Intersemiotic Complementarity in Public Health Communication: A Multimodal Analysis of Maternal and Child Health texts in Machakos County, Kenya

Maternal and child health (MCH) communication is central to the delivery and uptake of preventive and curative health services. However, the effectiveness of printed MCH materials depends not only on the availability of information but also on how verbal and visual resources work together to construct meaning. This study examines intersemiotic complementarity in MCH texts used in selected public healthcare facilities in Machakos County, Kenya. The study is guided by Systemic Functional Linguistics, Social Semiotic Theory, and Royce’s framework of intersemiotic complementarity. An exploratory, qualitatively driven mixed-methods design was adopted. Data were drawn from 26 printed MCH materials collected across 10 public facilities representing Levels 2–5 of Kenya’s health facility tier system. The corpus comprised 18 posters, 7 Group Antenatal Care brochures, and 1 national Mother and Child Health Handbook. The analysis was complemented by fifty key informant interviews with healthcare practitioners and six focus group discussions involving thirty-six expectant women and mothers of children under five years. The findings show that verbal and visual modes reinforce, extend, and specify one another in the construction of ideational, interpersonal, and compositional meanings. However, communication is weakened by technical English, dense layouts, culturally decontextualised imagery, limited procedural explanation, and the underrepresentation of important social actors. Fathers, community health workers, women with disabilities, and extended family members are largely absent, although these actors influence maternal and child health decision-making and service uptake. The study concludes that MCH materials should be designed as context-sensitive multimodal ensembles rather than as supplementary combinations of words and images. The findings have implications for county-level health communication policy, facility-based health education, and the development of accessible and socially inclusive MCH materials.

maternal and child health communication, intersemiotic complementarity, multimodal discourse analysis, public health communication, social actors, Machakos County

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