The concept and types of advocacy in healthcare
The concept of patient advocacy was officially recognized and defined in the 1970s in the United States of America (U.S.A.). George J. Annas and Joseph Healey introduced the concept of “patient advocacy”, arguing that weak and disadvantaged patients (e.g. young, illiterate, patients with difficulty in verbal communication, without a family environment, who did not speak English, etc.) need a person – an advocate, who can provide them with information but at the same time be able to claim and protect their rights as health users.

Advocacy in modern healthcare extends to two levels: a) micro-advocacy, which focuses on defending individual patients (e.g., protection from medical errors, protection of patients from rude behavior of colleagues and other members of the healthcare team, provision of information regarding the patient’s diagnosis, treatment, and prognosis, suggestions for alternative treatments in the treatment plan, provision of information regarding the hospital discharge plan, facilitating patients to make decisions freely, maintaining the dignity of their values ​​and personal beliefs, mediation between patients, families, and healthcare professionals), and b) macro-advocacy, which concerns systemic and political interventions. The main axes of patient advocacy aim at autonomy, representation, empowerment and ensuring the rights of patients, as well as at shaping the formulation of health policies and by extension at achieving the optimal degree of social justice.

Who is it practiced by and why is it important?
The principles governing patient advocacy are the basis for creating a healthcare environment that prioritizes both patient-centered care and the provision of universal, safe, quality, equitable and fair health services. At its core, patient advocacy ensures that the voice of the patient is heard and that care is aligned with understanding, consent and in accordance with their values ​​and needs. Patient advocacy as a concept is included in the codes of ethics and conduct and is a professional responsibility and commitment of all health professionals.

What are the barriers to patient advocacy in healthcare?
The uneven interpretation of the concept, role and practices of patient advocacy in each health system and setting at an institutional level, the lack of education and knowledge, the lack of communication skills and collaboration between the interdisciplinary team as well as the ineffective communication with the patients’ direct caregivers, the lack of a supportive organizational culture, the fear of retaliation upon disclosure of an incident, the lack of available time for the patient and the moral discomfort on the part of health professionals both in relation to their personal beliefs and values, as well as those of the patients, are factors that hinder the implementation of patient advocacy in practice.

Conclusions
The World Health Organization (WHO) has explicitly defined the defense of patients’ rights as a fundamental function of health promotion, especially in terms of promoting people-centered and equitable health systems. As advocacy is recognized as a catalyst for health equity, it is imperative to remove the aforementioned obstacles by integrating education and institutionalizing protocols and procedures towards this achievement. Because advocacy of health users not only empowers individuals, but also communities for the benefit of Public Health.

Fani Peyou, RN, MSc, PhD©,
Service “Help at Home”, Ptolemaida
Member of the National Council of Nurses (FFN Gr)