Resumen
Omaha System problem concepts describe a comprehensive, holistic view of health in simple terms that have been represented in a set of prototype icons intended for universal use by consumers and clinicians. The purpose of this study was to evaluate Omaha System prototype icons internationally across ten languages through an on-line survey and in-person focus groups. The icons were generally rated above 3 on a scale of 1 to 5 by 1568 survey respondents, with notable exceptions for some of the more abstract concepts. Overall, the icons were rated 3.49 on a scale of 1 = strongly disagree to 5 = strongly agree, with a range of 3.09 (Japanese language) to 3.88 (Norwegian language). A pattern of differential agreement was noted among respondents from Asiatic languages compared to all other languages. Feedback from survey respondents and focus group participants was used to refine the icons. General themes related to icon development were synthesized from focus group interviews. Further research should continue to refine and evaluate the icons in different languages for international use to support health literacy through visual literacy.