Advocacy coalition impacts on healthy public policy-oriented learning in Alberta, Canada (2009-2016): A difference-in-differences analysis

Since 2009, the Alberta Policy Coalition for Chronic Disease Prevention (APCCP) has pursued policy, systems, and environmental change strategies engaging policy elites to promote healthy public policy for chronic disease prevention in Alberta, Canada. Employing Advocacy Coalition Framework (ACF) vocabulary to facilitate our analysis, we examined whether concerted advocacy by the APCCP shifted elites' belief system structures over an eight year period compared to the general public as a baseline, by fostering healthy public policy-oriented learning. As data for the study, we employed a trend design series of cross-sectional Chronic Disease Prevention Surveys in Alberta, Canada between 2009 and 2016, comparing policy elite responses in 2009 (n = 183) and 2016 (n = 174) with general public responses in 2010 (n = 1203) and 2016 (n = 1200). Drawing on four scales developed in a published exploratory factor analysis, we examined changes in elite versus public beliefs with respect to (i) behavioral etiology, (ii) socio-ecological etiology, (iii) individual responsibility, and (iv) societal responsibility. Each scale was analyzed for reliability using Cohen's alpha (a), tested for sample mean (mu) value differences with analysis of variance (ANOVA) (p < .05), and compared between groups over time using difference-in-differences analysis. Cohen's alphas above approximately 0.700 indicated acceptable scale reliability (0.692 <= alpha <= 5 0.879). ANOVA testing indicated significant group mean difference for every scale but societal responsibility among elites (mu(2009) = 13.2, mu(2016) = 13.7; p =.06). Standardized beta coefficients (beta) presented significant differences between elites and the public for three of four scales, excepting behavioral etiology (beta= -0.009, p = .746). In ACF terms, transformation of elites' policy core beliefs is necessary, but not sufficient, for major policy change such as healthy public policy. Spanning provincial policy communities relevant to whole-of-government intervention for chronic disease prevention, our results provide evidence to support the plausibility of long term socio-ecological strategies aiming to foster policy-oriented learning among elites by advocacy coalitions like the APCCP.