Defining advocacy in public health: a scoping review to inform policy, training, and equity-oriented action

Abstract

Background

Advocacy is widely recognized as a catalyst for equity in health, yet its conceptual foundations, operational forms, and evaluative criteria remain fragmented. In health systems, advocacy is expected to amplify marginalized voices, address structural determinants, and promote participatory governance, but there is limited consensus on its definition and implementation. This scoping review systematically maps how advocacy has been conceptualized, practiced, and evaluated across public health and healthcare domains in democratic societies, with particular attention to its role in advancing equity.

Methods

We conducted a scoping review across four databases (PubMed, Scopus, Web of Science, CINAHL) including peerreviewed literature from health, legal, political, and social domains. Eligible studies explicitly addressed advocacy in health and care contexts, providing conceptual definitions, theoretical frameworks, or descriptions of practice, education, and evaluation. Thematic synthesis was applied to identify recurrent dimensions, strategies, and values.

Results

A total of 146 documents were included. Advocacy was consistently framed as a deliberate, value-driven practice oriented toward systemic change, social justice, and equity, despite considerable conceptual and operational variability. Applications spanned clinical care, public health promotion, community mobilization, and policy reform. Relational and communicative skills were widely emphasized as enabling factors, but evaluation remained limited: only 6 studies (4%) reported the use of specific measurement instruments, none of which were standardized. From this synthesis, we developed a preliminary blueprint for equity-oriented public health advocacy, structured around six components: normative grounding; multilevel orientation; relational and communicative practices; critical and systemic literacy; reflexive professionalism and civic agency; and evaluation and accountability mechanisms.

Conclusions

Advocacy emerges as both a professional competency and a civic practice essential for equity-driven health systems. This review provides a conceptual foundation and a translational framework to guide integration of advocacy into policy, training, and practice. Sustained collaboration between academia, civil society, and health systems is required to institutionalise advocacy as a driver of just and inclusive health governance.

Registration

OSF: https://doi.org/10.17605/OSF.IO/MEJHX

Introduction

Advocacy has become a central concern in contemporary public health and healthcare systems, where it is increasingly recognized as a critical lever to promote equity, amplify marginalized voices, and drive systemic transformation [1, 2]. The World Health Organization (WHO) has explicitly positioned advocacy as a fundamental function of health promotion, particularly in advancing people-centered and equity-driven health systems [3]. Across disciplines, advocacy is invoked both as a professional responsibility and as a civic practice, linking lived experiences to institutional decision-making and policy reform [4, 5]. It is also increasingly framed as an essential competency for health professionals, community leaders, and civil society actors to address structural determinants of health, redistribute resources, and challenge entrenched inequities [6–8]. From shaping legislative agendas to fostering community empowerment—understood as strengthening communities’ capacity to articulate priorities, participate in decision-making, and influence the conditions affecting their health—advocacy serves as a bridge between evidence, ethics, and power in the pursuit of just and inclusive health systems [9–11].

However, advocacy cannot be understood as a singular or static concept: while its core normative commitments may remain stable, both the meanings attributed to advocacy and the strategies through which it is enacted evolve in response to changing configurations of power, knowledge, and governance within health systems [12]. For instance, within global public health, advocacy practices and strategies have evolved in parallel with transformations in aid architectures, the rise of philanthropic actors, and transnational movements for human rights and climate justice [13, 14]. These shifts reflect broader dynamics such as health consumerism, welfare restructuring, the growth of civil society, and global mobilisations around equity and health rights [15]. Advocacy may be undertaken by professionals or patients, through formal organisational strategies or grassroots networks, and may target clinical practices, institutional policies, or public legislation. Its expressions are therefore multidimensional, spanning bedside clinical decision-making, patient representation, public campaigns, curriculum development, and legal initiatives. For instance, studies have examined how advocacy is conceptualised, taught, and operationalised within medical, nursing, and public health education. This body of work highlights a growing emphasis on advocacy-related knowledge, skills, and experiential learning within health professional training, particularly in relation to policy engagement, community action, and equity-oriented practice [16–18]; grassroots advocacy has been implemented via community health worker programs aimed at equity in low- and middle-income countries (LMICs) [19]; and legal advocacy through medical–legal partnerships demonstrates that addressing health-harming legal needs can contribute to health justice [20]. Throughout this review, the term advocacy is used as an overarching concept to capture a family of practices operating across public health and healthcare contexts. While the analysis is grounded in public health systems and equity-oriented goals, it encompasses diverse forms of advocacy—including public health advocacy, patient advocacy, and community-based advocacy—which differ in actors, targets, and levels of action, but share common normative commitments and mechanisms relevant to equity.

Yet, despite this diversity, advocacy remains under-theorized and inconsistently operationalised across contexts, often described more in normative terms than as an object of systematic study [5, 21]. Despite its strategic relevance, advocacy frequently lacks theoretical clarity and operational consistency. While endorsed in institutional discourse, curricula, and policy guidelines, its ethical assumptions, mechanisms of action, and scope are often implicit or contested [21, 22]. In healthcare settings, advocacy is sometimes reduced to individual acts of speaking up; in public health, it may be framed as either structural reform or a tool for democratic engagement [16, 23]. This conceptual ambiguity mirrors broader debates in political science and social movements research, where advocacy is variably understood as lobbying, activism, representation, or empowerment [22]. Such conceptual fluidity creates challenges for empirical study, curriculum design, policy evaluation, and the professionalization of advocacy roles, thereby hindering its systematic integration into health systems.

Notably, frameworks such as Carlisle’s dual model of representational and facilitative advocacy highlight the dual goals of protecting vulnerable individuals and empowering them to achieve autonomy [24]. Similarly, Christoffel’s process and product model emphasises structured stages and outcomes of public health advocacy [25]. More recent analyses adopt evolutionary and systemic perspectives: Farias et al. [26] conceptualized advocacy as an intentional action spanning micro- to macro-levels, jointly implemented with and for communities, particularly those facing health inequities, with the aim of preserving or improving health, well-being, and empowerment for health promotion. Other scholars highlight advocacy as a practice of ‘boundary spanning’ across clinical, community, and policy domains, requiring relational skills, political literacy, and the ability to mobilize both formal evidence and lived experience [4, 23]. These approaches highlight advocacy’s adaptive and multi-level nature, but also underline the absence of consensus regarding core values, competencies, and evaluation standards.

In health and care contexts—where advocacy directly affects health outcomes, priorities, and resource allocation—there is a vital need to promote evidence-informed advocacy. This concept integrates research evidence with contextual knowledge and stakeholder perspectives, ensuring that advocacy strategies are ethically grounded and demonstrably effective [6, 27, 28]. Farrer et al. [1] define it as a deliberate effort to influence decision-makers using research-based evidence to improve health equity. Nurses’ policy advocacy, for example, has been framed as effective only when grounded in evidence and focused on social determinants of health [29]. Yet, systematic evaluations of advocacy remain scarce, and existing assessment tools are often context-specific and lack validation [30, 31].

This review addresses these gaps by offering a systematic, interdisciplinary analysis of how advocacy is conceptualised, theorised, and operationalised across public health, clinical practice, education, and social science domains in democratic contexts. The objectives are to: (1) clarify the conceptual landscape of advocacy; (2) delineate its core values, strategies, and competencies; (3) examine how advocacy has been integrated into education and training; and (4) assess available approaches to its measurement and evaluation. In doing so, the review lays the groundwork for more coherent, equity-oriented and evidence-informed advocacy scholarship and practice, while also identifying gaps that require further empirical investigation.

Methods

Study design

This scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews [32, 33] and is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) reporting guideline and checklist [34]. The study protocol was registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/MEJHX) to ensure transparency and methodological rigor.

The objective of the review was to examine how advocacy is defined, conceptualised, and operationalised across public health, clinical practice, education, and social science domains in democratic contexts. The synthesis aimed to identify theoretical models, operational components, values, and educational implications, with particular attention to interdisciplinary perspectives that bridge health, legal, social, and policy domains.

Eligibility criteria

Studies were eligible for inclusion if they:

(a) provided an explicit definition or conceptualization of advocacy in public health and/or (b) presented theoretical models, frameworks, strategies, tools, or core components (e.g., competencies) related to advocacy and (c) were situated in any context where advocacy impacts public health, including through action on the social determinants of health; and (d) were published in English, including both peer-reviewed and grey literature (e.g., empirical studies, policy papers, institutional documents, or editorials with analytical content).

Eligible studies included empirical research, educational reports, and theoretical or conceptual papers. Studies were excluded if they did not focus primarily on the conceptualization or definition of advocacy, if advocacy was not thematically central to the work, or if the discussion was not situated within public health, healthcare, or health-related policy contexts in democratic societies. Review articles, meta-analyses, concept analyses, and opinion pieces lacking analytical grounding were excluded, as were publications not written in English.

Search strategy and information sources

An interdisciplinary search strategy was developed and refined in consultation with domain experts and an advisory group of health researchers and advocates. Searches were conducted across four electronic databases—PubMed, Scopus, Web of Science, and CINAHL—to capture a comprehensive body of literature relevant to the conceptualization of advocacy in public health healthcare, education, and social science domains.

The search strategy combined controlled vocabulary and free-text terms across three domains: (1) types of advocacy (e.g., “policy advocacy,” “patient advocacy,” “community advocacy,” “professional advocacy,” “legal advocacy,” “media advocacy,” “youth advocacy”); (2) conceptual or theoretical framing (e.g., “definition,” “conceptualization,” “framework,” “model,” “principle,” “theory”); and (3) public health contexts (e.g., “public health,” “population health,” “global health,” “health promotion,” “health equity,” “health policy,” “health rights”). All searches were run in March 2025.

Screening and selection process

All records identified through the database searches were imported into Rayyan [35] and screened in two phases. In the first phase, titles and abstracts were independently assessed by two reviewers (M.M.; S.B.) for alignment with the inclusion criteria. In the second phase, the same reviewers (M.M.; S.B.) independently examined the full texts of potentially eligible articles. Any discrepancies at either stage were resolved through discussion and consensus. The review team comprised interdisciplinary scholars with expertise in public health, patient engagement, health communication, and health policy.

Data extraction and analysis

Data extraction was carried out using a structured form developed and piloted by the research team. The extracted variables encompassed publication details (authors, year, country, document type, and focus); conceptualizations of advocacy and its application context; advocacy characteristics, including category, level, and form; as well as advocacy goals and operational components. Methodological study design (e.g., quantitative, qualitative, or mixed methods) was not systematically extracted, as the primary aim of the review was to map the conceptual, theoretical, and operational representations of advocacy rather than to synthesise empirical effects or outcomes. Consistent with scoping review methodology, emphasis was placed on conceptual content and normative framing rather than on methodological appraisal. Accordingly, data extraction prioritised definitions, normative assumptions, advocacy goals, levels, forms, and operational components. While many included documents drew on empirical material, methodological design and analytic procedures were not treated as analytically central variables within the scope of this review. In addition, information was collected on normative underpinnings, such as underlying values and the implicit vision of health, on reported or expected outcomes, and on advocacy-specific measurement tools, where these were available.

Data were analyzed through a thematic synthesis approach. This process involved inductive coding of textual segments, identification of recurrent patterns across conceptual and empirical contributions, and cross-mapping of emerging themes with advocacy categories and levels. The synthesis was iterative, with regular team discussions to refine thematic groupings and resolve coding ambiguities.

Advisory engagement and reflexivity

To ensure the review’s relevance and credibility across stakeholder groups, the process was supported by a multidisciplinary advisory board, including public health scholars, patient advocates, clinicians, and policy advisors. The advisory board was involved in refining the research questions, validating the methodological approach, and interpreting the emerging themes in light of practice-based insights. Reflexive attention was paid to the positionality of the authors and the diverse epistemological frameworks shaping the interpretation of advocacy in health.

Results

Search results

The initial search yielded 17,194 records. After removal of 8112 duplicates, 9082 records were screened by title and abstract. Of these, 8736 were excluded as not meeting the eligibility criteria. Among the 346 reports sought for full-text retrieval, 52 could not be retrieved because the full texts were unavailable despite attempts to access them through institutional subscriptions, interlibrary loan services, or direct contact with authors, or because the sources were no longer accessible (e.g., inactive links or discontinued publications). The remaining 294 full-text articles were assessed for eligibility, leading to the exclusion of 200 (studies as they did not meet the inclusion criteria. Ultimately, 146 documents were included in the final synthesis. The search results and study inclusion process were documented in detail and presented in Fig. 1, following the PRISMA-ScR extension guidelines [34, 36].

Fig. 1.

PRISMA flow diagram of study selection and inclusion process

Descriptive overview of included studies

The included documents consisted predominantly of peer-reviewed scientific articles (n = 142; 97.3%), complemented by a small number of grey literature sources in the form of reports (n = 4; 2.7%). Collectively, these materials reflect both academic and practice-oriented perspectives on advocacy. Although the majority of included documents were peer-reviewed scientific articles, these encompassed a heterogeneous body of work, including conceptual and theoretical papers as well as empirical contributions, the latter most often relying on qualitative or descriptive approaches rather than formal evaluative designs.

The literature was geographically concentrated in high-income countries, with the United States contributing more than half of all documents (n = 81; 55.5%). Other countries with notable contributions were Canada (n = 7; 4.8%), the United Kingdom (n = 6; 4.1%), Australia (n = 7; 4.8%), and India (n = 4; 2.7%). A limited number of studies originated from Brazil, Chile, China, Ethiopia, Germany, Guatemala, Iran, Ireland, Italy, Japan, Kenya, Tanzania, Macedonia, Netherlands, Nigeria, Philippines, South Africa, Spain, Thailand, and Turkey. In addition, a set of 17 documents (11.6%) adopted a global or multi-country perspective. Across the three decades (1995–2025) covered by the review, an increase in publications was observed from 2010 (n = 122; 83.6%), indicating a growing scholarly and policy interest in advocacy within health-related contexts.

Table 1 summarizes the key characteristics of the included studies, including publication details, advocacy domains, conceptualizations, and reported outcomes.

Table 1.

Characteristics and main findings of included studies

Authors, year	Country	Document type	Focus	Advocacy application context	Advocacy category	Advocacy level	Form of advocacy	Advocacy conceptualization	Implicit health vision	Underlying values	Advocacy goals	Operational components	Expected/reported outcomes	Measuring instruments
Abdikeeva & Covaci, 2017 [37]	Macedonia	Scientific article	Conceptualization/definition	Protection of the right to health for roma communities	Policy, Legal, Health	Macro	Community, Systemic	Advocacy as a rights-based and legal process involving empowerment, documentation, media engagement, and litigation to improve accountability and access to health for Roma communities.	Bio-psycho-social	Social Justice, Equity, Human Rights	Access, Accountability, Empowerment, Rights	NGOs, Paralegals, Training, Strategic Litigation, Media Advocacy	Increased Awareness Of Rights, Legal Cases, Administrative Changes	NA
Abdikeeva et al., 2013 [38]	Multiple countries	Scientific article	Conceptualization/definition	Protection of the right to health for roma communities in multiple contexts	Policy, Legal, Health	Macro	Community, Systemic	Advocacy as civil society’s capacity to use legal frameworks and rights-based tools (empowerment, documentation, media, litigation) to challenge systemic violations in healthcare.	Bio-psycho-social	Social Justice, Inclusion, Civil And Human Rights	Human Rights, Access, Accountability, Participation	NGOs, Legal Advocacy, Media, Strategic Litigation, Empowerment	Reduction Of Violations, Greater Accountability, Systemic Impact	NA
Aliani et al., 2021 [39]	USA	Scientific article	Conceptualization/definition	Medical education	Policy, Health	Micro	Professional	Advocacy as broad social, economic, educational, and political action to reduce suffering and improve health, recognized as a core professional responsibility of physicians.	Bio-psycho-social	Equity, Social Responsibility	Education, Empowerment	Student Feedback, Thematic Analysis Of Focus Groups	Students Felt Unprepared For Advocacy Role	NA
Anselin et al., 2024 [40]	USA	Scientific article	Curriculum/training	Health system and policy	Policy, Health	Meso, Macro	Professional, Systemic	Advocacy as medical students’ engagement in partnerships with communities to address social determinants of health and advance health equity.	Bio-psycho-social	Equity, Empowerment, Justice	Equity, Participation, Systemic Reform	Stakeholders, Public Institutions	Policy Alignment, Institutional Engagement	NA
Babu et al., 2016 [41]	Multiple countries	Scientific article	Conceptualization/definition	Maternal and child health policy	Policy, Health	Macro	Systemic	Advocacy as a collective and organized effort to secure political and financial support for evidence-based health interventions (specifically, cardiac rehabilitation).	Bio-psycho-social	Accountability, Efficiency	Policy Influence, System Integration	Coalitions, Stakeholder Engagement, Government Outreach	Increased MCH Program Integration	NA
Bachofer, Velarde & Clithero, 2011 [42]	USA	Scientific article	Curriculum/training	Family medicine training, academic and community context	Health, Policy	Micro, Meso	Professional, Community	Advocacy as a professional role of physicians, cultivated through training, that enables them to act on behalf of patients and communities in both health and policy arenas.	Bio-psycho-social, Community-centered	Responsibility, Civic Engagement, Self-Determination	Training for Engagement, Participation, Local Advocacy	Medical Residencies, Legislative Sessions, Community Engagement, Policy Analysis	Awareness Of The Physician’s Role As A Civic Actor, Engagement	NA
Banas & Gershon, 2024 [43]	USA	Scientific article	Curriculum/training	Public health education and training	Health, Policy,	Meso, Macro	Professional, Systemic	Advocacy as the ability of students to influence conditions affecting personal, peer, family, school, and community health through planning, communication, and persuasive action.	Bio-psycho-social	Justice, Inclusion, Preparedness	Professional Preparedness, Systems Change, Policy Engagement	Interdisciplinary Courses, Skills Development, Practice-Based Learning	Increased Student Engagement, Preparedness For Advocacy, Enhanced Policy Literacy	NA
Belkowitz et al., 2014 [44]	USA	Scientific article	Curriculum/training	Pediatric residency training	Health,	Meso, Macro	Professional, Systemic	Advocacy as a set of skills and knowledge developed through service-learning and community partnerships in medical education.	Bio-psycho-social	Justice, Responsibility, Compassion	Equity, Systems Improvement, Professional Development	Resident Seminars, Case-Based Learning, Project Work	Improved Awareness And Role Identification	NA
Bernard et al., 2019 [45]	Canada	Scientific article	Conceptualization/definition	Medical student engagement	Health,	Micro, Meso	Professional, Community	Advocacy as part of physicians’ professional identity across micro, meso, and macro levels of social accountability.	Bio-psycho-social	Social Justice, Equity, Responsiveness	Social Accountability, Equity	Advocacy Skill-Building, Community Project Involvement	Enhanced Engagement, Empowerment Of Learners	NA
Bhattarai et al., 2020 [46]	USA	Scientific article	Conceptualization/definition	Medical education	Health, Policy,	Meso, Macro	Professional, Systemic	Advocacy as the application of Rehabilitation Psychology’s foundational principles to promote equity, requiring a shift from individual-level to systemic and structural action.	Bio-psycho-social	Responsibility, Justice	Social Change, Medical Professionalism	Elective Courses, Reflection Exercises	Greater Awareness, Role Clarity	NA
Bhatti et al., 2022 [47]	Australia	Scientific article	Curriculum/training	Climate and health policy	Policy	Macro	Systemic	Advocacy as the active support of a cause through diverse strategies (speaking, writing, mobilization) to improve health policy and equity.	Bio-psycho-social	Climate Justice, Public Health	Climate Resilience, Health System Reform	Coalition Building, Media Outreach, Stakeholder Lobbying	COP Participation, Agenda Visibility	NA
Bhojani, Venkataraman & Manganawar, 2013 [48]	India	Scientific article	Conceptualization/definition	Tobacco control, urban health	Policy, Community	Meso, Macro	Community, Systemic	Advocacy as collective action using legal, media, and civil society strategies to counter harmful industry–state ties in tobacco control.	Bio-psycho-social	Equity, Participation, Health Rights	Policy Reform, Awareness Raising	Community Coalition, Policy Engagement, Media Use	Tobacco Vendor Policy Changes, Community Mobilization	NA
Blenner, Lang & Prelip, 2017 [49]	USA	Scientific article	Curriculum/training	Public health training, university-community partnerships	Public Health, Policy	Meso, Macro	Professional, Community, Systemic	Advocacy as a broad mechanism for systemic change influencing population health through legislation, policy, community engagement, and media.	Bio-psycho-social, Person-centered	Social Justice, Empowerment, Collective Health	Advocacy Capacity, Public Health, Equity, Participation	Universities, Cbos, Field Training, Policy Projects And Media Advocacy	Advocacy Skills, Systemic Change, Strengthening Of Cbos	NA
Bogumil-Uçan & Klenk, 2020 [50]	Germany	Scientific article	Conceptualization/definition	Health policy advisory systems	Policy	Macro	Systemic	Advocacy as coalition-based policy action shaped by actor beliefs, resources, and governance structures in health digitalization.	Bio-psycho-social	Transparency, Accountability, Normative Guidance	Knowledge-Based Policy Influence, Evidence Translation, System Accountability	Policy Advisors, Scientists, Advisory Bodies, Political Decision-Makers	Conceptual Framework, Improved Understanding Of Advocacy In Policy Advisory	NA
Bozlak, Kenady & Becker, 2018 [51]	USA	Scientific article	Conceptualization/definition	Childhood obesity prevention	Community, Health	Meso, Macro	Community, Systemic	Advocacy as mobilization of community and faith-based resources to influence policy and environmental change for childhood obesity prevention.	Bio-psycho-social	Community Empowerment, Inclusion	Health Equity, Community Mobilization	Resource Assessment, Training, Stipends, Policy Messaging	Community Capacity To Engage In Advocacy	NA
Brender et al., 2021 [52]	USA	Scientific article	Curriculum/training	Medical education	Health, Policy	Meso	Professional	Advocacy as physician action to promote social, economic, educational, and political change to advance health and well-being.	Bio-psycho-social	Empathy, Social Justice, Civic Engagement	Student Empowerment, Health Reform	Workshops, Storytelling, Reflection Exercises	Skill Development, Attitude Change	NA
Brown et al., 2018 [53]	Canada	Scientific article	Curriculum/training	Health education in regional medical campuses; homeless population	Health	Meso	Professional, Community	Advocacy as community engagement and social accountability through research-based theatre in medical education.	Bio-psycho-social, Person-centered	Social Justice, Responsibility, Empowerment	Social Accountability, Empowerment, Education, System Responsiveness	Students, Communities, Research-Based Theater, Educational Strategies, Educational Resources	Empowerment Of Students And Professionals, Change In Perception Of Inequalities	NA
Bruns & Brubaker, 2022 [54]	USA	Scientific article	Conceptualization/definition	Counseling for gun violence prevention	Policy, Health, Media	Macro	Professional, Systemic	Advocacy as counselors’ systemic engagement against gun violence, guided by ACA Advocacy Competencies and CSI Wellness Competencies.	Bio-psycho-social	Justice, Wellness, Community Safety	Safety, Mental Health, Community Wellness	Use Of ACA Advocacy Competencies And CSI Wellness Competencies	Empowerment, Wellness Advocacy	NA
Carlisle, 2000 [24]	UK	Scientific article	Conceptualization/definition	Health promotion and public health practice	Health, Policy	Micro, Meso, Macro	Professional, Community, Systemic	Advocacy as both case-based protection of the vulnerable and cause-based empowerment of the disadvantaged, integrated into a conceptual framework to address health inequalities.	Bio-psycho-social	Social Justice, Equity, Representation	Equity, Voice, Social Justice, Empowerment	Nurses, Health Professionals, Service Users, Community Groups	Greater Inclusion, Better Resource Allocation, Influence On Health Policy	NA
Carson, Hancher-rauch & Gebru, 2018 [55]	USA	Scientific article	Curriculum/training	Public health student education	Health, Policy	Meso	Professional	Advocacy as a professional responsibility and skill set that public health practitioners must develop through experiential training to influence policy and improve health outcomes.	Bio-psycho-social	Civic Responsibility, Inclusion	Skill Development, Policy Literacy	Statehouse Advocacy Summit, Planning Toolkit	Increased Confidence In Advocacy Skills	NA
Centeno et al., 2018 [56]	Multiple countries	Report	Conceptualization/definition	Palliative care policy	Policy, Health	Macro	Systemic	Advocacy as strategic, multi-stakeholder action to advance global palliative care, ensuring access, policy support, education, and certification.	Bio-psycho-social	Equity, Dignity, Care Access	Policy Integration, Resource Allocation	European Atlas Development, Partnership With EAPC And WHO	Policy Shifts, Increased Visibility Of Palliative Care	NA
Chenli & Abrokwah, 2021 [57]	China	Scientific article	Curriculum/training	Community health volunteer organisations	Community, Health	Micro, Meso	Community, Professional	Advocacy as discretionary, voluntary public action by community health volunteers, strengthened through training, supportive relationships, and psychological empowerment.	Bio-psycho-social	Empowerment, Support, Value Creation	Empowerment, Innovation, Improved Public Service	Training Support, Supportive Relationships, Psychological Empowerment	Enhanced Advocacy Behaviours, Increased Psychological Empowerment	NA
Coeytaux et al. 2014 [58]	Kenya, Tanzania	Scientific article	Conceptualization/definition	Women’s reproductive health in contexts with limited legal abortion	Community, Policy, Health	Meso, Macro	Community, Systemic	Advocacy as community-based education and harm-reduction framing to expand access to misoprostol in restrictive legal contexts.	Bio-psycho-social	Reproductive Justice, Right To Information, Self-Determination	Access, Self-Determination, Reduction of Maternal Mortality	Cbos, Traditional Midwives, Social Media, Pharmacies, Peer-To-Peer Campaigns	Increased Access To Misoprostol, Reduced Stigma, Community Networks	NA
Cohen, Taveow & McGrath, 2018 [59]	USA	Scientific article	Conceptualization/definition	Public health, community initiatives	Health, Policy, Community	Meso, Macro	Professional, Community	Advocacy as coalition-based mobilization using evidence, public opinion, and strategic campaigning to influence workplace health and safety policies.	Bio-psycho-social	Social Justice, Equity, Engagement	Policy Change, Access To Services	Community Partnerships, Strategic Messaging, Training	Improved Access, Policy Shifts, Community Empowerment	NA
Conrad et al., 2019 [60]	USA	Scientific article	Curriculum/training	Public health system strengthening	Policy, Health	Macro	Systemic	Advocacy as a professional competency of health promotion, defined as actions by individuals or groups to bring about social, organizational, or policy change to improve health.	Bio-psycho-social	Justice, Equity, Solidarity	Health Equity, Structural Change	Policy Briefs, Stakeholder Influence, Coalition Building	Improved Policy Attention To Underserved Populations	NA
Croft et al., 2012 [61]	Multiple countries	Scientific article	Curriculum/training	Social work education	Policy, Health, Social	Meso	Professional, Systemic	Advocacy as a fundamental physician role to promote social, political, and policy changes, requiring systematic curricular inclusion in medical education.	Bio-psycho-social	Self-Determination, Transparency, Inclusion	Empowerment, Participation, Structural Competence	Role-Plays, Reflective Practice, Social Justice Lens	Increased Competency In Advocacy-Related Skills	NA
Cropley, Hughes & Belcik, 2024 [62]	USA	Scientific article	Curriculum/training	Nursing education	Policy, Health	Meso, Macro	Professional, Systemic	Advocacy as nursing students’ capacity to influence health policy, strengthened by integrated curricular strategies combining leadership and population health competencies.	Bio-psycho-social	Equity, Inclusion, Accountability	Health Equity, Leadership	Leadership Coursework, Policy Pitch, Environmental Scan	Student Readiness, Leadership Growth	NA
Crosbie et al., 2024 [63]	Ethiopia	Scientific article	Conceptualization/definition	Tobacco control policy	Health, Policy	Macro	Systemic	Advocacy as sustained transnational and local coalition action to support adoption of FCTC-based tobacco control law through evidence use, legal assistance, and media engagement.	Bio-psycho-social	Evidence-Based Policymaking, Protection From Industry Interference	Policy Adoption, Public Health Protection	FCTC Implementation, Multi-Sectoral Collaboration, Legal Reforms	Adoption Of Law 1112, FCTC Compliance	NA
Cullerton et al., 2018 [23]	Australia	Scientific article	Conceptualization/definition	Public health nutrition	Policy	Macro	Systemic	Advocacy as active interventions aimed at influencing government nutrition policy, supported by a conceptual model for resource-poor advocates integrating policy theories and social network insights.	Bio-psycho-social	Justice, Strategic Influence, Empowerment	Policy Change, Nutrition Equity	Stakeholders, Public Health Advocates, Conceptual Model	Improved Advocacy Capacity (Model Proposed)	NA
Damico et al., 2024 [64]	Italy	Scientific article	Measurement tool	Public health nursing	Health, Community	Meso, Macro	Professional, Community	Advocacy as a core ethical and professional practice of public health nurses, operationalised through measurable competencies (raising awareness, empowerment, policy change, collaboration).	Bio-psycho-social	Beneficence, Non-Maleficence, Autonomy	Equity, Self-Determination, Patient Protection	Scale Development, Construct Validation, Factor Analysis	Validated Scale For PHN Advocacy Practices	Public Health Nurses’ Advocacy Practices (PHNAP) Scale, 27 items; Assesses public health nurses’ advocacy practices using five factors structure: (1) Raising awareness – highlighting the challenging situations faced by disadvantaged individuals; (2) Empowerment – supporting disadvantaged individuals to autonomously improve their own situation; (3) Community and local government engagement – establishing a foundation within local governments and community groups of disadvantaged individuals to initiate advocacy activities; (4) Policy change – working toward changes in health and social policies; (5) Collaboration – engaging with stakeholders and organizations to enhance the effectiveness of advocacy activities.
de Bok et al., 2024 [16]	Netherlands	Scientific article	Curriculum/training	Interdisciplinary medical education	Health, Community, Policy	Meso, Macro	Community, Systemic	Advocacy as physicians’ social responsibility to promote prevention and equity, conceptualized in curricula as part of the CanMEDS “health advocate” role, taught via public health and community-based courses.	Bio-psycho-social	Inclusion, Equity, Solidarity	Systemic Awareness, Curricular Reform	Reflective Exercises, Group Dialogues, Scenario Planning	Student-Reported Advocacy Competence Increase	NA
Dechert 2019 [65]	USA	Scientific article	Conceptualization/definition	Trauma surgery and health disparities	Health, Policy	Macro	Professional, Systemic	Advocacy as the translation of trauma research findings into policy and community action to address social determinants of health and reduce disparities.	Bio-psycho-social	Social Justice, Equity, Advocacy As Professionalism	Health Equity, Access, Policy Reform, Social Justice	Doctors, Legislators, Researchers, Students, Academic Education	Policy Change, Education, Professional Awareness	NA
Del Mundo et al., 2023 [66]	Philippines	Scientific article	Curriculum/training	Medical education (mccod)	Policy, Health	Meso, Macro	Professional, Systemic	Advocacy as structured educational and policy support to institutionalize correct medical certification of cause of death, framed with PRECEDE-PROCEED model.	Bio-psycho-social	Accuracy, Accountability, Health Systems Strengthening	Accurate Mortality Data, Training Quality	Training Modules, Stakeholder Engagement, Digital Learning	Reach Of 4000 Learners, Stakeholder Buy-In	NA
Dhaliwal et al. 2022 [67]	India	Scientific article	Conceptualization/definition	Postgraduate medical training (residency) in healthcare	Health	Micro, Meso	Professional, Community	Advocacy as locally rooted and context-specific strategies informed by caregivers’ perceptions of vaccination’s health, social, and economic benefits in low-coverage areas.	Bio-psycho-social, Person-centered	Social Justice, Responsibility, Agency, Professional Ethics	Education, Social Responsibility, Health Justice, Policy Influence	Universities, Academics, Trainees, Training Programs, Evaluation Tools	Improvement In Advocacy Skills, Change In Attitudes, Systemic Impact	NA
Dodick et al., 2018 [68]	Multiple countries	Scientific article; Declaration	Conceptualization/definition	Headache disorders and patient care	Patient, Health, Policy	Macro	Systemic	Advocacy as collective patient-driven actions (patients, professionals, NGOs, regulators) to promote access to care, reduce stigma, and influence health policy in headache care.	Person-centered	Equity, Access, Recognition	Access To Care, Reduce Stigma, Patient-Centered Policy	Summits, Declarations, Stakeholder Collaboration	Establishment Of Global Patient Advocacy Network	NA
Effland et al., 2021 [69]	USA	Scientific article	Strategies/actions	Child welfare system	Policy	Meso, Macro	Professional, Systemic	Advocacy as professional and community mobilization to reform regulatory frameworks, ensuring midwives’ full scope of practice and equitable access to medicines/devices for maternal health.	Bio-psycho-social, Child and family-centeres	Social Justice, Inclusion, Professional Empowerment	Support for Vulnerable Families, Systemic Change, Equity	Social Workers, State Agencies, Trainers, Training Programs	Policy And Practice Changes In Child Welfare Systems	NA
Elder et al., 2007 [70]	USA	Scientific article	Measurement tool	Geriatric outpatient setting, patient safety	Patient	Micro	Self, Systemic	Advocacy conceptualized as seniors’ self-advocacy in healthcare safety—behaviors of speaking up, ensuring safe practices, actively engaging in their own care.	Bio-psycho-social	Autonomy, Responsibility, Self-Determination	Error Prevention, Empowerment, Health Safety	Elderly People, Caregivers, Healthcare Workers, Measurement Tools	Improvement In Active Participation In Health Security	Seniors Empowerment and Advocacy in Patient Safety (SEAPS), 21 items; Comprises four subscales: (1) Outcome efficacy (OE), which refers to beliefs about the effectiveness of advocacy actions in producing change; (2) Attitudes (ATT), which capture the orientation toward the importance and legitimacy of advocacy; (3) Self-efficacy (SE), which measures confidence in one’s ability to engage in advocacy tasks; (4) Behaviors (BEH), which assess the frequency and consistency of self-reported advocacy practices.
Evans & McGaha, 1998 [71]	USA	Scientific article	Conceptualization/definition	Education, social work	Policy, Education	Meso	Professional, Systemic	Advocacy as actions by consumers/families (writing letters, giving testimony, engaging media, lobbying) to influence mental health policy and service delivery—framed as empowerment and equal participation.	Bio-psycho-social	Responsibility, Child-Centered Values	Child Welfare, System Reform	Training, Policy Engagement, School Collaboration	Improved Educator Awareness And System Responsiveness	NA
Evans, Williams & Perko, 2018 [72]	USA	Scientific article	Curriculum/training; Strategies/actions	Communities, chiropractic, health promotion	Health, Policy	Micro, Meso, Macro	Professional, Community, Systemic	Advocacy as chiropractors’ engagement in community-level health promotion, both micro (individual counseling) and macro (policy/community environment change).	Bio-psycho-social, Person-centered	Social Justice, Community Empowerment	Community Health, Prevention, Civic Participation	Chiropractors, Local Communities, Institutions, Policymakers	Improved Community Health And Systemic Changes	NA
Fagen et al., 2009 [73]	USA	Scientific article	Conceptualization/definition	Public health coalitions	Policy, Community	Meso, Macro	Systemic	Advocacy conceptualized as “a wide range of activities to influence decision makers, such as litigation, lobbying, public education, capacity building, network formation, communication, leadership development.”	Bio-psycho-social	Social Justice, Participation	Improving Health Systems Through Nurse Engagement	Advocacy Planning Frameworks, Coalition Assessment Tools	Improved Advocacy Capacity And Strategic Alignment	NA
Fazelipour et al., 2023 [74]	USA	Scientific article	Curriculum/training	Nursing education	Health,	Meso	Professional	Advocacy conceptualized as a health professional competency role enacted in daily practice (disease prevention, health promotion, seamless care, professional advocacy).	Bio-psycho-social	Social Responsibility, Patient Advocacy	Equity, Participation, Empowerment	Nursing Faculty, Curriculum Redesign	Improved Advocacy Competencies	NA
Figueira et al., 2018 [75]	Brazil	Scientific article	Conceptualization/definition; Strategies/actions	Nursing education	Health, Policy	Micro, Meso, Macro	Professional, Systemic	Advocacy conceptualized as defending patients’ rights, promoting autonomy, enabling user participation in health decisions, and changing social realities toward equity.	Bio-psycho-social	Ethics, Justice, Participation	Political Change, Professional Support, Social Justice	Curriculum Content, Educational Planning, Ethical Discussion	Improved Understanding Of Advocacy Roles Among Students	NA
Figueira et al., 2022 [76]	Brazil	Scientific article	Conceptualization/definition; Strategies/actions	Nursing	Policy	Macro	Professional, Systemic	Advocacy conceptualized as interventions by nurses to change ineffective policies at institutional, community, or governmental level, distinct from individual health advocacy.	Bio-psycho-social	Civic Engagement, Systemic Transformation	Education, Participation, Social Change	Policy Advocacy Engagement Scale	Increased Nurse Engagement In Political Advocacy	NA
Figueroa & Verma, 2023 [77]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Health policy	Policy	Macro	Systemic	Advocacy is conceptualized as constituent-driven policy action where researchers and community advocates engage policymakers through coalition-building, evidence, and science communication to achieve equitable health policies.	Person-centered	Justice, Inclusion, Responsiveness	Reach Marginalized Populations, Engage in Health Advocacy	Constituents, Coalitions, Leadership, Policy Champions	Policy Change	NA
Galer-Unti, Miller & Tappe 2004 [78]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Literature on health promotion and policy advocacy	Policy	Macro	Professional, Systemic	Advocacy is conceptualized as policy advocacy in health education, operationalised through terminology and coding descriptors to analyze scientific production in CNHEO journals.	Bio-psycho-social, Person-centered	Justice, Ethics, Professional Responsibility	Patient Rights, Self-Determination, Empowerment	Professional Organizations, Scientific Journals, Training Institutions	Increased Publications On Advocacy; Change In Awareness	NA
Galer-Unti, Tappe & Lachenmayr, 2004 [79]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Health promotion and health education	Health	Micro, Meso, Macro	Professional, Community	Advocacy is conceptualized as an intentional process to bring about social/organizational change in support of a health-related goal, with step-by-step strategies for novice advocates.	Bio-psycho-social	Social Justice, Responsibility, Ethics	Rights Protection, Quality of Care Improvement, Decision-Making Support	Individuals, Groups, Non-Profit Organizations, Health Professionals, Networks	Greater Participation Of Health Educators And Influence On Policies	NA
Garcia & Parker, 2011 [80]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Hiv prevention, religious communities	Health, Religion	Micro, Meso	Community	Advocacy is conceptualized as mobilization of financial, organizational, and cultural resources plus coalition-building, used by faith-based groups to influence HIV policy and prevention.	Bio-psycho-social	Social Inclusion, Equity, Community Empowerment	Health Equity, Empowerment, Legal-Health Integration	Use Of Resource Mobilization, Peer Educator Programs, National Religious Networks	Improved Outreach And Trust In HIV Prevention	NA
Gaylord & Grace, 1995 [81]	USA	Scientific article	Conceptualization/definition	Nursing field, patient-nurse relationship	Patient	Micro	Professional	Advocacy is conceptualized as the ethical practice of nursing: protecting the vulnerable, promoting autonomy, and acting across micro–macro levels of care as part of professional duty.	Bio-psycho-social, Person-centered	Ethics, Justice, Autonomy, Compassion	Road Safety, Environmental Health, Political Change	Nurses, Patients, Healthcare Facilities	Not Explicitly Reported	NA
Giffords, Guercia & Kass, 2010 [82]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Mental health field, training for patient rights advocacy	Patient	Micro, Meso	Professional, Community	Advocacy is conceptualized as coalition-driven legislative change, engaging stakeholders in structured steps to achieve systemic policy reform	Person-centered, Bio-psycho-social	Justice, Social Support, Inclusion	Access To Safe And Legal Abortion; Equity; Rights; Awareness	Social Workers, Students, Clinicians, Vulnerable Patients	Increased Knowledge, Improved Advocacy Capacity	NA
Girard et al., 2020 [83]	USA	Scientific article	Curriculum/training	Medical-legal partnership, medical education	Health, Law, Education	Meso, Macro	Professional	Advocacy is conceptualized as interprofessional action (medicine + law) to remove social and legal barriers to health, embedded into medical training	Bio-psycho-social	Social Justice, Collaboration, Empowerment	Empowerment, Awareness, Access, Policy Change	Interprofessional Training, Legislative Preparation, Medical-Legal Partnerships	Increased Medical Student Identity As Advocates, Policy Literacy	NA
Gomm et al., 2006 [84]	Australia	Scientific article	Strategies/actions	Advocacy campaign for sustainable transport and environmental health	Public Health, Media	Meso, Macro	Community, Systemic	Advocacy is conceptualized as community and organizational actions mobilized to address environmental determinants of health, emphasizing participation and empowerment.	Bio-psycho-social	Giustizia Ambientale, Partecipazione, Sostenibilità	Capacity Building, Equity, Training	Alleanze Comunitarie, Cittadini, Enti Locali, Media, Ricercatori	Riduzione Traffico Pesante, Attenzione Pubblica, Pressione Sulle Istituzioni	NA
Gormley, 2019 [85]	USA	Scientific article	Curriculum/training	School health, leadership education	Health, Education	Meso	Professional, Community	Advocacy is conceptualized as the nurse’s role in protecting patient dignity, rights, and preferences in end-of-life care, including systemic change and individual patient advocacy.	Bio-psycho-social	Inclusion, Equity, Empowerment	Improving Dementia Care, Systems Change	Workshops, School-Based Projects, Student Mentoring	Improved Leadership Skills And Confidence	NA
Hancher-Rauch, Gebru & Carons, 2019 [86]	USA	Scientific article	Curriculum/training	Public health education	Health, Policy	Meso	Professional	Advocacy is conceptualized as a fundamental competency for public health graduates, involving the ability to influence policy, communicate effectively, and mobilize communities.	Bio-psycho-social	Civic Responsibility, Social Justice	Systemic Change, Patient-Centered Care, Policy Influence	Advocacy Projects, Legislative Visits, Simulations	Increased Knowledge And Advocacy Self-Efficacy	NA
Hardin-Fanning et al., 2023 [87]	USA	Scientific article	Curriculum/training	Undergraduate nursing education	Health	Meso	Professional	Advocacy is conceptualized as a nursing skill and responsibility to engage in policy processes, trained through experiential curriculum design.	Bio-psycho-social	Social Justice, Civic Responsibility	Health Equity, Native American Youth Well-Being	Simulations, Storytelling, Reflective Assignments	Improved Advocacy Confidence And Narrative Skills	NA
Hatono et al., 2025 [88]	Japan	Scientific article	Measurement tool; Conceptualization/definition	Infermieristica di sanità pubblica a livello comunitario	Public Health	Micro, Meso, Macro	Professional, Community, Systemic	Advocacy is conceptualized as “an act taken to protect and speak up on behalf of those who are not receiving the quality of life and fairness that is guaranteed, to create change in what is causing difficulty in their situation.”	Biopsicosociale, Community-centered	Giustizia Sociale, Uguaglianza, Responsabilità Sociale	Equity, Capacity Building, Policy Change	Infermieri Di Sanità Pubblica, Enti Locali, Stakeholder	Adozione Di Buone Pratiche, Empowerment, Influenza Policy	Scale to Measure Public Health Nurses’ Advocacy Practices, 27 items; Grouped into five factors: (1) Raising awareness of the challenging situations faced by disadvantaged individuals; (2) Empowering disadvantaged individuals to improve their situation autonomously; (3) Establishing a foundation within local governments and community groups of disadvantaged individuals for advocacy initiatives, (4) Working toward policy changes; (5) Collaborating with stakeholders and organizations to enhance the effectiveness of advocacy activities.
Hearne, 2008 [89]	USA	Scientific article	Curriculum/training	Ambito educativo e policy nei programmi di educazione alla salute	Health, Policy	Macro	Professional, Systemic	Advocacy is understood as skills for translating public health science into policy action, including communication, policy analysis, and campaign strategies.	Person-centered, Bio-psycho-social	Giustizia Sociale, Equità Educativa, Empowerment	Policy Impact, Student Skill Development	Insegnanti, Policy Makers, Istituzioni Educative, Stakeholder	Miglioramento Contenuti Dei Curricula, Influenza Su Policy	NA
Hensel et al., 2023 [90]	USA	Scientific article	Curriculum/training	Medical education	Health, Education	Meso	Professional	Advocacy is conceptualized as community engagement in cancer research, bridging the gap between researchers and marginalized communities, empowering citizens as research advocates.	Bio-psycho-social	Equity, Professional Responsibility	Policy Improvement, Evidence-Based Impact	Workshops, Scenario-Based Learning, Role-Play	Increased Understanding Of Advocacy Role In Clinical Practice	NA
Hessini, 2005 [91]	Multiple countries	Scientific article	Conceptualization/definition; Strategies/actions	Reproductive health policy globally	Policy	Macro	Systemic	Advocacy is conceptualized as strategic action at global, national, and community levels to promote women’s rights, safe abortion, and reproductive justice, integrating public health and rights-based approaches.	Bio-psycho-social, Rights-based	Social Justice, Human Rights, Equity	Vaccine Uptake, Misinformation Reduction	Public Health Experts, Legal Advocates, Media, Health Professionals, Civil Society, Etc.	Policy Change, Increased Access, Public Awareness	NA
Hilliard et al., 2015 [92]	USA	Scientific article	Conceptualization/definition	Diabetes care and policy (chronic disease)	Health	Micro, Meso, Macro	Self, Community, Professional, Systemic	Advocacy is conceptualized as multi-level efforts (from individual to global) to increase awareness, reduce stigma, secure funding, influence policy, and improve health outcomes for people with diabetes.	Person-centered, Public health-oriented	Empowerment, Equity, Access, Health Literacy	Health Equity, Social Determinants, Access	Individuals, Families, Community Orgs, NGOs, International Federations	Improved Outcomes, Policy Awareness, Advocacy Engagement	NA
Hoffman & Silverberg, 2015 [93]	Canada	Scientific article	Curriculum/training	Global health education context (student training)	Global Health	Meso, Macro	Professional, Community	Advocacy is conceptualized as a core skill in global health, requiring experiential education, campaign design, and coalition-building to influence health equity and policy.	Person-centered, Interdisciplinary	Social Responsibility, Equity, Empowerment	Policy Change, Clinical Awareness	Educators, Students, Civil Society, Policymakers	Empowerment, Knowledge, Skill Development, Collaboration	NA
Hollister et al., 2021 [94]	USA	Scientific article	Conceptualization/definition	Health plan support for people with dementia	Policy, Health	Macro	Systemic	Advocacy is conceptualized as system-level change to improve dementia care capacity, integrating evidence, stakeholder engagement, and policy leverage in managed care health plans.	Bio-psycho-social	System-Level Responsibility, Inclusiveness, Support For Vulnerable Populations	Public Health Impact, Professional Preparation	Systematic Advocacy Model With Steps: Best Practices, Public Policies, Champions, Business Case, TA, Tracking	Improved Care Pathways, Caregiver Support, CBO Referrals	NA
Hudson et al., 2021 [95]	USA	Scientific article	Curriculum/training; Conceptualization/definition	Nursing education reform	Health, Policy	Micro, Meso, Macro	Professional, Systemic	Advocacy is conceptualized as youth empowerment and support for cancer patients/communities, with branches at national, community, and personal levels	Bio-psycho-social	Equity, Voice, Accountability	Improved Care, Equity, Systemic Responsiveness	Revised Nursing Standards, Community Partnerships, Experiential Learning	Updated Accreditation Standards, Increased Policy Engagement	NA
Idoate et al., 2020 [96]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Urban native american women’s health and wellness advocacy	Community, Health, Policy	Meso, Macro	Community, Systemic	Advocacy is framed as “knowing, being, and doing” rooted in Indigenous worldviews, relationality, cultural survival, and community wellness; it extends beyond clinical care to everyday roles of Indigenous women as advocates.	Bio-psycho-social	Respect, Cultural Identity, Equity	Equity, Inclusion, Rights, Systemic Change	Community Engagement, Storytelling, Data Dissemination	Empowerment, Community Action, Youth Health Policy Proposals	NA
Israel et al., 2010 [97]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Community-based participatory research in public health	Community, Health	Meso, Macro	Community, Systemic	Advocacy is conceptualized as community-driven policy change through CBPR, requiring equitable participation, capacity building, and empowerment to address structural health disparities.	Bio-psycho-social	Equity, Participation, Collaboration, Empowerment	Systemic Reform, Policy Awareness, Population Health	Academic-Community Partnerships, Participatory Evaluation, Dissemination Strategies	Policy Shifts, Increased Capacity, Sustained Partnerships	NA
Jansson et al., 2016 [98]	USA	Scientific article	Conceptualization/definition	Social work education	Policy, Health,	Meso, Macro	Professional, Systemic	Advocacy is conceptualized as interventions to change dysfunctional policies in institutions, communities, or governments, contrasted with patient advocacy (direct support to individuals).	Bio-psycho-social	Justice, Engagement, Rights	Empowerment, Access, Participation	Training Program, Fieldwork, Assessment Tools	Competency Improvement, Readiness For Advocacy Roles	NA
Jansson et al., 2017 [99]	USA	Scientific article	Measurement tool; Conceptualization/definition	Social work practice	Policy, Health	Macro	Professional, Systemic	Advocacy is defined as an intervention to change dysfunctional policies affecting patients’ rights, quality, access, and well-being; contrasted with case-based patient advocacy.	Bio-psycho-social	Inclusion, Justice	Equity, Justice, Voice For Marginalized	Survey Development, Statistical Validation	Validated Advocacy Measurement Scale	Policy Advocacy Engagement Scale (Policy-AES), 7 items; Connects policy advocacy directly with seven categories of patient problems that frontline professionals encounter in daily practice: (1) Issues related to biopsychosocial functioning, (2) Person-in-environment barriers, (3) Patient rights violations, (4) Gaps in patient-centered care, (5) Deficits in cultural responsiveness, (6) Access and affordability challenges, (7) Unmet needs in mental and community-based care.
Jennings et al., 2024	USA	Scientific article	Conceptualization/definition; Strategies/actions	Vaccine promotion and public health communication	Health, Media	Micro, Meso	Peer, Community	Advocacy is conceptualized as personal (peer-to-peer) and social (public communication) efforts to persuade and mobilize people toward vaccine uptake, using narrative or factual messaging.	Bio-psycho-social	Truthfulness, Empathy, Education	Representation, Access, Transparency	Social Media Messages, Narrative/Factual Content Strategies	Increased Advocacy Intentions, Message Effectiveness	NA
Kaczorowski et al., 2004 [100]	USA	Scientific article	Curriculum/training; Strategies/actions	Medical education and community health	Health	Micro, Meso	Professional, Community	Advocacy is conceptualized as a core pediatric role involving partnership with communities and child health organizations to address “new morbidity” (social determinants, prevention, equity).	Bio-psycho-social	Civic Engagement, Equity, Justice	Equity, Access, Systems Change, Collaboration	Medical Students, Faculty, Patients, Communities	Increased Awareness, Educational Impact, Clinical Engagement	NA
Kalra, Verma & Sahay, 2023 [101]	India	Scientific article	Conceptualization/definition	Non-communicable diseases, primary care	Health, Policy, Community	Meso, Macro	Professional, Systemic	Advocacy is conceptualized as a cyclical process led by physicians and stakeholders, beginning with awareness and leading to systemic action and policy engagement for NCD control.	Bio-psycho-social	Responsibility, Awareness, Action-Oriented Mindsets	Health Equity, Empowerment, Access, Community Well-Being	5A Model: Awareness, Acceptance, Assertion, Action, Audit	Strengthened Advocacy Cycle And Clinical Integration	NA
Kerr et al., 2017 [102]	USA	Scientific article	Curriculum/training; Strategies/actions	Health education certification and training	Health, Policy,	Meso, Macro	Professional, Systemic	Advocacy is conceptualized as a professional responsibility of health educators, encompassing communication, influencing policy, and promoting health systems change to benefit public health.	Bio-psycho-social	Social Responsibility, Empowerment	Reducing Disparities, Equity, Structural Competency	Survey, Training Modules, Policy Engagement	Greater Advocacy Involvement, Identified Training Gaps	NA
Knox et al., 2018 [103]	USA	Scientific article	Curriculum/training; Strategies/actions	Primary care	Health, Community, Patient	Micro, Meso	Professional, Community	Advocacy is conceptualized as physician responsibility to act on social determinants of health, combining medical practice with population health approaches to reduce inequities.	Person-centered	Justice, Empathy	Policy Change, Health Equity, Evidence-Based Practice	Clinical Vignettes, Faculty Mentorship	Reflection, Empowerment	NA
Krahn & Campbell, 2011 [104]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Disability rights and inclusion	Policy	Macro	Systemic	Advocacy is conceptualized as a political and legal process through which people with disabilities and their allies influence public health systems, access to services, and participation in society, complementing public health research and surveillance.	Bio-psycho-social, Rights-Based	Social Justice, Inclusion, Empowerment	Access, Empowerment, Stigma Reduction, Trust	Policy Makers, Advocates, Legal System, NGOs	Systemic Policy Reforms, Access, Cultural Change	NA
Krishnamurthy, Soltany & Montez, 2023 [105]	USA	Scientific article	Curriculum/training	Medical education	Health, Policy	Meso, Macro	Professional	Advocacy is conceptualized as any action by physicians to promote social, economic, educational, and political changes that reduce suffering and threats to health, making it a professional responsibility linked to both patient care and systemic reform.	Bio-psycho-social	Justice, Responsibility, Social Accountability	Trust Building, Access To Care, Inclusion	Physicians, Educators, Curricular Strategies	Training In Advocacy	NA
Kuehne et al., 2022 [106]	Multiple countries	Scientific article	Conceptualization/definition	Refugee and immigrant health	Community	Micro, Meso	Community, Peer	Advocacy is conceptualized as healthcare providers’ active engagement in influencing policies and systems to strengthen PHC, framed as a collective responsibility across professions and countries, guided by equity, social justice, and universal health coverage principles.	Bio-psycho-social	Equity, Participation, Self-Determination	Policy Impact, Skills Development	Community Leaders, Health Professionals, NGOs, Refugee Groups	Community Engagement, Improved Access To Services	NA
Kumar, Meher & Zhang, 2025 [107]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Health policy advocacy on social media (Twitter) during COVID-19	Policy, Health	Meso, Macro	Systemic	Advocacy is conceptualized as strategic communication by organized groups to influence public opinion and health policy reform, contrasting personalized, equity-driven narratives (PNHP) with data-heavy, industry-centered opposition (P4AHCF).	Bio-psycho-social	Social Justice, Empowerment, Representation	Access, Equity, Literacy	Case Studies, Community Involvement, Stakeholder Mobilization	Awareness, Policy Attention	NA
Lazuka-Nicoulaud et al., 2022 [108]	Multiple countries	Scientific article	Conceptualization/definition; Strategies/actions	Pharmaceutical policy, patient advocacy	Policy, Patient	Meso, Macro	Professional, Systemic	Advocacy is conceptualized as a structured process of influence—grounded in evidence, awareness, stakeholder mobilization, and empowerment of decision-makers—to advance public health issues like vision care within global development goals.	Bio-psycho-social	Transparency, Patient Rights, Equity	Equity; Rights; Empowerment; Social justice	Stakeholder Engagement, Regulatory Process Involvement, Lobbying	Increased Inclusion In Drug Evaluation Processes	NA
Lipsky, Adams & Okeke, 2024 [109]	Nigeria	Policy report	Conceptualization/definition; Strategies/actions	Universal health coverage	Health, Policy	Meso, Macro	Systemic	Advocacy is conceptualized as collective, networked action by civil society and stakeholders to influence government policy toward UHC, with success tied to cohesion, trust, collaboration, and transparency in advocacy coalitions.	Bio-psycho-social, Rights-Based	Social Justice, Trust, Inclusion, Transparency	Policy Change, Equity, Participation	Csos, Policymakers, Media, Academic Partners, Funders	Legislative Reform, Program Funding, Coalition Effectiveness	NA
Logan, 2019 [110]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Community health workers in marginalized communities	Health, Community	Micro, Macro	Community, Systemic, Professional	Advocacy is conceptualized as an essential component of the CHW role, empowering clients and communities, addressing social determinants of health, and influencing systemic policies, carried out across micro (individual), macro (community/policy), and professional levels.	Bio-psycho-social	Equity, Empowerment, Participation, Inclusion	Safety, Empowerment, Access To Resources	Chws, Client Relationships, Advocacy Strategies, Community Coalitions, Healthcare System Integration	Client And Community Empowerment, Increased Legitimacy Of Chws, Improved Social Determinants Of Health	NA
Long et al., 2014 [111]	USA	Scientific article	Curriculum/training	Medical education and health disparities	Health, Education	Meso	Professional	Advocacy is conceptualized as a teachable skill set in medical education, combining communication and negotiation techniques with policy knowledge to empower health professionals to influence healthcare reform.	Bio-psycho-social	Social Justice, Equity	Environmental Change, Policy Engagement	Workshops, Reflective Writing, Narrative Analysis	Improved Structural Competency And Advocacy Mindset	NA
Majmundar et al., 2024 [112]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Tobacco control policy	Policy	Macro	Professional, Systemic	Advocacy is conceptualized as evidence-based, collaborative action between researchers and advocacy organizations to shape tobacco control policy, grounded in shared values (integrity, equity, compassion, courage).	Person-centered, Evidence-based	Integrity, Compassion, Courage, Determination, Diversity	Professional Identity, Ethical Care, Rights Protection	Researchers, Advocates, Policy Makers, NGOs	Policy Influence, Informed Legislation, System Change	NA
Makhakhe et al., 2019 [113]	South Africa	Scientific article	Strategies/actions	Sexual and reproductive health of sex workers	Health	Micro, Meso	Peer, Community	Advocacy is conceptualized as health NGOs’ role in addressing stigma, discrimination, and systemic exclusion by creating trusted, tailored, and accessible services for marginalized populations (FSWs), filling systemic gaps in healthcare.	Person-centered	Social Justice, Dignity, Non-Discrimination	Empowerment, Competence, Health Equity	NGOs, Peer Educators, Mobile Clinics, Sex Worker Communities	Increased HIV Testing, Health-Seeking Behavior, Trust	NA
Manze et al., 2023 [114]	USA	Scientific article	Curriculum/training; Strategies/actions	Covid-19 response, immigrant health	Health, Community	Meso, Macro	Community, Systemic	Advocacy is conceived as physician and clinician action to secure access to abortion and contraception, emphasizing communication, relationship-building, and political engagement.	Bio-psycho-social	Equity, Cultural Humility	Policy Change, Youth Engagement	Community Health Workers, Outreach Strategies	Increased Outreach, Community Trust	NA
Manze et al., 2024 [115]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Public health graduate education	Policy, Health	Meso	Professional, Systemic	Advocacy is defined via the AMA’s definition—“the promotion of social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being.” Also operationalised as physicians’ strategic communication, media engagement, policymaking, and provision of abortion care	Bio-psycho-social	Empowerment, Transparency	Policy Change, Empowerment, Addressing Health Disparities	Advocacy Skill-Building, Community Engagement Projects	Stronger Civic Engagement And Policy Awareness	NA
Mashamba-Thompson, 2022 [116]	South Africa	Scientific article	Conceptualization/definition	Diagnostics access in vulnerable populations	Policy	Macro	Systemic	Advocacy conceptualized as building “diagnostic literacy” in vulnerable populations to empower them in health-seeking and improve equitable access to diagnostics.	Bio-psycho-social	Equity, Accessibility, Health Justice	Empowerment, Social Justice, Health Equity	Diagnostics Literacy Advocacy Model	Improved Diagnostics Access, Reduced Mortality	NA
Mathur et al., 2025 [117]	Multiple countries	Scientific article	Conceptualization/definition; Strategies/actions	Oral health at global, national, and community levels	Policy, Patient	Micro, Meso, Macro	Professional, Community	Advocacy is defined as “the strategic effort to support, recommend, defend, or argue for a particular cause or issue to effect change.”	Person-centered, Bio-psycho-social	Social Justice, Equity, Sustainability, Participation, Transparency, Empowerment, Collaboration	Rights, Well-Being, Health Equity	Multi-Stakeholder Coalitions; Economic Argumentation; Data And Emotional Appeals; Use Of Lived Experiences; Oral Health Diplomacy; Cross-Sectoral Partnerships; Community Leader Empowerment; Policy Framing; Commercial Determinant Regulation; Climate And Planetary Health Integration.	Ten Actionable Recommendations For Sustainable Oral Health Advocacy; Strengthening Coalitions; Greater Policy Influence; Inclusion Of Oral Health In Sustainability And UHC Agendas; Improved Oral Health Equity.	NA
McCall et al., 2005 [118]	Canada	Scientific article	Conceptualization/definition; Strategies/actions	Public health education	Health,Policy	Meso	Professional, Systemic	Advocacy conceptualized as networking and coalition-building at international and community levels to support school health promotion and influence policy	Person-centered, Policy-oriented	Social Responsibility, Justice, Empowerment	Awareness, Equity In Care	Students, Educators, Public Health Professionals	Increased Competence, Confidence, Policy Engagement	NA
McFarlane & Wiist, 1997 [119]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Abuse prevention among pregnant women	Health, Community	Micro, Meso	Peer, Community	Advocacy is conceptualized as support and referral work by community-based “mentor mothers” for abused pregnant women, combining empowerment with systemic linkage	Bio-psycho-social	Safety, Empowerment, Support	Policy Change, Health Equity, Awareness	Mentor Mother Model, Home Visits, Community Referrals	Referral Success Rates, Maternal Health Outcomes	NA
McPherson et al., 2012 [120]	USA	Scientific article	Curriculum/training	Childhood obesity prevention	Policy, Community	Meso, Macro	Professional, Systemic	Advocacy defined as “speaking on behalf of a group of people within the public sphere around a particular issue.”	Bio-psycho-social	Engagement, Social Change	Protecting Rights, Ensuring Equitable Care Access	Be Our Voice Training, Advocacy Resource Guide	Improved Advocacy Knowledge, Intent To Engage	NA
Midik & Coskum, 2018 [121]	Turkey	Scientific article	Curriculum/training	Nursing education	Health	Micro, Meso	Professional	Advocacy as an “action by a physician to promote those social, economic, educational, and political changes that ameliorate the suffering and threats to human health and well-being.” And CanMEDS framework—physicians contribute expertise to improve health.	Bio-psycho-social	Ethics, Responsibility, Justice	Cultural Sensitivity, Equity, Patient-Centered Care	Case-Based Teaching, Curriculum Integration	Stronger Sense Of Advocacy Among Students	NA
Miller et al., 2022 [122]	USA	Scientific article	Curriculum/training	Medical education in immigrant/refugee health	Health	Meso	Professional, Community	Advocacy conceptualized as equipping healthcare providers with competencies to act on behalf of immigrant and refugee populations, combining education, compassion, and systemic change	Person-centered	Social Justice, Compassion, Equity	Epistemic Justice, Rights Protection	Educators, Modular Curriculum, Interactive Activities, Consortium Platform	Increased Competency, Comfort, Motivation To Care	NA
Millstein et al., 2016 [123]	USA	Scientific article	Measurement tool; Conceptualization/definition	Community-based health initiatives	Community, Health	Meso, Macro	Community, Systemic	Advocacy refers to the process of increasing support for, recommending, and arguing to promote a cause or policy.”	Bio-psycho-social	Equity, Youth Empowerment	Promoting Child Advocacy, Cultural Competence	Training In Media, Organizing, Policy Messaging	Policy Proposals, Youth Participation	Youth Advocacy Scales (YEAH! program), ≈40 items across multiple subscales; The instrument operationalises advocacy through three broad domains: mediators (such as empowerment, self-efficacy, and advocacy skills), intervention processes (including group participation, adult leadership, and collective climate), and proximal outcomes (youth-led actions and policy or environmental changes).
Minkler, Griffin & Wakimoto, 2020 [124]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Community-based participatory research	Community, Policy	Meso, Macro	Community, Systemic	Advocacy is presented as organized, evidence-based policy action led by community-based organizations and formerly incarcerated people to transform structural inequities, drawing on Kingdon’s streams model to frame public health advocacy for decarceration during COVID-19	Bio-psycho-social	Social Justice, Equity, Participation	Policy Reform, Maternal Safety	Community Organizing, Partnership Building, Policy Engagement	Policy Influence, Community Capacity, Sustained Partnerships	NA
Miranda, Garcia-Ramirez & Albar-Marin, 2020 [125]	Spain	Scientific article	Conceptualization/definition; Strategies/actions	Roma communities, ethnic minorities	Community	Meso, Macro	Community	Advocacy is conceptualized as “meaningful community advocacy,” an empowerment process rooted in psycho-political empowerment at intrapersonal, organizational, community, and institutional levels. It emphasizes Roma communities’ leadership, building critical awareness, alliances, and capacity to enact transformative policies for health equity.	Bio-psycho-social	Justice, Empowerment, Anti-Discrimination	Systemic Change, Access To Trauma-Informed Care	Photovoice, Asset Mapping, Community Agents	Policy And Social Change	NA
Moledina et al., 2024 [126]	Canada	Scientific article	Curriculum/training	Medical education and resident competency	Health, Policy	Macro	Professional, Systemic	Advocacy is framed as a core CanMEDS physician competency involving social accountability and responsiveness to patients’ lived experiences and structural determinants of health, taught via experiential learning (“Health Advocacy Day”) to bridge the gap between clinical training and real-world inequities.	Bio-psycho-social	Social Accountability, Advocacy, Equity	Influence Public Policy, Tobacco Advertising Regulation	Physicians, Canmeds Framework, Training Gaps, Systemic Change	Enhanced Preparedness, Competency Frameworks, Systemic Change	NA
Morelli et al., 2023 [127]	USA	Report	Curriculum/training	Medical education, disability care	Health, Patient	Meso	Professional	Advocacy is understood as equipping future healthcare professionals with awareness, skills, and empathy to address systemic inequities faced by persons with disabilities. It emphasizes both patient-centered care and structural change, operationalised through immersive training that includes direct interaction with persons with disabilities and assistive technologies.	Person-centered	Equity, Inclusion, Awareness	Access, Equity, Destigmatization, Quality Of Life	Medical Students, Simulation Sessions	Improved Confidence And Understanding	NA
Morris et al., 2019 [128]	Canada	Scientific article	Conceptualization/definition; Strategies/actions	Public health, nursing education	Health, Policy	Meso	Professional	Advocacy is defined as the actions of parents, providers, and health systems to secure appropriate care, resources, and recognition for children with medical complexity. It is both a personal/family practice and a systemic effort to influence healthcare and policy structures for equity in access and support.	Bio-psycho-social	Social Justice, Civic Engagement, Responsibility	Empowerment, Improved Health Services Access	Experiential Course, Advocacy Campaign, Media Outreach	Improved Confidence, Public Engagement	NA
Nedjat-Haiem et al., 2013 [129]	USA	Scientific article	Conceptualization/definition; Strategies/actions	End-of-life care for latino patients	Health	Micro, Meso	Professional	Advocacy is conceptualized as actions by health professionals—especially social workers—to address gaps in care, protect rights, and empower vulnerable Latino patients at the end of life. It emphasizes advocacy as both clinical navigation and systemic change for equitable palliative care access.	Bio-psycho-social	Social Justice, Dignity, Patient-Centeredness	Empowerment, Political Action, Behavior Change	Care Coordination, Provider Education, Role Clarification	Improved Support In Terminal Care Decision-Making	NA
Noh, 2024 [130]	Multiple countries	Scientific article	Conceptualization/definition; Strategies/actions	Nursing education for north korean defectors	Health, Community	Micro, Meso	Professional, Community	Advocacy is framed as INGOs’ global political action to promote health justice during COVID-19. It is defined through framing theory as shaping public health agendas with human rights, evidence, and equity frames to counter vaccine nationalism, structural injustice, and market-driven inequities.	Bio-psycho-social	Equity, Respect, Person-Centeredness	Community Engagement, Policy Change	Nursing Students, Cultural Education, Empathy-Based Strategies	Increased Student Awareness, Improved Cultural Competence, Preparedness For Advocacy	NA
Newbigging & Riley, 2018 [131]	UK	Scientific article	Conceptualization/definition	Mental health	Health, Legal, Social	Micro, Meso	Professional	Advocacy is theorized as a liberatory practice aimed at redressing epistemic injustices in mental health. Independent advocacy is framed as enabling marginalized voices to be heard, countering systemic silencing, and creating epistemic justice by validating lived experience within inequitable health systems.	Bio-psycho-social	Justice, Knowledge, Human Rights	Cancer Awareness, Stakeholder Mobilization	Interviews, Service User Feedback	Epistemic Recognition, Voice To Service Users	NA
Pak-Gorstein et al., 2018 [132]	USA	Scientific article	Curriculum/training	Medical education, global health	Health	Meso	Professional	Advocacy is conceptualized as a professional responsibility of pediatricians to address child health beyond clinical care. It is framed as collaborative, community- and globally-oriented action for systemic child health equity, taught through immersive training (domestic and global) integrating clinical, community, and policy perspectives.	Bio-psycho-social	Cultural Sensitivity, Equity, Advocacy Awareness	Policy Change, Systemic Support For Marginalized Youth	Interactive Curriculum, Global Case Studies, Simulations	Improved Self-Efficacy In Advocacy Roles	NA
Payne et al., 2018 [133]	Multiple countries	Scientific article	Conceptualization/definition; Strategies/actions	Maternal health and policy	Health, Policy	Macro	Systemic	Advocacy is conceptualized as patient-driven collective action to increase disease awareness, ensure earlier diagnosis, and push for equitable treatment access in FH. It emphasizes the interconnection of patient empowerment, professional partnerships, and political influence to achieve systemic change.	Bio-psycho-social	Equity, Safety, Collaboration	Health Equity, Empowerment, Improved Access, Job Success	Stakeholder Mapping, Agenda Setting, Coalition Building	Legislation Introduced, Public Awareness Increased	NA
Pickover et al., 2020 [134]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Clinical psychology, trauma services	Health, Health	Meso, Macro	Professional, Systemic	Advocacy is conceptualized as systematic efforts to ensure just distribution of privileges, opportunities, and resources in society, requiring engagement across multiple ecological levels (micro to macro). It frames advocacy as a core professional competency for behavioral health providers.	Bio-psycho-social	Social Justice, Empowerment, Equity	Empowerment, Inclusion, Rights, Personal Development	Case Illustrations, Reflection On Power And Privilege	Conceptual Framework For Advocacy Roles	NA
Pierce, Stafford & Daube, 2017 [135]	Australia	Scientific article	Conceptualization/definition; Strategies/actions	Public health, tobacco control	Policy, Media	Macro	Systemic	Advocacy is framed as using media, community engagement, and policy influence to promote independent regulation of alcohol advertising, challenging industry self-regulation.	Bio-psycho-social	Transparency, Public Protection	Capacity Building, Professional Development	Media Strategy Analysis, Public Campaigns	Policy Change, Reduced Tobacco Exposure	NA
Potter & Beal-Stahl, 2024 [136]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Access to menstrual products, public health	Health	Meso	Professional, Systemic	Advocacy is understood as health professionals leveraging education, research, and policy engagement to address inequities in menstrual product access and combat stigma.	Bio-psycho-social	Social Justice, Equity, Transparency	Social Justice, Access To Care, Policy Change, Service Improvement	Pharmacists, Education, Cost Analysis, Health Communication	Access To Products, Quality Of Life Improvement, Stigma Reduction	NA
Puschel et al., 2024 [137]	Chile	Scientific article	Conceptualization/definition; Curriculum/training; Strategies/actions	Primary care, community health, cancer care	Community, Policy	Micro, Meso	Community	Advocacy is defined as “the process of arguing and/or acting in support of a particular cause, policy or group of people” and further conceptualized across practice, community, and policy domains, with competencies in knowledge, skills, and values.	Person-centered, Bio-psycho-social	Participation, Equity, Health Rights	Equity, Access, Empowerment, Systems Change	Community Workshops, Participatory Planning	Enhanced Community Involvement, Service Adaptation	NA
Ramirez et al., 2006 [138]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Tobacco control among youth	Policy	Macro	Community, Systemic	Defines policy advocacy as “individual and group actions to influence public policies by writing and/or speaking in person or by other medium in support of an issue at a societal level”. Tobacco control policy advocacy is specified as “actions to support public policies to reduce tobacco use or exposure to environmental tobacco smoke”.	Bio-psycho-social	Social Justice, Empowerment, Agency	Child Rights, Service Access, Systemic Change	Youth, Self-Efficacy Theory, Training, Measurement Tools	Increased Advocacy Self-Efficacy, Reduced Tobacco Use	NA
Raskob et al., 2024 [139]	USA	Scientific article	Curriculum/training; Strategies/actions	Internal medicine residency	Health, Community	Meso	Professional, Community	Advocacy is conceptualized as community-engaged action, with physicians joining community partners in identifying health needs and pursuing systemic change through shared activism.	Person-centered	Equity, Inclusion, Shared Leadership	Rights, Access, Equity, Public Health	Partnership With Cbos, Advocacy Day, Skills Workshops	Increased Confidence And Advocacy Skills	NA
Reams, Odedina & Pressey, 2013 [140]	Multiple countries	Scientific article	Conceptualization/definition; Strategies/actions	Cancer programs in Africa	Health, Media	Macro	Community, Systemic	Advocacy is conceptualized as efforts to promote awareness, mobilize communities, and influence policy through media to advance cancer programs in Africa.	Bio-psycho-social	Empowerment, Information Access, Equity	Health Promotion, Equity, Cancer Prevention	Media Use, Training Workshops, Community Engagement	Increased Visibility And Prioritization Of Cancer Programs	NA
Reed, Fitzgerald & Bish, 2018 [141]	Australia	Scientific article	Conceptualization/definition; Strategies/actions	Youth justice and disability services	Policy, Legal, Health	Meso, Macro	Systemic	Nursing advocacy as “action taken to support the health goals of people at the levels of the person, the community and the health system.” Also interpreted as promoting rights, values, and self-determination in end-of-life care.	Bio-psycho-social	Social Inclusion, Rights, Fairness	Empowerment, Participation, Inclusion, Social Change	Policy Analysis, Service Frameworks, Inter-Agency Collaboration	Increased Inter-Agency Support, Improved Service Alignment	NA
Rice & Wicks, 2007 [30]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Health promotion for welfare recipients	Health, Policy	Micro, Meso	Professional, Community	Advocacy is conceptualized as a nursing approach to health promotion that addresses not only individual health but also social determinants (poverty, homelessness, violence, illiteracy) that hinder engagement in health.	Bio-psycho-social	Social Justice, Empowerment, Prevention, Equity	Equity, Access, Systemic Reform	Nurses, Health Promotion Programs, Policy Advocacy, Community Participation	Improved Health Outcomes, Greater Job Success, Potential For Economic Independence	NA
Ridley, Newbigging & Street, 2018 [142]	UK	Scientific article	Conceptualization/definition; Strategies/actions	Mental health	Health, Social, Health	Micro, Meso	Self, Peer, Professional	Advocacy is framed as supporting people to have a voice, safeguarding rights, redressing unequal power relations, and enabling empowerment and self-advocacy.	Bio-psycho-social	Social Justice, Empowerment	Advocacy Skill-Building, Lifelong Engagement	Focus Groups, Service User Involvement, Feedback Loops	Empowerment, Increased User Involvement, Change In Treatment	NA
Rivera et al., 2016 [143]	USA	Scientific article	Curriculum/training	Student training, public health education	Health, Education	Meso	Professional	Advocacy is framed as a professional responsibility for health education specialists, aligned with credentialing standards. It is conceived as both a skill set to be taught (communication, legislative engagement, everyday advocacy) and a behavior shaping intention to act for health-related change.	Bio-psycho-social	Social Responsibility, Civic Engagement	Health Equity, Access, Rights	Advocacy Workshops, Policy Simulation Exercises	Increased Intent To Engage In Advocacy Post-Graduation	NA
Romero, Kwan & Chavkin, 2013 [144]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Maternal, child, and reproductive health policy	Policy, Public Health	Macro	Professional, Systemic	Advocacy is understood as the integration of empirical evidence into public health action and policy change, rooted in social justice. It is conceptualized as bridging rigorous research with social change, requiring researchers to embrace advocacy as an appropriate professional role while maintaining methodological rigor.	Bio-psycho-social	Social Justice, Scientific Integrity, Equity, Evidence-Based Policy	Policy and Environmental Change	Empirical Studies, Simulated Calls, Surveys, Interviews, Congressional Briefings, Collaboration With Advocacy Groups	Policy Impact, Service Access Changes, Legislative Influence	NA
Roy et al., 2024 [145]	India	Scientific article	Conceptualization/definition; Strategies/actions	Community-based medical education	Policy, Health	Meso	Professional, Community	Advocacy is framed as system-level mobilization for policy and health system change, emphasizing multi-sectoral collaboration, evidence synthesis, and consensus-building to reduce preventable mortality from trauma. It is less individual-centered and more structural/systemic.	Bio-psycho-social	Social Accountability, Transparency, Equity	Systemic Change, Accountability, Cross-Sector Engagement	Educators, Community Health Needs Assessment, Participatory Training Models	Community Engagement, Improved Health Services	NA
Rudolf et al., 1999 [146]	UK	Scientific article	Conceptualization/definition; Strategies/actions	Paediatrics and public health	Health, Policy	Micro, Meso, Macro	Professional, Systemic	Advocacy is defined operationally as addressing child health problems where the system fails, requiring political or professional action. It is conceptualized as both individual (clinical support for patients) and collective (community/national policy) responsibility of paediatricians.	Person-centered, Bio-psycho-social	Justice, Equity, Responsibility	Policy Prioritization, Awareness, Structural Change	Clinicians, Clinical Diary Logs, Community Planning	Improved Services, Child Health, Political Engagement	NA
Schorn, 2005 [147]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Policy change on emergency contraception access	Policy	Macro	Systemic	Advocacy is conceptualized through the Advocacy Coalition Framework—coalitions of diverse actors mobilizing around shared beliefs to influence policy. Here, advocacy is both grassroots (women’s groups) and systemic (legislative action).	Bio-psycho-social	Social Justice, Autonomy, Health Equity	Equity, Influence, Systemic Transformation	Women’s Health Safety Network, Coalition Building, Policy Lobbying	Legislation Proposed, Raised Awareness, Education	NA
Selig et al., 2005 [148]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Comprehensive cancer control (ccc) policy strategy	Policy	Macro	Systemic	Advocacy is defined as “the act or process of supporting a cause or a proposal”, and interpreted as a central mechanism to shape cancer control policy through mobilization, lobbying, and public engagement. It is positioned as indispensable for advancing comprehensive cancer control.	Bio-psycho-social	Social Accountability, Justice, Transparency	Equity, Inclusion, Mentorship, Visibility	Public-Private Partnerships, Coalition Building, Legislative Action	Policy Gains, Increased Funding, Expanded Programs	NA
Servaes & Malikhao, 2010 [149]	Multiple countries	Scientific article	Conceptualization/definition; Strategies/actions	Health communication and empowerment programs	Health, Media	Macro	Community, Systemic	Advocacy is conceptualized as participatory-based communication for social change, integrating interpersonal, media, and policy dimensions. It is seen as multidirectional (not only lobbying but also listening, empowering, and mobilizing communities) within broader health communication systems.	Bio-psycho-social	Empowerment, Participation, Equity	Support, Empowerment, Competency Development	Participatory Communication, Media Strategies, Local Empowerment Projects	Increased Participation, Community Agency, Inclusion Of Marginalized Voices	NA
Shah & Lou, 2024 [150]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Health policy and equity in oral health	Health	Macro	Systemic	Advocacy is conceptualized as a synergistic partner to quality improvement (QI). It frames advocacy as policy work that creates enabling environments (e.g., Medicaid coverage for donor milk) while QI operationalizes these changes locally. Advocacy is thus seen as systemic leverage to translate policy into improved patient outcomes.	Bio-psycho-social	Social Justice, Inclusion, Transparency	Ethical Collaboration, Transparency, Effective Treatment Access	Policy Briefs, Legislative Action, Stakeholder Engagement	Improved Access, Policy Change, Stakeholder Coordination	NA
Shankar et al., 2022 [151]	USA	Scientific article	Curriculum/training	Medical education, public health	Health, Policy	Meso	Professional	Advocacy is conceptualized as a physician’s professional responsibility to engage in social and public health issues, requiring structured training. Here, it is community-centered, stressing relational accountability, mentorship, and long-term engagement with marginalized groups.	Bio-psycho-social	Engagement, Equity, Accountability	Community Change, Policy Support, Senior Health Equity	Fellows, Mentors, Community Experts	Increased Knowledge And Motivation	NA
Sharp et al., 2008 [152]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Medical education, health disparities	Health/Policy	Meso, Macro	Professional, Systemic	Advocacy is interpreted as a deliberate, evidence-informed effort by health professionals to influence policy and social determinants of health, positioned at the interface of science, ethics, and political action.	Person-centered, Bio-psycho-social	Social Justice, Professionalism, Responsibility	Empowerment, Participation, Leadership, Social Justice	Medical Educators, Training Modules, Competencies	Improved Competence, Physician Engagement	NA
Shilton, 2006 [153]	Australia	Scientific article	Conceptualization/definition; Strategies/actions	Physical activity promotion, policy change	Health	Macro	Systemic	Advocacy is seen as social action primarily aimed at effecting changes in legislation, policy, and environments that support healthy living, with WHO definition cited (1995). Interpreted as a systemic, policy-oriented instrument of health promotion, moving beyond individual behavior.	Bio-psycho-social	Social Justice, Systems Change, Equity	Educazione, Consapevolezza, Coinvolgimento Nei Policy-Making	Health Professionals, Coalitions, Intersectoral Partnerships	Legislative/Policy Support, Environmental Change	NA
Shilton & Milton, 2024 [154]	Multiple countries	Scientific article	Conceptualization/definition; Strategies/actions	Global physical activity and health policy	Health	Macro	Systemic	Advocacy is framed as a mix of science and art: using data, evidence, and systems knowledge (science) together with persuasion, relationships, and communication (art). ISPAH illustrates global advocacy as coordinated, long-term mobilization to raise the political profile of physical activity in global policy.	Bio-psycho-social	Social Justice, Urgency, Responsibility	Policy Change, Awareness, Integration Of Cessation Practice In Ophthalmology	ISPAH, WHO, Advocacy Toolkit, Policy Briefs	Global Charter Recognition, Multisectoral Collaboration	NA
Shneyderman, 2024 [155]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Public health education	Health, Policy	Meso, Macro	Professional, Systemic	Advocacy is presented as one of the main strategies of health promotion, ethically grounded in social justice, aiming both to influence policy and to empower individuals/communities. It encompasses lobbying, media advocacy, and grassroots mobilization.	Bio-psycho-social	Equity, Communication, Leadership	Policy Change, Rural Health Equity, Sustainability	Coursework, Storytelling, Stakeholder Outreach	Increased Confidence In Advocacy, Community Engagement	NA
Smith, Artunduaga & Kotsenas, 2023 [156]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Medical professional practice and inclusion	Health	Micro, Meso	Self, Professional	Advocacy (from the Latin “advocare” that literally means to “add” a “voice”) is “any action that pleads for a cause, recommends or defends an action, or supports others or even ourselves.” It is everyday practice that can be small, intentional actions within clinical, educational, or institutional contexts—not only political lobbying.	Bio-psycho-social	Diversity, Inclusion, Empowerment, Intentionality	Social Justice, Systemic Change, Professional Development	Personal Strategies, Mentorship Structures, Institutional Recognition	Personal And Professional Development, Increased Advocacy Skills	NA
Soklaridis et al., 2018 [157]	Canada	Scientific article	Curriculum/training	Psychiatric training	Health	Micro, Meso	Professional, Self, Peer	Advocacy is a broad spectrum of relational actions—extending from self-advocacy to advocacy within the physician–patient relationship, the health team, and the community. Defined in Canadian CanMEDS framework as physicians contributing expertise and influence to improve health by working with patients, communities, or populations.	Bio-psycho-social	Voice, Empathy, Empowerment	Health Governance, Evidence-Informed Policymaking	Narrative Training, Reflective Writing, Feedback	Greater Empathy, Advocacy Awareness In Psychiatry Residents	NA
Stein et al., 2018 [158]	USA	Scientific article	Conceptualization/definition; Strategies/actions	Rare disease treatment development	Patient	Meso, Macro	Professional, Systemic	Advocacy is organizational action by patient groups to influence research, clinical trials, and policy—ensuring ethical, transparent, trust-based relationships with industry to support patients. Seen as a bridge between patients and biopharma.	Person-centered	Trust, Responsibility, Transparency, Patient Centrality	Autonomy, Participation, Informed Decision-Making	Patient Organizations, Biopharma Companies, Expert Panels, Guidelines	Improved Collaborations, Ethical Standards, Clearer Patient Involvement Roles	NA
Steinman et al., 2017 [159]	USA	Scientific article	Conceptualization/definition; Strategies/actions	State-level policy advocacy for breastfeeding-friendly legislation	Policy	Meso, Macro	Professional, Community, Systemic	Advocacy is interpreted as coalition-based mobilization where groups with shared beliefs push for policy changes. Seen as political and organizational action to promote breastfeeding-supportive environments, requiring framing, coalition-building, and anticipating opposition.	Bio-psycho-social	Social Justice, Inclusion, Civic Engagement	Learning, Strategy Refinement, Accountability, Reflection	Community Agencies, Public Health Workers, Students, Cross-Sector Coalitions	Policy Impacts, Empowerment Of Communities, Advocacy Skill Development	NA
Story et al., 2018 [160]	USA	Scientific article	Strategies/actions	HIV prevention	Policy	Micro, Meso	Peer, Community	Advocacy is coalition-driven social and political action to advance harm reduction policies (e.g., syringe decriminalization, naloxone access). Conceptualized as collective advocacy for marginalized populations, aiming to shift criminalization frameworks toward public health protection.	Bio-psycho-social	Social Justice, Equity, Participation	Patient Health, Health Equity, Policy Change	Youth Leaders, Adult Allies, Community Organizations	Leadership Development, Increased Community Engagement, System Awareness	NA
Talmon et al., 2020 [161]	USA	Scientific article	Curriculum/training	Medical education, training pathologists in health policy	Health, Policy	Meso	Professional	Advocacy is conceptualized as a professional obligation of physicians, including pathologists, to act as “faithful witnesses” to the real-world consequences of legislation and regulation, and to work through professional societies and policy processes to influence health policy in ways that improve patient care.	Person-centered	Educazione, Partecipazione, Responsabilizzazione Professionale	Health Equity, Systemic Change, Global Solidarity	Facoltà, Residenti, Società Professionali, Test Pre/Post, Incontri Educativi	Aumento Conoscenza, Comprensione Ruolo Advocacy, Interesse Futuro	NA
Thornton et al., 2007 [162]	UK	Scientific article	Conceptualization/definition; Strategies/actions	Smoking-related eye disease awareness and policy change	Health, Policy	Meso, Macro	Professional, Systemic	Advocacy is conceptualized as coordinated actions to influence policy, public opinion, and institutional priorities for cancer prevention and control, drawing from examples in tobacco, alcohol, obesity, and screening.	Biomedical	Public Awareness, Prevention, Accountability	Curriculum Innovation, Professional Responsibility, Systems Change	Ophthalmologists, Optometrists, Policy Makers, Media, Public Health Units, NGOs	Awareness Increase, Policy Recommendations, Inclusion Of Warning Labels On Cigarette Packs	NA
Tsatali et al., 2024 [163]	Multiple countries	Scientific article	Conceptualization/definition; Strategies/actions	Dementia care and support	Health, Policy	Meso, Macro	Peer, Community, Systemic	Advocacy framed as youth-driven efforts to raise awareness, mobilize peers, and influence European tobacco policies, integrating civic engagement and health promotion.	Bio-psycho-social	Inclusion, Compassion, Equity, Human Dignity	Equity, Rights, System Change	Peer Support Workers, Caregivers, NGOs, Health Professionals	Increased Quality Of Life, Reduced Isolation, Improved Support Delivery	NA
Tuli et al., 2024	Ireland	Policy report	Conceptualization/definition; Strategies/actions	Rural health policy and gp sustainability	Policy, Health	Meso, Macro	Community, Systemic	Advocacy is conceptualized as collective rural GP and community mobilization to protect healthcare access, counter “structural urbanism,” and influence health system policy, with campaigns such as “No Doctor, No Village.”	Bio-psycho-social	Justice, Equity, Collective Action	Empowerment, Autonomy, Rights	Public Campaigns, Community Organizing, Political Engagement	Policy Reinstatement, Funding Restoration, Increased Rural Access	NA
Twis, Cimino & Files, 2022 [164]	USA	Scientific article	Curriculum/training; Strategies/actions	Social work education, youth anti-sex trafficking program	Policy	Meso, Macro	Professional, Systemic	Advocacy is defined as equipping medical trainees with legal and systemic tools to advocate for patient rights and address social determinants of health through interprofessional collaboration.	Bio-psycho-social	Justice, Empowerment, Social Responsibility	Trust, Health Promotion, Participation	Advocacy Courses, Experiential Learning, Political Involvement	Enhanced Competence, Increased Engagement In Advocacy Roles	NA
Uzochukwu et al., 2020 [165]	Nigeria	Scientific article	Conceptualization/definition; Strategies/actions	Health system strengthening	Health, Policy	Macro	Systemic	Advocacy is defined as actions enabling social voice, alliance-building, and accountability to prioritize maternal and child health services in policy agendas; both representational and facilitative advocacy are described.	Bio-psycho-social	Accountability, Participation, Collaboration	Empowerment, Inclusion, Service Improvement	Stakeholder Engagement, Capacity Building, Use Of Evidence	Policy Uptake, Improved Health System Responsiveness	NA
Vahdat et al., 2015 [166]	Iran	Scientific article	Measurment tool	Chronic patient self-advocacy	Patient	Micro	Self	Advocacy as patients’ active participation in health decision-making, asserting needs, preferences, and rights through communication and informed engagement.	Person-centered	Bioethical Principles, Autonomy, Participation, Respect	Policy Awareness, Anti-Smoking, Youth Involvement	Patients, Healthcare Providers, Scale Designers	Improved Communication, Informed Choices, Autonomy	Patient Self-Advocacy Scale (PSAS) – Persian validated version, 12 items; Assesses patients’ capacity to advocate for their own health needs across three domains: (1) Illness education (knowledge acquisition and provider communication); (2) Assertiveness (confidence in expressing needs and asking questions); (3) Mindful non-adherence (reasoned refusal of recommendations inconsistent with preferences or values).
van Oort et al., 2023 [167]	Netherlands	Scientific article	Conceptualization/definition; Strategies/actions	Global health advocacy program evaluation	Policy, Health	Macro	Systemic	Advocacy as diverse NGO activities (educating, mobilizing, agenda setting, policy monitoring) and framed as a dynamic process requiring participatory evaluation to strengthen effectiveness.	Bio-psycho-social	Learning, Transparency, Accountability	Engagement, Policy Change Awareness	Participatory Evaluation, Advocacy Tools, Stakeholder Engagement, NGOs	Enhanced Evaluation Practice, Improved Advocacy Strategies, Stakeholder Learning	NA
Vance & Kennedy, 2020 [168]	USA	Scientific article	Curriculum/training; Conceptualization/definition	Psychiatric residency education	Health	Micro, Meso, Macro	Professional, Systemic	Advocacy is defined as physicians’ public support for patient health causes, encompassing policy influence, insurer engagement, and social determinants.	Bio-psycho-social	Professional Responsibility, Equity, Patient-Centeredness	Equity; Rights; Empowerment; Social justice	Didactic Sessions, Experiential Learning (E.G., Legislative Visits), Mentorship	Improved Advocacy Competence, Curriculum Development	NA
Vervoot et al., 2021 [169]	Multiple countries	Scientific article	Conceptualization/definition; Strategies/actions	Global health and surgery equity, pediatric cardica surgery in LMICs	Policy, Health	Macro	Systemic	Health advocacy as “activities aimed at influencing decisions within political, economic, and social systems”. Advocacy as coordinated stakeholder engagement and messaging to influence domestic and global health policy for congenital heart disease and rheumatic heart disease, aiming at equity in surgical care.	Person-centered, Equity-focused	Social Justice, Equity, Inclusion, Solidarity	Equity; Rights; Empowerment; Inclusion	NGOs, Global Health Actors, Academic Community	Policy Inclusion, Funding Prioritization, Systemic Visibility	NA
Walker et al., 2024 [170]	Multiple countries	Scientific article	Conceptualization/definition; Strategies/actions	Prison health, advocacy for hepatitis C testing and treatment scale-up	Health	Meso, Macro	Professional, Systemic	Advocacy is understood as mobilizing policymakers, prison systems, and stakeholders to ensure equitable access to HCV testing and treatment in prisons, reducing health disparities and supporting WHO elimination goals.	Bio-psycho-social	Collaboration, Justice, Person-Centered Care	Equity; Rights; Participation; Empowerment; Accountability	Co-Designed Curricula, Interprofessional Collaboration, Clinical Integration	Increased Readiness For Advocacy Roles, Systemic Awareness, Interprofessional Competence	NA
Warren, Markovic & Manderson, 2006 [171]	Australia	Scientific article	Conceptualization/definition	Rural women with gynecological health issues	Lay-Health, Patient	Micro, Meso	Self, Peer	Advocacy as lay-health action by rural women to improve reproductive health services, categorized into typologies (advocacy-seekers, providers, storytellers).	Bio-psycho-social, Person-centered	Social Justice, Equity, Inclusion	Empowerment, Supporto, Rappresentanza, Riduzione Stigma	Rural Women, Storytellers, Social Networks, Support Groups	Reduction Of Isolation, Empowerment, Institutional Recognition	NA
Waterston, 2002 [172]	UK	Scientific article	Conceptualization/definition; Strategies/actions	Children’s health and social policy	Health	Macro	Systemic	Advocacy is framed as the duty of pediatricians to speak on behalf of children and families, ensuring their rights and needs are recognized. It spans both individual support (helping patients navigate health and social systems) and systemic influence (shaping policy, legislation, and services).	Person-centered, Rights-based	Social Justice, Child Rights, Ethical Duty	Equity; Rights; Empowerment; Participation	Health Professionals, Policy Makers, Child Health Organizations	Influence On National And International Child Health Policy	NA
Whittaker, 2003 [173]	Thailand	Scientific article	Conceptualization/definition; Strategies/actions	Abortion law reform advocacy	Health, Policy	Micro, Meso	Systemic	Advocacy is conceptualized as a process of enabling voice and influence in public health, where professionals translate evidence into policy change. It is grounded in equity and representation of marginalized groups, requiring communication and alliance-building.	Bio-psycho-social	Care Ethics, Empowerment, Dignity	Rights; Equity; Empowerment; Participation	Evidence generation, Political lobbying, Coalition building, Media engagement, Framing strategies	Increased Awareness And Skill Among Nursing Students	NA
Williams et al., 2023 [174]	Guatemala	Scientific article	Conceptualization/definition; Strategies/actions	Vaccine confidence and local advocacy	Health	Micro, Meso	Community, Peer, Systemic	Advocacy is seen as community-based action to promote vaccination, rooted in trust, local leadership, and collective responsibility. It emphasizes mobilizing voices at the grassroots level to support immunization programs and reduce barriers.	Bio-psycho-social	Trust, Responsibility, Equity	Equity in Health Access, Community participation, Empowerment of local voices	Religious Leaders, Community Members, Health Workers	Increased Vaccine Confidence, Influence Of Local Leaders	NA
Yang et al., 2011 [175]	China	Scientific article	Strategies/actions	Tobacco control education	Health	Meso	Professional, Community	Advocacy is defined as students’ ability to act for tobacco control through knowledge, attitudes, and behaviors. It combines policy engagement, awareness raising, and professional responsibility, making advocacy a core skill for future public health practitioners.	Bio-psycho-social	Civic Engagement, Health Promotion, Responsibility	Equity; Empowerment; Participation; Rights (protection from secondhand smoke)	Public Health Students, Schools Of Public Health, Training Program	Increased Advocacy-Related Attitudes And Behaviors (Not Smoking)	NA
Yu et al., 2022 [176]	USA	Scientific article	Curriculum/training	Medical training during covid-19	Health	Micro, Meso	Professional	Advocacy is conceptualized as health professionals’ engagement in advancing equitable care through education, organizational involvement, and influencing policy. It reflects a competency that bridges clinical expertise with systemic health change.	Bio-psycho-social	Awareness, Civic Duty	Equity; Participation; Empowerment; Rights (policy engagement in pandemic response)	Virtual Advocacy Day, Evaluation Survey	Greater Advocacy Interest And Intention	NA

Domains of application and advocacy typologies

The application of advocacy described in the documents included was wide-ranging. A substantial proportion of the literature examined advocacy in medical and health professional education, often in relation to undergraduate curricula or postgraduate training programs. Other works explored advocacy in public health promotion, targeting domains such as tobacco control, lifestyle modification, and health communication. Specific health policy areas were also well represented, particularly maternal and child health, mental health advocacy focusing on stigma reduction and access to care, and advocacy for the prevention and management of chronic conditions, including diabetes and cardiovascular disease. Alongside these more established domains, several studies investigated community-driven initiatives and patient-focused advocacy, reflecting advocacy’s diverse applications across health systems.

Regarding categories, the studies demonstrated an emphasis on health advocacy and policy advocacy, with several documents combining different forms into hybrid approaches that integrated policy, health, legal, and community perspectives. Analysis of the level at which advocacy was enacted revealed that meso-level efforts (n = 103; 70.5%), such as those directed at institutions and organizations, and macro-level activities (n = 92; 63.1%) aimed at systemic and policy reform, were predominant. Micro-level advocacy (n = 41; 28.1%), typically involving individual professionals or small groups, was less frequently reported. Similarly, the categorization by form of advocacy indicated that systemic (n = 91; 62.3%) and professional (n = 88; 60.3%) approaches were most common, while community-based (n = 53; 36.3%) initiatives were less represented. A smaller subset of publications addressed peer (n = 10; 6.8%) or self-advocacy (n = 7; 4.8%), highlighting the breadth but also the uneven emphasis across advocacy practices.

Conceptualization and definitions of advocacy

Most of the included studies provided an explicit conceptualization of advocacy. Commonly, advocacy was framed as a deliberate and purposeful effort to influence health determinants, professional practice, and policy agendas. A recurrent element in many definitions was the reference to social justice, equity, empowerment, and human rights as values underpinning advocacy activities. In several cases, this orientation was linked to a bio-psycho-social understanding of health, highlighting the interplay between social, political, and biomedical determinants.

Several authors presented advocacy as an ethical responsibility intrinsic to the role of health professionals, while others underscored its multidisciplinary and context-sensitive character, adapting across domains and professional fields. Some contributions were domain-specific, linking advocacy to areas such as maternal and reproductive health or nursing practice. At the same time, a number of studies pointed to the need for greater conceptual and operational clarity, particularly in distinguishing advocacy from overlapping practices such as leadership, communication, or patient representation. Despite this, many studies offered explicit definitions.

Illustrative definitions included, for instance, descriptions of advocacy as “the active support of a cause through diverse strategies (speaking, writing, mobilization) to improve health policy and equity” [47] or as “a professional responsibility” [55, 102, 105, 132, 143] to speak and act on behalf of patients and communities in pursuit of equity. Other authors described advocacy as “enabling marginalized voices to be heard” [131], underscoring its function of amplifying marginalized perspectives. Several studies highlighted advocacy as “a collective and organized effort to secure political and financial support for evidence-based health interventions” [41] while others defined it as “an act taken to protect and speak up on behalf of those who are not receiving the quality of life and fairness that is guaranteed” [88]. In more domain-specific framings, advocacy was conceptualized as “a core ethical and professional practice of public health nurses, operationalized through measurable competencies” [64], or as “actions by consumers and families—writing letters, giving testimony, engaging media, lobbying—to influence mental health policy and service delivery” [71].

Taken together, these definitions reveal both the technical-operational side of advocacy—mobilizing resources, building coalitions, engaging media, using legal frameworks—and its ethical dimension, rooted in justice, equity, and professional duty. They also show that advocacy may be framed as a broad systemic endeavor (“a wide range of activities to influence decision makers, such as litigation, lobbying, public education, capacity building” [73]) or as locally grounded, relational work (“community engagement and social accountability through research-based theatre in medical education” [53]). Overall, this diversity of framings is consistent with the coding in the extraction table under the variables “Advocacy conceptualization”, “Implicit health vision”, and “Underlying values”, where social justice, empowerment, and ethical duty were among the most frequently reported anchors.

Strategies and actions in advocacy practice

The literature provided rich descriptions of the strategies and actions through which advocacy is implemented. Commonly reported practices included the formation of coalitions and stakeholder networks, the mobilisation of legal and policy tools, and the strategic use of media and narrative framing to shape public and political discourse. Several studies highlighted grassroots mobilisation and community engagement as central to advocacy efforts, particularly in contexts of health inequities and vulnerable populations. Educational approaches and participatory mechanisms were also frequently described, reinforcing advocacy as both a technical and a social process.

The goals associated with these strategies ranged from improving access to healthcare and protecting individual rights to promoting institutional accountability, systemic reform, and community empowerment. Many studies underscored the interdependence of these goals, suggesting that effective advocacy is not limited to discrete outcomes but rather contributes to broader transformations in health systems and policy environments.

These strategies and goals were directly aggregated from the extraction table categories “Operational components” and “Advocacy goals” where coalition-building, media engagement, and empowerment consistently emerged as dominant themes across literature.

Measurement and evaluation of advocacy

Despite the broad emphasis on strategies and outcomes, only a minority of studies (n = 6; 4.1%) reported the use of instruments to measure advocacy processes or impacts. These tools included locally developed surveys, simulation-based assessments, and qualitative interviews, often tailored to specific educational or community contexts. None of the included documents employed standardized or validated instruments applicable across settings. This finding highlights a significant methodological gap, as advocacy remains largely under-evaluated in terms of its effectiveness and impact on health outcomes.

Beyond formal measurement, many studies described expected or reported outcomes. These included increased awareness of rights among patients or communities, greater institutional accountability, enhanced participation and empowerment, and, in some cases, the integration or reform of health programs and policies. However, such outcomes were typically presented narratively rather than supported by systematic evaluation.

Overall, the evidence indicates that while advocacy is often assumed to contribute to meaningful social and health change, the lack of robust and standardized evaluation frameworks limits the ability to compare across settings or to establish its effectiveness with confidence.

These findings were drawn from the extraction table variables “Measuring instruments” and “Expected/reported outcomes”, which confirm the scarcity of validated instruments and the reliance on narrative accounts of change.

Discussion

This scoping review sought to clarify how advocacy is defined, conceptualized, and operationalised within public health and healthcare literature in democratic societies. Across the 146 included studies, three broad findings stand out. First, advocacy is consistently described as a multidimensional and dynamic practice that adapts to changing social, institutional, and political contexts. Second, while advocacy is widely invoked as a driver of equity and systemic transformation, its conceptualization remains fragmented and inconsistently operationalised across domains. Third, despite the strategic importance attributed to advocacy, robust and validated approaches to training and evaluation are still scarce. Together, these findings confirm that advocacy is both central to contemporary health systems and under-theorized as a professional and civic practice.

While its manifestations vary across disciplines and domains, the literature consistently portrays advocacy as a deliberate, value driven process oriented toward systemic change, social justice, and the redistribution of power in health systems. This normative orientation toward empowerment and participation is consistent with recent work emphasising that equity-oriented action in health systems must be deliberate and co-produced with affected communities, rather than treated as an incidental by-product of innovation or service design [11]. These are foundational principles of health equity, which seek to address avoidable, unfair, and remediable differences in health outcomes across population groups [3, 8]. Our findings resonate with Carlisle’s [24] conceptual framing of advocacy as a central function of health promotion, aimed at challenging inequities and amplifying marginalized voices, and with more recent work emphasizing its inherently normative character, in which advocacy is simultaneously a professional duty and a form of civic engagement [5, 26].

The review also demonstrates that advocacy is not static but evolves alongside transformations in healthcare governance, patient–professional relationships, and public expectations. In line with the results, we observed that the diversification of advocacy models reflects broader contextual changes, such as the expansion of patient and community agency, the politicization of health disparities, and the global movement toward participatory health systems [10, 177]. These findings also mirror themes raised in the introduction, where advocacy was situated within global shifts in philanthropy, human rights, and civil society mobilisation [13, 14]. In this sense, advocacy emerges as an adaptive practice, responsive to emergent equity challenges such as digital divides, environmental crises, and declining trust in science and institutions [14, 178].

Our results confirm that relational and communicative competencies—including storytelling, negotiation, public speaking, and media engagement—are widely recognised as core enablers of advocacy effectiveness, particularly in contexts where policy and public discourse shape the distribution of health opportunities [179, 180]. At the micro level, qualitative evidence further shows that communicative practices are not neutral transmission tools, but relational mechanisms that can either support or undermine engagement, trust, and perceived agency. For instance, studies on clinical documentation highlight how language, tone, and co-designed formats function as extensions of the clinical relationship and shape patients’ capacity to participate meaningfully in care and decision-making [181]. Yet, only around one-third of the studies reported specific tools for measuring advocacy, and these were predominantly context specific and rarely validated. This confirms the gaps noted in the introduction regarding the absence of coherent evaluation frameworks and limits the ability to demonstrate advocacy’s concrete contributions to equity—a gap also highlighted in recent methodological reviews [182]. Recent scoping work further suggests that these evaluation challenges stem less from definitional plurality than from the lack of shared operational anchors across levels and settings, underscoring the need for frameworks that balance conceptual coherence with contextual adaptability [183]. Importantly, the conceptual fluidity of advocacy does not preclude meaningful evaluation. Rather than requiring a single, fixed definition, evaluation can be anchored in relatively stable elements identified across the reviewed literature—such as core equity-oriented values, levels of action, and functional mechanisms through which advocacy seeks to influence health systems and outcomes.

In health and care settings, the case for evidence based advocacy as a driver of equity is compelling. Evidence based advocacy integrates the best available research with contextual knowledge and stakeholder perspectives to ensure that strategies are not only ethically justified but demonstrably effective in reducing disparities [2, 184]. Without such grounding, advocacy risks reproducing existing inequities, misdirecting scarce resources, and losing legitimacy among the communities it seeks to serve. Conversely, when advocacy is guided by robust evidence and equitycentred principles, it can directly inform prioritysetting, strengthen accountability, and promote structural change in health systems [3]. This aligns with educational research showing the need to embed advocacy skills into curricula for health professionals, thus bridging the gap between theory and practice.

The blueprint for equity-oriented advocacy presented below is grounded in the patterns that emerged from the analysis of the included literature. Specifically, it synthesises recurrent conceptual, normative, and operational elements identified across the reviewed papers, translating these shared features into an integrative and practice-oriented framework. Each component of the blueprint reflects domains that were consistently emphasised across the analysed studies, including the normative grounding of advocacy, its multi-level orientation, the centrality of relational and communicative practices, and the limited but emerging attention to evaluation and accountability.

A distinctive contribution of this review lies in its integration of the conceptual synthesis into a structured, equityoriented advocacy framework. The conceptual framework was developed through iterative thematic analysis, moving from descriptive coding of advocacy definitions, values, and practices, to the development of higherorder conceptual categories that captured crosscutting dimensions relevant to health equity. This approach allowed us to map not only the content of advocacy (what it is) but also the processes through which it operates (how it is enacted) and the levels at which it exerts influence (where it acts).

Unlike previous conceptual models, which have often focused on either representational or structural dimensions of advocacy, our framework explicitly integrates normative, relational, and evaluative components into a single equity-oriented structure. This makes it both conceptually comprehensive and practically applicable across different health system contexts. By consolidating these dimensions, we formulated a preliminary blueprint for evidencebased, equityoriented advocacy in health. This conceptual integration is represented in Fig. 2, which depicts the Pyramid Model of Equity-Oriented Advocacy.

Fig. 2.

Conceptual framework for equity-oriented public health advocacy. Reflexive professional role and civic engagement are shown as enabling individual-level capacities that originate at the micro level and support advocacy across meso and macro domains, rather than as a distinct level of action

Clarification is warranted regarding the positioning of “Reflexive Professional Role and Civic Engagement” within the framework presented in Fig. 2. This dimension is not conceived as a separate level of advocacy action, but rather as a set of individual capacities that are primarily enacted at the micro level. At this level, reflexive professionalism refers to critical self-reflection on one’s professional or civic role, ethical awareness of inequities encountered in everyday practice, and recognition of advocacy as a legitimate responsibility. These reflexive processes shape how individuals interpret their power, responsibilities, and opportunities for action, thereby enabling engagement in collective (meso-level) and policy-oriented (macro-level) advocacy. In this sense, reflexive professional role and civic engagement function as enabling conditions that sustain advocacy across levels, rather than as an independent layer of action.

The model illustrates how normative foundations, relational practices, and evaluative mechanisms build progressively from micro to macro levels, highlighting advocacy’s role as a systemic equity driver.

The blueprint bridges the gap between conceptual understanding and practical implementation, providing a translational tool that can guide:

• Policy formulation, by articulating advocacy’s role in addressing structural determinants of health;

• Training and professional development, by identifying core competencies and reflective practices;

• Evaluation, by proposing accountability mechanisms and measurable indicators aligned with equity outcomes.

The framework positions advocacy as a systemlevel change agent and explicitly links it to the redistribution of power, participatory governance, and the pursuit of fair health opportunities. While designed to be adaptable to different health system contexts, its normative grounding in justice and equity makes it particularly relevant for settings aiming to institutionalise advocacy as part of health system governance. The six components of this blueprint—along with their definitions, operational implications, and explicit links to equity—are summarized in Table 2, which is intended as a practical reference for policymakers, educators, and practitioners seeking to integrate advocacy systematically into public health action. Whereas Table 2 details the operational implications of each component, Fig. 2 provides a visual synthesis of their hierarchical and interconnected structure. By making explicit the connections between these recurring findings and the proposed components, the blueprint offers a structured synthesis of the existing literature rather than a prescriptive model detached from it. To support interpretation of this framework, Table 2 provides an expanded description of each component, detailing its operational implications and explicit linkages to equity, including the micro-level processes underlying the “reflexive professional role and civic engagement” dimension.

Table 2.

Preliminary blueprint for equity-oriented advocacy in health: components, operational implications, and equity linkages

Blueprint component	Definition	Operational implications	Equity linkage
Normative grounding	Advocacy anchored in principles of social justice, equity, solidarity, and human rights.	Guides value-based decision-making and priority setting in advocacy actions.	Ensures that advocacy efforts focus on reducing avoidable and unjust health disparities.
Multilevel orientation	Advocacy action spanning individual, organizational, community, and policy levels.	Supports the design of interventions that address health determinants across interconnected system layers.	Enables action on inequities at both micro (patients and communities) and macro (institutions and policies) levels.
Relational & communicative practices	Use of storytelling, negotiation, alliance-building, and strategic communication.	Strengthens influence, fosters partnerships, and mobilizes stakeholders and coalitions.	Amplifies marginalized voices and improves representation in decision-making spaces.
Critical & systemic literacy	Ability to analyse social and structural determinants of health, power relations, and governance processes.	Enables informed, context-sensitive, and strategically targeted advocacy actions.	Directs attention toward structural drivers of health inequities rather than individual deficits.
Reflexive professional role and civic engagement (Micro level)	Individual capacity for critical self-reflection on one’s professional or civic role, ethical responsibility, and positionality in relation to communities and systems.	Supports ethical awareness, role clarity, and recognition of advocacy as part of everyday professional or civic practice; prepares individuals to engage in collective and policy-oriented advocacy.	Promotes inclusive and participatory approaches grounded in lived experience and community priorities.
Evaluation & accountability mechanisms	Development and use of tools and indicators to assess advocacy processes and outcomes.	Facilitates transparency, learning, and continuous improvement of advocacy strategies.	Ensures accountability and demonstrable impact on equity-relevant outcomes.

Strengths and limitations

The strengths of this review include its interdisciplinary scope, which integrates conceptual and applied evidence from medicine, nursing, public health, policy studies, and the social sciences, and its inclusion of diverse geographical perspectives that broaden the interpretive lens. This breadth allows for a nuanced understanding of how advocacy contributes to advancing equity across varying sociopolitical contexts. However, certain limitations must be acknowledged: the restriction to English-language peer-reviewed literature may have excluded valuable contributions from the Global South; the heterogeneity of definitions and frameworks required interpretative synthesis; and the reliance on published studies may under-represent informal, community-driven advocacy efforts. Furthermore, the predominance of cross-sectional evidence across the included studies restricts insights into the longitudinal impacts of advocacy initiatives. Importantly, this limitation does not reflect an absence of empirical engagement with advocacy, but rather the predominance of conceptual, descriptive, or qualitatively informed accounts, alongside a relative scarcity of studies employing standardized, comparative, or outcome-oriented evaluative designs. Despite these limitations, the interdisciplinary scope and integration of diverse perspectives ensure that the findings remain directly relevant to policymakers, educators, and practitioners seeking to institutionalise advocacy as a lever for equity.

Future research should focus on codeveloping theorydriven, equityfocused frameworks that can guide both implementation and evaluation of advocacy across health systems. Longitudinal, participatory research is needed to assess how advocacy efforts influence equity trajectories over time. Importantly, the creation of validated, transferable evaluation tools will be critical for demonstrating how advocacy impacts structural determinants of health. By embedding equity as a central criterion for assessing success, the field can move toward a coherent, accountable, and evidenceinformed approach to advocacy that supports more inclusive, just, and resilient health systems.

Conclusion

This review offers a systematic, interdisciplinary analysis of how advocacy is conceptualized, theorized, and operationalised across public health, clinical practice, education, and social science domains in democratic contexts. Taken together, our findings underline advocacy’s dual character as both professional competency and civic practice, oriented toward addressing structural determinants of health and redistributing power. The proposed framework provides a blueprint for integrating equity-oriented advocacy into policy, practice, education, and evaluation.

Future research should focus on the co-development of theory-driven, equity-focused frameworks and validated evaluation tools, as well as on participatory approaches that center the voices of marginalized communities. By embedding equity as both a guiding principle and an evaluative criterion, advocacy can move from fragmented practice toward a coherent, evidence-informed, and accountable force for systemic transformation.

Abbreviations

ACA

American Counseling Association

AMA

American Medical Association

CBPR

Community-Based Participatory Research

CBO

Community-Based Organization

CSI

Chi Sigma Iota (Counseling Academic & Professional Honor Society)

ELPA

European Liver Patients’ Association

FH

Familial Hypercholesterolemia

JBI

Joanna Briggs Institute

NGO

Non-Governmental Organization

PRISMA-ScR

Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews

SEAPS

Seniors Empowerment and Advocacy in Patient Safety

UHC

Universal Health Coverage

WHO

World Health Organization

YEAH

Youth Engagement and Action for Health

Author contributions

Michela Monaci: Conceptualization, Formal analysis, Writing – Original Draft; Marko Korenjak: Resources, Validation, Writing – Review & Editing, Patient advocacy Supervision; Beatrice Credi: Resources, Writing – Review & Editing, Patient advocacy Supervision; Sarah Bigi: Validation, Writing – Review & Editing; Serena Barello: Conceptualization, Methodology, Supervision, Validation, Writing – Review & Editing.

Funding

This review was conducted within the framework of the ICONIC project, which was funded through an unrestricted educational grant provided by European Liver Patients’ Association (ELPA). The funding body had no role in the design of the study, the collection, analysis, and interpretation of data, or in writing the manuscript.

Data availability

All data generated or analyzed during this study are included in this published article and its supplementary information files. The data extraction table and related materials are available from the corresponding author only upon reasonable request.

Declarations

Ethics approval and consent to participate

Not applicable. This study is a systematic review of published literature and did not involve human participants or the collection of identifiable personal data.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.