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The Complementary and Alternative Medicine (CAM) Product Information Brochure: How is Generic Structure Used to Persuade Potential Users?

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Abstract

The presence and influence of complementary and alternative therapies have been increasingly felt in recent years. One reason for this is the active promotion of its services and products through various media channels. The current study focused on information brochures that are placed on pharmacy counters and shelves, and examined how they function as persuasive texts in promoting products and persuading potential users to buy them. The study utilised genre analysis as a method for examining how language and information in texts are systematically selected and structured to perform particular actions and achieve particular communicative purposes. Genre hybridisation as a theoretical concept is drawn on to explain the inter-generic realisation of forms of discourse. One hundred brochures providing information on complementary and alternative health products produced by pharmaceutical companies were collected from pharmacies in Malaysia and analysed for their communicative content in terms of rhetorical moves used to promote the products. This paper describes the generic structure of the print content in the brochures and discusses how it functions to present a favourable view of complementary and alternative health products to the reader. The results show that across all the brochures, regardless of the type of product, a uniform set of moves that is comparable to the sales promotional genre is identified. The findings also reveal that such information brochures on pharmacy counters are in fact persuasive promotional literature. As these brochures are ubiquitous in pharmacies and drugstores in most countries, they are an important force in influencing consumer and patient knowledge, and beliefs about complementary and alternative medicine. © 2019, Universiti Kebangsaan Malaysia Press. All rights reserved.
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The Complementary and Alternative Medicine (CAM) Product
Information Brochure: How is Generic Structure
Used to Persuade Potential Users?
Ching Fen Goh
agnesgohchingfenagnes@gmail.com
Faculty of Modern Languages and Communication,
Universiti Putra Malaysia
Mei Yuit Chan
cmy@upm.edu.my
Faculty of Modern Languages and Communication,
Universiti Putra Malaysia
Afida Mohd Ali
afida@upm.edu.my
Faculty of Modern Languages and Communication,
Universiti Putra Malaysia
Sabariah Md Rashid
smrashid@upm.edu.my
Faculty of Modern Languages and Communication,
Universiti Putra Malaysia
ABSTRACT
The presence and influence of complementary and alternative therapies have been
increasingly felt in recent years. One reason for this is the active promotion of its services and
products through various media channels. The current study focused on information
brochures that are placed on pharmacy counters and shelves, and examined how they
function as persuasive texts in promoting products and persuading potential users to buy
them. The study utilised genre analysis as a method for examining how language and
information in texts are systematically selected and structured to perform particular actions
and achieve particular communicative purposes. Genre hybridisation as a theoretical concept
is drawn on to explain the inter-generic realisation of forms of discourse. One hundred
brochures providing information on complementary and alternative health products produced
by pharmaceutical companies were collected from pharmacies in Malaysia and analysed for
their communicative content in terms of rhetorical moves used to promote the products. This
paper describes the generic structure of the print content in the brochures and discusses how
it functions to present a favourable view of complementary and alternative health products to
the reader. The results show that across all the brochures, regardless of the type of product, a
uniform set of moves that is comparable to the sales promotional genre is identified. The
findings also reveal that such information brochures on pharmacy counters are in fact
persuasive promotional literature. As these brochures are ubiquitous in pharmacies and
drugstores in most countries, they are an important force in influencing consumer and patient
knowledge, and beliefs about complementary and alternative medicine.
Keywords: genre; complementary and alternative medicine; information brochures;
promotional genre; hybrid genre
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INTRODUCTION
Complementary and alternative medicine (CAM) is defined as “a group of diverse medical
and health care systems, practices, and products that are not presently considered to be part of
conventional medicine” (Stephen, 2000). The terms “complementary” and “alternative” in
CAM have each been explained by CAM proponents; the word “complementary” is said to
denote the use of CAM treatments to supplement mainstream medicine (Kemper, Vohra &
Walls, 2008; Van Hemel, 2001; Ventola, 2010), such as the use of herbal products together
with conventional medicine in treating an illness (!"#"$%&'()*)!+(,-)./012)Evans, Ibrahim,
Halimatu, Rabiatu & Gbedema, 2018; Modi, Wright & Seeff, 2007; Welz, Emberger-Klein &
Menrad, 2018;) and the term “alternative” refers to the use of CAM treatments to replace
treatments by mainstream medicine (Johnson, Kozhimannil, Jou, Ghildayal & Rockwood,
2016; Modi et al., 2007; Passarelli, 2008; Van Hemel, 2001). Whichever way CAM is
defined, it is clear that CAM is positioned through reference to mainstream medicine or
conventional medicine. The fact that the term “conventional medicine” is used
interchangeably with the term “mainstream medicine” affirms its central position whereas
CAM is relegated to a fringe position of the “unconventional” and “non-mainstream”, that is,
the “alternative”.
While conventional medicine is characterised by objective evidence bases, and strict
regulatory compliance and accreditation for safety, CAM relies on a different interpretation
of wellness and the status of traditional use known as GRAS (Generally Regarded as Safe).
However, despite its weaker position vis-a-vis mainstream medicine as an option to healing,
CAM has gained a large following among the health-seeking public, resulting in increased
consumer spending on CAM services and products (see Briggs & Killen, 2013; Eisenberg,
Davis, Ettner, Appel, Wilkey, Rompay & Kessler, 1998; Harris, Cooper, Relton & Thomas,
2012; Nahin, Barnes, Stussman & Bloom, 2009; Pal, 2002; Reid, Steel, Wardle, Trubody &
Adams, 2016). In a World Health Organisation report (2003), the global market of herbal
medicines is said to be worth more than USD60 billion yearly and is expected to expand
exponentially. A report by the National Centre for Complementary and Integrative Health
(NCCIH) (Barnes, Bloom & Nahin, 2008) found that 38 percent of adults in the United States
were using some form of CAM. In Malaysia, it has been reported that the nutritional
supplement retail sales doubled from USD248 million in 2005 to USD572 million in 2014
(Euromonitor International, cited in Yap & Wan Khatina, 2016).
The increasing popularity and commercial success of CAM in the health industry
necessitates closer attention to how the CAM industry players, that is, the producers and
distributors of CAM supplements, promote their products to potential users. Research on
CAM focusing on issues related to the use of CAM has mainly been about safety and adverse
effects, disclosure of the use of CAM by patients to their primary care doctors, understanding
why patients use CAM and for what ailments, how doctors should respond to patients who
wish to use CAM, and how CAM can or should be integrated with conventional medicine
(see Table 1 in the appendix for selected references of these published works)3)
Among these categories of research, studies that sought to find out the reasons why
patients use CAM appear to have shed some light on how users have been persuaded or
convinced about the efficacy of CAM products. The act of persuasion, however, is inherently
a discursive process with language as its tool, and can be more effectively understood
through the examination of language use. What is needed but lacking in the research field is
an investigation on the strategic use of language in persuading potential users, particularly in
convincing them of the need to use CAM products.
CAM products are promoted through various screen and print advertising media
channels. The context of promotional product literature as they appear in an advertising
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medium would typically tag the literature as an “advertisement” with commercial intent, and
therefore alert the reader or viewer to its commercial goal. However, there is a category of
printed text whose status as “advertising material” is less clear. These are print information
brochures or flyers found on pharmacy shelves and counters. The purpose of these brochures
appears to be to provide product information to potential users, and can often be found at the
position of point-of-sale in pharmacies. This makes the information brochure a potent
marketing tool, especially when its sales promotional character is obscured in a hybrid
(mixed) genre (see Bhatia, 1997; Fairclough, 1993).
Information brochures of CAM products are unique as they lie in the intersection
between what is commonly known as promotional material and the non-promotional type
which characterises the information leaflets of conventional or prescription medicines.
Advertising of prescription medicines is tightly regulated through legislation in most
countries, for example, the Therapeutic Goods Act 1989 in Australia (see Roughead, 1990)
and various laws under the purview of the FDA in the United States. In Malaysia, the
Medicines (Advertisement and Sale) Act 1956 (Pharmaceutical Services Programme, 2019)
regulates all forms of advertising1 related to medical products and services. In evaluating the
quality of information in journal advertisements of prescription medicines, Othman, Vitry
and Roughead (2010) outlined several important information elements that are expected to be
included. They are brand name and generic name of the drug, indications and contra-
indications, dosage, drug interactions and warnings and precautions. Also, Clerehan, Hirsh
and Buchbinder (2009) who conducted a linguistic analysis of prescription drug patient
information leaflets (for sulphasalazine and prednisolone) found that providing information
on the background of the drug, instructions for use, dosage, and contra-indications,
monitoring and storage are among the moves used. As CAM information brochures typically
contain some of these elements that are associated with prescription drug information leaflets
and advertisements, it is easy for readers to interpret the brochures as a genre that is
providing balanced information about the product as one would expect of regulated
prescription drug information leaflets.
The success of CAM in spawning a lucrative industry in the domain of health care
attests to the power of the discourse of CAM in influencing beliefs about health care and the
health care seeking behavior of a large section of society. In view of the increasingly
widespread use of CAM products, this study that sought to shed light on the subtle ways in
which hybrid informational-promotional genres are structured to achieve a persuasive
function addresses an issue of significant social importance.
Part of the concern about the increasing popularity of CAM among the health seeking
public is its unregulated use without the supervision of medical practitioners. In Malaysia,
CAM supplements have many times hit the newspaper headlines as the suspected cause of
serious ailments such as liver and kidney failure (Chu, 2018), and especially when patients do
not disclose their use of CAM to their doctors. While CAM has become more acceptable and
has been included as integrated health care in some environments, suspicions towards CAM
among many medical practitioners remain high.
While all aspects of language use would bear upon the meaning of a text and
contribute to its function, in the present study, we focused on the macro-organisational level,
on how communicative actions are structured to achieve the goal of the genre. We examined
how the generic structure of the text in CAM information brochures is employed to promote
CAM products to potential users. The genre analysis framework (Bhatia, 1993), a method of
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1The term “advertising” within the context of the Act refers not only to clearly defined traditional forms of advertisements,
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text and rhetorical action analysis developed in the field of linguistics,2 is adopted to describe
and interpret the structure of the text and the communicative meanings it serves to convey.
GENRE AND HYBRID GENRES
Genres are communicative events that are a "typification of rhetorical action" (Miller, 1984,
p. 37) which are recognised and understood by people who use them. They have structures
that can be identified as stages, where each stage in the structure carries out a set function in
order to accomplish the overall goal of the genre. Genres are thus described as a group of
communicative events that are staged and goal-oriented (Martin, 1984), and in which
“consistency of communicative purposes” (Bhatia, 1993, p. 181) can be discerned.
As genres are socially recognisable discourse types due to its regularised pattern,
content and typified use of lexico-grammatical resources, their purpose, conventions and
expected responses are immediately understood by people who use them. For example,
discourse types such as a food recipe, a job application letter, or a research paper, all have
their own schematic structure, grammar and vocabulary sets, and people who are familiar
with them know exactly what they are about, and are able to quickly form expectations about
what purpose and goal these texts aim to achieve.
While some genres are clearly distinct from one another, such as the examples
mentioned, there are others whose boundaries are not so firmly defined. The line that
separates an informational text and a commercial persuasive advertisement is sometimes
blurred. This gives rise to what is known as informercials, for example. The process is known
as hybridisation or mixing of genres. Fairclough (1993, p. 141) posits that there has been an
extensive shifting of boundaries between orders of discourse and between discursive
practices; for example, the genre of consumer advertising is said to have colonised
professional and public service orders of discourse, generating new hybrid genres. It is not
surprising that among the genres that are involved in hybridisation, the promotional or
advertising genre is the most dominant. Bhatia (2005) observes that promotional genres in
recent years have invaded professional and academic forms of discourse. Advancement of
advertising activities has influenced other types of discourses resulting in the infusion of
elements of promotion/persuasion into the non-promotional genres in various fields.
Traditionally informative and non-promotional genres are fast becoming promotional in
character as their contents emphasise mainly the positive and omit or obscure the negative
(Bhatia, 2005), reflecting the nature of commercial advertising. The main functions of
informing or reporting are made to incorporate the functions of persuading to market a
product or service (Fairclough, 1993). This phenomenon of promotional initiatives finding
their way into various discursive activities has been blamed on the “consumer culture” of
modern society (Featherstone, 1991, pp. 66 - 68). Particularly in the field of medicine, there
is concern about the growing commercialisation of medicine and medical services in various
forms (see Brody, 2014; Civaner, Balcioglu & Vatansever, 2016; Riley, 1996). While CAM
is arguably not within the purview of conventional medicine, its role in influencing the health
beliefs and health seeking behaviour of patients warrants close attention.
In promotional discourse, persuasion is the cement that holds the writers and the
target readers together. Effective persuasion, however, according to Ostman (2005) is
implicit in nature. Persuasion in a genre loses its power to persuade readers or potential
customers if the persuasive acts in the text are obvious to its target readers (Bhatia, 2004).
Hence, in order for persuasion to be effective in a genre, the linguistic markers of persuasion
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2 It is acknowledged that the concept of genre and the analysis of it have roots in diverse disciplinary fields such as media
studies, literature, linguistics, and sociology. In this study, we draw on genre as it is developed in the tradition of linguistics,
rhetorical and discourse studies (see Bazerman, 1994; Bhatia, 2004; Halliday, 1978; Miller, 1984; Swales, 1990).
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need to be strategically subtle. The more persuasion is exposed and becomes clear to the
reader, the more it loses its power to persuade. In contrast, the less conscious readers are with
the persuasive intent of the genre, the more successful it would be in persuading the target
audience to accept the ideas, products or services being marketed. In hybrid genres, the
persuasive intent of the genre may be obscured when different genres and discourses are
mixed. Incorporating different genres in a discourse is an effective way to achieve different
goals within a text (see Shabudin & Aman, 2014).
This paper reports on an investigation on a hybrid genre, which is the information
brochure of CAM products found on pharmacy counters. We sought to examine the extent to
which the informational text in the brochure has been infused with the promotional goals of
an advertisement genre through genre mixing. The study addressed two questions: (1) What
is the generic structure of CAM information brochures placed in pharmacies in Malaysia?
and (2) In what ways does the generic structure of CAM information brochures adopt the
promotional genre of print advertising texts to influence readers?
The contribution of this article is two-fold; the first is the description of the generic
structure of CAM product information brochures which has not been described as yet. The
details of the genre, for example the move structure can reveal what communicative acts are
actually performed in a particular type of communication activity. Descriptions of genre are
important as they provide the base line from which comparisons and further analysis can be
made for the understanding of social practices in the field. Second is the examination of
CAM brochures as a hybrid genre. With new genres emerging and existing genres taking new
shape, as genres are not fixed patterns of communication but are constantly evolving (see
Evangelisti-Allori, Bateman & Bhatia, 2014), studies examining the nature and character of
genres are important to provide insight into larger narratives such as, possibly, the
commercialisation of health care.
The focus of this study is on generic structure and how it can be used, through genre
mixing, to persuasive effect. Genre as a potent tool that can be manipulated to persuade
readers has not been fully explored, particularly in a field as sensitive as health care, and as
controversial as CAM. Close examination of what moves are present and what information
elements are highlighted in performing the genre can shed light on explicit and implicit
meanings achieved.
METHODOLOGY
The analysis of genre is based on the premise that generic structure is a means by which
discourse and social actions are performed (Swales, 1990; Bhatia, 1993; Miller, 1984). As
genre is defined by its communicative intent, its structure is organised according to how
communication is carried out. By communicating through particular conventionalised
structures, the text draws its discursive force from that structure whose communicative
purpose and goals are recognised by users of the genre.
The current study employed the genre analysis method in describing, interpreting and
explaining the generic structure of the CAM information brochure. Specifically, the move-
step analytical framework (Swales, 1990; Bhatia, 1993) was used to determine the staged
rhetorical structure of the genre and the discourse acts that realise each of the stages. CAM
information brochures were analysed and compared to a known promotional genre described
by Kathpalia (1992). This is the nine-move sales promotional structure of print
advertisements. The extent to which the CAM information brochure has adopted the
promotional genre is then discussed. Figure 1 shows the research design of the study.
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!
FIGURE 1. Research design
One hundred CAM information brochures were collected from pharmacies located in
urban areas in two states in Malaysia. All the brochures were connected to CAM products in
the category of “biologically-based therapies” according to the classification scheme for
CAM by the National Centre for Complementary and Alternative Medicine (Stephen, 2000,
pp. 8-9). Biologically-based therapies include products such as herbs, supplementary foods,
vitamins, minerals and special diets. While the CAM brochures were collected in Malaysia,
the products accompanied by the brochures were not all Malaysian ones. The CAM products
included those manufactured by international pharmaceutical and health supplement
companies and the accompanying brochures were supplied by these companies or their local
representative offices. The brochures selected were either in the English language, or in
multiple languages including the English language. The brochures had both linguistic and
non-linguistic (diagrams, pictures) print elements.
In analysing genres, it is common to base the analysis on a large number of texts in
order to capture the patterns that are present in the texts. While there is no hard and fast rule
as to the exact number of texts to be used, past researchers have used from fewer than 20
texts to the hundreds when attempting to describe the generic structure of texts.3 It is
generally accepted that the higher number of texts will enable a better coverage of generic
patterns; however, the availability of samples as well as the time factor for manual coding
should also be taken into consideration. In the current study, brochures available from
international and local companies were collected, and the 100 brochures adequately
represented products from these companies.
The generic structure of the selected texts was analysed in terms of its moves and steps.
A move is defined as “a rhetorical unit that performs a coherent communicative function”
(Swales, 2004, p. 228); hence, moves are identified through semantic/functional criteria. A
unit of text in a genre that can be discerned as performing some communicative function is
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3For example, Clerehan, Hirsh and Buchbinder (2009) used 18 texts, Al-Khasawneh (2017) used 20, Behnam and
Mahmoudy (2013) used 38, Hung, Chen and Tsai (2012) used 40, Kaur, Arumugam and Yunus (2013) used 58, at the lower
end. At the higher end where larger numbers of texts are based on, Parkinson (2017) used 60 texts, Catenaccio (2008) used
70, Hayati, Shokouhi and Hadadi (2011) and Ismail and Ahamad Shah (2014) used 100, and Dobakhti and Hassan (2017)
used 300 texts.
Informational
genre
!
Hybrid
genre
Comparison with
Kathpalia’s (1992)
nine-move
sales/promotional
structure of print
advertisements
!
Analysis of CAM
information
brochures
Genre description and
comparison
Interpretation and
explanation of hybrid
genre
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marked off as a “move”, regardless of the length of the text (Swales, 2004). In a written text,
a move may be a word, phrase or clause, a single sentence or may span over several
sentences. Identifying moves requires the researcher to reflect on the communicative function
of the unit of text within the context of the genre: who the text producers and readers are, the
environment in which the text is used, and the purpose of the text. Where there are images,
their communicative functions can also be determined by considering them in relation to and
their positions in the text. The communicative function is articulated in terms of an action
performed, such as “to appraise …” or “to assure…”. It is also common for nominalised
terms (e.g. appraisal, assurance) to be used, as the action encapsulated in the nominal form is
understood. The formulation of the move labels must ensure mutual exclusivity, as all moves
should be seen as distinct. Further, moves may be comprised of “steps” which are specific
discourse acts that realise the communicative purpose of moves. They may be viewed as
smaller moves within a move, or sub-moves.!
The text (including images) in the brochures was coded for moves and steps with the
aid of the NVivo8 software. The number of brochures in which each move and step appeared
in was recorded. This would reflect the prevalence of the move/step found in the genre.
Cohen’s Kappa for inter-coder reliability on the coding of 10% of the text conducted by two
independent coders was .89. Any disagreements on the coding were discussed and resolved to
ensure congruence and reliability of the coding process.
RESULTS AND DISCUSSION
The move structure of the CAM product information brochure is described, followed by its
comparison with Kathpalia’s (1992) nine-move print advertisement genre. The extent to
which generic moves and steps in the CAM information brochure resembles those of the print
advertisement is discussed.
GENERIC STRUCTURE OF THE CAM PRODUCT INFORMATION BROCHURE
From the analysis of the CAM brochures, eight moves were discovered, with each move
comprising between one and five steps or sub-moves. The percentage of brochures using
each of the steps is also shown in parenthesis as an indication of the prevalence of the move
used in the genre. This information is important for providing insight into the extent to which
the CAM brochure has adopted characteristics of the advertising genre.
MOVE 1
The first move introduces the company to the reader by way of identifying the name of the
company, the company logo and sometimes the company slogan or tag line.
Move 1: Introducing the Company
Step 1: Company name (66%)
Step 2: Company logo (86%)
Step 3: Company slogan or tag line (51%)
The purpose of the move is to acquaint the reader with the identity of the company and
its values or philosophy through its tag line. If the company happens to be a well-known and
established manufacturer or pharmaceutical marketer, presenting the name, logo and tag line
of the company is a part of branding strategy which serves to enhance the credibility of the
product. Two examples of tag lines from the data are:
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i. Trusted Remedies from Mother Nature.
ii. Life begins with a cell, a cell begins with flax.
MOVE 2
The CAM brochure is not short on the use of attention-getting strategies. In Move 2, these are
used at the beginning section of the brochure to attract the reader to continue reading the
brochure.
Move2: Getting the Attention of the Reader
Step 1 Using various attention getting strategies such as shocking images, play with
fonts and wordings, rhetorical questions or statistics. (87%)
The examples below from the data show the propensity of CAM brochures in utilising the
attention getting move, a strategy commonly associated with the advertising genre:
iii. Rhetorical questions – “Suffering from bad breath?”,
iv. Bold/highlighted font - “Oh no! Going to catch the cold?”
v. Shocking statement - “Warning! Your lifestyle may affect your liver.”
vi. Play of words and font –“Jump Start Your Circulation NOW!”
MOVE 3
In Move 3, information about the product is presented. It begins with the name of the product
and an image of the product, followed by the ingredients used in the product. As CAM
products leverage on natural ingredients, the names of the plants and other ingredients used,
and most ostentatiously their images in their natural state (or minimally processed state such
as the powdered form) are often depicted in the brochure.
Move 3: Providing Product Information
Step 1: Product name (95%)
Step 2: Product image (95%)
Step 3: Details of the ingredients of the product (87%)
Step 4: Images of natural ingredients (95%)
In the data, 95% of the brochures had natural ingredients emphasised through images.
Ingredient images are often accompanied by a list of the names of the ingredients such as the
examples below, whether using common layman names or scientific sounding names:
vii. [Name of product]4 is a unique combination of colostrum with lingzhi, UMF Active
Manuka Honey (tested for its anti-bacterial activity), DHA, 7 types of popular greens,
probiotics with FOS, 7 types of enzymes, calcium and more.
viii. The two main ingredients in [name of product] are Thuja Occidentalis and Baptisiae
Tinctoriae
The purpose of providing information on the ingredients appears not so much about
giving comprehensive understanding about the product but more towards convincing the
reader about the value of the product. Assertions such as “7 types of popular greens” and “7
types of enzymes” as ingredients do not serve any real information purpose but aim to
impress the reader. The same may be said of the use of scientific sounding terms such as
“Thuja Occidentalis”, for example. On the other hand, the use of the scientific name of the
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4The brand names of products and names of companies have been omitted to avoid any legal implications.
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ingredients puts the CAM discourse closer to the scientific discourse of prescription drug
journal advertisements, which are required to provide the scientific generic name of the drug
apart from the brand name (Othman, Vitry & Roughead, 2010).
MOVE 4
In Move 4, some explanation about the disease or health problem that can be alleviated by the
product is presented. The benefits of using the product are then described, followed by
instructions or advice for using the product, and finally, disclaimers and warnings about
misuse. At a glance, Move 4 resembles conventional drug manuals where description of the
disease, and the use and misuse of the drug are usually provided. However, the low
percentages of the CAM brochures using Step 1 (28%) and Step 4 (29%), and the high
percentage of the use of Step 2 (98%) tells us in which way the CAM brochures are skewed
in providing information about the use of the product.
Move 4: Providing Information about Use of the Product
Step 1: Details of the health problem/disease targeted (28%)
Step 2: Benefits/value of the product (98%)
Step 3: Instructions or advice for using the product (55%)
Step 4: Disclaimers and warnings about misuse (29%)
An example of an illness being described (Step 1) is shown in (ix) below:
ix. Common cold is caused by infections of the upper respiratory tract from over 200 kinds
of viruses. A weakened immune system aggravated by stress or allergies increase one’s
susceptibility to cold. That is why doctors normally recommend rest and plenty of
uids in order to support your immune system, thereby increasing your resistance to the
common cold.
In the description of the benefits of the product, listings of benefits or efficacies
attributed to the product are found to be prevalent in the brochures; however, it is noted that
the scientific pathways or explanation of how the efficacies are achieved are lacking. For the
most part of Move 4, the main aim is to impress upon the reader the benefits the product has
to offer. Two examples of this (Step 2) from the data are:
x. Health benefits
o Strengthen metabolism function - To eliminate excessive fat, protein and urine
o Improve digestive function - Complete digestion and nutrient absorption,
promote active probiotic growth
o Promote detoxification - Activate liver and kidney, helps to eliminate heavy
metal pathogen and metabolic residues
o Enhance body function - Reduce acidity in the body. Fight fatigue and
improve rejuvenation
o Rejuvenate skin, reduce wrinkles – Prevent inflammation, defence from UV
light and avoid pigmentation on skin
xi. Flaxseed oil is high in lignans, phytoestrogens which are able to inhibit estrogen-
dependent cancers, such as breast and uterus cancers.
It is also observed that there does not exist a move or step in the genre where objective
measures by which the effectiveness of the supplements may be evaluated by users are
explained; neither is there information about conditions in which the supplements would
provide no benefit (i.e. would not work).
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Instructions for taking the product (Step 3) sometimes appear together with a caution
about using the product (Step 4) (see example xii, in bold). However, no explanation is given
on any adverse effects that may result due to overdose. A disclaimer is more often used
instead of warnings of misuse (examples xiii and xiv below). All of Step 3 makes 29% of the
brochures examined, this indicating the intention of minimising potentially negative
information in the brochure, while maximising the positive impact of stating the value of the
product (Step 2, 98%).
xii. Directions: Take one measuring capful (20ml) once daily before a meal. The indicated
recommended daily dose should not be exceeded. Shake bottle before use.
xiii. Our product is not for diagnosing or curing diseases. This natural product is intended to
be used for alternative healing. Use as instructed and if symptoms persist, please
consult your doctor.
xiv. Disclaimer: The information provided is for educational purposes only. It is not
intended to provide medical advice.
MOVE 5
Move 5 has to do with positioning the product as credible. This is done through presenting
evidence of external authorisation that would encourage readers to view the product as
credible and trustworthy.
Move 5: Establishing Credibility
Step 1: Expert opinions (46%)
Step 2: Scientific evidence and research references (84%)
Step 3: Images of scientific activity and other supporting images (84%)
Step 4: Awards/ certificates/recognition from authorities (59%)
Step 5: Testimonials from satisfied consumers (8%)
The following are examples from the data where authorisation is indicated for the
purpose of enhancing the reader’s perception of the product’s credibility:
xv. [Name of product] has also been recognised by the British Herbal Pharmacopeia as the
herb used for conjunctivitis. Sunny Mavor, A.H.G. and coauthor of Kids, Herbs and
Health (Interweave, 1998) has recommended [name of product] as one of the essential
herbs for drying excessive nasal secretions.
xvi. [Name of product] is produced in GMP certified facilities in the USA with strict
adherence to the manufacturing, safety and quality control guidelines. It has achieved
GRAS (Generally Regarded As Safe) status as recognised by the US FDA and is
certified Halal.
xvii. “[Name of product] really does work. It's a well-priced, New Zealand made product
and I always recommend it,[name of consumer], BSc (Hons), DipPod (New Zealand).
xviii. It works on me, my skin’s smooth like a baby’s, and whitening..it also minimised my
open pores. I take it every night before going to sleep. You guys out there should try
this, worth your money. I feel more confident in myself.
Where visual images5 are used, pictures of scientists at work in the lab, statistical
tables, images of certificates and awards for good manufacturing practices, product testing
certificates by testing bodies, and so forth are found in the brochures. The majority of the
brochures appear slanted towards drawing on scientific discourse to help prop up perception
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
5Visual examples are not shown due to copyright reasons.
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of the product’s credibility (Step 2, 84%; Step 3, 84%). This could be CAM’s response to
discourses critical of it as an option to health and healing, among which is criticism about the
lack of scientific and regulatory credibility. On the other hand, the CAM brochures have
avoided using testimonials from satisfied consumers as a way of boosting its image (Step 5,
8%), showing a preference for depending on impressions of scientific credibility over
credibility derived from lay consumer experience.
MOVE 6
Move 6 identifies the group of people for whom the product is meant. Unlike conventional
medicines where users are specified through the diseases the drugs are made to provide relief
for, CAM product usage is much broader as many of the products claim to enhance wellness
rather than cure diseases. Hence, it is not uncommon to see the target group of users being
represented as broad demographic categories of people such as the elderly, children, and
whole families, which are groups that most readers of the brochure would inevitably belong
in. Target users are either shown as images or mentioned in the text. Groups such as men,
women, adults, children, pregnant women, lactating mothers, senior citizens, vegetarians, and
specific age groups are also often named.
Move 6: Identifying Target Users of the Product
Step 1: Human images representing the target group (73%)
Step 2: Naming/specifying groups of people (47%)
Where illnesses are used to define users, the symptoms are often referred to, such as
tummy troubles, running nose, and sore throat. In the examples shown below, the groups of
users targeted are in bold:
xix. Generally, [name of product] is recommended for both men and women who want to
support their heart in the long run. Due to the natural ageing process, the power of the
heart begins to decrease at 30 so it is wise to start to fuel the heart at this age onwards.
[name of product] is also an ideal supplement for sportsmen and sportswomen who
put higher demands on their hearts.
xx. The small fruits of this Mediterranean tree have been used for menstrual disorders by
women since Greco-Roman times
xxi. [Name of product] by [name of company] is perfect for people who are taking
Steroidal Anti-Inflammatory Drugs (NSAID) for long term inflammation and pain
management. [Name of product] by [name of company] has none of the adverse
Gastrointestinal, Cardio-Vascular and Renal side effects of NSAID.
MOVE 7
In Move 7, problems in life that may contribute to poor health are highlighted to justify the
need for CAM products. It is clear from Move 7 that CAM products do not only target people
who are suffering from health issues, but cast their nets wider to include people not currently
ill. In order to justify the need for the general populace to use CAM products, Move 7 is used.
Non-specific fear of ill health, aging, loss of beauty as well as fear of diseases such as cancer
is targeted. As the problems that affect all people in general are highlighted to create worry in
readers, CAM products are the understood recommended solution.
Move 7: Invoking Need for CAM Products
Step1: Creating worry about health due to life’s challenges such as age, diet,
environment, and lifestyle (57%)
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Examples of Move 7 (Step 1) shown below articulate the dangers and risk to one’s
health due to factors that are largely unavoidable, such as aging and environmental pollution.
xxii. We consume an overwhelming amount of potentially toxic substances every day. We
are surrounded by pesticide, processed junk food, additives, growth hormones,
antibiotics and chemicals that were routinely added to our diets. Our bodies will usually
clean up all these rubbish automatically but as time goes by and we age, the deadly
toxins begin to accumulate and slowly overpower our natural body cleansing and
immune system.
xxiii. A dull, dry, rough & wrinkled skin is a manifestation of your busy lifestyle, inadequate
dietary systems and everyday stressors. Our busy lifestyle often causes us to consume
junk food. Not only do they provide insufficient nutrition, junk food is rich in free
radicals which decreases the vital functions in our body, making us more susceptible to
illness which is often manifested through poor skin.
MOVE 8
In the final move, the reader is encouraged to contact representatives of the company for
further information. However, at the implicit level, providing the company’s address and
contact information also serves to increase the credibility of the company as well as the
product. This is because in CAM, there is the perception that products are not stringently
controlled by the government, and hence, consumers rely on the reputation of the company
producing the product. The location of the manufacturer is also an important piece of
information that readers may rely upon to judge the trustworthiness of the company and the
product.
Move 8: Encouraging Reader Action
Step 1: Providing company address and contact information (97%)
In considering the overall move structure of the CAM brochure, it is observed that not
all the moves can be described as merely “providing information” about the product, but
appear to go beyond that towards promoting the product to the reader using persuasive
means. In the next section, we compare the structure of the CAM brochure with the structure
of print advertisements as described by Kathpalia (1992). The print advertisement, as a
known hard-sell promotional genre, is set up to persuade readers to adopt certain beliefs or
actions. Information provided in the promotional genre is not meant to merely inform, but is
structured to privilege certain information and to suppress certain other information to
achieve the required effect on the reader. The aim of persuasion is thus to present information
in a way that encourages the reader to view the product favourably and at the same time to
dismiss any potentially unfavourable views.
CAM INFORMATION BROCHURES AS PROMOTIONAL GENRE
To evaluate in what ways CAM information brochures incorporate promotional functions, the
moves and steps for CAM brochures and print advertisements (Kathpalia’s (1992) nine-move
structure) are compared, taking into consideration similarities in functions between the two
genres (see Table 2 in the appendix for Kathpalia’s structure of print advertisements).
Although move labels may differ, the underlying communicative functions and the manner in
which they are carried out through specific moves and sub-moves are carefully considered.
Moves and steps in both genres pointing to similar communicative intent were identified and
compared.
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COMPANY INFORMATION FOR ENHANCING CREDIBILITY
In the CAM brochure, the act of identifying the company is seen as an informational move if
the overall intention of the genre is to inform. In any communication event, parties
communicating with each other must be identified in order for the communication to be
meaningful. Hence, it is expected that identifying the company is the first move in the
brochure to fulfil the readers’ need to know who their interlocutor is. However, when the
company name, and particularly the company logo and slogan are highlighted in the CAM
brochure, the communicative aim extends beyond informing readers about who the company
is towards presenting the company as a reputable brand. In the case of the advertisement, the
act of identifying and describing the company is seen as a promotional strategy which
contributes to establishing the credentials of the company (Print advertisement Move 5, Steps
1 and 3). Move 1 and Move 8 of the CAM brochure fulfil this function.
CATCHING ATTENTION
Move 2 (getting the attention of the reader) in the CAM brochure directly resembles Move 1
(headlines) of the print advertisement, in that both aim to capture the attention of readers,
making use of interesting or shocking captions, catchy words and phrases. A shocking
statement such as “Warning! Your lifestyle may affect your liver” to elicit an emotional
response used as an attention-grabber and leading to a product offered as the solution can be
definitively described as performing a clear persuasive function. The existence of Move 2
marks the CAM brochure as a genre adopting the promotional style of communication. In
print advertisements, getting the attention of the reader using a variety of catchy headlines
and styles is the first move, as obtaining the reader’s attention is the most crucial step in the
success of an advertisement.
PROVIDING INFORMATION ABOUT THE PRODUCT
In Move 4 (appraising the product) of the print advertisement genre, three steps are executed
sequentially: (1) introducing the product or service, (2) giving details of the product or
service, and (3) stating value/benefits of the product or service. The steps of providing
information about the product or service are presented first before the value or benefits of the
product can be described. All of these constitute Move 4, known as appraising (or positively
evaluating) the product, as no negative information is highlighted. In the advertisement genre,
providing information is not aimed only at informing but is a means to present the product (or
service) in a positive light.
In the CAM brochure, providing information about the product is accomplished in two
moves, Move 3 (providing product information) and Move 4 (providing information about
use of the product). This is because CAM brochures that operate within the practice of health
care product communication are conventionally expected to describe the product, particularly
its ingredients and the ailments targeted, as well as how it should be used, particularly
directions for use, dosage, and so forth (see Clerehan, Hirsh & Buchbinder, 2009). In Move 3
where information on the ingredients of the product is conveyed, natural ingredients are
highlighted in lists, and eye-catching illustrations of ingredients in the natural state are
projected. These images are portrayed to emphasise the “naturalness” of the product, where
“natural” is often equated with “better” in the CAM philosophy (White et al., 2014). This
gives an indication that the communicative intent is to project the CAM product as natural
and safe rather than to educate the reader about the scientific aspects of the product, and at
the same time, fulfilling the purpose of “providing information.”
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In Move 4 (providing information about the use of the product) of the CAM brochure,
the description of the value or benefits of the product found in Move 4, Step 2, outweighs the
other steps. Among the steps in Move 4, Step 2 is the most dominant with 98% of brochures
utilising the step. This step is similar to Move 4 Step 3 of the advertisement genre, where all
things positive about the product is presented. In the CAM brochure, it is difficult to find any
negative information about the product such as adverse effects or toxicity. As described in
the earlier section, Step 4 (disclaimers and warnings about misuse) consists of general
warnings about not exceeding the recommended dosage without giving specific information
about overdose symptoms, and disclaimers in the form of advising users to see the doctor if
the symptoms suffered by the user persist. Hence, while Move 3 of the CAM brochure can be
regarded as having both informational and persuasive elements, Move 4 can be described as
predominantly persuasive.
CONSTRUCTING CREDIBILITY
In advertisements, positioning the product or service as credible, usually through
endorsement or authorisation from external parties is a powerful technique used to gain trust
and persuade readers. Both the CAM brochure and print advertisement genres exhibit this
move. In the CAM brochure we named it Move 5 (establishing credibility) and in Kathpalia’s
framework it is Move 6 (endorsements/testimonials), where both moves have the same
persuasive strategies. As explained earlier, scientific endorsement (scientific evidence,
research references, images of scientific activities) is drawn on more frequently than other
types of endorsement in the CAM brochures. This is interpreted as positioning CAM
products as scientifically credible (Move 5) while at the same time claiming that most of the
product ingredients are natural and traditionally known as safe (Move 3) (see White et al.,
2014).
SPECIFYING GROUPS OF USERS
Product advertisements identify the users of the product, not just to inform potential users,
but as an implicit “invitation” to the named groups to use the product. This is Move 2
(targeting the market) in the advertisement genre. In the CAM brochure, a similar move is
found, that is, Move 6 (identifying target users of the product), which is done through naming
groups of potential users or by depicting images of the target group, such as pictures of the
elderly, children, or women. The target users of CAM products are typically broadly defined
to include general demographic categories, and may not be limited to people with specific
ailments. This strategy is comparable to promotional advertisements’ specification of “the
market” for the product where the net is cast wide to include more potential users. Further, it
is observed that in specifying groups of users, there is no specification of non-users, that is,
people who cannot use the product. The only caveat found but rarely is that for pregnant
women where users are advised to consult their doctors.
INVOKING NEEDS
Creating needs is a well-known strategy in advertising and marketing, where consumers are
made to feel worried and inadequate if they do not possess the product being promoted.
Needs are said to be “created” by advertisers because often consumers are not aware of these
needs until they are persuaded by the advertisements that their life is incomplete without the
product. This strategy of creating needs is found in Move 3 Step 2 (establishing a niche by
presenting current situations and why the readers need the product or service) in the
advertisement genre. In the CAM brochures, this is Move 7 (invoking need for CAM
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products) executed through creating worries in the reader about health due to life’s challenges
such as age, diet, environment, and lifestyle. Some needs are specified based on narrowly-
defined problems, such as “people who are taking Steroidal Anti-Inflammatory Drugs
(NSAID) for long term inflammation and pain management”, but on the whole, the needs
invoked are those that have largely unavoidable causes, such as aging or the stresses of
contemporary lifestyle. With needs created and broadly targeted, CAM products such as
anti-aging products and products aimed at repairing the ravages of the environment on health
will not be short of users. The existence of this move in CAM brochures clearly positions the
genre as promotional in character.
ENCOURAGING READER ACTION
In the last move, CAM brochures (Move 8) and advertisements (Move 9) both list the
company’s and distributors’ addresses and contact details, with either an explicit or implicit
invitation to the reader to make contact with the company representative for more
information or to purchase the product. CAM brochures stop at the invitation to make
contact, whereas advertisements go on to encourage the reader to go for the product in order
to obtain its benefits. Hence, the extent of the promotional strategy in CAM brochures in
urging reader action is more muted compared with print advertisements. The listing of the
company’s address and contact information serves another function apart from encouraging
reader action. By providing its contact information, the company positions itself as
approachable, transparent and responsible as a manufacturer/distributor that would stand by
the quality of its product. This enhances the company’s as well as the product’s
trustworthiness in the eyes of the reader.
HARD-SELL STRATEGIES
These are strategies that are not used in the CAM brochures. Hard-sell strategies found in the
advertisement genre such as Move 7 (offering incentives) and Move 8 (pressure tactics) are
not part of the generic structure of the CAM brochures. The hard-sell moves which are
characteristic of marketing and promotional genres aim to deny the autonomy of the reader to
make a rational decision by creating a false urgency through the offering of incentives and
using pressure tactics to induce action. Lacking these moves, CAM brochures cannot be
thought of entirely as typical advertisements.
CONCLUSION
In this paper, we have shown that CAM information brochures that are placed in pharmacies
accompanying CAM products are potent promotional material that functions to persuade the
reader to use the product. While they retain the appearance of informational texts providing
information about health products and their use similar to conventional drug manuals, close
examination of the generic structure of the text type showed that it has incorporated elements
of the promotional genre to achieve a markedly persuasive goal. Moves within the CAM
brochure are structured to utilise similar strategies as the print advertisement, a known
promotional genre, to influence the reader to adopt a favourable view of the product but at the
same time, appear to provide helpful information to readers. This process is enabled through
what is known as genre mixing, a phenomenon that is pervasive in modern day discourse
activities (Bhatia, 2004, 2005).
Two characteristics of the genre that obscure its promotional character are worth
mentioning. The first is the propensity of the genre for drawing on scientific discourse as its
mode of constructing credibility for its products through scientific references, projection of
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scientific activities and citing of scientific evidence. This is aimed at entrenching CAM as a
field of medicine and distances its products from other general products that utilise consumer
testimonials or celebrity endorsements. Depiction of scientific authorisation also serves to
position CAM products as backed by hard evidence and therefore do not require exploitation
of emotional appeal which is the hallmark of hard-sell advertisements. Next is the avoidance
of the two hard-sell strategies found in advertisements, which are “offering incentives” and
“using pressure tactics.” These clear cut promotional strategies are missing in the CAM
brochures, which is in line with ethics in the field of medicine that frowns upon commercial
advertising of health products.
Despite these characteristics that put the CAM brochures apart from hard advertising,
the brochures, as we have shown in the analysis, are not free from promotional elements.
Ironically, the masking of the promotional character of the genre makes its subtle form of
persuasion more potent, as readers’ awareness of the commercial intent of the genre is
unlikely to be easily triggered (Fairclough, 1993; Bhatia, 1997). It is in fact, the nature of
hybrid genre that does the work of persuasion more effectively through manipulation of
readers’ expectations and understanding of genre.
In comparison with a similar study, Lee and Cheong’s (2018) analysis of
advertisements of milk formula (which may be regarded broadly as a dietary supplement),
found all nine moves in Kathpalia’s print advertising framework. It appears that CAM
brochures do vary in that some take a more hard-sell approach than others. Lee and Cheong
found that moves such as providing celebrity or typical user endorsement, offering incentives
and urging action which are regarded as hard-sell strategies are found in some of the milk
formula advertisements. This rather differs from the findings of the current study that
indicated celebrity and user endorsement is dispreferred compared to use of references to
scientific activity and certification from authorities. When the data is comprised of brochures
on a single product type, the generic practices may display variations typical in the promotion
of the particular product.
The notion of genre hybridisation discussed in the current study is not a new
phenomenon in health care. A study conducted by Grego and Vicentini (2011) on medical
health care tourism discourse found that genre multi-hybridisation occurred, where the genre
is modified to include structures that aim at achieving different goals, such as health services
information, entertainment, and economic benefit. Such hybrid discourse is seen to construct
its target readers as patients seeking medical services as well as “tourists” seeking
entertainment with the added goal of financial benefit in the form of lower treatment costs.
The same phenomenon of infusing promotional elements into a genre is similarly applicable
to CAM information brochures as shown in the current study, where target users are defined
in expanded social categories to capture a bigger market.
In another health-related study, Helan (2012) who examined the medical case report
described the case report as a hybrid genre because it incorporates characteristics of academic
writing as well as those of professional communication practice. This means the genre targets
different communicative purposes and achieves different goals. Further, he found that the
structure of the case report evolved through time to reflect the practice of medical case
reporting of the time, from a loosely structured form to move-based structure and towards the
problem-solution form. This study, as well as those discussed earlier, demonstrates the
flexibility of genre in varying its structure strategically to achieve new functions and goals.
The study has shown that health care discourse is not exempt from Bhatia’s (2005, p.
213) observation that the “compulsive nature of advertising and promotional activities” has
pervaded many areas of discourse activities through colonisation of genres and genre mixing.
It has also highlighted one of the contributions of genre analysis that has often been
neglected, that is to “understand and account for the private intentions of the author, in
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addition to socially recognised communicative purposes” (Bhatia, 2002, p. 5). Through genre
analysis, the flexibility of genres as communicative action that can be adapted in response to
novel situations as well as manipulated to achieve the intentions of the author is revealed.
This is in contrast with previous views of genre as fixed discourse forms. Future research
could expand on the current study to examine further the persuasive power of CAM discourse
through other linguistic means, particularly its harnessing of the power of ideology in
language. As Grego and Vicentini’s (2011) and other works in the volume edited by Sarangi,
Polese and Caliendo (2011) have shown, hybridisation in discourses can occur at multiple
levels and in different inter-discursive configurations. On further research to illuminate the
notion of hybridisation of genres in health care and their connection with manipulation for
commercial gain, it would be useful to investigate generic strategies used in various health
care genres to reveal how hybridisation of genre is affecting health care discourse.
DECLARATION
The authors declare that there are no competing interests.
!
ACKNOWLEDGEMENTS
The authors would like to thank the guest editor of this publication and the reviewers who
have provided critical and constructive comments.
!
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APPENDIX
TABLE 1. A summary of selected published research on Complementary and Alternative Medicine (CAM)
Topic
Reference
Safety and adverse effects of
CAM
Bello, Winit-Watjana, Baqir & McGarry (2012)
Harvey (2009)
Hijazi et al. (2019)
Jaqua, Weintraub, Tu, Nguyen & Cho (2019)
Mathes & Bellanger, 2010
Rabito & Kaye (2013)
World Health Organisation (2002)
Disclosure of the use of CAM by
patients to their primary care
doctors
Anak Kelak, Cheah & Safii (2017, 2018)
Chao, Wade & Kronenberg (2008)
Jou& Johnson (2016)
Understanding why patients use
CAM and for what ailments
Bishop, Yardley & Lewith (2007)
Ching, Zainul, Fuziah & Mehrdad (2013)
Kristoffersen, Stub, Musial, Fonnebo, Lillenes & Norheim (2018)
Larussa, Rossi, Suraci, Larasco, Imeneo, Abenavoli & Luzza
(2019)
4565-)!'7"%&-)895%&+5-)!:(+-);5&<()*)=>5?+&)@./01A
How doctors should respond to
patients who wish to use CAM
Hall, Brosnan, Frawley, Wardle, Collins & Leach (2018)
Koenig, Ho, Yadegar & Tarn (2012)
Verhoef, Boon & Page (2008)
Wahner-Roedler, Vincent, Elkin, Loehrer, Cha & Bauer (2006)
How CAM can or should be
integrated with conventional
medicine
Agarwal (2018)
B55C$)*);5DC()@./01A))
Barnett & Shale (2012)
Frenkel & Borkan (2003)
Kretchy, Okyere, Osafo, Afrane, Sarkodie & Debrah (2016)
Singer & Adams (2014)
TABLE 2. Move structure of print advertisements (summarised from Kathpalia, 1992)
MOVE 1 Headlines
Step 1Attracting attention with subheadings
Step 2 Product / service guarantee or warranty, and after-sales service
Step 3 Presenting the company profile
MOVE 2 Targeting the Market
Step 1 Specifying the different types and age groups of people who may need the product or service
Step 1 Introducing identity of the product or service
Step 2 Giving details of the product or service
Step 3 Stating value/benefits of the product or service
MOVE 3 Justifying the Product or Service
Step 1 Indicating the importance of product or service
Step 2 Establishing a niche by presenting current situations and why the readers need the product or service
MOVE 4 Appraising the Product
Step 1 Introducing the product or service
Step 2 Giving details of the product or service
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Step 3 Stating values/ benefits of the product or service
MOVE 5 Establishing Credentials
Step 1 Identification of the company through the name of the company or manufacturer
Step 2 Product / service guarantee or warranty, and after-sales service
Step 3 Presenting the company profile
MOVE 6 Endorsements/Testimonials
Step 1 Presenting the testimonials of famous authorities
Step 2 Presenting the official citation of achievements and seals of approval
Step 3 Presenting the testimonies of satisfied consumers
Step 4 Presenting the testimonies of fictitious consumers
MOVE 7 Offering Incentives
Step 1 Giving away free delivery, gifts, discounts, redemption, coupons collection or accumulation of reward
points for product buyers
MOVE 8 Pressure Tactics
Step 1 Imposing pressure on customers to buy the product or service through time limitation or quantity
limitation for the product or service advertised
MOVE 9 Urging Action
Step 1 Listing out company information (telephone numbers, fax numbers, company address, email address,
website address)
Step 2 Urging readers to purchase the product or service to take advantage of the offer
ABOUT THE AUTHORS
Ching Fen Goh has just completed her PhD in English Language at Universiti Putra
Malaysia. Her research interest is in critical discourse studies and genre analysis. She is
passionate about sharing her knowledge about the use of language with teenage and college
students, and has been actively conducting language and motivation courses for students in
secondary school and a private university in Malaysia.
Mei Yuit Chan is an associate professor at the Faculty of Modern Languages and
Communication, Universiti Putra Malaysia. Her research interests include the study of social
practice through discourse analysis and language use in institutional contexts.
Afida Mohamad Ali is a senior lecturer at the English Language Department, Faculty of
Modern Languages and Communication, Universiti Putra Malaysia. Her research interests are
mainly in the areas of LSP/ESP, corpus linguistics, and genre analysis, specifically genres
used in professional settings i.e. business, finance, health, tourism and the new media. She is
currently involved in research on oral case presentations by medical students in the field of
medical communication.
Sabariah Md Rashid is an associate professor at the Faculty of Modern Languages and
Communication, Universiti Putra Malaysia. She obtained her Ph.D. degree in English Studies
from Universiti Kebangsaan Malaysia and Master of Arts and Master of Philosophy degrees
from University of Reading, U.K., and Bachelor’s degree from University of Essex, U.K. Her
research interests and publications are in the areas of applied linguistics, language testing,
cognitive semantics, pragmatics and translation.!
!
... While genre analysis is most often investigated based on its linguistic features, most studies have concentrated on the rhetorical moves found in different genres and further developed their own framework for move analysis; for instance, the studies have examined corporate discourse such as annual report narratives (Rutherford, 2005) and sections of annual reports involving Management Forewords (Mobasher & Ali, 2015) and Letters to the Shareholders (Falco, 2018). Other studies have also involved Arabic patent abstracts and a product information brochure (see Alzarieni et al., 2019& Goh et al., 2019. Robayany et al. (2019) views 'risk' as coherent with uncertainties and probabilities pertaining to profits and losses. ...
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Introduction Pharmacists are uniquely positioned to provide patients with evidence-based information in order to ensure effective and safe use of Complementary and alternative medicine (CAM) products. Objective Assess beliefs, practices and knowledge related to CAM products among community pharmacists in Lebanon. Design, methods and setting Using stratified random sampling, a nationally representative survey was conducted among community pharmacists in Lebanon. Through face-to-face interviews, pharmacists completed a multicomponent questionnaire consisting of four sections: (1) sociodemographic characteristics; (2) beliefs related to regulation of CAM products, role of media in promoting their safe use, availability of resources and continuing education; (3) practices including selling CAM products, providing advice for patients and reporting adverse effects and (4) knowledge about specific CAM products, their uses, side effects and interactions. Results A total of 341 pharmacists agreed to participate (response rate: 86%). Only pharmacists with complete data were included in this study (n=310). Pharmacists agreed that CAM products are effective (63.8%) and that they should be exclusively sold in pharmacies (80.3%), but disagreed that commercially marketed CAM products are well regulated (63.5%) and that media plays a positive role in educating users about these products (55.8%). As for practices, 64.5% of pharmacists were always or often advising patients on safe use; however, 74.2% of participants rarely or never reported adverse effects. Regarding knowledge, although the majority of pharmacists were aware of the uses of CAM products, fewer knew about their side effects and their interactions with drugs. After adjustment for covariates, receiving education/training on CAM products during university was the sole predictor of higher knowledge score (ß=0.68, 95% CI 0.29 to 1.07). Conclusions This study revealed positive beliefs of pharmacists in Lebanon towards CAM products and indicated important gaps in their practice and knowledge. Deliberate efforts to enhance the education of pharmacists are warranted to ensure the safe integration and use of CAM products in Lebanon.
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Background : Many people integrate complementary and alternative medicine (CAM) into their health care. Nurses potentially play a significant role in communicating with patients about their CAM utilisation. Aim : The study aimed to explore whether, how and why nurses working in Australia communicate about patients’ CAM use. Methods : This paper reports on phase one of a mixed methods study. Qualitative data was obtained, via interviews, with nineteen registered nurses who work in a wide variety of clinical environments across all states of Australia. Findings : Four themes related to nurses’ communication with patients about CAM, were developed from the qualitative data; engaging with patients about CAM, communication with doctors about patients’ use of CAM, connecting with CAM practitioners and barriers to CAM communication. Discussion : Despite their positive attitudes, nurses are often not comfortable discussing or documenting patients’ CAM use. Furthermore, nurses perceive that patients may be apprehensive about disclosing their use. CAM communication with colleagues is moderated by the workplace culture and the perceived attitude of co-workers. There is very little evidence of nurses referring or collaborating with CAM practitioners. Professional expectation, time restraints and the nurses’ lack of relevant CAM knowledge all have a powerful effect on limiting CAM communication. Conclusion : Communication about patients’ use of CAM is imperative to support safe therapeutic decisions. Currently, this is limited in the Australian healthcare workplace. The nursing professional needs to consider introducing basic CAM education and flexible guidelines to enable nurses’ to respond appropriately to the patient driven demand for CAM.