The research behind the pictograms

The question care leaders ask first, once they watch staff use Clex during a shift, is why a pictogram and a sentence, rather than a sentence alone. The answer is not design preference. It is a fifty-year-old result in cognitive psychology, and it is the reason bilingual staff and staff with dyslexia pick up Clex fastest.

Dual-coding theory in one paragraph

In Imagery and Verbal Processes (1971), Allan Paivio proposed that the brain stores and retrieves information through two parallel systems: a verbal channel that handles language, and a visual-imagery channel that handles pictures. The two channels are associatively linked but functionally distinct. When information is encoded through both channels at once, retention, comprehension, and recall are measurably stronger than through either channel alone. The result has been replicated in educational psychology, second-language acquisition, and applied ergonomics across five decades.

Why it matters for care documentation

A care worker writing a journal note in a language other than their first language is asking their verbal channel to do two jobs at once - meaning and grammatical output - under time pressure, at the end of a shift. A care worker with dyslexia or another language-processing difference is asking their verbal channel to do that same work at reduced capacity. Both are classic conditions in which single-channel encoding fails and dual-channel encoding restores accuracy.

Clex is built around exactly that principle:

• The pictogram carries the meaning. Body area, condition, care situation. The visual channel does the semantic work.
• The sentence carries the record. Correctly phrased Danish or Swedish, in the formal register required for the record system. The verbal channel does the output work.
• Read-aloud confirms the match. The care worker hears the sentence before saving, connecting what they see to what the record will say.

What would otherwise be a single-channel task (write this note) becomes a dual-channel task (see the concept as a pictogram, confirm the sentence). The cognitive load that causes errors is redistributed, not increased.

The cognitive science behind the product

A care leader who looks at Clex and sees “a keyboard with pictures” has it the wrong way round. The keyboard is the surface; underneath it sits a fifty-year-old cognitive-science result. The documentation challenges during a shift are rarely about motivation. They are cognitive and linguistic, and dual-coding is among the best-established and most-replicated approaches for reducing cognitive load.

Further reading

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