OpenUCT :: Browsing by Subject "Health Sciences Education"

Browsing by Subject "Health Sciences Education"

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Open Access
Clinical education in physiotherapy: The experiences of final year students workplace-based learning at the University of Cape Town
(2022) Timothy, Nastassia; Pienaar, Lunelle; Manie, Shamila
Clinical education in the profession of Physiotherapy involves the teaching and training of students in real life clinical settings such as hospitals and clinics. The pedagogical support that Physiotherapy students receive in clinical settings is both formal and informal (Dornan, 2012). In the South African context and at the University of Cape Town (UCT), educational and professional support is provided to Physiotherapy students by both academic representatives from the university, clinical educators, and physiotherapy clinicians who are employed by the clinical site in which the clinical education occurs. The phenomenon of clinical education in Physiotherapy is well described in literature emanating from the global North, with fewer studies focused on the learning experiences of students in the South African context. Aligning with the need for curriculum transformation, specifically in this study landscape which is Physiotherapy at UCT, a better understanding of learning on the clinical platform is warranted. This study was conceptualised and conducted through an interpretivist lens and by drawing on the theoretical underpinnings of Lave and Wenger's (1991) Situated Learning Theory (SLT) and Communities of Practice (CoP). Encompassed within SLT is an understanding that learning is not isolated and internal but rather a social process which is dependent on interactions with others and the context in which the learning takes place (Jackson, 2007). Thus this study set out to determine how sociocultural and contextual elements influence learning experiences of final year Physiotherapy students during their clinical placements. This was done by the use of a qualitative, cross-sectional exploratory study design as this was determined to best capture the experiences of students (Austin & Sutton, 2014). Research data was collected by the use of both video diaries and follow-up semi-structured interviews with the six study participants. Discourse Analysis was used to analyse the data, using an analysis framework informed by concepts from both the theoretical framework and the literature review. The study results signify that for this cohort of participants, sociocultural influences, including influences of participation in the clinical site and the interactions and relationships with others, were more important than contextual influences such as the physical learning environment. Unanticipated findings included emotional and mental wellbeing and issues of power related to the physiotherapy clinician. Three main themes emerged from the evaluation of the study findings. Theme one: Student attributes and approach to learning; Theme two: Teacher attributes, skill and power and Theme three: Resources and support at clinical placement site. These themes were able to answer the research question for the study. What has been determined in this research study is that Physiotherapy students bring their own personal and learning attributes to the clinical placement which contribute to their development as a student physiotherapist and their ability to engage actively with learning opportunities. In addition the teacher, either a clinician or clinical educator, must have certain preferable qualities which allows for the development of good relationships between teacher and student, as well as fostering the student's ability to be agentic in maximising learning opportunities. Furthermore the study demonstrated that supported participation in physiotherapy practice allowed participants to learn, thus necessitating that the clinical site possess a culture which is accepting of students and their clinical learning. It is therefore of utmost importance that any limitation to student participation be addressed with urgency at the institution. Appropriate clinical sites must also be considered carefully in relation to the demands of the curriculum, the needs of Physiotherapy as a profession and the institutional culture of the placement.
Open Access
Developing indicators for Monitoring and evaluation of the implementation of the Primary Health Care Approach in Health Sciences at the University of Cape Town using a DELPHI method
(2021) Datay, Mohammed Ishaaq; Singh, Shajila; Irlam, James
Background The University of Cape Town Faculty of Health Sciences (UCT FHS) adopted the Primary Health Care (PHC) approach as its lead theme for teaching, research, and clinical service in1994 Aim To develop indicators to monitor and evaluate the implementation of the PHC approach in Health Sciences Education . Method A Delphi study, conducted over two rounds, presented indicators of Social Accountability from the Training for Health Equity Network (THEnet), as well as indicators derived from the principles of the PHC approach in the UCT FHS, to a national multidisciplinary panel. An electronic questionnaire was used to score each indicator according to relevance, feasibility/measurability, and its application to undergraduate and postgraduate curricula. Qualitative feedback on the proposed indicators was also elicited. Results Round 1: Of the 59 Social Accountability indicators presented to the panel, the 20 highest ranked indicators were selected for Round 2. Qualitative feedback challenged the link between social accountability and PHC, resulting in an additional 19 PHC-specific indicators being presented in Round 2. Round 2: The indicators which scored >85% and made the final list were: PHC: Continuity of care (94%); Holistic understanding of health care (88%); Respecting human rights (88%); Providing accessible care to all (88%); and Promoting health through health education (88%). THEnet: Safety of learners (88%); Education reflects communities' needs (86%); Teaching embodies social accountability (86%); Teaching is appropriate to learners' needs (86%) Conclusion These PHC and THEnet indicators can be used to assess the implementation of PHC in Health Sciences Education. The specific indicators identified reflect priorities relevant to the local context. One limitation is that some key priority indicators did not make the final list.
Open Access
Exploring first year health sciences students' perceptions and experiences of teamwork: an introduction to interprofessional education
(2020) Hendricks, Adibah; Hartman, Nadia
Teamwork has become an important goal of contemporary healthcare. Therefore, one of the objectives of educating health professionals is to impart teamwork skills. While teamwork skills have become widely acknowledged as important for health sciences education (HSE), teamwork pedagogy within the ambit of interprofessional education within HSE is contested in the literature. The need to trouble the meaning of concepts within the interprofessional field to understand its nature and process in different contexts has been highlighted and remains an area in which further research is needed. Understanding the point of view of students can help educators, curriculum planners and evaluators make optimal use of their opportunities and resources within HSE. Thus, the present study sought to explore students' perceptions and experiences of teamwork within a HSE context with a view to contributing to this resource base. Implicit in the study context is the occurrence of first year health sciences students coming into contact with each other in a mixed professions course “Becoming a health professional” (BHP). A theory about social interaction, contact theory, postulates that when individuals from different groups have opportunities to come together under certain conditions, positive social outcomes may result. On the contrary, contact between distinct groups could also bring about adverse effects. In this study different groups referred to students registered for different health professional degree programmes. Based on the proviso that teamwork can be associated with positive, functional interactions between people, which of contact theory's suppositions were experienced by the students in this study was explored. Since teamwork is innately a social activity which is experienced in relation to others, one of the assumptions underpinning this study was that students' perspectives of teamwork may be co-constructed. Thus, the study was positioned within an interpretivist paradigm in which reality is subjective but also co-constructed by individuals, including participants and researchers. Using a qualitative design, this exploratory study offers insight into first year students' perspectives of teamwork within the undergraduate mixed professions course BHP. The primary data production method was focus group discussion and data were evaluated using thematic analysis. The thematic analysis yielded three broad themes: the purpose of teamwork in BHP; the persons involved in teamwork; and the process of teamwork in BHP. The findings of this study revealed that students had a comprehensive perception of what teamwork entails in their educational context, although their experiences of teamwork varied. These perspectives have been linked in concrete ways to the literature reviewed in this study and its theoretical framework. Thus, the findings were used to generate a heuristic for teamwork learning for health sciences students. The impact of this study is that students' perspectives of teamwork may be useful to the future design and delivery of entry level interprofessional courses aiming to instil teamwork skills. The underlying rhetoric of this thesis is that students are capable of contributing to their own learning, and the present findings manifested in one such contribution, the development of a pedagogical tool for teamwork.
Open Access
Exploring students' conceptions of the racial and socio-cultural differences in the learning environment of a medical specialty
(2018) Wamono, Aye Aye; Hartman; Nadia
Study problem In the education of South African postgraduate medical specialities, various challenges that could have negative impacts on learning are evident. Racial and socio-cultural diversity in South Africa has roots in a previous societal structure that systematically discriminated against particular social groups resulting in significant political, economic and social inequalities between the groupings. With the current processes of transformation underway, the sphere of training postgraduate students in medical specialities reveals visible differences in racial backgrounds between students and consultants at the training centres across the nation, with the majority of consultants being Whites and Indians, whilst the majority of students are Black Africans and a few Indians. The recent high failure rate of the summative exit examination in certain specialities has stimulated a high level of interest into how racial and socio-cultural diversity may have influenced the training and learning of postgraduate students or registrars. Theoretical framework In this thesis, a conceptual framework is used that combines dimensions from the theories of Collins (1987), Collins, Brown and Holum (1991) on cognitive apprenticeship, Vygotsky (1978), Lave and Wenger (1991) on socio-cognitive and socio-cultural learning, and Bronfenbrenner’s (1977) theory on Human Ecology. Collectively they posit that relationships are central to the quality of learning and training. The education of postgraduate students, so called registrars or intermediary novices, is structured as personal mentoring in the form of cognitive apprenticeship and their legitimate participation in the departmental Community of Practice. Learning in this context occurs through daily service provision under supervision or mentorship, as well as unscheduled informal discussions (engagement) that reflect socio-cultural learning in which novices and consultant specialists interact socially and academically. This form of learning is dependent on effective mediation and participation, which depends upon understanding, trust and mutual respect in a relationship between the two parties. This relationship could be influenced by factors such as inter-personal differences. Whether the factors translate into socio-cultural differences such as language, culture and social identities, need to be determined. Aim and objectives The aim of the study was to explore the conceptions of two student groups, one who had left the specialist programme, and the other who had recently qualified, regarding the nature of racial and socio-cultural diversity in their learning environment, the influences on their learning, and how they responded to them. Methodology Using one of the medical speciality disciplines as a focus area, a qualitative enquiry using faceto-face in-depth interviews followed by a thematic analysis of descriptive data was employed. Participants were former students who had either left the formal training programme after being unsuccessful in the summative examination and reached the end of their employment contracts, or those who had recently passed the examination and qualified as junior specialists. The interviews were semi-structured to explore participant’s learning background through schooling, undergraduate and postgraduate studies, with focus on experiences in formative learning through these stages. The participant’s family socio-cultural background was also explored. Data analysis and interpretation were done using a social constructionist epistemology where meanings were co-constructed based on multiple perspectives Findings and analysis The following themes were identified from the data analysis: Theme 1: Racial and socio-cultural differences as barriers in learning, with the sub-themes: constructing ‘race’, ‘language’, ‘culture’, and ‘feeling excluded by social status’ as barriers to learning; Theme 2: Relationships in the learning environment shaping learning, with sub-themes: ‘relationships in the early learning stage’, ‘relationships in undergraduate medicine’, and ‘relationships in postgraduate learning stage of speciality training’; Theme 3: Challenges in the learning process, with sub-themes as: ‘lack of curricular clarity’, and ‘lack of formative learning structure’; Theme 4: Resilience, with sub-themes: ‘capacity for adaption’, and ‘the ways in which resilience has been shaped by the micro- and macro-environments’. The further analysis found the socio-cultural diversity and relationships affecting engagement during formative learning themes to be inter-related, whilst sub-themes race, language, culture and social identities were also inter-connected. The curriculum, formative training, relationships, people’s perspectives and culture of the community were found to be intricate and complex, yet difficulties could still be overcome using certain attributes and skills. Conclusion Participants perceived the racial and socio-cultural diversity such as language, culture, personality and socio-economic status in the postgraduate learning environment as barriers to learning. Participants in the group who had qualified were however able to negotiate the diversity by being resilient, adaptable and emotionally mature. These attributes enabled them to navigate difficulties and remain focussed on their goal. An ability to initiate and form relationships with new peers and consultants emerged as an important feature in this group. These findings could hopefully benefit both current and future students and highlight the need to create opportunities for cross-cultural engagement activities in medical speciality training programmes.
Open Access
Factors influencing lecturer assessment practice in diverse southern contexts
(2020) Sims, Danica Anne; Cilliers, Francois
Assessment practice in Health Professionals Education (HPE) has serious consequences for the student and public as it impacts on student learning and outcomes, ultimately certifying a graduate as safe for public practice, and thereby affecting patient care. The goal is for assessment to be practiced in such a way as to drive student learning and outcomes in a desirable manner using assessment to help contribute to the creation of powerful learning environments. Critically, this may not take place without the assessor. In resource-constrained, Southern contexts, the individual lecturer is usually responsible for practicing assessment, as opposed to a collective assessment committee. It is crucially important to explore how lecturers practice assessment and if their practice positively drives learning. Although lecturers are the key role players in assessment practice in the South, little is known of lecturer HPE assessment practice in the global South. Additionally, these lecturers in HPE generally have no or little formal training in assessment. There is a need for evidencebased, theory-informed, valid and appropriate interventions for faculty training and continued professional development that target lecturer assessment practice. I propose that lecturer assessment practice is a behaviour, and that how lecturers' think of assessment (their underlying understanding or conceptions, including assessment literacy) and interacting factors (personal and contextual influences), shape their assessment behaviour. In order to explore this behaviour, the conceptual frameworks of Health Behaviour Theory (HBT) and Southern Theory were employed as theoretical underpinnings guide this research study into lecturer assessment practice in the global South. To this end, using purposive and maximum variant sampling, lecturers in diverse Southern contexts were interviewed (South Africa and Mexico) and lecturers' conceptions of assessment and factors influencing their assessment practice were identified and described in a Phenomenographic outcome space and novel HBT-derived model of lecturer assessment practice respectively. The findings from this study, while needing to undergo further validation in additional Southern contexts, may assist in guiding the design and implementation of strategic and targeted faculty assessment training interventions to enhance lecturer assessment practice leading to the creation of powerful learning environments, thereby improving student outcomes and ultimately improving patient care.
Open Access
Optimizing learning & teaching on paediatric ward rounds
(2023) Mantzor, Savarra; Cilliers, Francois
Bandura's Social Cognitive Theory asserts that an individual's perceptions of his/her self-efficacy influence not only their ability to learn knowledge and skill, but more importantly, influences their ability to act utilizing that knowledge or skill. In the context of health professional education, it is not enough to know the facts of medicine, but learners must also have a positive perception of their selfefficacy in order to practice medicine as a competent physician. The aim of this study was to improve the quality of ward round learning and teaching for University of Botswana medical trainees working in the Department of Paediatrics at Princess Maria Hospital in order to enhance their self-efficacy beliefs regarding their ability to provide paediatric patient care. Specifically, we utilized a threepronged approach to 1) improve trainees' participation in, and sense of belonging to, a local community of clinical practice, 2) introduce a structured bedside teaching model, and 3) promote a favourable clinical learning environment, all of which we postulated could improve trainees' selfefficacy beliefs. In this research I assert that four educational elements, (i) the method of teaching (i.e. bedside teaching), (ii) the environment in which learning occurs (i.e. the clinical learning environment), (iii) the epistemological value of social participation (i.e. communities of practice), and (iv) an individual's ability to both acquire and utilize their knowledge (i.e. perceived self-efficacy), are not distinct phenomena, but are interrelated, dynamic forces that influence each other in meaningful ways. This study was conducted as an action research (AR) project using mixed methods evaluation for data capture and analysis. Following the iterative Plan-Act-Observe-Reflect cycles of action research, a total of three phases occurred. In Phase 1, we developed an in-depth understanding of trainees' and faculty's perceptions of the prevailing paediatric ward rounds. In Phase 2, through ongoing departmental collaboration and review of the literature, we conceptually analysed the findings from Phase 1 to determine specific interventions for Phase 3. In Phase 3, we implemented the Phase 2 generated solutions, including the introduction of a structured bedside teaching model, SNAPPS (Summarize-Narrow-Analyse-Probe-Plan-Select); this was subsequently adapted to provide local and contextual relevance. Throughout all Phases, we conducted serial measurements of trainees' perceptions of (i) the clinical learning environment (CLE) on ward rounds, (ii) their sense of participation in, and belonging to, the community of practice on ward rounds (COP); and (iii) their perceived self-efficacy (PSE) to provide paediatric patient care. The types of study instruments and data sources included focus group discussions, interviews, debriefs, my action research journal, and questionnaires. Four consecutive types of data analysis occurred throughout the project: qualitative data analysis, quantitative data analysis, mixed methods integration, and critical reflection. Over the 28-month study period, there was a total of 208 participants, including representation from faculty, senior residents, junior residents, and medical students. There were three primary outcomes of this action research project. 1) Trainee use of SNAPPS was associated with (i) a CLE that was more favourable to respecting uncertainty; (ii) an increase in trainees' participation in and, sense of belonging to, a paediatric ward round; and (iii) positive influences on their perceived self-efficacy to manage patients. 2) We identified several non-traditional uses of SNAPPS that created opportunities for trainees to learn and faculty to teach beyond the primary diagnosis. 3) In contrast to the literature, we were unsuccessful at introducing SNAPPS at a department-wide level. Note, when I first set out to do this research, I postulated that bedside teaching, the clinical learning environment, and participation in a community of practice all had the potential to influence an individual's perceived self-efficacy. I assumed that while bedside teaching models (BTM) provide a structured approach to student engagement to enhance the content of bedside teaching, they do not, in and of themselves, regulate the clinical learning environment in which they occur. I did not consider the influence of a BTM on a learner's sense of belonging to a community of clinical practice. Through the findings of this project, I discovered the power of the BTM itself, which shifted the foci of influence, that not only does it have the potential to positively influence learner's PSE, but indeed has direct influential effects on the CLE and elements of COP. These findings compliment and broaden my original assumptions that the educational dimensions involved are not isolated elements, but together simultaneously impact learning and teaching. Note, during the course of this project, my positionality as the researcher underwent considerable shifts from “outsider” conducting “participatory action research” to “insider” conducting “practitioner research”. In turn, an unexpected secondary aim and outcome developed – to explore, understand and articulate the influences of SNAPPS on my own practice as a physician and clinical teacher. Limitations included: over utilization of traditional research instruments and analysis; lack of quality control of the implemented intervention; difficulty in interpreting results; delays in important critical reflections during the project; inability to achieve full collaboration with other department members; and unsuccessful attempt to introduce SNAPPS department-wide. Based on the findings from this study, a structured bedside teaching model, specifically SNAPPS, offers a holistic approach to maximize learning and teaching, addressing several learner and environmental needs concurrently. That said, when clinical teachers set out to introduce SNAPPS, they ought to be prepared to offer ongoing support for the successful implementation beyond a brief SNAPPS sensitization. The flexibility and potential advantages of SNAPPS promotes its use, especially in clinically challenging teaching environments.
Open Access
Optimizing learning & teaching on paediatric ward rounds
(2023) Mantzor, Savarra; Cilliers, Francois
Bandura's Social Cognitive Theory asserts that an individual's perceptions of his/her self-efficacy influence not only their ability to learn knowledge and skill, but more importantly, influences their ability to act utilizing that knowledge or skill. In the context of health professional education, it is not enough to know the facts of medicine, but learners must also have a positive perception of their selfefficacy in order to practice medicine as a competent physician. The aim of this study was to improve the quality of ward round learning and teaching for University of Botswana medical trainees working in the Department of Paediatrics at Princess Maria Hospital in order to enhance their self-efficacy beliefs regarding their ability to provide paediatric patient care. Specifically, we utilized a threepronged approach to 1) improve trainees' participation in, and sense of belonging to, a local community of clinical practice, 2) introduce a structured bedside teaching model, and 3) promote a favourable clinical learning environment, all of which we postulated could improve trainees' selfefficacy beliefs. In this research I assert that four educational elements, (i) the method of teaching (i.e. bedside teaching), (ii) the environment in which learning occurs (i.e. the clinical learning environment), (iii) the epistemological value of social participation (i.e. communities of practice), and (iv) an individual's ability to both acquire and utilize their knowledge (i.e. perceived self-efficacy), are not distinct phenomena, but are interrelated, dynamic forces that influence each other in meaningful ways. This study was conducted as an action research (AR) project using mixed methods evaluation for data capture and analysis. Following the iterative Plan-Act-Observe-Reflect cycles of action research, a total of three phases occurred. In Phase 1, we developed an in-depth understanding of trainees' and faculty's perceptions of the prevailing paediatric ward rounds. In Phase 2, through ongoing departmental collaboration and review of the literature, we conceptually analysed the findings from Phase 1 to determine specific interventions for Phase 3. In Phase 3, we implemented the Phase 2 generated solutions, including the introduction of a structured bedside teaching model, SNAPPS (Summarize-Narrow-Analyse-Probe-Plan-Select); this was subsequently adapted to provide local and contextual relevance. Throughout all Phases, we conducted serial measurements of trainees' perceptions of (i) the clinical learning environment (CLE) on ward rounds, (ii) their sense of participation in, and belonging to, the community of practice on ward rounds (COP); and (iii) their perceived self-efficacy (PSE) to provide paediatric patient care. The types of study instruments and data sources included focus group discussions, interviews, debriefs, my action research journal, and questionnaires. Four consecutive types of data analysis occurred throughout the project: qualitative data analysis, quantitative data analysis, mixed methods integration, and critical reflection. Over the 28-month study period, there was a total of 208 participants, including representation from faculty, senior residents, junior residents, and medical students. There were three primary outcomes of this action research project. 1) Trainee use of SNAPPS was associated with (i) a CLE that was more favourable to respecting uncertainty; (ii) an increase in trainees' participation in and, sense of belonging to, a paediatric ward round; and (iii) positive influences on their perceived self-efficacy to manage patients. 2) We identified several non-traditional uses of SNAPPS that created opportunities for trainees to learn and faculty to teach beyond the primary diagnosis. 3) In contrast to the literature, we were unsuccessful at introducing SNAPPS at a department-wide level. Note, when I first set out to do this research, I postulated that bedside teaching, the clinical learning environment, and participation in a community of practice all had the potential to influence an individual's perceived self-efficacy. I assumed that while bedside teaching models (BTM) provide a structured approach to student engagement to enhance the content of bedside teaching, they do not, in and of themselves, regulate the clinical learning environment in which they occur. I did not consider the influence of a BTM on a learner's sense of belonging to a community of clinical practice. Through the findings of this project, I discovered the power of the BTM itself, which shifted the foci of influence, that not only does it have the potential to positively influence learner's PSE, but indeed has direct influential effects on the CLE and elements of COP. These findings compliment and broaden my original assumptions that the educational dimensions involved are not isolated elements, but together simultaneously impact learning and teaching. Note, during the course of this project, my positionality as the researcher underwent considerable shifts from “outsider” conducting “participatory action research” to “insider” conducting “practitioner research”. In turn, an unexpected secondary aim and outcome developed – to explore, understand and articulate the influences of SNAPPS on my own practice as a physician and clinical teacher. Limitations included: over utilization of traditional research instruments and analysis; lack of quality control of the implemented intervention; difficulty in interpreting results; delays in important critical reflections during the project; inability to achieve full collaboration with other department members; and unsuccessful attempt to introduce SNAPPS department-wide. Based on the findings from this study, a structured bedside teaching model, specifically SNAPPS, offers a holistic approach to maximize learning and teaching, addressing several learner and environmental needs concurrently. That said, when clinical teachers set out to introduce SNAPPS, they ought to be prepared to offer ongoing support for the successful implementation beyond a brief SNAPPS sensitization. The flexibility and potential advantages of SNAPPS promotes its use, especially in clinically challenging teaching environments.
Open Access
Patient-centred communication and patient education: a multimodal social semiotic approach
(2017) Weiss, Rachel; Archer, Arlene
Patient-centred communication and patient education: a multimodal social semiotic approach This study explores the phenomenon of patient-centred communication within the South African health context. Patient-centred communication involves several distinct but interlinked elements, namely, taking a holistic approach to illness, 'seeing' through the patient's eyes, 'co-constructing' a shared understanding or therapeutic alliance, and sharing decision-making and responsibility where possible. While adopted by medical curricula across the world, a lack of conceptual clarity is common among students, educators, researchers and policy-makers. Furthermore, little research has been done that accounts for contextual factors and non-western settings. This study looks at how fourth year medical students operationalise the 'classroom-taught' principles of patient-centred communication during a health education encounter with patients. Drawing on a qualitative, interpretivist paradigm, the research focuses on communication in the context of language barriers, cultural value differences and socio-economic inequality. This study views students' multimodal health education artefacts as instances of 'informed flexibility' to patients' needs and challenges. The research is located within a Pharmacology curriculum activity where medical students produce personalized health promotion artefacts for rheumatic heart disease patients. Their artefacts are instances of patient-centred communication as well as instances of purposeful pedagogic recontextualisation, in that they realise both epistemic and relational dimensions of health education. Students also write a critique on the process, reflecting on the patient interview and motivating their design choices. Taking a multimodal social semiotic approach, the study draws on Bezemer and Kress' semiotic principles of recontextualisation (2008) for analysis of artefacts. Thematic analysis of students' critical reflections as well as follow-up interviews with their patients illuminate the context and assumptions underpinning students' design choices. The study is significant in several ways. It highlights the complex, multifaceted, multi-layered nature of doctor-patient communication, argues for realism in what can be taught and assessed in a classroom and suggests novel pedagogic approaches. The study also brings an African perspective to patient-centred communication, and in highlighting challenges relevant to the South African health care system, it supports contemporary calls for 'decolonisation' of health sciences curricula. The research contributes to ongoing efforts to eradicate rheumatic heart disease by giving patients a 'voice', raising awareness and supporting preventative programs. Methodologically, the study contributes to Bezemer and Kress' (2008) pursuit of articulating a semiotic methodological framework for multimodal texts.

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