Finding social (mis)alignment in older adult and opioid health policy implementation with corpus-assisted discourse analysis

Abstract

• Attends to beliefs of stakeholders in health policy implementation pathway. • Argues for “policies” as social activities rather than objects. • Confirms that health systems and their agents often have conflicting policy beliefs. • Corpus-assisted discourse analysis of both documents (text) and interviews (talk). • Policymakers could use these findings and methods to align language use in policy. The effective implementation of health policies addressing opioid addiction may be jeopardized by the complex and sometimes mismatched beliefs and discourses held by policymakers, agency administrators, case managers, and ultimately target populations. Policies must be “aligned” socially across service levels, but misalignment by well-meaning stakeholders becomes a potential hindrance to implementation at different administrative levels. This observation motivates the study to ask, what do health policies and agents actually say? Data for this study come from policy documents (n = 100; words = 571,481) and ethnographic interviews (n = 29; words = 171,492) collected from rural, older adult health service offices. Results and analysis focus on comparing linguistic features, keywords and collocations, between policy texts and agents’ talk. Findings show a complex, socially mediated relationship between priorities and stances in official documents and the enacting agents, especially regarding the causes and effects of the opioid epidemic.