title: From the clinic to the community: the activities and abilities of effective health advocates.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Ms. Dobson is project director, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada. Dr. Voyer is clinical assistant professor, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Dr. Hubinette is clinical assistant professor, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Dr. Regehr is associate director of research and senior scientist, Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dobson
authors.forename: Stephane
authors.initials: S
authors.lastname: Voyer
authors.forename: Maria
authors.initials: M
authors.lastname: Hubinette
authors.forename: Glenn
authors.initials: G
authors.lastname: Regehr
mesh_terms: D001955:British Columbia; D003256:Community Participation; D003159:Community-Institutional Relations; D006293:Health Promotion; D006801:Humans; D010344:Patient Advocacy; D010819:Physician's Role; D066107:Social Skills