Emojis in health communication

🧐🔓💹⚕️💬, aka can emojis unlock value in health communication?

Looking for the right words to tell your friends how embarrassed you are – or how close to a heatstroke? Or a shorthand for the “everything is fine” meme? Apparently, you’re not alone.

By popular vote, the “melting face” emoji has been declared the most anticipated emoji of 2021 by Emojipedia, expected to be rolled out with Emoji 14.0. The “face with peeking eye” and the “saluting face” came in second and third, in case you were wondering.

But much more importantly, the new batch of emojis is shaping up to be the most inclusive yet. Gender-neutral options for “princess” and “prince” as well as “pregnant woman” have all made it to the finalists, along with 15 different handshake skin tone combinations.

In celebration of the new emoji drop, we’re taking a deep dive into how these tiny faces have become a language of their own – and why it’s time healthcare communicators took notice.

Emoji history: 🎌 to 🌎

When they first became popular, emojis were mostly shrugged off as a passing fad. By 2017, they had their own movie (even though New York Post’s Johnny Oleksinski deemed it so bad he wished he could restore his eyes to factory settings after watching it). The silver screen debut came two years after the “face with tears of joy” emoji had become the first-ever pictograph to be selected as Oxford Word of the Year, as it “reflected the ethos, mood, and preoccupations of 2015”. As I’m writing this article, it’s been tweeted well over 3 billion times.

Not bad from a “language” that started out as a bunch of 12-by-12-pixel pictograms that occupied just over 3 kilobytes.

“If you were given the challenge of translating 176 ideas, including people, places, emotions and concepts into 12-bit symbols, all within 5 weeks time, most designers would faint at the idea,” Jesse Reed, co-founder of Standards Manual, told CNN. Faint, however, artist Shigetaka Kurita did not. Instead, in 1999 he created the first pager-native glyphs for Japan’s premier mobile carrier, DoCoMo. Inspired by manga and pictograms, the original set was acquired by New York City’s Museum of Modern Art for its permanent collection in 2016.

Emojis quickly gained popularity in Japan and were inevitably copied by competitors. But it wasn’t until 2010 that they took over mobile phones all across the globe. That year, they were incorporated in Unicode, the universal character representation standard for text in computer processing, and a set of 722 emojis were released on both iPhone and Android. The first standard emoji keyboard arrived to iOS in 2011 and to Google Android two years later. In 2022, the global emoji count is expected to grow to 3,460.

Emojis vs. emotions: it’s complicated

But what drives us to spurt out some 10 billion emojis each day? The answer is: emotions. More precisely, the complexity of human emotions, which makes communicating them in all their subtlety through text near-impossible. Like punctuation, emojis help us tell others what we’d otherwise express with body language and tone of voice. “Why can’t we make do with six then?” it begs the question. After all, that’s how many human emotions are experienced universally (happiness, sadness, anger, surprise, fear and disgust).

But, and I can’t believe I’m writing this, it seems that the Emoji Movie might have got one thing right. In a 2017 study from UC Berkeley, researchers identified 27 distinct categories of emotion, including craving, nostalgia and triumph, and mapped out the connections between them. “We don’t get finite clusters of emotions in the map because everything is interconnected,” said study lead author Alan Cowen. “Emotional experiences are so much richer and more nuanced than previously thought.”

Say it with 🦠: health emojis on the rise

Healthcare-related emojis are most certainly coming to a screen near you. Well, with one notable exception.

The 2019 release of the “drop of blood” was celebrated by many as a leap towards tackling the stigma of menstruation and a symbol of activities like blood donation. A year prior to that, a mosquito emoji was added to raise awareness of dengue and malaria. Other new arrivals included the “🤒” and “🤧” to put a face on common cold and flu symptoms, along with “microbe”, “test tube”, “Petri dish” and “DNA” as new means of communicating scientific data.

“At a time when in-person conversations are harder to come by, many people are choosing to express their thoughts about 🦠 with a practical mix of 😷 and 🛒,” the CNN reported at the height of the coronavirus pandemic. And as the health crisis evolved, so did the emojis. Apple was the first to put a smile on the “face with medical mask” as mask-wearing became mainstream and to remove the blood from its syringe emoji to celebrate vaccine rollout efforts.

Is healthcare communication ripe for an emoji overhaul?

Definitely maybe, researchers say. According to a 2020 Antimicrobial Resistance & Infection Control article, emojis can be a great way to capture attention when added to weaker, less interesting health messages. In a study, elementary school students said that seeing a “green smiley face” near plain milk and vegetables made them lean towards healthier buying choices. In another one, emojis were found to be a more efficient and less time-consuming tool for detecting depression post stroke.

“The need to listen to patients is at the core of our mission as physicians, and the use of emoji is a great opportunity to take communication to another level,” says Shuhan He, MD, attending physician in the Emergency Department at Massachusetts General Hospital. “Emoji could be particularly important in treating children with still-developing language skills, people with disabilities that impair their ability to communicate, and the many patients who speak a different language.” But that’s not all. Besides symptoms and concerns, emojis could also be used to better explain hospital discharge instructions that most patients struggle to comprehend.

In a 2019 study, researchers set out to explore if technology-enabled youth therapy, and emojis in particular, can help clinicians better understand and predict the risk of behavioural and health issues for adolescents and young adults with mental health problems. Every day for three months, research participants had to report how they were feeling using one of the icons available in G-Moji, an app specifically developed for this purpose. The results showed that emojis can be useful in identifying positive and negative feelings in a clinical setting. In fact, G-Moji has the potential to improve both treatment and assessment outcomes.

But emojis can be just as (if not more) effective when it comes to simple concepts.

If there’s one thing the coronavirus pandemic has brought home, it’s the importance of hand hygiene. Despite being a low-effort, high-impact procedure, the adoption of alcohol-based handrubs is still worryingly low. Emojis, however, might be able to help healthcare workers turn WHO’s multimodal hand hygiene improvement strategy into a working reality.

In a German hospital, for example, feedback devices were installed above handrub dispensers that went from “frowny face” to “smiley face” when people remembered to sanitise. The verdict? Researchers concluded that emojis have the potential of boosting hospital hygiene by offering visual cues and reminders. Not to mention reinforcing the right hand hygiene behaviour by providing instant feedback.

2 January 2023