**3. Healthcare message design**

Communication means (1) information exchange by speaking, writing, or using some other medium, (2) the successful conveying or sharing of ideas and feelings, and (3) social contact by means of sending or receiving information [21]. Immanuel Kant (1724–1804) provided the philosophical premise of communication and proposed the concept of *ӓsthetische Kommunikation* in the *Critique of Judgment* [22, 23]. *Social communication of beauty* should include not only the other but also the self; thereby, a social sharing of emotion is possible. Previous research has focused on efficient communication between providers and consumers fostered through mutual empathy [24, 25]. Emmanuel Lévinas stated, "The *Subject* is absorbed in the object it absorbs, and nevertheless keeps a distance" [26]. He also defined "the *Other* [as] an absolutely different person." Lévinas added that the Object is represented to the Subject as a painful face deprived of everything.

Empathy, which is the ability to understand the others in their experience, can make communication easier through a shared metaphor such as *beauty* or design [8, 22]. The philosophical underpinnings of empathy date back to Kant, who related empathy to the universal sense of *beauty* between the Subject and the Object [22, 23]. Kant utilized the term *Gemeinsinn* (*sensus communis*) to describe the universal sharing of the sense of *beauty*. *Ӓsthetischer Gemeinsinn* (*sensus communis aestheticus*), referred to by Kant as *ӓsthetische Kommunikation* [23], made an individual feel *beauty*, and because *beauty* is universal, an individual is able to reach into the realm of universal thought. *Ӓsthetischer Gemeinsinn*, in other words, is a subjective condition of *universal communicability*. In the *Critique of Judgment* [22], universal communicability was viewed as social esthetics. The term "universal" includes both the Subject and the Object; thus, universal communicability can actualize the body of social communication by an individual's choice in public sphere [6]. Social communication is possible when there is freedom to assert one's thought in the public domain while recognizing the differences of others [23].

The scope of health communication covers "disease control and prevention, emergency preparedness and response, injury and violence prevention, environmental health, and workplace safety and health" [40]. Patient-centered communication based on empathy has demonstrated clinically positive effects on patient outcomes such as satisfaction, compliance, and diagnosis or treatment [16, 17]. For example, Wanzer et al. stressed that empathy in particular can reduce patients' anxiety [14]. Fox et al. reported that doctors who had experienced serious health problems felt more empathy when they communicated with their patients and especially showed more empathy when communicating with patients who had similar health

Healthcare Message Design toward Social Communication: Convergence Based…

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Origins of design are the Latin *disegno* and *designare*. *Disegno*, or *desseing*, means "a plan to draw a picture." This originates in the division made in *Trattato di pittura* (1509) by the sixteenth-century painter Lancilotti, who said that the characteristics of painting consisted of *disegno*, *colorito*, *compositione*, and *inventione*. Therefore, the meaning of *disegno* is akin to the dictionary definition of "plan" [41], and its meaning has been expanded to include creative thinking, which is working in an artist's mind. *Designare* is a compound word using the prefix, *de,* and the root word, *signare*. *De* means to take away and *signare* means sign or symbol. Combining these two meanings, *designare* has been expanded beyond the primary dictionary meaning of symbol or sign to include the meaning of "meta," which is the interpretation and creation of cultural symbols as well [42]. In this sense, design can be described as an effort to

In healthcare, design plays a meaningful role throughout the entire therapeutic and or healing process that is "other-centered "or "audience-centered" caring and the consideration of other people's circumstances [44]. Design in healthcare as an integrated practice of empathic design results in healthcare systems that place an increased value on the patient's engagement in care process [45, 46]. Designing healthcare systems requires a deep understanding of care protocols, patient safety, and efficacy requirements, user needs and experience, environmental and technological contexts, and organizational behaviors [12, 13, 45–48]. Ulrich [12] focused on psychosocial support in creating a healing environment that maintains and improves the status of health, namely supportive design [13]. The approach of design in healthcare unifies theories and practices by focusing on human experience that redefines healthcare design and

In this context, designing is the shared metaphor that enables individuals to understand the emotions of others. Designing health communication is a progress of signifying practice through the intervention of design. For designing messages in health communication, empathy of consumer's various tastes and preferences should be taken into consideration by healthcare professionals. To that end, it should be based on a certain degree of philosophical premise to the other within oneself. In other words, HMD represents the experiences of the Subject and the Object as a shared metaphor formulating empathy between providers and consumers. As a result, HMD can play an important mediatory role in enhancing health outcomes and simultaneously facilitate the therapeutic and or healing process when it is

problems to theirs [24].

patient care [49].

create a meaningful order in human behavior [43].

approached through the meta-concept based on social esthetics.

Philosophy recognizes empathy as the extension of image schemata and expands the concept to include the other within oneself who recognizes others as different from oneself [26]. Bodily pain is "a complex social and psychological entity" beyond the pain [27]. Communication that delivers messages regarding human dignity and the value of life can be considered an important medium of artistic nursing [28]. Decision making for self-care is essentially based on informed decisions; therefore, information is essential to the improvement of health outcomes. Consumers gain power and confidence by actively participating in their care according to accurate and reliable information. Therefore, there is a need to design health communication that effectively delivers information.

Especially in the discipline of nursing, which is based on the philosophical understanding of a person as a whole, Carl Rogers [29] defined empathy as "being able to perceive another's feelings and experiences with accuracy." It has also been reported that empathy is one of the most important characteristics for aiding therapeutic relationships [7, 24, 30]. Florence Nightingale (1820–1910) actualized the concept of empathy by addressing social and psychological environment including chattering hopes and advices, and petty management. Nightingale defined "petty management" of the other as the Object in the community; in other words, "by not knowing how to manage that what you do when you are there, shall be done when you are not there" [31].

The importance of empathy has been introduced as a core of common aims within a conceptual framework for health professionals [32, 33]. Empathy is a core competence of healthcare providers; however, the concept of empathy seems to be still complex and multidimensional [7, 34–36]. Theoretically, it is assumed that empathy plays a role in healthcare providers' performance, which is related to patient satisfaction or even patient compliance, patient enablement, and clinical outcomes [14, 24, 30, 37, 38]. Empathy has three different competencies such as an affective attitude (compassionate care), a cognitive skill (perspective taking), and communicative behaviors, which provide insight into others' thoughts and emotions [7, 30, 32].

For the philosophical understanding of communication in health care, the awareness of oneself and others originates in philosophy. According to Kant, there is a kind of shared meaning that is not reducible to conceptual and propositional content alone [22, 23]. This insight was expanded by Mark Johnson who proposed that such thought is pre-conceptual and involves the metaphoric extension of image schemata, which means the acknowledgement of the distance between each other [39]. The Object cannot be the cognitive possession of the Subject nor recognized as the same as oneself (the Subject) when recognized as the Object.

The scope of health communication covers "disease control and prevention, emergency preparedness and response, injury and violence prevention, environmental health, and workplace safety and health" [40]. Patient-centered communication based on empathy has demonstrated clinically positive effects on patient outcomes such as satisfaction, compliance, and diagnosis or treatment [16, 17]. For example, Wanzer et al. stressed that empathy in particular can reduce patients' anxiety [14]. Fox et al. reported that doctors who had experienced serious health problems felt more empathy when they communicated with their patients and especially showed more empathy when communicating with patients who had similar health problems to theirs [24].

individual feel *beauty*, and because *beauty* is universal, an individual is able to reach into the realm of universal thought. *Ӓsthetischer Gemeinsinn*, in other words, is a subjective condition of *universal communicability*. In the *Critique of Judgment* [22], universal communicability was viewed as social esthetics. The term "universal" includes both the Subject and the Object; thus, universal communicability can actualize the body of social communication by an individual's choice in public sphere [6]. Social communication is possible when there is freedom to assert one's thought in the public domain while recognizing the differences of others [23].

Philosophy recognizes empathy as the extension of image schemata and expands the concept to include the other within oneself who recognizes others as different from oneself [26]. Bodily pain is "a complex social and psychological entity" beyond the pain [27]. Communication that delivers messages regarding human dignity and the value of life can be considered an important medium of artistic nursing [28]. Decision making for self-care is essentially based on informed decisions; therefore, information is essential to the improvement of health outcomes. Consumers gain power and confidence by actively participating in their care according to accurate and reliable information. Therefore, there is a need to design health communica-

Especially in the discipline of nursing, which is based on the philosophical understanding of a person as a whole, Carl Rogers [29] defined empathy as "being able to perceive another's feelings and experiences with accuracy." It has also been reported that empathy is one of the most important characteristics for aiding therapeutic relationships [7, 24, 30]. Florence Nightingale (1820–1910) actualized the concept of empathy by addressing social and psychological environment including chattering hopes and advices, and petty management. Nightingale defined "petty management" of the other as the Object in the community; in other words, "by not knowing how to manage that what you do when you are there, shall be

The importance of empathy has been introduced as a core of common aims within a conceptual framework for health professionals [32, 33]. Empathy is a core competence of healthcare providers; however, the concept of empathy seems to be still complex and multidimensional [7, 34–36]. Theoretically, it is assumed that empathy plays a role in healthcare providers' performance, which is related to patient satisfaction or even patient compliance, patient enablement, and clinical outcomes [14, 24, 30, 37, 38]. Empathy has three different competencies such as an affective attitude (compassionate care), a cognitive skill (perspective taking), and communica-

For the philosophical understanding of communication in health care, the awareness of oneself and others originates in philosophy. According to Kant, there is a kind of shared meaning that is not reducible to conceptual and propositional content alone [22, 23]. This insight was expanded by Mark Johnson who proposed that such thought is pre-conceptual and involves the metaphoric extension of image schemata, which means the acknowledgement of the distance between each other [39]. The Object cannot be the cognitive possession of the Subject

tive behaviors, which provide insight into others' thoughts and emotions [7, 30, 32].

nor recognized as the same as oneself (the Subject) when recognized as the Object.

tion that effectively delivers information.

30 Selected Issues in Global Health Communications

done when you are not there" [31].

Origins of design are the Latin *disegno* and *designare*. *Disegno*, or *desseing*, means "a plan to draw a picture." This originates in the division made in *Trattato di pittura* (1509) by the sixteenth-century painter Lancilotti, who said that the characteristics of painting consisted of *disegno*, *colorito*, *compositione*, and *inventione*. Therefore, the meaning of *disegno* is akin to the dictionary definition of "plan" [41], and its meaning has been expanded to include creative thinking, which is working in an artist's mind. *Designare* is a compound word using the prefix, *de,* and the root word, *signare*. *De* means to take away and *signare* means sign or symbol. Combining these two meanings, *designare* has been expanded beyond the primary dictionary meaning of symbol or sign to include the meaning of "meta," which is the interpretation and creation of cultural symbols as well [42]. In this sense, design can be described as an effort to create a meaningful order in human behavior [43].

In healthcare, design plays a meaningful role throughout the entire therapeutic and or healing process that is "other-centered "or "audience-centered" caring and the consideration of other people's circumstances [44]. Design in healthcare as an integrated practice of empathic design results in healthcare systems that place an increased value on the patient's engagement in care process [45, 46]. Designing healthcare systems requires a deep understanding of care protocols, patient safety, and efficacy requirements, user needs and experience, environmental and technological contexts, and organizational behaviors [12, 13, 45–48]. Ulrich [12] focused on psychosocial support in creating a healing environment that maintains and improves the status of health, namely supportive design [13]. The approach of design in healthcare unifies theories and practices by focusing on human experience that redefines healthcare design and patient care [49].

In this context, designing is the shared metaphor that enables individuals to understand the emotions of others. Designing health communication is a progress of signifying practice through the intervention of design. For designing messages in health communication, empathy of consumer's various tastes and preferences should be taken into consideration by healthcare professionals. To that end, it should be based on a certain degree of philosophical premise to the other within oneself. In other words, HMD represents the experiences of the Subject and the Object as a shared metaphor formulating empathy between providers and consumers. As a result, HMD can play an important mediatory role in enhancing health outcomes and simultaneously facilitate the therapeutic and or healing process when it is approached through the meta-concept based on social esthetics.
