Teaching health advocacy in primary health care: a qualitative study with professors from the University of São Paulo medical school

Contemporary medical education continues to face challenges in integrating social determinants of health and social responsibility into the training of future physicians. In Brazil, the National Curriculum Guidelines for medical education emphasize comprehensive care across all levels of health attention, but the development of ethical, critical, and socially engaged competencies such as Health Advocacy remains limited. According to the CanMEDS framework, Health Advocacy involves recognizing health needs, mobilizing resources, and promoting equity-oriented changes in collaboration with individuals and communities. This study aimed to explore how professors involved in teaching Primary Health Care (PHC) at the Faculty of Medicine, University of São Paulo perceive and address the challenge of developing competency in Health Advocacy among undergraduate students. A qualitative study with a hermeneutic approach was conducted through a focus group with eleven professors from different specialties -Gynecology and Obstetrics, Pediatrics, Psychiatry, Preventive Medicine, Internal Medicine, and Family and Community Medicine - all of whom were actively engaged in PHC teaching. The session was audio-recorded, fully transcribed, and analyzed through comprehensive interpretive reading to identify analytical categories that were subsequently discussed in light of relevant theoretical frameworks. Participants described the identification of health needs beyond explicit patient demands as a central educational challenge, particularly the articulation between individual clinical care and collective dimensions of health. PHC was consistently identified as a privileged setting for this learning, though participants noted that its contribution is often undervalued within the curriculum. The main obstacles identified were institutional - curricular fragmentation, assessment gaps, and the hidden curriculum - rather than pedagogical. Participants pointed to strategies already embedded in PHC teaching - role modeling, PCCM, small-group learning, and reflective portfolios - as underrecognized opportunities for developing Health Advocacy. Making these practices visible and intentional, and aligning assessment and institutional support with them, may be an important condition for embedding Health Advocacy across the curriculum.