EVALUATING THE COMMUNICATIVE EFFECTIVENESS OF MULTIMODAL MATERNAL AND CHILD HEALTHCARE TEXTS IN MACHAKOS COUNTY, KENYA: A SOCIAL SEMIOTIC ANALYSIS
DOI:
https://doi.org/10.46827/ejphs.v9i3.281Keywords:
multimodality, maternal and child health, health communication, Visual Social Semiotics, information dissemination, Machakos CountyAbstract
Maternal and child healthcare communication materials are widely used in Kenyan health facilities, yet their communicative effectiveness remains uncertain. This study evaluated the communicative effectiveness of multimodal maternal and child healthcare texts used in public health facilities in Machakos County, Kenya. Specifically, it sought to determine how effectively posters, brochures, and the national Mother and Child Health Handbook disseminate health information to expectant women and mothers of children aged 0–5 years. The study was anchored on an integrated theoretical framework incorporating Kress and van Leeuwen’s (2006) Social Semiotic Theory, which focused on analysing the visual mode; Halliday and Mathiessen’s (2014) focus on analysing the verbal mode; and Royce’s (2007) intersemiotic complementarity, which focused on analysing the interaction of the verbal and visual modes. The World Health Organisation framework of principles of effective communication was applied in evaluating the effectiveness of the MCH texts. An exploratory mixed-methods design was adopted, with qualitative analysis supported by quantitative descriptions of semiotic features. Data were drawn from 26 MCH texts comprising 18 posters, seven brochures, and one Mother and Child Health Handbook across ten public health facilities, together with key informant interviews and focus group discussions involving healthcare providers and intended users. Findings show that posters are the most effective because they integrate simple language, salient images, colour, and clear visual organisation; brochures are moderately effective, while the MCH Handbook is least effective as a standalone communication tool. Effectiveness is further constrained by technical terminology, English-dominant content, sociocultural mismatch, participant exclusion, disability-related accessibility gaps, weak visual hierarchy, and fragmented sequencing. The study concludes that communicative effectiveness depends on the meaningful integration of verbal and visual resources within users’ linguistic, cultural, and social contexts. The study therefore recommends simplifying technical language, expanding multilingual content, strengthening inclusive and culturally grounded representation, improving visual hierarchy and sequencing, and redesigning the MCH Handbook to support independent use by mothers and caregivers.References
Al Shamsi, H., Almutairi, A. G., Al Mashrafi, S., & Al Kalbani, T. (2020). Implications of language barriers for healthcare: A systematic review. Oman Medical Journal, 35(2), e122. https://doi.org/10.5001/omj.2020.40
Algabbani, A. M., Alzahrani, K. A., Sayed, S. K., Alrasheed, M., Sorani, D., Almohammed, O. A., & Alqahtani, A. S. (2022). The impact of using pictorial aids in caregivers’ understanding of patient information leaflets of pediatric pain medications: A quasi-experimental study. Saudi Pharmaceutical Journal, 30(5), 544–554. https://doi.org/10.1016/j.jsps.2022.02.017
Balogun, O. O., Aoki, A., Tomo, C. K., Mochida, K., Fukushima, S., Mikami, M., Sadamori, T., Kuramata, M., Freitas, H. R., Sapalalo, P., Tchicondingosse, L., Mori, R., Aiga, H., Francisco, K. R., & Takehara, K. (2023). Effectiveness of the maternal and child health handbook for improving continuum of care and other maternal and child health indicators: A cluster randomized controlled trial in Angola. Journal of Global Health, 13, 04022. https://doi.org/10.7189/jogh.13.04022
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
Creswell, J. W., & Plano Clark, V. L. (2018). Designing and conducting mixed methods research (3rd ed.). SAGE Publications. Retrieved from https://books.google.ro/books/about/Designing_and_Conducting_Mixed_Methods_R.html?hl=th&id=YcdlPWPJRBcC&redir_esc=y
Dobos, A. R., Orthia, L. A., & Lamberts, R. (2015). Does a picture tell a thousand words? The uses of digitally produced, multimodal pictures for communicating information about Alzheimer’s disease. Public Understanding of Science, 24(6), 712–730. https://doi.org/10.1177/0963662514533623
Galmarini, E., Marciano, L., & Schulz, P. J. (2024). The effectiveness of visual-based interventions on health literacy in health care: A systematic review and meta-analysis. BMC Health Services Research, 24, 718. https://doi.org/10.1186/s12913-024-11138-1
Gray, C., Porter, G., Lobo, R., & Crawford, G. (2024). Development and evaluation of health education resources for culturally and linguistically diverse populations: A systematic review. Health Education Research, 39(2), 102–118. https://doi.org/10.1093/her/cyad015
Halliday, M. A. K. (1978). Language as social semiotic: The social interpretation of language and meaning. Edward Arnold. Retrieved from https://books.google.ro/books/about/Language_as_Social_Semiotic.html?id=SjVxAAAAIAAJ&redir_esc=y
Halliday, M. A. K. & Matthiessen, C. (2014). Introduction to functional grammar (4th ed), Routledge. Retrieved from https://books.google.ro/books/about/Halliday_s_Introduction_to_Functional_Gr.html?id=odUqAAAAQBAJ&redir_esc=y
Houts, P.S., Doak, C. C., Doak, L. G., & Loscalzo, M. J. (2006). The role of pictures in improving health communication: A review of research on attention, comprehension, recall, and adherence. Patient Education and Counselling, 61(2), 173–190. https://doi.org/10.1016/j.pec.2005.05.004
James, T. G., Panko, T., Smith, L. D., Helm, K. V. T., Katz, G. R., Caballero, M. E., Cooley, M. M., Mitra, M., & McKee, M. M. (2023). Healthcare communication access among deaf and hard-of-hearing people during pregnancy. Patient Education and Counseling, 112, 107743. https://doi.org/10.1016/j.pec.2023.107743
Kawakatsu, Y., Sugishita, T., Oruenjo, K., Wakhule, S., Kibosia, K., Were, E., & Honda, S. (2015). Effectiveness of and factors related to possession of a mother and child health handbook: An analysis using propensity score matching. Health Education Research, 30(6), 935–946. https://doi.org/10.1093/her/cyv048
Khan, M., Dave, A., Benton, M., Moss, N., & Kaler, M. K. (2024). Health literacy interventions for pregnant women with limited language proficiency in the country they live in: A systematic review. BMC Public Health, 24, 3287. https://doi.org/10.1186/s12889-024-20747-8
Kress, G., & van Leeuwen, T. (2006). Reading images: The grammar of visual design (2nd ed.). Routledge. Retrieved from https://books.google.ro/books/about/Reading_Images.html?id=vh07i06q-9AC&redir_esc=y
Krueger, R., & Casey, M. (2000). Focus groups. A practical guide for Applied Research. (3rd ed.). Sage Publications Ltd. Retrieved from https://books.google.ro/books/about/Focus_Groups.html?id=BPm4izC3prUC&redir_esc=y
Machakos Level 5 Hospital. (2025). Viral load testing information with Kikamba translation [Health education material].
Mbanda, N., Dada, S., Bastable, K., Gimbler-Berglund, I., & Schlosser, R. W. (2021). A scoping review of the use of visual aids in health education materials for persons with low literacy levels. Patient Education and Counselling, 104(5), 998–1017. https://doi.org/10.1016/j.pec.2020.11.034
Ministry of Health. (2018). Newborn Child and Adolescent Health Policy. Ministry of Health, Kenya.
Mudany, M. A., Sirengo, M., Rutherford, G. W., Mwangi, M., Nganga, L. W., & Gichangi, A. (2015). Enhancing maternal and child health using a combined mother & child health booklet in Kenya. Journal of Tropical Paediatrics, 61(6), 442–447. https://doi.org/10.1093/tropej/fmv055
Nishimura, E., Rahman, M. O., Ota, E., Toyama, N., & Nakamura, Y. (2023). Role of maternal and child health handbook on improving maternal, newborn, and child health outcomes: A systematic review and meta-analysis. Children, 10(3), 435. https://doi.org/10.3390/children10030435
Nutbeam, D. (2000). Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International, 15(3), 259-267. https://doi.org/10.1093/heapro/15.3.259
Royce, T. (2007). Intersemiotic complementarity: A framework for multimodal discourse analysis, in New Directions in the Analysis of Multimodal Discourse, T. D. Royce and W. L. Bowcher, Eds. Mahwah, Lawrence Erlbaum Associates Publishers. Retrieved from https://www.taylorfrancis.com/chapters/edit/10.4324/9780203357774-2/intersemiotic-complementarity-terry-royce
Schneider, L., Kosola, M., Uusimäki, K., Ollila, S., Lubeka, C., Kimiywe, J., & Mutanen, M. (2021). Mothers’ perceptions on and learning from infant and young child-feeding videos displayed in Mother and Child Health Centres in Kenya: A qualitative and quantitative approach. Public Health Nutrition, 24(12), 3845–3858. https://doi.org/10.1017/S1368980021002342
Schubbe, D., Scalia, P., Yen, R. W., Saunders, C. H., Cohen, S., Elwyn, G., van den Muijsenbergh, M., & Durand, M.-A. (2020). Using pictures to convey health information: A systematic review and meta-analysis of the effects on patient and consumer health behaviors and outcomes. Patient Education and Counselling, 103(10), 1935–1960. https://doi.org/10.1016/j.pec.2020.04.010
UNICEF. (2022). Ensuring safe childbirth around the world. From UNICEF: http://unicef.org/supply/stories/ensuring-safe-childbirth-around-world.
World Health Organisation. (2021). WHO Recommendations on Intrapartum Care for A Positive Childbirth Experience, World Health Organisation, Geneva.
World Health Organisation. (2023). Fact Sheets https://www.who.int/news-room/fact-sheets (accessed September 5, 2023).
World Health Statistics (2023). Monitoring Health for the SDGs, Sustainable Development Goals. Retrieved from https://www.who.int/publications/i/item/9789240074323
World Health Organisation. (2017) WHO principles for effective communications. Retrieved August 11, 2026, from the World Health Organisation website. Retrieved from https://www.who.int/about/communications/principles
Zhao, X. (2020). Health communication campaigns: A brief introduction and call for dialogue. International Journal of Nursing Sciences, 7(1). https://doi.org/10.1016/j.ijnss.2020.04.009
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