What is public health advocacy? Australasian practitioner perspectives on defining the field and identifying effective practice and required competencies

Public health advocacy is a core function of public health practice, yet it remains underexamined, with limited consensus on its definition, effective strategies, and required competencies. This study explored public health advocacy practice among Australasian advocates, examining how advocacy is defined, which strategies are perceived as effective, and the competencies required for practice. Public health advocates completed an online survey between December 2024 and April 2025. Data were analysed using descriptive statistics and content analysis. A total of 101 advocates completed the survey. Public health advocacy was commonly defined as an intentional, outcomes-focused practice that uses strategic actions to influence policy and practice to improve population health. Relationship building (59%), influencing decision makers (57%), and media use (46%) were identified as the most effective strategies. Reported barriers included inadequate organizational resourcing (funding 63%, time 61%, personnel 47%), limited access to decision makers (56%), organizational concerns about repercussions (39%), low priority (32%), and insufficient training (32%). Required competencies included contextual understanding of the health issue, policymaking literacy, knowledge of advocacy methods, and skills in communication, collaboration, research, and media engagement. Australasian advocates hold broadly consistent views of public health advocacy and identify key competencies and effective strategies. However, barriers related to capacity, organizational support, and evaluation processes continue to constrain practice. Strengthening workforce capability requires targeted education and training, greater organizational prioritization and resourcing of advocacy, and the development of strong relational networks with stakeholders and decision makers to enhance advocacy effectiveness. These findings have relevance beyond Australasia, particularly in comparable high-income democratic countries.