{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T04:57:52Z","timestamp":1793681872820,"version":"4.5.1"},"reference-count":27,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"unspecified","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"European Association of Liver Patients","award":["NA"],"award-info":[{"award-number":["NA"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,5,5]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To explore how patient advocates active in liver health understand and enact meaningful advocacy across diverse cultural and health-system contexts and to identify empirically grounded competencies that can inform evidence-based training and capacity building for patient advocacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-country qualitative study using a focused ethnographic approach, based on in-depth semi-structured interviews and reflexive thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Patient advocacy organisations active in liver health at local, national and international levels across Europe and selected non-European contexts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>23 experienced patient advocates affiliated with liver disease patient organisations in 17 countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Semi-structured interviews were conducted via videoconferencing. Data were analysed following a reflexive thematic analysis approach, with maximum-variation purposive sampling to capture diversity in advocacy roles, experience and health-system contexts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Five interrelated themes were identified, conceptualising patient advocacy as a relational and value-driven practice enacted across multiple levels of action. Findings highlighted a set of communicative, ethical, strategic, emotional and contextual competencies that advocates progressively develop to translate lived experience into system-relevant action. Advocacy was described as shaped by structural constraints, cultural norms and emotional burden, requiring adaptive strategies and sustained reflexive learning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patient advocacy in liver health relies on a constellation of competencies that extend beyond lived experience alone and can be explicitly supported through structured training. By articulating these competencies, this study provides an empirical foundation for developing evidence-based educational tools for patient advocates and for strengthening mechanisms that integrate experiential knowledge into health policy and governance, including \u201cListening-Informed\u201d Policy approaches.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-116516","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T12:00:26Z","timestamp":1779883226000},"page":"e116516","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Building capacity for patient advocacy in liver health: a cross-country qualitative study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8514-2563","authenticated-orcid":false,"given":"Serena","family":"Barello","sequence":"first","affiliation":[{"name":"WHYpsy Lab, Department of Brain and Behavioural 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