Abstract
In the previous letter, we looked at what advocacy means, its types and processes needed to advocate for someone or something. In this letter, we cover how to advocate for various groups of patients who may come from vulnerable communities.
We shall begin with various methods that can be used for the purposes of advocating. The skills needed for advocating and giving a clear message can be learnt. It is important to be clear about who the target audience is, what the message is and how this message is going to be understood and conveyed accordingly. It is helpful to steer away from technical jargon. Often because doctors are experts in their specialty, they use the language that may be jargonistic to an average listener. It should be possible to break down larger advocacy skills into their smaller subsets so that messages can be both big and small. The doctor must be fully aware of these components to ensure that the messages they are giving are simple. An easy-to-understand straightforward language must be used to convey these messages and avoid complex, jargon-filled ones. A degree of preparation is essential, and rehearsals can be helpful. Even big-name politicians often try out their messaging privately before facing their audiences in public. These skills about communication will be described at some length in a subsequent letter.
Clinical research can be an effective tool in sharing ideas and helping influence policy development. Research findings can enable doctors to argue more effectively, provided they are able to demonstrate that clinical application of latest research findings may help improve services, alter clinical practice by making it more effective, leading to better outcomes. Research can be applied to provide better targeted and personalised treatments, and if successful, these examples can be used to educate stakeholders and influence policy.
As part of the role as an advocate, doctors can build on the skills and information they give routinely to their patients and patients’ care partners. Incorporating evaluated research evidence can help strengthen arguments, and doctors must be prepared to look at counter evidence being provided so that informed debate can take place. A key advantage in oral presentations is an ability to engage competently as well as sensitively respond to questions and audience responses. These messages can be conveyed using online approaches but interactions may be stilted.
The second type of communication skill is using written information, which can again be through online communications in various media. These messages need to be clear and effective and target the potential readers. Letters to editors and op-ed columns can help in generating a debate, thereby building potential alliances, and this also offers an opportunity for understanding and responding to potential as well as real objections. A key facet of communication is clear messaging that must be succinct and focused.
As described in a previous letter, the advocate needs to be cognisant of target of advocacy, e.g. whether it is organisational, legislative, patient family, community or at regional level. These approaches look at specific targets and thus written information, including leaflets etc., can be developed and used accordingly. However, use of language for written as well as oral information has to be simple, clear and culturally appropriate. Working with teams can be helpful especially when advocating for vulnerable groups. By identifying the strengths and weaknesses of various team members, responsibilities for various actions within the process of advocacy can be delegated. Doctors need to be aware of local systems and legislative functioning and frameworks, as well as be able to develop and work in networks. A key competency identified in this context by Kennedy and Gilman 1 is that of perseverance and resilience. There is every likelihood that depending upon the political system there may not be many options, or advocacy gets ignored multiple times, which can make the doctor feel unable to cope and may even lead to poor resilience and likelihood of burning out.
Advocacy relies on message transmitted directly or indirectly, type of target audience, specific environment in which advocacy-related messages are delivered and various other factors that may help convey the right message at the right time and open-mindedness of the audience. Experience in advocacy can be gained by shadowing, being part of an ongoing campaign and subsequently being mentored.
Advocating for vulnerable groups depends on identifying specific challenges various vulnerable groups face and how they and their views can be represented. Advocacy and activism need to be differentiated.
Children and young people
Children and young people often face physical and psychiatric problems, and the onset of various illnesses needs addressing with parents, teachers, school systems and education is important to develop preventive strategies. Early identification of distress, whether physical or mental, and early interventions are essential. These can only happen with proper engagement with all stakeholders, including parents, teachers, policy makers, etc. Where possible, this engagement needs to start with education about illnesses the children are susceptible to, and partnerships with parents and teachers will be fruitful. By identifying needs of children and the families and championing their causes can help.
In the UK, in recent times, child poverty has become a major issue that needs to be tackled, and often non-government organisations may be better placed to take this agenda forward; hence, working with them can raise the profile of various issues and help solve problems through advocacy. Local-level advocacy can be through community panels, WhatsApp groups, patient, carer and community groups, where people can discuss problems and share experiences to help other parents and teachers to manage various illnesses. For each of the vulnerable groups, similar groups can be set up. At regional and national levels, different approaches using local and national media can take place.
Older adults
As older adults are more likely to have complex co-morbidities, very often they end up falling between two specialties. Hence, it is critical that advocacy efforts are collaborative and that public health perspectives are integral to these efforts. Furthermore, very often, families look after older adults and their needs must be recognised and they must partner any advocacy efforts. Social care, where available, should be supported and involved as partners in advocacy work.
Gender
Many conditions are more common in women and they are also more likely to be caregivers in the family. Thus, their involvement in advocacy can be extremely helpful as they can personalise experiences of care giving. They can be powerful voices in highlighting advocacy issues.
LGBTQ+
There is considerable evidence that discrimination against LGBTQ+ individuals at both the institutional and personal levels stops them from seeking help, which affects therapeutic outcomes. Considering internalised stigma in some individuals, any advocacy must involve community organisations and individuals as well as care partners. Advocacy may be needed while working with families, partners, employers, etc., taking into account factors such as age, gender, religious values and local legal situation, as in many countries and settings same-sex behaviour is illegal and punishable by law. Hence, strategies for advocacy may require tailoring according to cultures.
Migrant groups
In the past decade or so, in many countries, there has been an increasing anti-migrant rhetoric that has led to often very institutionalised/organisational racism. These policies then stop people from seeking treatment, affecting therapeutic engagement, and subsequent poor outcome. Clinicians need to be aware of their own prejudices and biases and through cultural competency are best placed in providing access to services and helping improve therapeutic engagement.
Engaging with the media will be described at length in a subsequent letter. Suffice it to say that support can be built from interviews, podcasts, written articles, and the use of social media. While working with specific groups, targeted strategies may be required in engaging them as partners in advocacy. Clinicians can and must work with other professionals to create collaborative models in developing strategies for advocacy. Not all clinicians may be aware or familiar with latest developments in other fields of medicine; hence, working with colleagues can help develop partnerships to create effective targeted advocacy strategies. Working across medical disciplines can strengthen advocacy.
To conclude, it is important that doctors are aware of advocacy, and even if they do not have specific skills, they can work with other stakeholders to educate and influence policy at local, regional, national or international levels. Illnesses need to be recognised in the context of social and geopolitical factors, and doctors, by virtue of their clinical experience and status as valued members of society, can provide true leadership in developing advocacy skills.