Coherence in hybrid texts: The case of the Patient Information Leaflet genre

  • Aage Hill-Madsen
Keywords: hybridity; derivation; Patient Information Leaflets; coherence; contextual consistency; cohesive harmony


This article investigates the degree of coherence in a particular type of hybrid text, viz. the Patient Information Leaflet, which is a lay-oriented genre fusing original and derived textual elements. Having their source in the specialized genre named Summary of Product Characteristics, derived segments undergo various kinds and degrees of registerial simplification in the transfer to the Patient Information Leaflet. Given this complex textual genesis, the aim of the article is to investigate the nature and degree of coherence in the Patient Information Leaflet genre, and, more specifically, to investigate the degree of integration between derived and non-derived elements. Following Halliday/Hasan’s (1976) definition of the coherence concept, the article examines the genre’s contextual coherence in the form of registerial consistency and its text-internal coherence in the form of cohesiveness. For the investigation of cohesiveness, the analytical framework known as Cohesive Harmony Analysis (Hasan 1984, 1985) has been applied to a sample text from the genre, and likewise to a parallel lay-oriented, but non-hybrid text from the health column of a British quality newspaper, which serves as a control. While the investigation confirms already well-known problems with registerial consistency in the Patient Information Leaflet genre, the analytical results reflect a high degree of cohesiveness, and one that is even markedly higher than that of the non-hybrid control text. Further, the results reflect a high level of integration between derived and non-derived segments in the Patient Information Leaflet.


Armstrong, Elizabeth 1987: Cohesive harmony in aphasic discourse and its significance to listener perception of coherence. In Clinical Aphasiology 17, 210–15.
Armstrong, Elizabeth 1991: The potential of cohesion analysis in the analysis and treatment of aphasic discourse. In Clinical Linguistics and Phonetics 5 (1), 39–51.
Askehave, Inger/Zethsen, Karen K. 2003: Communication Barriers in Public Discourse: The Patient Package Insert. In Document Design 4 (1), 22-41.
Bateman, John A./Rondhuis, Klaas Jan 1997: Coherence relations: Towards a general specification. In Discourse Processes 24 (1), 3-49.
Bhatia, Vijay K. 2010: Interdiscursivity in Professional Communication. In Discourse & Communication 21 (1), 32-50.
Bjerrum, Lars/Foged, Annette 2003: Patient Information Leaflets - Helpful Guidance Or a Source of Confusion? In Pharmacoepidemiology and Drug Safety 12 (1), 55-59.
Blum-Kulka, Shoshana 1986: Shifts of Cohesion and Coherence in Translation. In House, Juliane/Blum-Kulka, Shoshana (eds.), Interlingual and Intercultural Communication. Discourse and Cognition in Translation and Second Language Acquisition Studies. Tübingen: Narr.
Bottenberg, Donna/Lemme, Margaret/Hedberg, Natalie 1985: Analysis of oral narratives of normal and aphasic adults. In Clinical Aphasiology 15, 241–7.
Bradley, B./Singleton, M./Li Wan Po, A. 1994: Readability of Patient Information Leaflets on Over-the-Counter (OTC) Medicines. In Journal of Clinical Pharmacy and Therapeutics 19 (1), 7-15.
Bühler, Karl 1934: Sprachtheorie: die Darstellungsfunktion der Sprache. Jena: Fischer.
Calsamiglia, Helena/van Dijk, Teun A. 2004: Popularization Discourse and Knowledge about the Genome. In Discourse and Society 15 (4), 369-389.
Camus, Julia T. W. 2009: Metaphors of Cancer in Scientific Popularization Articles in the British Press. In Discourse Studies 11 (4), 465-495.
Carrell, Patricia 1982: Cohesion is not coherence. In TESOL Quarterly 16 (4), 479-88.
Ciapuscio, Guiomar E. 2003: Formulation and Reformulation Procedures in Verbal Interactions between Experts and (Semi-)Laypersons. In Discourse Studies 5 (2), 207-233.
Clerehan, Rosemary/Buchbinder, Rachel 2006: Towards a More Valid Account of Functional Text Quality: The Case of the Patient Information Leaflet. In Text & Talk 26 (1), 39-68.
Das, Debopam/Taboada, Maite 2018: Signalling of Coherence Relations in Discourse: Beyond Discourse Markers. In Discourse Processes 55 (8), 743-770.
Demantik, Maman 2008: A cohesive harmony analysis of reader’s letters column in “Time” and “The Jakarta Post”. In Leksika 2 (2), 32–44.
European Medicines Agency 2016: Quality Review of Documents human product information annotated template (English) version [online]. 004368.pdf (accessed 11 October 2018).
European Commission 2004: Directive 2004/27/EC of the European Parliament and of the Council of 31 March 2004 amending Directive 2001/27/EC of the Community code relating to medical products for human use. In Official Journal of the European Union L 136/34 [online]. (accessed 11 October 2018).
European Commission 2009: Guideline on the readability of the labelling and package leaflet of medicinal products for human use [online]. (accessed 11 October 2018).
Ezpeleta Piorno, Pilar 2012: An Example of Genre Shift in the Medicinal Product Information Genre System. In Montalt, Vicent/Shuttleworth, Mark (eds.), Translation and Knowledge Mediation in Medical and Health Settings (Linguistica Antverpiensia New Series - Themes in Translation Studies 11). Antwerpen: ASP, 173-186.
Fairclough, Norman 1992: Intertextuality in Critical Discourse Analysis. In Linguistics and Education 4, 269-293.
Fries, Peter H. 1983: On the status of Theme in English: Arguments from discourse. In Petöfi, János S./Sözer, Emel (eds.), Micro and macro connexity of texts. Hamburg: Helmut Buske.
Fries, Peter 2004: What Makes a Text Coherent? In Banks, David (ed.), Text and Texture: Systemic Functional Viewpoints on the Nature and Structure of Text. Paris: L’Harmattan, 9-50.
Fulcher, Glenn 1989: Cohesion and Coherence in theory and reading research. In Journal of research in reading 12 (2), 146-163.
García-Izquierdo, Isabel/Montalt, Vicent 2013: Equigeneric and Intergeneric Translation in Patient-Centred Care. In HERMES - Journal of Language and Communication in Business 51, 39-51.
Givón, Talmy 1995: Coherence in text vs. coherence in mind. In Gernsbacher, Morton A./Givón, Talmy (eds.), Coherence in spontaneous text. Amsterdam: Benjamins, 59-116.
Gotti, Maurizio (2014): Reformulation and Recontextualization in Popularization Discourse. In Ibérica: Revista De La Asociación Europea De Lenguas Para Fines Específicos/Journal of the European Association of Languages for Specific Purposes (AELFE) 27, 15-34.
Hadjipavlou, Marios/Khan, Sharid/Rane, Abhay 2013: Readability of Patient Information Leaflets for urological conditions and treatments. In Journal of Clinical Urology 6 (5), 302-305.
Halliday, M. A. K. 1978: Language as Social Semiotic: The Social Interpretation of Language and Meaning. London: Edward Arnold.
Halliday, M. A. K. 1985: Context of situation. In Halliday, M. A. K./Hasan, Ruqaiya (eds.), Language, Context and Text: Aspects of Language in a Social-Semiotic Perspective. Oxford: Oxford University Press, 3-14.
Halliday, M. A. K./Hasan, Ruqaiya 1976: Cohesion in English. London: Longman.
Halliday, M. A. K./Matthiessen, Christian M. I. M. 2014. Halliday’s Introduction to Functional Grammar. 4th ed. London/New York: Routledge.
Hank, Peter 2006: Definition. In Brown, Keith (ed.), Encyclopedia of Language and Linguistics, 2nd edition. Oxford: Elsevier, 399-402.
Harwood, A./Harrison, J. E. 2004: How Readable are Orthodontic Patient Information Leaflets? In Journal of Orthodontics 31 (3), 210-219.
Hasan, Ruqaiya 1984: Coherence and Cohesive Harmony. In Flood, James (ed.), Understanding Reading Comprehension: Cognition, Language and the Structure of Prose. Newark, DE: International Reading Association, 181-219.
Hasan, Ruqaiya 1985: The Texture of a Text. In Halliday, M. A. K./Hasan, Ruqaiya (eds.), Language, Context and Text: Aspects of Language in a Social-Semiotic Perspective. Oxford: Oxford University Press, 70-96.
Hill-Madsen, Aage 2015a: Lexical Strategies in Intralingual Translation between Registers. In Hermes – Journal of Language and Communication in Business 54, 85–105.
Hill-Madsen, Aage 2015b: The ‘unpacking’ of grammatical metaphor as an intralingual translation strategy: From de-metaphorization to clausal paraphrase.” In Maksymski, Karin/Gutermuth, Silke/Hansen-Schirra, Silvia (eds.), Translation and Comprehensibility. Berlin: Frank & Timme, 195–226.
Hill-Madsen, Aage in press: The Heterogeneity of Intralingual Translation. In Meta 64 (2).
Hill-Madsen, Aage/Pilegaard, Morten 2019: Variable scope for popularization of specialized terminology: The case of medico-pharmaceutical terms. In Fachsprache. Journal of Professional and Scientific Communication 41 (1–2), 22–40.
Hoey, Michael 1991a: Another Perspective on Coherence and Cohesive Harmony. In Ventola, Elija (ed.), Functional and Systemic Linguistics: Approaches and Uses. Berlin/Boston: de Gruyter, 385-414.
Hoey, Michael 1991b: Patterns of Lexis in Text. Oxford: Oxford University Press.
Hoover, M. L. 1997: Effects of textual and cohesive structure on discourse processing. In Discourse Processes, 23 (2), 193–220.
Hospira UK Ltd 2017: Daptomycin Hospira: EPAR - Product Information [online]. (accessed 4 May 2018).
Huddleston, Rodney/Pullum, Geoffery K. 2002: The Cambridge Grammar of the English Language. Cambridge: Cambridge University Press.
Jakobson, Roman 1959: On Linguistic Aspects of Translation. In Brower, Reuben A. (ed.), On Translation. Cambridge: Harvard University Press, 232-239.
Jakobson, Roman 1960: Linguistics and poetics. In Sebeok, Thomas A. (ed.), Style in Language. Cambridge, Mass.: MIT Press.
Kastberg, Peter 2011: Knowledge Asymmetries - Beyond “to Have and Have Not”. In Fachsprache 34 (3), 137-151.
Khoo, Kristin M. 2016: ‘Threads of Continuity’ and Interaction: Coherence, Texture and Cohesive Harmony. In Bowcher, Wendy L./Liang, Jennifer Yameng (eds.), Society in Language, Language in Society. London: Palgrave MacMillan, 300-330.
Mann, William C., Matthiessen, C. M. I. M. and Thompson, Sandra A. 1992: Rhetorical Structure Theory and text analysis. In Mann, W. C./Thompson, S. A. (eds.), Discourse description: Diverse linguistic analyses of a fund-raising text. Amsterdam/Philadelphia: Benjamins, 39-78.
Mann, William C./Thompson, Sandra A. 1988: Rhetorical structure theory: Toward a functional theory of text organization. In Text 8 (3), 243–281.
Matthiessen, C. M. I. M./Teruya, Kazuhiro (2015): Grammatical realization of rhetorical relations in different registers. In Word 61(3): 232-81.
Martin, James R. 1992: English Text: System and Structure. Amsterdam/Philadelphia: Benjamins.
Mossop, Brian 2016: ‘Intralingual Translation’: A Desirable Concept? In Across Languages and Cultures 17 (1), 1-24.
Montalt, Vicent/Shuttleworth, Mark 2012: Research in Translation and Knowledge Mediation in Medical and Healthcare Settings. In Montalt, Vicent/Shuttleworth, Mark (eds.), Translation and Knowledge Mediation in Medical and Health Settings (Linguistica Antverpiensia New Series - Themes in Translation Studies 11, 9-29.
Motta-Roth, Désirée/Scherer, Anelise S. 2016: Science Popularization: Interdiscursivity among Science, Pedagogy, and Journalism. In Bakhtiniana: Revista De Estudos do Discurso 11 (2), 171- 194.
Muñoz-Miquel, Ana/Ezpeleta-Piorno, Pilar/Saiz-Hontangas, Paula 2018: Intralingual Translation in Healthcare Settings: Strategies and Proposals for Medical Translator Training. In MonTI 10, 177-204.
Myers, Greg 1991: Lexical cohesion and specialized knowledge in science and popular science texts. In Discourse Processes 14 (1), 1-26.
Pander Maat, Henk/Lentz, Leo 2010: Improving the Usability of Patient Information Leaflets. In Patient Education and Counseling 80 (1), 113-119.
Parsons, Gerald 1991: Cohesion coherence: scientific texts. In Ventola, Elija (ed.), Functional and Systemic Linguistics: Approaches and Uses. Berlin/New York: Mouton de Gruyter, 415–30.
Parsons, Gerald 1996: The development of the concept of cohesive harmony. In M. Berry (ed.), Meaning and Form: Systemic Functional Interpretations (Vol. 57). Norwood, NJ: Ablex Publishing, 585–600.
Raichvarg, Daniel 2010: “La vulgarisation des sciences: fausse «traduction» et vraie «interprétation».” In Hermés 56 (1), 105-112.
Raynor, D. K./Blenkinsopp, A./Knapp, P./Grime, J./Nicolson, D. J./Pollock, K./Dorer, G./Gilbody, S./ Dickinson, D./Maule, A. J./Spoor, P. 2007: A systematic review of quantitative and qualitative research on the role and effectiveness of written information available to patients about individual medicines. In Health Technology Assessment 11 (5), i-180.
Robinson, Ann 2018: Seven ways to minimize the risk of having a stroke [online]. (accessed 2 July 2018).
Ross, Beth/Stearman, Linda S. Potter/Armstrong, Kay A. 2006: Improving Patient Educational Literature: An Understandable Patient Package Insert for “the Pill”. In JOGNN - Journal of Obstetric, Gynecologic and Neonatal Nursing 33 (2), 198-208.
Sanford, Anthony J. 2006: Coherence: Psycholinguistic Approach. In Brown, Keith (ed.), Encyclopedia of Language and Linguistics, 2nd ed. Oxford: Elsevier, 585-591.
Sanford, Anthony J./Moxey, Linda M. 1995: Aspects of coherence in written language: A psychological perspective. In Gernsbacher, Morton A./Givón, Talmy (eds.), Coherence in spontaneous text. Amsterdam: Benjamins, 161-188.
Seidlhofer, Barbara/Widdowson, Henry 1999: Coherence in summary: The contexts of appropriate discourse. In Bublitz, Wolfram et al. (eds.), Coherence in Spoken and Written Discourse: How to create it and how to describe it. Selected papers from the International Workshop on Coherence, Augsburg, 24-27 April 1997. Amsterdam/Philadelphia: Benjamins.
Spiegel, Dixie L./Fitzgerald, Jill 1990: Textual cohesion and coherence in children’s writing revisited. In Research in the Teaching of English 24, 48–66.
Stoddard, Sally 1991: Text and Texture: Patterns of Cohesion. Norwood, NJ: Ablex.
Taboada, Maite/Mann, William C. 2006: Rhetorical Structure Theory: Looking back and moving ahead. In Discourse Studies 8 (3), 423–459.
Tanskanen, Sanna-Kaisa 2006: Collaborating towards coherence: Lexical cohesion in English. Amsterdam/Philadelphia: Benjamins
Thompson, Susan E. 1994: Aspects of cohesion in monologue. In Applied Linguistics 15, 58–75.
Van Vaerenbergh, Leona 2003: Fachinformation und Packungsbeilage: Fachübersetzung oder mehrsprachiges inter- und intrakulturelles Technical Writing? In Schubert, Klaus (ed.), Übersetzen und Dolmetschen: Modelle, Methoden, Technologie. Tübingen: Narr, 207-224.
Van Vaerenbergh, Leona 2007: Wissensvermittlung Und Anweisungen Im Beipackzettel. Zu Verständlichkeit Und Textqualität in Der Experten-Nichtexperten-Kommunikation. In Villiger, Claudia/ Gerzymisch-Arbogast, Heidrun (eds.), Kommunikation in Bewegung: Multimedialer Und Multilingualer Wissenstransfer in Der Experten-Laien-Kommunikation. Frankfurt a. M.: Lang, 167-185.
Van Vaerenbergh, Leona/Schubert, Klaus 2010: Options and Requirements. A Study of the External Process of Specialized Document Production. In Hermes - Journal of Language and Communication Studies 44, 9-24.
Zethsen, Karen K. 2007: Beyond Translation Proper. In TTR: Traduction, Terminologie, Redaction 20 (1), 281-308.
Zethsen, Karen K./Hill-Madsen, Aage 2016: Intralingual Translation and Its Place within Translation Studies – A Theoretical Discussion. In Meta 61 (3), 692–708.
How to Cite
Hill-Madsen, A. (2019). Coherence in hybrid texts: The case of the Patient Information Leaflet genre. HERMES - Journal of Language and Communication in Business, 59(1), 153-187.