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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