Karel van de Waarde

“Can Symbols Harm your health”

Situation: Symbols are often used in the medical domain to inform patients about therapies and medicines. Henri Dreyfuss dedicated a separate section to medicine-symbols as examples of standardized, universally understandable graphic symbols. In the last 50 years, several very substantial collections of medical-symbols have been designed. The healthcare literature often mentions that symbols – or pictograms – directly relate to positive treatment outcomes, such as a better understanding, and improved adherence.

Question: In which specific circumstances is there evidence that symbols really enable patients to act more appropriately?

Approach: The assumption of ‘universally understandable symbols’ might need to be questioned. Empirical findings of a single symbol often score lower than required. It seems therefore necessary to approach this question from the heterogeneity of the five components.

Findings: ‘Patients’, ‘symbols’, ‘actions’, ‘circumstances’, and ‘performance criteria’ do vary substantially in both practice as well as in the research literature. This variation explains some of the empirical findings and discrepancies in beliefs about the effectiveness of pictograms. The visual qualities of symbols, the experiences and knowledge of individual patients, the variety and complexity of actions, geographical and cultural differences, and the different performance criteria all affect the ‘measure of successful interpretation’ of a symbol. Symbols can only be evaluated within a specific context, for relatively simple actions, and by asking ‘what do you see?’ and ‘what does this mean?’ Secondly, it is clear that medical symbols can only be effective if they are integrated into more extensive visual and aural communication.

Conclusion: A single symbol does not provide enough information to enable patients to act safely. It is essential to enhance interpretations through the design of the context (training, education, support), and through an integration of symbols in information strategies. Standardized, universally understandable graphic symbols are interpreted correctly by some people. However, the misinterpretation by others does cause harm and increase risks.

Biography
Karel van der Waarde studied graphic design in the Netherlands (The Design Academy, Eindhoven) and in the UK (De Montfort University, Leicester and the University of Reading). He received his doctorate in 1994 for a dissertation entitled: ‘An investigation into the suitability of the graphic presentation of patient package inserts’.

In 1995, he started a design - research consultancy in Belgium specializing in the testing of information design. His company develops patient information leaflets, packaging, instructions, forms, protocols, and the information architecture for websites. Most of the projects are related to information about medicines for patients, doctors and pharmacists. [www.graphicdesign-research.com]

Karel van der Waarde frequently publishes and lectures about visual information. He has taught at Avans University of Applied Sciences (The Netherlands), Loughborough University (UK), University of South Australia and Swinburne University (Australia), the IIID-summer school, and the Basel School of Design (Switzerland). In 2022 he teaches at BA, MA, and PhD level at the Lucerne University of Applied Sciences and Arts (Switzerland), and University of Hasselt (Belgium).

Van der Waarde is a life-Fellow of the Communication Research Institute (Melbourne, Australia), a board member of International Institute for Information Design (IIID, Vienna, Austria), and editorial board member of Information Design Journal, She-Ji, the Journal of Visual Political Communication, and Visible Language.