Experiences of professional public health advocacy in the UK health and social care system: a qualitative survey study [using the Theoretical Domains Framework].

BACKGROUND: Advocacy of public health principles (PHP) is crucial to tackling health inequities. Advocacy skills are therefore a core competency of Public Health speciality training in the UK. A survey of UK-trained specialist registrars found that the perceived ability to advocate for PHP varied significantly across work settings. This study explores barriers and enablers to PHP advocacy across workplaces, offering insights into how advocacy can be better supported in the UK public health landscape.

METHODS: An online survey was sent to UK-based public health specialty trainees, consultants, and public health practitioners on the portfolio route to consultant practice currently. Free-text survey responses were analysed using template analysis and the Theoretical Domains Framework.

RESULTS: Sixty-four respondents completed the survey. This study found that role clarity, organizational support, and advocacy skills significantly affect public health specialists' ability to advocate. Barriers included unclear responsibilities, fear of consequences, resource constraints, and inadequate training and mentorship. Supportive leadership and shared values facilitated success.

CONCLUSIONS: To promote advocacy, the Faculty of Public Health should ensure specialists are positioned as autonomous experts, address biases in recruitment, and integrate advocacy skills further into training. Organizations must evaluate how their structure, culture, and leadership support public health advocacy.