29 [DOI:10.15694/mep.2019.000029.1]
40. Majeed A, Newton H, Mahesan A, Vazifedan T, Ramirez D. Advancing advocacy: implementation of a child health advocacy curriculum in a pediatrics residency program. MedEdportal 2020; 16: 10882 [DOI:10.15766/mep_2374-8265.10882]
41. Dodson N, Talib H, Gao Q, Choi J, Coupey S. Pediatricians as child health advocates: the role of advocacy education. Health Promotion Practice 2021; 22: 13-17 [DOI:10.1177/1524839920931494]
42. Maloney D, Moodie R, Daube M, Wilson A. Are Australian junior doctors failing to act as health advocates? A qualitative analysis. Australian and New Zealand Journal of Public Health 2022; 46: 527-532 [DOI:10.1111/1753-6405.13266]
43. Singh A, Ahire N. Health advocacy trends and unexplored facets a bibliometric analysis based on scopus database. Hospital Topics 2024; 1: 1-13 [DOI:10.1080/00185868.2024.2390956]
44. Keller D. Child Advocacy in Action: if not you, who? if not now, when?. Pediatric Clinics 2023; 70: 1-10 [DOI:10.1016/j.pcl.2022.09.004]
45. Jenkins T, Underman K, Vinson A, Olsen L, Hirshfield L. The resurgence of medical education in sociology: a return to our roots and an agenda for the future. Journal of Health and Social Behavior 2021; 62: 255-270 [DOI:10.1177/0022146521996275]
46. Newbigging K, Ridley J. Epistemic struggles: the role of advocacy in promoting epistemic justice and rights in mental health. Social Science & Medicine 2018; 219: 36-44 [DOI:10.1016/j.socscimed.2018.10.003]
47. Carlisle S. Health promotion, advocacy and health inequalities: a conceptual framework. Health Promotion International 2000; 15: 369-376 [DOI:10.1093/heapro/15.4.369]
48. Paulson J. Pediatric advocacy. Pediatric Clinics of North America 2001; 48: 1307-1318 [DOI:10.1016/S0031-3955(05)70376-X]
49. Stevens G, Seid M, Mistry R, Halfon N. Disparities in primary care for vulnerable children: the influence of multiple risk factors. Health Services Research 2006; 41:507-531 [DOI:10.1111/j.1475-6773.2005.00498.x]
50. Hguig S, Siafa L, Dhillon J, Ferroum A, Bourdache L, Housni A, Chirgwin J. Addressing healthcare barriers faced by asylum seekers and refugees through an interprofessional symposium. Canadian Medical Education Journal 2023; 14: 127-132 [DOI:10.36834/cmej.74654]
51. Hubinette M, Dobson S, Towle A, Whitehead C. Shifts in the interpretation of health advocacy: a textual analysis. Medical Education 2014; 48:1235-1243 [DOI:10.1111/medu.12584]
52. Hanks J. Protective nursing advocacy scale (doctoral dissertation, the university of Texas medical branch graduate school of biomedical sciences) 2008.
53. Kinman E. Evaluating health service equity at a primary care clinic in Chilimarca, Bolivia. Social Science & Medicine 1999; 49: 663-678 [DOI:10.1016/S0277-9536(99)00147-1]
54. Walker E, vanDenBroek T, Priante A, Ehrenhard M. Patient‐activist or ally? Assessing the effectiveness of conscience and beneficiary constituents in disease advocacy fundraising. Sociology of Health & Illness 2023; 45: 1652-1672 [DOI:10.1111/1467-9566.13655]
55. Laue J. Sociology as advocacy: there are no neutrals. Sociological Practice 1989; 7: 15
Send email to the article author
| Rights and Permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |