The development of graphic symbols for medical symptoms to facilitate communication between health care providers and receivers.

Since there are a variety of communication barriers in health care settings in Japan, a study was designed to improve communication by the use of graphic symbols. At the beginning of this study, graphic symbols were developed to correspond to 26 basic symptoms. Seventy-six subjects voluntarily evaluated the comprehensibility of these symbols: nursing students (n = 29), manual sign language interpreters (n = 24), hearing impaired subjects with normal (n = 10), limited (n = 11), and minimal (n = 2) literacy abilities. The comprehension by each respondent of each symbol was compared with that of the authors. On the average, numbers of the matching meanings were 24.9 +/- 1.36 (mean +/- S.D.) for students, 24.5 +/- 1.77 for interpreters, 23.4 +/- 2.22, and 21.5 +/- 3.01 for the first two groups of the hearing impaired. Among the 26 symbols, 10 showed high levels of the matching rates (> 90%) for all groups. These symbols were considered to be effective alternatives to verbal expression. Further refinements of the graphic symbols were suggested to suppress the differences in interpretation of the remainder of the symbols. During this study, colleagues and subjects suggested cognitive strategies to clarify and enhance the meaning of the graphic symbols such as (a) the subtraction of excessive information, (b) the addition of further information, and (c) the simplification of the setting by minimizing social and cultural bias.