Emerging Technologies Center

Face with Tears of Joy Is Word of the Year: Are Emoji a Sign of Things to Come in Health Care? Diane J. Skiba, Editor

he Oxford Dictionary Word of the Year (WOTY) is not a word but From Blagdon’s (2013) article, I was able to link to some interest- a pictograph, Face with Tears of Joy. For those of you who are ing websites, for example, Narratives in Emoji (http://narrativesinemoji. T not familiar with this pictograph, it is one of the many emoji avail- tumblr.com/) with Les Miserables. I also found an emoji version of Moby able for use on your cell phones, tablets, and other devices. In case you Dick (http://blogs.loc.gov/loc/2013/02/a-whale-of-an-acquisition/) and missed it, we transitioned from emoticons [;-)] to emoji in the late 1990s. an emoji “zine” by Womanzine (http://issuu.com/lindseyweber5/docs/ Face with Tears of Joy was chosen as WOTY because it re- emoji_by_womanzine). flected the ethos, mood, and preoccupations of 2015 (Oxford Dictionaries, Sternbergh (2014) wrote that “elasticity of meaning is a large 2015). The Oxford University Press worked with SwiftKey, a mobile part of the appeal and, perhaps, the genius of emoji.” Emoji can technology company, to analyze usage statistics across the world. express emotion on a small screen in an easy manner, making This emoji was chosen among several competitors because it made it easier for those of us who find using our thumbs for text messag- up 20 percent of the emoji used in the United Kingdom and 17 percent ing to be a challenge. “These seemingly infantile cartoons are instantly of those used in the United States. recognizable, which makes them understandable even across lin- Even the word emoji has tripled in use since it emerged in 1997. guistic barriers.” You are probably aware of the smiley faces you get on text messages or how your adolescents order pizza at Dominos. To test your knowl- IMPLICATIONS FOR RESEARCH, EDUCATION, AND edge of emoji, visit the Learning Network at the New York Times (http:// HEALTH CARE learning.blogs.nytimes.com/2014/08/05/test-yourself-emoji/?_r=0). If emoji are recognizable across boundaries, what are their implica- A BRIEF HISTORY tions for research, education, and health care? To answer this ques- tion, I ventured forward to learn more, beyond my simple use of Shigetaka Kurita developed the concept of emoji while working for a smiley faces. I discovered a growing use of emoji in marketing, edu- Japanese company, Docomo, that was creating a mobile Internet cation, and, yes, even health care. platform to provide news, weather, email, and reservations. Accord- A research article (Pavalanathan & Eisenstein, 2015) examines ing to Blagdon (2013), “The lack of visual cures made the service whether emoji will replace ASCII character emoticons. Using a causal more difficult to use…and could benefit majorly from some extra inference model, Pavalanathan and Eisenstein compared a treatment characters to show contextual information.” group (those using emoji for a specified time) to a control group (those I was intrigued by how Kurita viewed the new technology and its who did not use emoji), with emoticon usage as the dependent vari- impact on communication. According to Kurita, the Japanese tradi- able. They found a statistically significant difference in the use of emo- tionally wrote long letters for communication, and the brevity of more ticons, with the treatment group using less and less. In their discussion, casual email sometimes led to miscommunication. Kurita also no- they noted that, although emoticons were primarily designed using fa- ticed that face-to-face and phone conversations also provided cues cial expressions to express emotion, they were also used to “establish to assess mood or feelings. He concluded “that the promise of digital more of a conversational connection, a playful interaction or a shared communication — being able to stay in closer touch with people — and secret uniqueness within a particular relationship.” was being offset by this accompanying increase in miscommunica- Here are examples of how others use emoji: tion” (Blagdon, 2013). Hence, emoji were born as a mechanism to • The White House uses emoji to communicate with millennials provide contextual information and emotions. Although it took awhile (Mosendz, 2014). for global acceptance, emoji were eventually adopted into Unicode, a • Gonzalez (2015) describes various uses of emoji to engage computing industry standard for consistent encoding, representa- learners; she points to a university campaign to address sexual tion, and the handling of text expressed in most of the world’swriting assault (http://students.ubc.ca/livewell/topics/sexual-assault/ systems. Emoji made their international debut in 2011 when they consent) and provides a link to the GE Emoji Science website were released on Apple’siOS5. (http://emojiscience.com) with an Emoji Table of Content, lessons plans, and YouTube videos. • GE Healthcare created a YouTube video with emoji to educate Copyright © 2016 National League for Nursing the public about breast density (http://newsroom.gehealthcare. doi: 10.1097/01.NEP.0000476112.24899.a1 com/breast-density-explained-with-emoji/).

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• An app called Abused Emoji (www.abusedemojis.com) was There are lots of emoji for emotions, but there are relatively few, if any, designed by a Swedish not-for-profit group to help children that are health related. talk about issues such as bullying and being mistreated. So, are you up for the challenge? Let’s see what we can do in • On World AIDS Day, the Durex Company announced the de- 2016. Perhaps we can have a student contest to design health- velopment of the Safe Sex Emoji Campaign (www.youtube. related emoji and test them across populations. I will throw down the com/watch?v=WiquWxZHBR4). • In the Gomer blog (http://gomerblog.com/2014/10/emoji-icd- gauntlet with my humble string of emoji. If you can interpret their 10/), some ICD-10 emoji, for a variety of health conditions, meaning, send me an email at [email protected]. were developed to give everyone a laugh. • Writing in the Chronicle of Higher Education, Thompson (2014) tells how researchers took to Twitter (#emojiresearch) to describe their research in emoji because many lay people have difficulty interpreting research articles. • The best example comes from a groupofUniversityofMichigan students who created the Diabeticons app (www.health designby.us/diabeticons/), which started when two teenagers struggling to manage their Type 1 diabetes brought their idea REFERENCES for an app to health researcher Joyce Lee (Tenderich, 2015). Arcia, A., Suero-Tejeda, N., Bales, M. E., Merrill, J. A., Yoon, S., Woollen, J., & Bakken, S. Dr. Lee helped the teens participate in the 2014 #MakeHealth, (2015). Sometimes more is more: Iterative participatory design of infographics a maker fair, and the University of Michigan students brought for engagement of community members with varying levels of health literacy. ’ Journal of the American Medical Informatics Association pii: ocv079. doi:10. the teens work to reality. 1093/jamia/ocv079 [Epub ahead of print]. What great mechanisms for patients and consumers to indicate Blagdon, J. (2013, March 4). How emoji conquered the world: The story of the smiley the impact of their health conditions. Imagine what can happen when face from the man who invented it. The Verge Retrieved from www.theverge. people share their thoughts and emotions in this way. You can imag- com/2013/3/4/3966140/how-emoji-conquered-the-world Chaudry, B., Connelly, K., Siek, K., & Welch, J. (2012). Mobile interface designs for ine a support group responding to sad or painful faces by sending low-literacy populations. In Yang C., & Lou G., & Liu J. Eds., Proceedings of the their support and encouragement, greatly improving communication 2nd ACM SIGHIT International Informatics Symposium. New York, NY: Associ- in a connected care ecosystem. ation of Computing Machinery. Gonzalez, A. (2015, November 23,). Emoji pedagogy–Engaging digital learners with HEALTH LITERACY emojis. The University of British Columbia Education Technology Support.Re- trieved from http://ets.educ.ubc.ca/emoji-pedagogy-engaging-and-educating- The article about diabetes got me thinking about how we might use digital-learners-with-emojis/ emoji as a mechanism to address health literacy. I immediately Mosendz, P. (2014, October 10). Why the White House is using emoji. The Atlantic. thought of some pioneering work done by researchers at Columbia Retrieved from www.theatlantic.com/technology/archive/2014/10/why-the-white- house-is-using-emojis/381307/ University under the direction of Dr. Suzanne Bakken and the early Oxford Dictionaries. (2015, November 16). Word of the year. Retrieved from http:// work of Dr. Kate Siek of Indiana University. Dr. Bakken’s team ex- blog.oxforddictionaries.com/2015/11/word-of-the-year-2015-emoji/ plored how infographics can be used to facilitate health literacy and Pavalanathan, U., & Eisenstein, J. (2015). Emoticons vs. emojis on Twitter: A causal engage patients with their own health data (Arcia et al., 2015; Woollen inference approach. Cornell University Library. Retrieved from http://arxiv.org/ ’ abs/1510.08480 & Bakken, 2015). Dr. Siek s work focused on the use of pictures and ra- Sternbergh, A. (2014, November 16). Smile, you’re speaking emoji: The rapid evolu- dio buttons to facilitate health communication for low-literacy patients tion of a wordless tongue. In New York Magazine. Retrieved from http://nymag. (Chaudry, Connelly, Siek, & Welch, 2012). com/daily/intelligencer/2014/11/emojis-rapid-evolution.html# Given the growing use of mhealth apps and their use by diverse Tenderich, A. (2015, May 27). Teens with diabetes design their own solutions. Retrieved from www.healthline.com/diabetesmine/design-thinking-workshop- populations, including those with low literacy, we could help to re- diabetes#1 move not only the digital divide but also the health literacy divide. Thompson, A. (2014, October 20). Finally! Academics describe their research in To me, this would be a fascinating area of research and develop- terms we can understand. Retrieved from http://chronicle.com/blogs/ticker/ ment. Imagine if nursing were to develop a set of emoji that could finally-academics-describe-their-research-in-terms-we-can-understand/88245 Woollen, J., & Bakken, S. (2015). Engaging patients with advance directives using an be used in the care of patients and allow patients to better under- information visualization approach. Journal of Gerontological Nursing.doi:10. stand and communicate their challenges with managing their health. 3928/00989134-20150804-63 [Epub ahead of print].

Nursing Education Perspectives VOLUME 37 NUMBER 1 57