Health advocacy: A gulf between instruction and practice

Systematic ways to teach health advocacy, an educational outcome for pharmacy graduates, is lacking. We developed a workshop to facilitate understanding and application of a novel structured framework for health advocacy and explored how pharmacy students enacted opportunities for health advocacy during subsequent outpatient experiential training. A two-hour workshop was introduced for year 2 students in 2019. Its content was organized around a health advocacy framework. With patient and faculty facilitators, students worked through examples characterized into the framework's four quadrants: 1) shared advocacy “with patients” at the individual- or 2) systems-level and 3) directed advocacy “for patients” at the individual-or 4) systems-level. We then conducted a longitudinal diary study asking pharmacy students ( N  = 23) to reflect on opportunities to practice health advocacy skills in community pharmacy practice. A systematic, multi-coder reflexive thematic analysis of diary entries was employed. Pharmacy students did not express a fulsome view of patient health advocacy and mischaracterized self-reported practice examples into inappropriate categories of the health advocacy framework. Most overemphasized usual pharmacist care as acts of health advocacy. No systems-level activities were undertaken, although isolated episodes of shared advocacy with patients were identified. Lasting impacts of a health advocacy workshop in our pharmacy curriculum were not widely apparent. While longer training periods in community pharmacy practice may yield more opportunities to develop and enact this role, gaps in student conceptualization of health advocacy and inabilities to practically observe and exercise system-level advocacy are ultimately problematic for patient care.