Reaching Consensus: Development of an Advocacy 2.0 Instructional Model for Schools and Programs of Public Health

ABSTRACT

Policy adoption and effective policy implementation have proven to be two of the most effective tools available for improving public health. As the field of public health becomes more focused on improving the social determinants of health, dismantling structural racism, and tackling chronic disease and other public health problems, training the workforce in how to effectively engage in policy change advocacy becomes essential. Despite authoritative mandates requiring schools and programs of public health to teach advocacy to students, studies suggest a lack of workforce preparedness to effectively engage in policy change processes. Both a preliminary environmental scan and a subsequent analysis of the current state of advocacy teaching in schools and programs of public health (SPPH) suggest that the current advocacy instructional model may contribute to this lack of workforce preparedness. The leadership challenge seems to be rooted in the current SPPH academic culture/climate, lack of SPPH faculty training/capacity, and lack of a usable innovation (i.e., lack of consensus on both essential advocacy skills and an advocacy definition). By engaging SPPH administrators, faculty, students, employers, and advocates in a national consensus process, we can better define public health advocacy and the essential skills needed by public health students and take steps towards a more implementable Advocacy 2.0 instructional model that will better prepare the public health workforce for the adaptive challenges ahead.

Implementation science frameworks may help to explain why public health students are underprepared to engage in advocacy campaigns. Several frameworks analyzed point to potential flaws in advocacy instructional model design and a lack of SPPH readiness to adopt an effective advocacy instructional model. Redesigning the current advocacy model (aka Advocacy 1.0) into a more usable innovation (aka Advocacy 2.0) and increasing SPPH readiness to implement this new instructional model may help better prepare students and the overall workforce effectively engage in advocacy campaigns that will solve present and future public health challenges.

Using a pragmatic lens, a pre-action research approach, and an expert-informed Delphi Research Method, this study explored whether a national consensus process could help to create a more usable Advocacy 2.0 instructional model for schools and programs of public health. This study utilized a modified e-Delphi Research Method to engage advocacy experts in a consensus process to determine public health advocacy’s definition, a set of needed advocacy skills for students and practitioners, and fidelity measures meant to increase consistency of skill instruction in SPPH. This study resulted in a consensus definition of public health advocacy and its core elements, an overall list of 69 advocacy skills that SPPH should consider teaching to students wanting to specialize in public health advocacy, a subset of 24 essential advocacy skills that should be required learning for all MPH students enrolled in SPPH to help them better engage in advocacy activities regardless of their chosen academic specialty, a subset list of 23 important but not essential advocacy skills that curriculum designers might consider adding to advocacy-related courses if there is space, and a list of consensus andragogical approaches (i.e., methods and principles used in adult education) for five of the essential skills.

The research findings will be used to develop future SPPH guidance that may aid in the implementation of a new Advocacy 2.0 andragogy and result in a better prepared and more competent workforce ready to engage in advocacy campaigns.