title: Inspiring health advocacy in family medicine: a qualitative study.
abstract: BACKGROUND
  The Canadian Medical Education Directions for Specialists identifies health advocacy as an essential role for physicians. Health advocacy is also an integral part of the principles of family medicine. It relates to the physician's responsibility to identify and respond appropriately to the social determinants of health and the healthcare needs of vulnerable and marginalized populations. The competencies related to health advocacy are regarded by medical educators as difficult to integrate into residency training.
  
  
  OBJECTIVE
  This qualitative study investigates what family medicine residents, educators and physicians perceive inspires them to engage in health advocacy, and explores how best to incorporate related competencies into medical training.
  
  
  METHODS
  In-depth, semi-structured interviews conducted with a purposive sample of four family medicine residents, three physicians and two educators who self-identified or were identified by peers as health advocates. Interviews were recorded, transcribed and analyzed using framework analysis. Transcripts were made available to the participants to ensure transcript accuracy.
  
  
  RESULTS
  Early exposure to social injustice, parental influences, role modeling and internal motivators were seen as important inspirations for health advocacy.
  
  
  CONCLUSIONS
  Creating an enabling and nurturing environment prior to and during residency training may be necessary to sustain the motivation to engage in health advocacy. Findings from this study suggest possibilities for a resident-guided participatory curriculum development process around health advocacy. Recommendations for promoting health advocacy in postgraduate training include effective integration of health advocacy in the curriculum by providing protected time and resources, providing experiential learning opportunities and fostering a community of practice for physician health advocates.
authors.affiliation: The University of British Columbia, Vancouver, BC, Canada. lisajjmu@gmail.com
authors.forename: Lisa
authors.initials: L
authors.lastname: Mu
authors.forename: Farah
authors.initials: F
authors.lastname: Shroff
authors.forename: Shafik
authors.initials: S
authors.lastname: Dharamsi
mesh_terms: D002170:Canada; D005194:Family Practice; D006801:Humans; D007407:Interviews as Topic; D010344:Patient Advocacy; D010819:Physician's Role; D012935:Social Justice; D012941:Social Responsibility