Towards an international research agenda for public health advocacy: Practice, preparedness and knowledge gaps.

Advocacy is a core function of public health practice and is essential for advancing population health, whether by promoting preventative measures or encouraging evidence-based policy reform. However, public health advocates, globally, face considerable barriers, including limited knowledge of effective strategies, resource constraints (such as time and funding), low prioritisation within organisations, and interference from powerful commercial industries seeking to impede policy change. To better support advocacy efforts, we sought to understand global advocacy practices, identify effective strategies, and determine where additional resources or evidence are most needed. We conducted an online cross-sectional survey with 156 self-identified public health advocates across 36 countries. Most respondents (80%) reported engaging in advocacy regularly, dedicating approximately half of their work time on related activities. Working in coalitions on policy issues was one of the most frequently used and effective strategies. While 61% of respondents felt well-equipped with advocacy knowledge, many reported gaps in other areas of preparedness, including insufficient funding, lack of time, limited access to networks, and gaps in advocacy skills, particularly regarding engaging with industry. Notably, respondents from middle-income countries reported higher self-assessed advocacy skills than those from low- or high-income countries. These findings highlight the need for tailored support and resources, particularly in relation to capacity building and evidence generation. In response, we propose a research agenda to address the most pressing issues facing public health advocates, globally.