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Advocacy, enablement and mediation

In the previous step we identified how the five levels of action of the Ottawa Charter are underpinned by advocacy, enablement and mediation, which we will now go on to look at in more detail.

We will start by defining advocacy, enablement and mediation and how they might be applied. In the next step we consider a case study to identify circumstances in which you might use these approaches.

So, health promotion goes beyond the healthy lifestyle focus and needs us to explore not only what we can do but how we can work with patients and clients.


Health may be viewed as political and advocacy may be described as work carried out to represent or defend a cause. It may include lobbying in order to influence policy or work that you undertake on behalf of a client. Advocacy can be challenging as in many situations it requires you to influence without having authority. An example of advocacy is lobbying that takes places to amend abortion legislation.


Enablement is work that is carried out in partnership with the community, helping people develop skills and ultimately addressing their own determinants of health. As a nurse this would involve you working to support change and then allowing people to take control of their own destiny. Much community development work is about enablement and the example below is about a headteacher who wanted to improve the health of her pupils so she gave the children in her school the opportunity to run for 15 minutes a day.

Review the Daily Mile website to see how one headteacher has not only enabled her local community, but has also influenced enablement nationally and internationally.


Mediation is the work taken to bring groups together to influence evidence-based decision-making. In many instances mediation requires finding common ground in order to help forge a path forward.

We encourage you to visit www.ted.com, search for and watch “William Ury, The Walk from ‘No’ to ‘Yes’ “, in which William talks about mediation and how to create agreement in difficult situations.

Your task

Read about advocacy that resulted in a change in legislation on abortion in Ireland.

As a nurse, what are the facilitators and barriers to your role in advocacy, mediation and enablement?


McDonald, H., Graham-Harrison, E., and Baker, S. (2018) ‘Ireland Votes by Landslide to Legalise Abortion’. The Guardian [online] 26 May. available from https://www.theguardian.com/world/2018/may/26/ireland-votes-by-landslide-to-legalise-abortion [19 June 2018]

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This article is from the free online course:

Could You Be the Next Florence Nightingale?

Coventry University