Contextual Factors
What is the impact of contextual factors on advocacy and policy? Contextual factors can range from internal (the organization, the practice, the environment, the culture, etc.) to external (laws, policies, politics, regulations, etc.). However, whether originating internally or externally, contextual factors have the capability of advancing or hindering an advocacy priority.
For this Discussion, you will consider how contextual factors impact policy making, focusing specifically on how these factors might impact your advocacy priority. Consider what contextual factors might promote getting your priority on the agenda, as well as those that might work against it.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
· Dawes, D. E. (2020).
The political determinants of health. Johns Hopkins University Press.
· Chapter 4, “How the Game is Played: Successful Employment of the Political Determinants of Health” (pp.78–111)
· Porche, Demetrius J. (2023).
Health policy: Applications for nurses and other health professionals (3rd ed.). Jones & Bartlett Learning.
· Chapter 9, “Policy Formulation and Implementation” (pp.101-112)
· Chapter 10, “Policy Analysis” (pp.113-140)
The following media resources address the contextual factors impacting the answer to the following question, “How did we get here?” regarding the current state of healthcare in the U.S.
Please select at least two from the following to view.
· CNBC. (2018, December 26).
Why medical bills in the U.S. are so expensiveLinks to an external site.
[Video].
Note: The approximate length of this media piece is 15 minutes.
· FRONTLINE PBS. (2021, May 18).
The healthcare divide Links to an external site.
(full documentary): FRONTLINELinks to an external site.
[Video].
Note: The approximate length of this media piece is 53 minutes.
· IntelligenceSquared Debates. (2017, October 6).
The U.S. health care system is terminally brokenLinks to an external site.
[Video].
Note: The approximate length of this media piece is 95 minutes.
· PBS NewsHour. (2021).
Health care: America vs. the WorldLinks to an external site.
.
Note: The approximate length of this media piece is 56 minutes.
To Prepare:
· Review resources about contextual factors.
· Consider how contextual factors will impact your advocacy priority.
By Day 3 of Week 4
Post a response detailing the following:
· Which contextual factors will promote getting your advocacy priority on the agenda?
· Which contextual factors might work against it?
RESPOND TO THIS DISCUSSION POST
ES PI BI
Several contextual factors enhance the chances of behavioral and mental health advocacy reaching the policy agenda. Political support and a favorable public mood provide a significant foundation for advancing such priorities. Kingdon’s (1995) agenda-setting model identifies three critical streams – problem, policy, and politics – that converge to create a “window of opportunity” for policy success (Milstead & Short, 2019). Mental health issues are increasingly recognized as a public health crisis, with rising concerns about accessibility, stigma, and disparities in care. This recognition builds momentum for advocacy efforts by framing mental health as a pressing societal problem.
Social constructions of the target population also play a key role. Nurses, as advocates for vulnerable populations, are positively perceived within policymaking environments. Policymakers often favor policies associated with groups seen as dependable and deserving, such as patients experiencing mental health challenges. Schneider and Ingram’s (1993) framework explains how positive perceptions of nurses and underserved populations can advance policies that promote equitable care models (Milstead & Short, 2019).
Organizational involvement strengthens bolsters advocacy efforts. Nurse leaders and professional associations, like the American Nurses Association (ANA), provide institutional support, creating unity and amplifying the policy message. The ANA and similar organizations serve as critical facilitators by engaging stakeholders, organizing advocacy campaigns, and aligning resources to highlight barriers to care for marginalized groups. This organized approach increases the visibility of advocacy priorities within institutional and systemic agendas, moving issues closer to decision-making forums.
Evidence-based research is another key promoting factor. Research demonstrating the link between integrated mental health care and improved patient outcomes strengthens the policy argument. For instance, findings that mental health integration reduces overall healthcare costs and enhances holistic care align with policymakers’ goals of cost efficiency and quality improvement (Isaacs & Mitchell, 2024). Advocacy efforts grounded in data-driven insights are more likely to gain bipartisan political support, particularly when framed as addressing both human dignity and economic priorities.
Despite the presence of enabling factors, several contextual barriers can obstruct advocacy efforts. One significant challenge is political partisanship and competing priorities. Policymaking often occurs within highly competitive and polarized environments, where health issues must vie for limited legislative attention. As Cairney et al. (2022) highlight, political complexity and resource limitations can undermine the feasibility of advancing new policies.
Economic constraints represent another obstacle. Funding for behavioral and mental health initiatives may be deprioritized due to competing budget demands, particularly in states or regions with limited financial resources. Policymakers are often reluctant to support policies perceived as costly, even when long-term benefits are clear. Additionally, stakeholder opposition from powerful interest groups, such as insurance providers or competing healthcare sectors, can dilute support for integrated mental health care models.
Stigma surrounding mental health continues to pose a cultural barrier. Societal misconceptions and entrenched biases about mental illness influence public attitudes and policymaker decisions. As noted by Milstead and Short (2019), changing deeply rooted perceptions requires strategic advocacy and public education, which can be slow and resource-intensive. Stigma can also affect the allocation of resources, as mental health may be perceived as a lower priority compared to physical health initiatives.
Within organizations, internal resistance to change can hinder advocacy efforts. Healthcare systems that prioritize acute care models may be slow to adopt integrated mental health approaches due to concerns about workflow disruption or resource allocation. Additionally, a lack of education and policy competency among nurses in some regions may limit their ability to engage in strategic policymaking (Hajizadeh et al., 2021). Enhancing nurses’ understanding of the policymaking process, particularly in developing countries, remains an essential step for overcoming this internal challenge.
Overall, the integration of behavioral and mental health into equitable care models is heavily influenced by contextual factors. Political support, public awareness, and organizational involvement create opportunities for advancing this advocacy priority. Conversely, political competition, economic constraints, and persistent stigma present major barriers. Strategic advocacy efforts must leverage enabling factors while addressing hindrances through evidence-based research, coalition building, and persistent public education.
References
Cairney, P., St Denny, E., & Boswell, J. (2022). Why is health improvement policy so difficult to secure?
Open Research Europe, 2, 76.
to an external site.
Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R., & Khodayari-Zarnaq, R. (2021). Factors influencing nurses participation in the health policy-making process: A systematic review.
BMC Nursing, 20(1), 128.
to an external site.
Isaacs, A. N., & Mitchell, E. K. L. (2024). Mental health integrated care models in primary care and factors that contribute to their effective implementation: A scoping review.
International Journal of Mental Health Systems, 18(1), 5.
to an external site.
Milstead, J. A., & Short, N. M. (2019).
Health policy and politics: A nurse’s guide (6th ed.). Jones & Bartlett Learning.
· Expand discussion thread from Esta N/A Pierre Bazelais
