Background The issues of language barrier involving medical services and thus directly relating to health concerns remain a challenge. Communication is particularly critical between pharmacists and visitors as judgments of symptoms mostly rely on the subjective descriptions given by the visitors. The nonverbal communication of pictograms, as a visual language, is a reliable form of symptom communication because it does not depend on users’ mother tongue and requires no prior learning experience. To this end, the present paper explores the visual and cognitive factors influencing users’ comprehension of symptom pictograms.
Methods The study was carried out in two stages of an observational study and a user survey. In the observational study, symptom pictograms currently being used were collected and classified by their visualization strategy through a Delphi process involving ten design experts. Then, symptom pictogram stimuli were developed as a reinterpretation of the sample. These stimuli were evaluated by 238 participants (104 American, 134 Chinese) from the general public through a user survey on the cognitive factors of semantic distance, complexity, concreteness, and familiarity. Chi- squared and logistic regression analyses are used to analyze the data.
Results Analyses revealed that user comprehension is generally higher for symptom pictograms with a mixed combination of both depictive and abstract motifs, whose relation with the referent symptom is arbitrary rather than direct or indirect, whose semantic distance is closer to the referent symptom, is less complex, is less concrete, and is more familiar.
Conclusions The perceptive cognition, more so than the visualization strategy, should be given particular attention when developing symptom pictograms. Their cognitive aspects should be not only beneficial to the overall comprehension but also well-balanced such that the synergy resulting from discreetly combining the advantages of being semantically close, less complex, less concrete, or more familiar surpasses the disadvantage that may result from the limitation of visualization strategy feasibility. Specific cultural differences are also discussed.