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<p>Citizen co-production in policy processes has become increasingly significant, and policy narrative theory has offered insights into how policies are communicated, understood, and implemented.&#xa0;Yet current research remains skewed toward top-down, elite narratives, with limited attention to bottom-up production in non-Western settings and to integration with adjacent theories. Addressing these gaps in context and perspective, we adopt a Gioia-guided, multi-setting qualitative design, combining 47 semi-structured interviews, 8 focus groups, and 189 narrative-rich social media items. First-order in vivo coding and second-order theorization yield a transparent data structure that links design, encounters, and meaning. Third-order analysis inductively maps a fourfold citizen narrative ecology: Hierarchical, Experiential, Conflict, and Functional narratives. Additionally, we integrate the Narrative Policy Framework with policy feedback theory to specify two feedback channels. Findings indicate that Hierarchical and Experiential narratives primarily audit the resource pathway, foregrounding access, distributional fairness, and learning/compliance/psychological costs.&#xa0;By contrast, Functional and Conflict narratives operate on the interpretive pathway, recalibrating perceptions of policy purpose, deservingness, and trust, which are structured by social norms and belief systems.&#xa0;This study offers a citizen-narrative microfoundation of policy feedback, linking Hierarchical and Experiential narratives to the resource pathway and Functional and Conflict narratives to the interpretive pathway.&#xa0;It also provides a diagnostic principle: pair each resource improvement with a visible signal of procedural fairness to shift narratives from conflict and friction to function and competence and move the system from a self-undermining equilibrium to a self-reinforcing legitimacy loop.</p>

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Who tells the policy story? Exploring the citizen policy narrative framework and feedback mechanisms in China’s healthcare reform

  • 期刊论文

  • 发表日期：

    2026年1月27日

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  • Guang Yang,
  • Yu Zhang

摘要

Citizen co-production in policy processes has become increasingly significant, and policy narrative theory has offered insights into how policies are communicated, understood, and implemented. Yet current research remains skewed toward top-down, elite narratives, with limited attention to bottom-up production in non-Western settings and to integration with adjacent theories. Addressing these gaps in context and perspective, we adopt a Gioia-guided, multi-setting qualitative design, combining 47 semi-structured interviews, 8 focus groups, and 189 narrative-rich social media items. First-order in vivo coding and second-order theorization yield a transparent data structure that links design, encounters, and meaning. Third-order analysis inductively maps a fourfold citizen narrative ecology: Hierarchical, Experiential, Conflict, and Functional narratives. Additionally, we integrate the Narrative Policy Framework with policy feedback theory to specify two feedback channels. Findings indicate that Hierarchical and Experiential narratives primarily audit the resource pathway, foregrounding access, distributional fairness, and learning/compliance/psychological costs. By contrast, Functional and Conflict narratives operate on the interpretive pathway, recalibrating perceptions of policy purpose, deservingness, and trust, which are structured by social norms and belief systems. This study offers a citizen-narrative microfoundation of policy feedback, linking Hierarchical and Experiential narratives to the resource pathway and Functional and Conflict narratives to the interpretive pathway. It also provides a diagnostic principle: pair each resource improvement with a visible signal of procedural fairness to shift narratives from conflict and friction to function and competence and move the system from a self-undermining equilibrium to a self-reinforcing legitimacy loop.