We have all been in a public building like a hospital and tried to navigate ourselves through the maze of corridors. We see signs, some with arrows, some with figures, others with symbols that look vaguely familiar, while others still are wholly new and disorienting. One has a red cross. Another shows a toilet-like shape with a slash; another is showing what looks like a face mask. We might pause to ponder their meaning. We might guess and we might get it right or maybe not. If you are in an emergency, the disorientation is even more compounded.

This is the gap between seeing and understanding. This is what visual literacy is all about.

In healthcare, where life-changing and even life-saving instructions are delivered through signs, leaflets, app icons and pictograms, visual communication has evolved from being a helpful aid to an essential part of patient-facing communication. However, not all patients “read” visuals in the same way. They are not all as clear as we assume. They can be ambiguous or difficult to decipher without learning what it means beforehand. This causes misunderstandings that can lead to serious consequences.

What Is Visual Literacy?

Visual literacy is the ability to interpret, understand and act on visual messages, whether they are icons, symbols, images or diagrams. It is more than just “recognising” a picture. It includes:

• Understanding what the visual means in context.

  
  

• Evaluating what action it wants you to take.

  
  

• Differentiating between an emotion and an instruction.

  
  

• Connecting the visual with a real-world decision and action.

In healthcare, visual literacy is what allows a person to:

• Know that 💊could mean ‘medication’.

  
  

• Understand that combining🕒 + 💊 together could mean “take medication at this time”.

  
  

• Recognise that ⚠️can mean danger or caution.

  
  

• Read a pain scale that has a range of sad-to-happy faces (😫to 🙂) and has to select one face appropriately.

Who Has Visual Literacy?

Visuals are not universal. It is a design myth to suggest otherwise. Visual literacy, just like text literacy, varies widely across populations. Some of the key factors include the following:

• Education and Literacy Levels: People with lower formal education or limited (text) literacy may struggle with visual abstraction, especially if the symbols are unfamiliar.

• Cultural Background: Visual metaphors are culturally loaded. For example:

-   🍽️may denote “meal” in Western cultures, but not in places where food is eaten without cutlery. In such cultures, if this symbol is understood, then it is interpreted as availability of Western-style food.

-   🚻might be obvious in Western societies, but potentially meaningless elsewhere.

-   🙏 might mean prayer, thanks or apologising, depending on the culture.

• Age and Exposure to Technology: Younger people might instantly interpret emojis or digital User Interface icons, while older adults, especially those with limited or no smartphone experience, may be unfamiliar with touch-screen visuals altogether.

  
  

• Cognitive or Language Barriers: People with dementia, autism or aphasia may not interpret abstract visuals correctly. Recent migrants may draw upon different symbolic frameworks that influence how they interpret the visuals they are confronted with.

The Role Visual Literacy Plays in Healthcare

Visuals are found in nearly every form of health communication today. They help explain dosage instructions, warnings and side effects. In Patient-Reported Outcomes or Informed Consent Forms, icons like ☑️ might guide attention, but vague or overloaded symbols might create confusion about what the patient is agreeing to.

In health promotion campaigns, emojis and stylised visuals, such as ❤️ for “healthy heart” are common in youth campaigns but may be misread or culturally misaligned. In public signage, such as during the Covid-19 pandemic and hospital navigation, bathrooms, handwashing stations, restricted areas, all depend on users interpreting pictograms correctly and quickly. Digital Health interfaces such as apps, portals, wearables use icons for navigation, symptom logging and compliance prompts. Misunderstanding these can lead to missed medication or false reporting.

The Consequences of Visual Misunderstanding

Misinterpreting a symbol can be minor, until it isn’t. In healthcare, the stakes are high. An image that is misunderstood could result in:

• Medication errors or missed or incorrect doses.

  
  

• Missing follow-up appointments.

  
  

• Misreporting, under- or overreporting of symptoms

  
  

• Delayed emergency response

  
  

• Uninformed consent.

Testing how visuals are understood is as important as testing the text. This is not a luxury. It is a safety issue. The illusion of clarity is pervasive. This is where designers often assume that their visuals make sense and contain a clear message. But clarity is not what the creator intends, it is what the user understands. What seems obviously clear in a design studio can become dangerously misunderstood in the real world, especially when a patient is under stress, fatigue or illness. For example:

• Does a red ‘X’ on a syringe mean ‘don’t inject’, ‘already used’ or ‘discard’?

  
  

• Does an icon of a pill with a visual of a spoon next to it mean ‘take with food’ or ‘crush with spoon and dissolve’?

  
  

• Does an image of a drop of water mean hydration, dilution or handwashing?

Without visual literacy, the patient only has recourse to guessing. This should never be the case in a health context.

Visual Literacy Is Different from Simplicity

There is a desire amongst designers of patient-facing visuals to “keep visuals simple”. This is commendable, but simplicity alone is not the answer. For successful interpretation, visuals need to be:

• Clear in the concept they convey.

  
  

• Consistent across use

  
  

• Valid across cultures and contexts

  
  

• Easy to learn through repeated exposure.

Therefore, designers need to keep visuals simple as well as designing to support visual learning.

If designers want patients to follow medical instructions, understand risks and take control of their health and part of accessing these messages are through visuals, then they need to stop assuming that visuals “speak for themselves”. They do not. In fact, visuals do not speak at all; people read them instead. And not everybody reads them in the same way. Design for visual literacy using visuals that teach, reinforce and empower through the information they convey.

Thank you for reading,

Mark Gibson

Leeds, United Kingdom, April 2025