The affective practices of health policy implementation: Rural, elderly health policy in the face of the opioid epidemic
Open Access
- Author:
- Diaz, Brett
- Graduate Program:
- Applied Linguistics
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- March 16, 2021
- Committee Members:
- Robert William Schrauf, Dissertation Advisor/Co-Advisor
Robert William Schrauf, Committee Chair/Co-Chair
Sinfree Bullock Makoni, Committee Member
Xiaofei Lu, Committee Member
Christopher Daryl Cameron, Outside Member
Daniel Max Crowley, Committee Member
Robert William Schrauf, Program Head/Chair - Keywords:
- applied linguistics
corpus linguistics
mixed methods
health policy implementation
emotion
evaluative language
discourse analysis
opioid epidemic
elder services - Abstract:
- This dissertation addresses social aspects of elderly health policy implementation in rural Pennsylvania, as it turns to face the opioid epidemic. Between June of 2017 and July of 2019, the researcher conducted ethnographic interviews with elderly health services administrators, with the goal of learning about the rural, elderly experience of aging. These agents directed the interviews toward the effects of the opioid epidemic in their populations. Official policies portrayed aging and elderly health needs in one way, through one channel of how and why policy gets done. And yet, these agents seemingly represented different positions, or different beliefs, about those same how and why questions for their populations. This observation led to the question, how do values, goals, and cultural beliefs interact between rural, elderly health services and official policy documents, as they confront the ravages of the opioid epidemic? To answer these questions, this dissertation attends to the stance-taking events present in these policies and interviews by utilizing corpus-assisted discourse analysis. Data come from a multi-modal corpus of text (n = 100; 571, 481 words), in the form of official policies, brochures, and outreach materials from elderly health agencies, and talk, in the form of bi-monthly ethnographic interviews (n = 29; 171,492 words) with 6 director-level agency administrators and 5 of their protective services case workers. Texts are compared with interviews by extracting frequent keywords and collocations from both, and then qualitatively analyzing their semantic properties in the form of semantic preference and semantic prosody. Stance-taking is then explored within single interactive events in the interviews using qualitatively based discourse analytic procedures. Through these processes, the role of evaluative language to establish beliefs in the official policies and the interviews becomes highly visible. A contemporary theory of emotion called psychological construction is used to better understand evaluative aspects of language. Evaluative contours of the language are tracked across both existent texts, and in fine-grained interactive contexts, and ultimately finding that patterns of evaluation are core aspects of health policy beliefs, how they are understood, and thus what makes it into the how and why of health policy implementation at different sites and infrastructural levels. Results show that (1) health policy implementation in rural, elderly settings is often as much about culturally situated social beliefs as it is about official mandates; (2) stance-taking can be tracked across multiple levels of discourse in consistent ways; (3) evaluative language is used by both policy documents, and directors and their caseworkers, in consistent ways that expose their experiences, expectations, and their values through the social activity that is implementation. The significance of these findings for the study of health policy implementation as a subject, and for discourse analysis as a methodology, are discussed.