title: How Universal Are Universal Symbols? An Estimation of Cross-Cultural Adoption of Universal Healthcare Symbols.
abstract: OBJECTIVE
  To evaluate the effectiveness of universal health symbol usage and to analyze the factors influencing the adoption of those symbols in Taiwan.
  
  
  BACKGROUND
  Universal symbols are an important innovative tool for health facility wayfinding systems. Hablamos Juntos, a universal healthcare symbol system developed in the United States, is a thoughtful, well-designed, and thoroughly tested symbol system that facilitates communication across languages and cultures.
  
  
  METHODS
  We designed a questionnaire to test how well the selected graphic symbols were understood by Taiwanese participants and determined factors related to successful symbol decoding, including participant-related factors, stimulation factors, and the interaction between stimulation and participants. Additionally, we further established a design principle for future development of localized healthcare symbols.
  
  
  RESULTS
  (1) Eleven symbols were identified as highly comprehensible and effective symbols that can be directly adopted in Taiwanese healthcare settings. Sixteen symbols were deemed incomprehensible or confusing and thus had to be redesigned. Finally, 14 were identified as relatively incomprehensible and could thus be redesigned and then have their effectiveness evaluated again. (2) Three factors were found to influence the participants' differing levels of comprehension of the Hablamos Juntos symbols.
  
  
  CONCLUSIONS
  In order to prevent the three aforementioned factors from causing difficulty in interpreting symbols, we suggest that the local symbol designers should (1) use more iconic images, (2) carefully evaluate the indexical and symbolic meaning of graphic symbols, and (3) collect the consensus of Taiwanese people with different educational backgrounds.
authors.affiliation: National Chiao-Tung University, Hsinchu, Taiwan Hsuan-Chuang University, Hsinchu, Taiwan.
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Joy Lo
authors.affiliation: National Yang Ming University, New Taipei City, Taiwan.
authors.forename: Huey-Wen
authors.initials: HW
authors.lastname: Yien
authors.affiliation: National Chiao-Tung University, Hsinchu, Taiwan iping@faculty.nctu.edu.tw.
authors.forename: I-Ping
authors.initials: IP
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D032882:Comprehension; D003431:Cross-Cultural Comparison; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D008123:Location Directories and Signs / Q000592:standards*; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D013561:Symbolism; D013624:Taiwan; D014481:United States; D055815:Young Adult
keywords: Hablamos Juntos; Pierce’s semiotics; universal medical symbols; wayfinding