Visual communication is playing an increasing role in all aspects of health communication, whether on a mobile app, wayfinding signage in hospitals, wearable devices or patient-facing platforms. This is where symbols and imagery, sometimes in place of text and sometimes accompanying it, are helping patients read and interpret instructions, track symptoms, navigate systems and understand their own care.

But what do we mean by “visuals”? Very often, in our understanding, we blur the lines between different types of visual communication: icons, emojis, pictograms, amongst others. These are not interchangeable, but sometimes we think they are. They are different kinds of visual tools, each having their own characteristics and functions, as well as strengths and weaknesses. Each type also has their own conventions for appropriateness of use. Choosing the right visual for the appropriate content is vital in forms of communication in health – and, indeed, in wider societies – that are emergent and still evolving.

This article examines the differences between icons, emojis and pictograms and how they can be used in patient-facing communication.

What Are Icons?

Icons are graphic symbols that are used to represent actions, objects or elements of language in a simplified, abstract way. They are a vital part in the design of interfaces and are most often used in apps, software interfaces and digital dashboards.

Common uses of icons include:

·       💊 Pill to indicate medication

·       🗓️ Calendar for appointments

·       🧪 Test tube for lab results

·       🛌 Bed for rest or recovery

They are functional and not meant to be expressive. They are designed to be understood quickly, perhaps even when the user is under pressure to absorb information and act upon it. They are designed with minimal distraction, emotional or stylistic content. Icons need to be clean, scalable and easy to read and interpret across different screen sizes and devices.

Key Strengths of Icons:

·       They are purpose-built for clarity

·       They are designed for consistent use across UI/UX systems

·       They can be easily integrated into interactive environments

·       They can be used as stand-alone or in combinations and sequences.

The Limitations of Icons:

·       They can be ambiguous if they have not been well designed or over-stylised.

·       They often require cultural or app-specific context

·       They are not often intuitive: their meaning has to be learnt.

What are Emojis?

Emojis are small, colourful symbols that are used to express emotions, ideas or everyday objects in informal communication. We are all familiar with their origin in text messaging and they have now become a global phenomenon. They are integrated into most platforms via the Unicode Standard.

In health-related contexts, common uses of emojis include:

·       🤒 Feeling unwell

·       😷 Respiratory symptoms

·       💉 Vaccination or injection

·       ❤️ Emotional wellness or self-care tracking

They are often used in patient engagement tools, mood trackers and mental health apps, where expressing feelings quickly is more important than precise clinical detail. They are also helpful in patient-reported outcomes (PRO) measures, especially with children and nonverbal patients.

The Strengths of Emojis:

·       They are by now – for many people – universally familiar and emotionally expressive.

·       They are light and engaging, making them ideal for patient interaction, but this would depend on the appropriateness of the context

·       They can be useful in diaries, check-ins or emotional context.

Limitations:

·       They are emotionally charged

·       They can be ambiguous, e.g. 😩can mean pain, stress or sadness

·       Their visual style varies across platforms, i.e. ISO versus Android versus the web

·       They are not standardised for clinical use

·       They are easily misunderstood across cultures.

In health communication, emojis work best in non-critical contexts where mood, emotion or quick engagement are more important than accuracy. That said, they are increasingly seen in paediatric clinical measures, such as Patient-Reported Outcomes, Visual Analog Scales, etc.

Pictograms

Pictograms are standardised symbols used in public signage, safety communications and instructional diagrams. Pictograms are different to icons and emojis in the sense that they are more formal, undergo a more robust testing and development process and are governed by standards such as WHO, ANSI, ISO that are carefully tested for comprehension and cross-cultural appropriateness.

Common pictograms used in healthcare include:

• ⚠️ Warning signs for medication safety

• 🧼 Handwashing instructions

• 🚻 Universal restroom symbols

• 🆘 Emergency exits and first-aid stations

Pictograms are designed to be universally understood, independently of language. Their typical characteristics include:

·       Strong contrast

·       Minimal detail

·       Images that are highly literal and not stylised like emojis.

The Strengths of Pictograms:

·       They are globally validated and highly recognisable

·       They are ideal for urgent, safety-critical instructions

·       They support accessibility and cross-linguistic comprehension.

Limitations:

·       The visual vocabulary of pictograms is limited, focused on navigation, safety and hygiene

·       They are not easily customised or expanded for digital applications

·       They do not have much possibility for nuance that is required for conditional or complex communication, e.g. ‘if your pain continues, contact the doctor’.

Pictograms are most effective in environmental signage and public health messaging, i.e. places where speed, clarity and visibility are vital.

Summary:

Why Is This Important?

In health communication, misinterpretation can have serious consequences: missed doses, incorrect follow-ups, misunderstandings that can cause physical harm and affect health outcomes. Knowing which visual tool is most appropriate to use is not just a design decision, it is a matter of safety too.

For instance:

·       Icons can guide patients through actions in an app or portal: logging symptoms, checking doses and tracking progress

·       Emojis offer low-risk ways to share how someone feels or check in on wellness; they can be useful in paediatric assessments and patient diaries in general

·       Pictograms provide high-impact instruction, whether for taking a medication or finding your way around a hospital. They are especially useful in multilingual areas or during health crises, such as the Covid-19 pandemic.

Towards A Visual Grammar?

But what about more complex instructions? What happens when we need to communicate “Take this pill three times a day before meals, unless fasting”, without using text? Visuals can be ordered and combined to make intentional messages. However, for this to be adopted and gain currency as a communication practice, the order in which they appear will need to be codified, conventionalised and governed by rules, with structures and modifiers and even diacritics and conditional logic. This would be a ‘visual grammar’. This would be an exciting development.

Thank you for reading,

Mark Gibson

Leeds, United Kingdom, April 2025