Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.


Health Promotion and Behavioral Sciences

Committee Chair

Wilson, Richard W.

Author's Keywords

Public health advocacy


Public health administration--Kentucky; Patient advocacy--Kentucky


Background: One of the core functions of public health is to develop policies that support community and individual health. There are many historic examples in which public health practitioners have advocated successfully for policies that ultimately protected and improved populations' health. Prior research suggests that local health departments are not fully engaged in health policy advocacy, thereby missing opportunities to more effectively solve public health problems. Objective: To identify the barriers and enabling factors to advocacy in Kentucky local health departments. Methods: Kentucky health policymakers and advocates were interviewed to determine which advocacy skills were effective and appropriate for use by local health department directors. Interviews were then conducted with 18 directors representing a diversity of health departments from across the Commonwealth. The interviews identified which advocacy skills local health departments employed and the conditions that assisted or inhibited these skills. Results: The advocacy skills identified by policymakers were: research and analysis, coalition building, educating policymakers and solutions identification. Advocates agreed that research and analysis, coalitions and educating policymakers were effective. Additionally, they added lobbying and educating the public as important skills. The directors reported that the most often-used skills were: public education, research and analysis, coalition building, stakeholder engagement and educating policymakers. Based on analysis of the transcripts, the enabling factors for this advocacy were: a supportive governing body, a director with vision for the community and the organization, public health member organizations that advocated for specific policies and community partners and adequate funding for advocacy. Barriers were: a lack of support from a governing body, community attitudes regarding the role of public health, a director's lack of clarity about lobbying and advocacy, as well as the director's personality and priorities for the organization. Community partners opposed to certain public health issues also posed barriers. Conclusions: Advocacy skills are employed in Kentucky local health departments, however barriers and enabling factors appear to exist. Steps can be taken to attempt to overcome the barriers, and the enabling factors can be communicated as models. Additional research can be conducted to verify these findings.