FAQ

1. Why would I use symbols in my sign system?
   A picture is worth a thousand words. Health facilities are struggling to meet federal laws requiring signage in the languages of their patients. Because health care facilities serve patients that speak many different languages, meeting the wayfinding needs for these patients can not be done well with typical signs. Multilingual signs can be expensive and difficult to accommodate in most wayfinding programs. Research has shown that symbols are an effective means of communication for people with Limited English Proficiency (LEP) regardless of their primary language.


2. Where can I get the symbols for use on signs?
   The health care symbols developed through Hablamos Juntos can be downloaded from this web site, as the complete group in PDF. That means they can be opened and read in Adobe Acrobat Reader, as well as most vector-based software programs such as Adobe Illustrator, Corel Draw, AUTOCAD, etc. Vector-based software will allow the symbols to be accessed and used for other applications such as signs.



3. How much does it cost to use the symbols?
   The symbols and any materials developed to aid in their use are free. Upon completion of the initial set, the symbols were designated as public domain, thanks to the grant of the Robert Wood Johnson Foundation.



4. Can I change these symbols?
   No. Although these symbols are free and permission is not needed to use them, but the images have been protected by the Robert Wood Johnson Foundation under United States copyright law. The value of the symbols is in their ability to convey the information they were designed to convey. This comes with the public’s ability to recognize they symbols’ intended meaning. Modifications or changes to the symbols works against this important goal.



5. Our signage is not very good, will adding these symbols help?
The symbols are meant to be adaptable and to be used in any signage system, but were designed as complete images to follow the recognized DOT standards. Image within a rounded corner square and proportioned negative space around them. They were also designed to be used in the reverse. When using the symbols in either positive or negative form, you should follow best practices for contrast and size for the environment and ADA guidelines.

ADA guidelines state that when symbols are used to identify a space (wall mounted identification sign), they must be within a designated 6” field; that field can be any shape, but must provide a separation from everything else around it. That shape is not specifically dictated to the one around these symbols. For example, California’s Unified Building Code (UBC) requires the use of a circle and triangle with the women’s and men’s symbols to identify restrooms. So if using different shapes, careful consideration should be used so not to create confusion as to the meaning of the symbol and/or the shape it is in.

6. What does wayfinding mean?
   Wayfinding is the method for providing consistent and overt information that can guide a person to their destination. This information can be through maps and signs, clues embedded in the architecture or through the use of color, pattern and texture in the interior design of a facility. Wayfinding is more than signs. It is the practice of looking at navigating your facility from a visitor’s perspective, understanding why your visitors are there and using this information to design information and clues to help guide your visitors to their destinations.



7. I don't see some symbols that I need. Why not?
   Symbols are a universal language, which means the language of health care symbols needs to be learned. Based on research conducted for the project, having too many symbols would create challenges in learning what each symbol means. By starting with a small set of symbols users can begin learning this new language. Over time it is envisioned that new additional symbols will be added.


8. Why were these referents chosen to develop symbols?
   The health care symbols include 28 referents commonly found in health facilities. These were identified as priority terms through surveys conducted in the ten Hablamos Juntos demonstration sites. A survey containing over 200 terms in nearly 60 categories was given to hospital administrators, staff, social workers and others in health facilities participating in the Hablamos Juntos demonstrations located throughout the country. Respondent were asked to select the top 30 terms representing locations visitors most frequently used in their facilities. The results were tabulated, and the top 30 terms overall were determined. To learn more go to About Symbols.



9. How were the symbols designed?
   All the health care symbols were designed for this project. You may find elements you’ve seen before. This is because initially, existing symbols were collected and associated with one or more of the references included in the project. These existing symbols were analyzed for the concepts used to represent the referent. A team of designers with expertise in health care, symbol and graphic design, selected existing symbols or designed new ones. Over 600 symbols were evaluated or created for the project. Through a survey method, successfully used in many different countries and adopted by the International Organization for Standardization (ISO), symbols were tested for comprehensibility with four language groups. To learn more about the survey tool click here.
   
   In the Comprehension Estimation survey, for each referent, five or six symbols were displayed and survey responders were asked to estimate the percent of the population that spoke their language would comprehend the symbols to mean the referent. Three rounds of surveys were conducted in ten states; bilingual survey administrators and interpreters were used to reach limited English speaking respondents. Ultimately, nearly 300 persons, from four language groups (English, Spanish, Indo European and Asian languages) took part in the surveys. After each round, symbols that received scores greater than 87 were retained and retested for potential use in the final symbol set. Symbols that tested less than 87 were modified and retested or discarded depending on the rating. To learn more about how symbols were developed go to About Symbols.



10. What is the significance of <87 and >87 to the testing?
    The symbols were tested through a well known survey method call Comprehension Estimation testing. This method has been used in many different countries and adopted by the International Organization for Standardization (ISO) because it produces consistent and reliable results. The instrument has the accepted threshold of greater than 87% as a measure of effectiveness. In other words, symbols that achieve a rating of greater than 87% are found to be comprehended by a vast majority. To learn more about how symbols were developed go to About Symbols.



11. Did all the symbols in this set receive scores >87?
    No. 17 symbols had at least one symbol that achieved scores greater than 87. When more than one symbol for the same referent achieved this threshold, the design team had options to select the strongest symbols for inclusion into the set. Most often, those turned out to be the symbols receiving the highest scores. Eleven symbols did not reach the threshold. These were generally referents with no single or common meaning such as oncology, or less commonly understood referents such as diabetes. The symbols selected for these referents were informed by the test results and rely on features that worked well in the higher rated symbols. To learn more about how symbols were developed go to About Symbols.



12. Will there be additional symbols developed?
    Hablamos Juntos with demonstrations in ten states offered a unique opportunity that will be expensive to replicate. The Society for Environmental Graphic Design (SEGD) is evaluating the possibility of continued health care symbol design through the proven testing procedures, but no official program has been established.



13. Can I use these symbols as a logo for my medical business?
    The power of symbols comes with linking the image to the concept. These symbols were developed for use as wayfinding tools. To the degree that symbols help communicate specific destinations, medical services or health activities we anticipate the use of symbols will go beyond their original purpose. However, using them as a logo or for marketing purposes is not recommended.



14. Our facility could use the symbols, but some of the referents differ from our terminology. Can we still use the symbols?
    Yes. Public education is the key to success. Symbols can be used with referents that are closely related (X-Ray, Imaging, Radiology). These symbols were developed and tested to link a referent with a concept and image. Definitions were made as simple as possible while still conveying the basic meaning. Substituting a similar referent and definition can be successful with public education. Keep in mind, translations for major language groups are available only for the original referents and definitions used in the testing.