256 - How Pediatric Residents Enact Health Advocacy: A Grounded Theory Study of Resident Advocacy Work

Poster Number: 256
Publication Number: 256.419

Hannah L. Anderson, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Noreena S. Lewis, The Children's Hospital of Philadelphia, Wilmington, DE, United States; Beth Rezet, CHOP, Havertown, PA, United States

Background: Health advocacy (HA) is a critical component of pediatric training and practice. Pediatric residents have unique HA experiences because they not only learn skills, but also conduct real-world HA projects. As more residents engage in project-based HA work, advocacy training must appropriately support their efforts and development. To do this, we first need to understand how residents’ do project-based HA work.

Objective: In this study, we sought to understand how pediatric residents "do" or enact HA by studying their advocacy work and self-reflection on that work over a period of 8 years.

Design/Methods: We used grounded theory methodology to conceptualize how residents enact HA. We purposefully sampled HA projects completed by pediatric residents at the Children’s Hospital of Philadelphia from 2013-2021. We iteratively assembled a data archive consisting of two document types: project posters (n = 45) and written self-reflections related to each project. We deidentified data and coded it using the constant comparative method. Codes, connections between codes, and findings were refined by discussion. 

Results: We found that residents enacted four different types of HA: some residents enacted directed agency or directed activism. Other residents enacted shared agency or shared activism. [Table 1] Depending on the type of HA enacted, residents reflected on different learning experiences; residents who engaged in shared forms of HA often learned skills such as “Partnering,” “Evaluating,” and “Planning.” Residents who did directed forms of HA shared lessons on “Leading, “Presenting,” and “Intervening.” Projects also changed over time: early projects (2013-2016) were grounded in a resident's personal interaction with a family, patient, or colleague and identify needs in the clinical or educational setting. In later projects (2016-2021) residents took increased ownership of the title and role of 'advocate' and expanding their advocacy work to community settings. Health equity and policy have a larger presence in recent projects, and political climate was salient in reflections.Conclusion(s): Pediatric residents contribute to their program and community by enacting HA through shared activism and agency and directed activism and agency. Over the past 8 years, resident HA work has changed in focus and setting. Our findings have important implications for advocacy training. No one type of advocacy is best but learning experiences may differ depending on the type of HA residents do. Advocacy training should be sensitive to the varied, changing ways residents enact HA and provide appropriate support.
Table 1Types of Health Advocacy Enacted by Pediatric Residents in a Grounded Theory Study of Resident Advocacy Projects (adapted from Hubinette, Dobson, Scott, and Sherbino, 2017)