Developing Academic Writing in Health Science Education: A Mixed-Methods Study of Cohesion and Coherence in ESL Student Essays at Bibiani College of Health Sciences, Ghana
Abstract
Mastering cohesion and coherence is essential for effective academic writing; however, it continues to be a persistent challenge for learners of English as a second language in health science education. This study examined the use of cohesive and coherent devices in the essays of first‑year students at Bibiani College of Health Sciences, Ghana. Utilizing a concurrent mixed-methods design, the study examined 30 randomly selected expository essays from an initial purposive sample of 67 students and performed semi-structured interviews with 12 students and five English instructors. Quantitative analysis revealed a dominant reliance on grammatical cohesion—particularly “reference” (48.2%) and “conjunctions” (31.5%)—with limited use of lexical cohesion, substitution, and ellipsis. Pearson correlation results confirmed a significant positive relationship between lexical cohesion diversity and coherence scores (p < 0.05). Qualitative findings indicated that students’ writing challenges stem from limited vocabulary, cognitive overload from content‑heavy coursework, and list‑based instructional practices that emphasize connectors over functional discourse use. Teachers reported constraints such as limited instructional time and insufficient genre‑based modeling. The study concludes that current pedagogical approaches do not adequately support the development of advanced discourse competence. It recommends explicit lexical instruction, genre‑based writing pedagogy, and structured feedback mechanisms to strengthen cohesion and coherence in health‑science academic writing.
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