Measuring Policy Advocacy Engagement and Identifying Possible Predictors Among Frontline Health Professionals in Acute Care Hospitals

Background. With the passage of the Affordable Care Act greater attention has been given to the need to improve the quality of care for patients who access health care systems throughout the country.  Data from the PCORI Pilot Project: Improving Health Care Outcomes Through Advocacy is the first of its kind that describes the extent to which frontline workers are aware of health care problems and the policy advocacy available to fix these problems. A substantial amount of research documents that millions of Americans face unresolved problems in seven core areas: 1) Affordable/Accessible Care; 2) Evidence-based/Quality Care; 3) Ethical Rights; 4) Culturally-competent Care; 5) Preventive Care; 6) Mental Health Care; and 7) Community-based Care. Nurses, social workers, and medical residents (frontline workers) are uniquely suited to address patient problems through policy advocacy engagement however, little research has been done as to why frontline workers engage in policy advocacy, despite their ethical imperative to do so.  This research seeks to better understand the factors that contribute to frontline workers engaging in policy advocacy.

Methods. The present study is based on the data collected from 300 frontline workers from 8 types of short-term acute care hospitals within Los Angeles County, using online survey software (Qualtrics). From the 300 participants: 100 are medical residents, 100 registered nurses, 100 social workers. Approximately 70% of the sample is female and 39% male (0.3 % identified as other).  Five advocacy scales are included in the research.  The policy advocacy intervention scale (dependent variable) is used to measure policy advocacy regarding seven identified patients’ health problems over the previous six months.  Policy advocacy eagerness, tangible support, skills, and ethical commitment scales (independent variables) measure the attributes that frontline workers believe are important when thinking about policy advocacy engagement. OLS regression models were used.

Results. In the present study, policy advocacy eagerness was found to be significantly associated with policy advocacy engagement.  Frontline workers are uniquely suited to address the seven core healthcare problems and this research shows that eagerness to engage in advocacy is more important than ethical commitment, organizational receptivity, or skills. Ethical commitment, organizational receptivity, advocacy skills, and eagerness were hypothesized to be important in determining whether or not a healthcare professional engages in policy advocacy.  The results however, show that eagerness to engage is the only significant variable in the model.  Because previous research showed that ethical commitment and organizational receptivity were significant, the findings are surprising. 

Conclusions. This research provides important insight into the causality of policy advocacy engagement thus providing implications that are important to an evidence-based advocacy practice. Identifying significant advocacy drivers will enhance practice and give increased attention to research that positively affects policy outcomes.  Thus, social welfare advocacy empowerment and education should focus on tapping into eagerness to engage in policy advocacy as a tool to increase engagement.