From Signs to Systems: A Semiotic–Pragmatic Framework for Digital Health

ABSTRACTIn 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.