From Signs to Systems: A Semiotic-Pragmatic Framework for Digital Health
DOI:
https://doi.org/10.5281/zenodo.21416834Keywords:
Semiotic Usability, Digital Health Interfaces, Human–Computer Interaction, Multimodal Communication, Accessibility in UX Design, Health App DesignAbstract
In contemporary digital health ecosystems, particularly in mental health, usability research has largely emphasized functional efficiency while under-theorizing communicative meaning-making. Despite advances in human–computer interaction, no empirically validated framework conceptualizes usability as a communicative semiotic phenomenon embedded in cultural and contextual conditions. This study addresses this gap by developing and empirically testing the Semiotic Framework for Usability (SFU), reconceptualizing usability as a communicative semiosphere grounded in Jakobson’s language functions and Lotman’s semiosphere theory. The framework was applied to eleven digital health applications and evaluated with 30 heterogeneous participants (aged 18–72) using a mixed-methods triangulated design combining semiotic coding, A/B testing, NASA-TLX cognitive load assessment, adaptive onboarding, surveys, and semi-structured interviews. Results indicate semiotic-informed redesign increased symbolic comprehension by 25%, reduced cognitive load by 39%, and improved task completion by 30%. Semantic ambiguity was the primary usability barrier, confirming the centrality of communicative clarity. Multimodal reinforcement strategies—including visual glossaries, interpretative metaphors, and redundant coding—enhanced emotional alignment and trust perception. These findings reposition usability as a communicative and educational practice rather than solely a technical attribute. The study contributes a replicable semiotic–pragmatic model for evaluating digital health interfaces, with implications for media education, inclusive design, and culturally sensitive systems aligned with ISO 9241-210 and WCAG standards.
References
Aguirre-Urreta, M. I., & Marakas, G. M. (2025). The Role of Computer Self-Efficacy in Task Performance: Insights from Two Empirical Studies. International Journal of Human–Computer Interaction, 41(19), 12325–12348. https://doi.org/10.1080/10447318.2025.2456539
Area-Moreira, M., & Pessoa, T. (2012). From solid to liquid: New literacies to the cultural changes of Web 2.0. Comunicar, 38, 13–20. https://doi.org/10.3916/C38-2012-02-01
Barra Almagiá, E. (2003). Influence of emotional state on physical health. Terapia Psicológica, 21(1), 55–60. https://www.researchgate.net/publication/235760005
Barrett, L. F. (2017). How Emotions Are Made: The Secret Life of the Brain. Pan Macmillan.
Barthes, R. (1977). Image, Music, Text. Fontana Press.
Chamberlain, A., Bødker, M., Hazzard, A., McGookin, D., De Roure, D., Willcox, P., & Papangelis, K. (2017). Audio Technology and Mobile Human Computer Interaction: From Space and Place, to Social Media, Music, Composition and Creation. International Journal of Mobile Human Computer Interaction (IJMHCI), 9(4), 25–40. https://doi.org/10.4018/IJMHCI.2017100103
Clear, A., Clear, T., Impagliazzo, J., & Wang, P. (2020). From Knowledge-based to Competency-based Computing Education: Future Directions. In 2020 IEEE Frontiers in Education Conference (FIE) (pp. 1–7). IEEE. https://doi.org/10.1109/FIE44824.2020.9274288
Cobley, P., Jansz, L., & Appignanesi, R. (2002). Mengenal Semiotika for Beginners. Mizan.
de Saussure, F. (1983). Course in General Linguistics (R. Harris, Trans.). Duckworth. (Original work published 1916)
de Souza, C. S. (2005). The Semiotic Engineering of Human-Computer Interaction. MIT Press. https://doi.org/10.7551/mitpress/6175.001.0001
Derboven, J., De Roeck, D., & Verstraete, M. (2012). Semiotic analysis of multi-touch interface design: The MuTable case study. International Journal of Human-Computer Studies, 70(10), 714–728. https://doi.org/10.1016/j.ijhcs.2012.05.005
Eco, U. (1976). A Theory of Semiotics. Indiana University Press. https://iupress.org/9780253202178/a-theory-of-semiotics
Eco, U. (1991). The Limits of Interpretation. Indiana University Press. https://iupress.org/9780253208699/the-limits-of-interpretation
Edwards-Groves, C. (2012). Interactive Creative Technologies: Changing learning practices and pedagogies in the writing classroom. The Australian Journal of Language and Literacy, 35(1), 99–113. https://doi.org/10.1007/BF03651876
Ganter, B., & Wille, R. (1999). Formal Concept Analysis: Mathematical Foundations. Springer. https://doi.org/10.1007/978-3-031-63422-2
Islam, M. N., Karim, M. M., Inan, T. T., & Islam, A. K. M. N. (2020). Investigating usability of mobile health applications in Bangladesh. BMC Medical Informatics and Decision Making, 20(1), 19. https://doi.org/10.1186/s12911-020-1033-3
ISO. (2019).ISO 9241-210:2019. Ergonomics of human-system interaction—Part 210: Human-centred design for interactive systems. International Organization for Standardization. https://www.iso.org/standard/77520.html
ISO/IEC. (2006). ISO/IEC 25062:2006 Software engineering — Software product Quality Requirements and Evaluation (SQuaRE) — Common Industry Format (CIF) for usability test reports. International Organization for Standardization & International Electrotechnical Commission. https://www.iso.org/standard/43046.html
ISO/IEC. (2023). ISO/IEC 25010:2023 Systems and software engineering — Systems and software Quality Requirements and Evaluation (SQuaRE) — Product quality model. International Organization for Standardization & International Electrotechnical Commission. https://www.iso.org/standard/78176.html
Jakobson, R. (1960). Linguistics and Poetics. In T. A. Sebeok (Ed.), Style in Language (pp. 350–377). MIT Press.
Kautz, K. (2021). Editorial for The Australasian Journal of Information Systems 2021: Volume 25. Australasian Journal of Information Systems, 25. https://doi.org/10.3127/ajis.v25i0.3853
Kohn, M. S., Topaloglu, U., Kirkendall, E. S., Dharod, A., Wells, B. J., & Gurcan, M. (2022). Creating learning health systems and the emerging role of biomedical informatics. Learning Health Systems, 6(1), e10259. https://doi.org/10.1002/lrh2.10259
Kress, G., & van Leeuwen, T. (2006). Reading Images: The Grammar of Visual Design (2nd ed.). Routledge. https://doi.org/10.4324/9780203619728
Kress, G., & van Leeuwen, T. (2021). Reading Images: The Grammar of Visual Design (3rd ed.). Routledge. https://doi.org/10.4324/9781003099857
Krippendorff, K. (2023). A Critical Cybernetics. Constructivist Foundations, 19(1), 82–93. https://constructivist.info/19/1/082
Leeds-Hurwitz, W. (1993). Semiotics and Communication: Signs, Codes, Cultures. Routledge. https://doi.org/10.4324/9780203821909
Lim, W. M. (2018). Dialectic Antidotes to Critics of the Technology Acceptance Model: Conceptual, Methodological, and Replication Treatments for Behavioural Modelling in Technology-Mediated Environments. Australasian Journal of Information Systems, 22. https://doi.org/10.3127/ajis.v22i0.1651
Lotman, Y. M. (1990). Universe of the Mind: A Semiotic Theory of Culture. Indiana University Press.
Mayer, R. E. (2020). Multimedia Learning (3rd ed.). Cambridge University Press. https://doi.org/10.1017/9781316941355
Molina-Recio, G., Molina-Luque, R., Jiménez-García, A. M., Ventura-Puertos, P. E., Hernández-Reyes, A., & Romero-Saldaña, M. (2020). Proposal for the User-Centered Design Approach for Health Apps Based on Successful Experiences: Integrative Review. JMIR mHealth and uHealth, 8(4), e14376. https://doi.org/10.2196/14376
Moungui, H. C., Nana-Djeunga, H. C., Anyiang, C. F., Cano, M., Ruiz Postigo, J. A., & Carrion, C. (2024). Dissemination Strategies for mHealth Apps: Systematic Review. JMIR mHealth and uHealth, 12, e50293. https://doi.org/10.2196/50293
Nasr, E., Alsaggaf, W., & Sinnari, D. (2023). Developing Usability Guidelines for mHealth Applications (UGmHA). Multimodal Technologies and Interaction, 7(3), 26. https://doi.org/10.3390/mti7030026
Norman, D. (2013). The Design of Everyday Things: Revised and Expanded Edition. Basic Books.
Nöth, W. (1995). Handbook of Semiotics. Indiana University Press. https://iupress.org/9780253209597/handbook-of-semiotics
Peirce, C. S. (1931–1958). Collected papers of Charles Sanders Peirce (Vol. 1–8). Harvard University Press.
Ramos Linares, V., Piqueras Rodríguez, J. A., Martínez González, A. E., & Oblitas Guadalupe, L. A. (2009). Emoción y Cognición: Implicaciones para el tratamiento. Terapia psicológica, 27(2), 227–237. https://doi.org/10.4067/S0718-48082009000200008
Riemer, K., & Peter, S. (2021). Algorithmic audiencing: Why we need to rethink free speech on social media. Journal of Information Technology, 36(4), 409–426. https://doi.org/10.1177/02683962211013358
Rönkkö, M., Aalto, E., Tenhunen, H., & Aguirre-Urreta, M. I. (2022). Eight Simple Guidelines for Improved Understanding of Transformations and Nonlinear Effects. Organizational Research Methods, 25(1), 48–87. https://doi.org/10.1177/1094428121991907
Scolari, C. (2009). The sense of the interface: Applying semiotics to HCI research. Semiotica, 2009(177), 1–27. https://doi.org/10.1515/semi.2009.067
Selwyn, N. (2016). Education and Technology: Key Issues and Debates. Bloomsbury Publishing. https://doi.org/10.5040/9781474235952
The New London Group. (1996). A Pedagogy of Multiliteracies: Designing Social Futures. Harvard Educational Review, 66(1), 60–93. https://doi.org/10.17763/haer.66.1.17370n67v22j160u
Torkildsby, A. B., Hallnäs, L., & Olausson, S. (2020). Addressing the Issue of Comfort in Intensive Care Unit Environments Through Interdisciplinary Design Workshops. In K. Christer, C. Craig, & P. Chamberlain (Eds.), Proceedings of the 6th International Conference on Design4Health, Amsterdam (pp. 11–18). Lab4Living, Sheffield Hallam University. https://www.researchgate.net/publication/344337178
Torous, J., Bucci, S., Bell, I. H., Kessing, L. V., Faurholt-Jepsen, M., Whelan, P., Carvalho, A. F., et al. (2021). The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality. World Psychiatry, 20(3), 318–335. https://doi.org/10.1002/wps.20883
WHO. (2021). Global strategy on digital health 2020-2025. World Health Organization. https://www.who.int/publications/i/item/9789240020924
Xie, Y., Fadahunsi, K. P., Kelleher, C., Tarn, D. M., Grace, A., & Donoghue, J. O. (2025). Towards an inclusive digital health ecosystem. Bulletin of the World Health Organization, 103(2), 170–173. https://doi.org/10.2471/BLT.24.292020
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Comunicar
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
