Health Science

Communication

Biosci. Biotech. Res. Comm. 10(2): 53-57 (2017)

The advocacy skills of health workers in

Gilan Province

Soraya Shakory

, Fatemeh Rakhshani

and Ali Ramezankhani

Ph.D.Student of Health Education & Promotion,Public Health Department, Shahid Beheshti University of

MedicalSciences, Tehran,Iran

Professor of Health Education, Safety Promotion and Injury Prevention Research Center (SPIPRC), Public

Health Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Professor of Health education, Public Health Department,Shahid Beheshti University of MedicalSciences,

Tehran,Iran

ABSTRACT

Since advocacy affects the decision-makings related to public policy, this study aims at assessing the advocacy skills

of health workers in Gilan province.The main objective of the present research was to assess the advocacy skills of

health workers in Gilan province. This cross-sectional study has been carried out in 2016 on 80 employees of health

centers in Gilan province. The instrument included a self-made questionnaire with content validity ratio (CVR) of

0.8 and content validity index (CVI) of 0.9. The results were analyzed using SPSS 17 software and descriptive tests.

The mean advocacy score of the employees was equal to 14.1 ± 6.3 out of 40. There was no signi cant difference

between the advocacy score and genders and work experience.Based on the results, it is necessary to train employees

to cooperate with other health-related organizations.

KEY WORDS: ADVOCACY SKILLS, HEALTH WORKERS, GILAN PROVINCE

ARTICLE INFORMATION:

*Corresponding Author: rakshanif@gmail.com

Received 12

Feb, 2017

Accepted after revision 18

May, 2017

BBRC Print ISSN: 0974-6455

Online ISSN: 2321-4007 CODEN: USA BBRCBA

Thomson Reuters ISI ESC and Crossref Indexed Journal

NAAS Journal Score 2017: 4.31 Cosmos IF : 4.006

reserved.

Online Contents Available at: http//www.bbrc.in/

INTRODUCTION

Advocacy is a process, in which individuals and organi-

zations try to affect the public policy decision-making

(Stafford and Mitchell, 2009). The goal of advocacy

programs is to increase the ability and willingness of

communities to participate actively in determining the

health and development issues and application of solu-

tions to meet their health needs (American Public Health

Association, 2012).

On the other hand, one of the goals of the people

working in the health care system is to establish a

54 THE ADVOCACY SKILLS OF HEALTH WORKERS IN GILAN PROVINCE BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Shakory, Rakhshani and Ramezankhani

change to improve the health of the community.If the

changes are re ected in the policy-makings and rules,

they will have long-term effects (Bateman, 2000). The

enforcement of advocacy will lead to the promotion of

community participation, empowerment and develop-

ment of democratic methods in the systems for provid-

ing health services (Moore et al., 2013). Therefore, in the

 eld of health, in addition tothe knowledge and spe-

cialized skillssuch as clinical skills and communication

skills, the skill for designing and implementing an advo-

cacy program is considered among key skills (Shams

et al., 2013).

In this regard, health educators believe that a com-

prehensive advocacy is an integral part and an impor-

tant inseparable strategy for health promotion.So

health workers who communicate with people and tar-

get groups, and make efforts to create the context and

healthy and health supporting environments, should

equip themselves with knowledge, skills and methods of

planning of comprehensive advocacy programs (Caira

et al., 2003). As the understanding of the principles and

key concepts of advocacy, and proper use of them in

line with health system goals, besides educational meas-

ures, and health care provision can increase the effec-

tiveness of measures taken in this regard. To this end,

the World Health Organization has published the educa-

tional materials about advocacy skills for health work-

ers (International Council of Nurses, 2008; World Health

Organization, 2003).

The programs designed based one comprehensive

advocacy include components foridenti cation and

analysis of the problems, development general and spe-

cialized goals, identi cation and analysis ofthe stake-

holders, fabrication of an advocacy message, selection

and implementation of the advocacy strategy, prepara-

tion of the advocacy proposal and planning (JHU/CCP;

CEDPA, 1999). Investigation of studies in Iran suggests

applying a comprehensive advocacy strategy to reduce

salt intake at the community level and at-risk groups,

and the use of disposable plastic containers (Moham-

madifard et al., 2012; Amini et al., 2009). The study of

King et al. (2015) with the aim of evaluating the one year

results of educational intervention of health advocacy

among the youths to gain the advocacy of those health

policies promoting the community demonstratedthat

advocacy intervention in the future is recommended

(King et al., 2015).

Given that the employees employed at the headquar-

ter level should have a proper and effective relationship

with clients and partners, moreover, they need to com-

municate with other organizations and higher of cials

and key people to convince them to do health care. This

study aims at evaluating the advocacy skills among the

health workers in Gilan Province. The present study's

main purpose was to assess the advocacy skills of health

workers in Gilan Province.

METHODOLOGY

This cross-sectional study has been carried out in 2016

on 80 employees of health centers in Gilan province

using a random sampling method. Inclusion criteria

comprised having a bachelor's degree and higher, and

work experience of more than  ve years. Data collection

tool included a self-made questionnaire with content

validity ratio (CVR) of 0.8 and content validity index

(CVI) of 0.9. The  nal questionnaire consisted of six

parts, including selection of advocacy topic (7 questions),

the stakeholders analysis (5 questions), development of

a message (3 questions), encouraging techniques and

approaches (13 questions), the proposed plan (1 ques-

tion), and program assessment (1 question). 1 score and

two scores were assigned to the correct answer of the

closed questions andopen questions, respectively. Using

SPSS 17 software, the data were analyzed and descrip-

tive tests (frequency, mean and standard deviation) were

used for data analysis.

RESULTS AND DISCUSSION

The mean age of participants was 43.8 ±3.8, 56.2% male;

the majority had undergraduate education (93.8%), and

with work experience of 5 years. According to the results

of Table 1, the mean score gained for various parts are

as follows: issues and goals with score of 3.4 (maximum

9 score), stakeholders with score of 2.7 (maximum six

points), message with score of (maximum four points)

0.5, encouraging techniques and approaches with score

of 6.9 (maximum 17 points), action plan with score of

0.2 (maximum two points) and evaluation with score of

0.2 (maximum 2 points). In general, given that the mean

score for the advocacy of health workers was14.1, only

35 percent of them had the necessary skills for advo-

cacy. Based on the mean scores of the individuals in

each section following results were obtained: the skill

level of employees in selecting the topic is equal to 38%,

determining the stakeholders is equal to 44 %, devel-

opment of the message is equal to 14.5%, encouraging

techniques and approaches is equal to 41%, action plan

is equal to 10%, and evaluation is equal to 11 %. Table 2

presents the values obtained for - mean advocacy score.

With regard to table 2, the mean scoreout of the whole

questionnaire was 14.1 out of 40, and the highest score

achieved was related to the employees of the Health

Education Department, and Network Development.

As the results indicate, the highest scores are related

to selecting topic questions (essential features gaining

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS THE ADVOCACY SKILLS OF HEALTH WORKERS IN GILAN PROVINCE 55

Shakory, Rakhshani and Ramezankhani

Table 1. Distribution of correct answers, average and standard deviation of the subjects on the basis

of advocacy components

Questions Frequency (%)

Subject selection

The de nition of advocacy 6(7.5)

The main objective of the advocacy strategy 48(60)

The main difference between advocacy strategy with IEC strategy 59(73.8)

Essential characteristics 69(86.2)

The  rst step in advocacy 55(68.8)

Prioritization and selection criteria issue 24(30)

Choose a theme framework program 5(6.2)

Mean of subject selection(SD) 3.4(1.6)

Determine stakeholder

The de nition of stakeholders 9(11.2)

Categories of stakeholders 49(62.2)

Highlights Stakeholder analysis 65(81.2)

Specify the primary bene ciaries of the high death rate of motorcyclists in accidents 41(51.2)

Specify secondary bene ciaries of the high death rate of motorcyclists in accidents 45(56.2)

Men of Determine stakeholder(SD) 2.7(1.5)

Development message

Write a message to problems Question 11 18(22.5)

Features of an Effective Message 12(15.0)

The  rst step is to produce messages 4(5.0)

Mean of Development Message 0.5(1.0)

choosing the persuasive approaches

Persuasion techniques suitable for all stakeholders 67(83.8)

To in uence the debate on which group is involved? 62(77.5)

The main feature negotiation 55(68.8)

A variety of ways to negotiate 24(30.0)

In the absence of a superior position to negotiate your way 41(51)

Negotiation technique, especially if you are going to their relationships with partner 67(83)

Which potential problems are overcome using the skill via which the negotiator can put

himself in the position of opposite side and see the situation from his perspective?

2(2.5)

Stages of Negotiation 11(13.8)

The lack of negotiations 41(51.2)

Measures to negotiate 11(13.8)

Which group involved in bargaining or lobbying for better? 56(70.0)

The main focus on bargaining 59(73.8)

Important to implement effective bargaining 9(11.2)

Mean of Choosing Persuasive approaches 6.9(2.8)

The action plan preparation

Stage of action plan 0.2(0.6)

Mean of the Action Plan Preparation 0.2(0.6)

Evaluation

Evaluation program 0.2(0.6)

Mean of Evaluation(SD) 0.2(0.6)

Mean of Total Score(SD) 14.1(6.3)

56 THE ADVOCACY SKILLS OF HEALTH WORKERS IN GILAN PROVINCE BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Shakory, Rakhshani and Ramezankhani

advocators) and the selecting the encouraging approach

and techniques (encouraging techniques appropriate

for stakeholders and the negotiating method aiming to

establish favorable relationships with the negotiating

party) and the lowest scores were related to the select-

ing the encouraging approach and techniques (the skill

with which the negotiator can be in the position of the

other party and see through his eyes), the development

of the message (the  rst stage to produce a message for

comprehensive advocacy programs) and topic selection

(the framework to select the topic of advocacy program)

andin general, the scores obtained in parts of topic selec-

tion (advocacy de nition), while the scores obtained

for preparation of an action and evaluation plan were

not satisfactory and this could indicate a defect in their

knowledge in these  elds.The results obtained bySiamin

et al. (2014) indicated that the scores of participants

among communication skills was such that punishment

and reward skill had the highest score, and the feedback

skill had the lowest score (Siamian et al., 2014).

Belkowitz et al. (2014) in a study entitled "health

advocacy education to medical students at the Univer-

sity of Miami Miller", concluded that advocacy educa-

tion to medical students can be bene cial in promoting

the knowledge on comprehensive advocacy of students

and their skill in addressing the health issues (Belkowit-

zet al., 2014). The results of the study, entitled " rst year

medical students' attitude on advocacy in Medicine" by

Press et al. (2015) with a main aim of introducing the

advocacy course, proved that adding advocacy to the

curriculum makes the students able to perceive their

professional role (Press et al., 2015).

According to the results, the departments with health

education program and the development department

exhibited a better performance. In general, the scores of

the departments were less than the half of the expected

advocacy score. Therefore, the need for education in all

departments, especially school health department with

the lowest score seems to be essential. The study of Lang

et al. (2014) was done with the aim of bridging the gap

in the curriculum of residents and other health work-

ers during the years 2011-2013. The results showed an

increase of approximately 1 score in the score of advo-

cacy. It was also suggested that advocacy education and

health policy should be considered as an important com-

ponent in the education of specialists (Long et al., 2014).

In this regard, the Peltzeret al. (2016) showed that

de ning the periodical assignments for undergraduate

and graduate students working with the government

was conducive to further learning in the  eld of advo-

cacy (Peltzer et al., 2016). Also de ning an advocacy

course and one internship course for medical students

in the study of Lang et al. (2011) also represented an

increase in empowerment, improved ef cacy in advo-

cating their health, and in general showed that the advo-

cacy curriculum based on gaining learning experience

community-based services is effective in increasing the

empowerment of the students, and tendency to serve the

community (Long et al., 2011).

CONCLUSION

According to the results, it is recommended that increa-

sein the advocacy skills in formal educational and in-

service programs is highly required.

ACKNOWLEDGMENT

This paper was part of a research project thesis, entitled

“Development of assessment tool of Advocacy skills and

study of effectiveness of education for promotion these

skills among health workers in Gilan province 2016,

approved by Shahid Beheshti University of Medical Sci-

ences in 2016 under the code: Ir. SBMU. Retech.REC.

13950305

Table 2. Mean advocacy score based on organizational units, health care

workers

Unit N Mean Std. Deviation

health education 5 17.40 8.142

occupational Health 7 12.86 3.338

Environment Health 14 13.14 4.990

Family Health 22 14.14 7.206

School Health 5 8.80 5.675

Disease 11 14.36 7.366

Expand 6 17.17 7.195

Nutrition 5 15.00 5.000

Mental Health 5 16.40 5.273

Total 80 14.17 6.358

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS THE ADVOCACY SKILLS OF HEALTH WORKERS IN GILAN PROVINCE 57

Shakory, Rakhshani and Ramezankhani

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