Pill testing policy: A comparative analysis using the Advocacy Coalition Framework.

Introduction: Pill testing is regarded as a controversial harm reduction intervention and provides an ideal case study for examining how policy change comes about. Two Australian jurisdictions were analysed to explore factors that may account for policy change by comparing the ACT which allowed a pill testing trial, and NSW where pill testing has not been permitted. Methods: The analysis was conducted using the Advocacy Coalition Framework (ACF). Data sources were first coded to establish the subsystem actors beliefs and advocacy coalitions; then coded using a deductive approach and classified against core dimensions of the ACF. An inductive approach was then applied to generate and link themes in the data. Results: A dominant and minority coalition was identified in each jurisdictions' policy subsystem. The results show how in the ACT a dominant 'harm reduction' coalition shifted their secondary beliefs and introduced a pill testing policy. Whereas in NSW, a shift in both the secondary and policy core beliefs of the dominant 'law enforcement' coalition was required, something which rarely occurs according to the ACF. Discussion and Conclusions: The analysis supports the ACF's assertion that advocacy coalitions will respond to pressures for change by restricting change to secondary beliefs, while keeping policy core beliefs intact. It also demonstrates that secondary and policy core beliefs matter in the context of minority and dominant coalitions. Further research is needed to explore whether a minority coalition's strategic re‐framing of an issue to align with the policy core beliefs of their opponents would have more success than advocating from their own belief paradigm. [ABSTRACT FROM AUTHOR]