#1 Health Advocacy Education in South Africa

Host: Jonathan Sherbino


Dr Jonathan Sherbino, portrait.
Photo: Erik Cronberg

Today’s article:

Staden, D. van, & Duma, S. (2022). The teaching, learning and assessment of health advocacy in a South African College of Health Sciences. South African Journal of Higher Education, 36(5), Art. 5.


It’s tricky starting from scratch.  Or perhaps I’m reading too much into this.  But I wanted my first selection for The PAPERS podcast to reflect a little something about me… and the scholarship that moves me.  I think this paper is a great representation. 

The first and most obvious theme is health advocacy.  Jason and Linda, you will know that I led the working group on Health Advocacy for CanMEDS 2015.  Advocacy is a tricky thing… should all physicians do it?  Does everyone have to go after big tobacco? What really is advocacy?  And so shout out to some of the world class research that I’ve been fortunate to connect with and who continue to advance the field – Maria Hubinette (profile on Twitter) and Jennifer Hulme (profile on Twitter) .  But this paper also speaks to friends and colleagues – connected by the health professions education community from around the world.  This paper connects me to South Africa, where I have had the good fortune to become friends with Flavia Senkubuge -who is a professor of public health medicine and the youngest and first Black woman to serve as the president of the Colleges of Medicine of South Africa. (Also she has a Wikipedia page; Flavia Senkubuges Wikipedia page.) 

So this paper – advocacy and an international community of health educators has it all!   

  • Jason:  Advocacy is a big domain… how do you define it?  
  • Lara: Why should physicians be advocates?
  • Linda: What is your experience in teaching it? 

Ok, that’s a good place to situate this conversation, let’s dive into the article! 


The authors state: 

“This research therefore set out to investigate the extent to which health advocacy as a core competency within health professions education and training is taught and assessed within health professions training programmes at a South African university.” 


This is a sequential mixed-methods study of undergraduate programs at a single college of health sciences with programs in audiology, dental therapy, medical science, medicine, nursing, occupational therapy, pharmacy, physiotherapy speech language therapy, sport science and optometry.  

A convenience sample of 8 of 12 curricula were mapped, using explicit and implicit search terms (e.g., advocate, social justice) to identify relevant learning outcomes.  Content analysis, including frequency of learning outcomes, was completed to identify common and different competencies relevant to health advocacy.  

Key informant focus groups were conducted with recruitment via purposive sampling. The questions addressed how health advocacy is taught, assessed, and incorporated into curricula. Thematic data analysis of transcriptions and field notes was performed by the PI.   A second researcher re-coded the data to ensure credibility.  

Key themes identified by the coding was triangulated to the curriculum mapping results.  


There were 6 key themes: 

  • Perceived importance of HA role for health practitioners
    • HA is necessary and valued competency for health professionals to address social injustice and health inequities.
  • Implicit HA content in curriculum
    • HA content is NOT explicitly (only one of eight programs) articulated in curriculum maps with no program specifying specific skills.
  • Health advocacy as an implicit learning outcome
    • Implicit learning occurs via projects and experiential learning opportunities. 
  • Teaching HA in a spiral curriculum approach
    • A lack of experience requires differential expectations and iterative learning between novice and experienced learners  
  • Authentic Assessment of HA
    • Peer assessment, self-reflection, and project presentations are common assessment methods.
  • Barriers to full incorporation of HA into health sciences curriculum
    • Imprecise definitions and expectations, limited educational resources, and lack of institutional leadership impairs HA curricula. 

Overall, the importance of the topic, as identified via key informant interviews is unbalanced via the design, delivery and support of HA education. 

This study is limited as the student experience is not included in the data collection nor analysis. 


HA is perceived as an important role for health professionals but it is not explicitly taught and assessed in undergraduate health sciences programmes. Barriers to its teaching and assessment can be addressed through capacity development of academics.” 


References and resources mentioned in the episode

  • Braun, V., & Clarke, V. (2021). Thematic Analysis: A Practical Guide. Sage Publications Limited.
  • Frank, J. R., Snell, L., & Sherbino, J. (2015). Canmeds 2015 Physician Competency Framework. Royal College of Physicians and Surgeons of CA.

Thank you

For listening and following Papers Podcast

What are your experiences in of Health Advocacy? Do you have it in your program? How does it occur? And do you assess it? Please share your experiences and examples. Comment below or via LinkedIn or Twitter.


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