Comparative dimensions of COVID-19 visual health literacy: social media news imagery in Germany and China

The COVID-19 pandemic saw widespread use of social media for disseminating public health information, with visuals playing a crucial role. This study investigates how national healthcare strategies are reflected in the visual representation of online news posts, comparing Germany and China due to their contrasting pandemic management approaches (mitigation vs. elimination). The research aims to understand how differing strategies and cultural contexts shape digital visual health communication, exploring both similarities and differences in visual discourse data. The authors leverage their linguistic and cultural expertise in Mandarin and German to conduct a reliable comparative analysis of data collected from national news media outlets in 2022, focusing on the transition to the endemic phase. The study bridges discourse analysis, digital humanities, public health relations, and media studies, introducing the concept of "visual dataset fingerprints" to explore how dataset qualities may reflect broader public health realities.

Existing literature highlights the importance of visual health literacy in promoting health understanding and behavior change. Studies show that diverse visual approaches enhance comprehension and that culturally sensitive visuals are crucial for effective communication. Research on COVID-19 visual communication in China reveals that while visually appealing, posters often lack substantial information. In contrast, research on Germany emphasizes the accelerated adoption of televisual medicine and the importance of audiovisual media for reaching socially disadvantaged groups. The review emphasizes the need for effective and culturally sensitive visual health communication strategies in both countries.

This study employs a multifaceted methodological approach drawing from visual discourse analysis, grammar of visual design, representational photography, translational pictography, and metaphorical mapping. The core data consists of photorealistic images from leading national news media accounts on microblogging sites in Germany and China (Twitter, Weibo) from January 1, 2022, to December 31, 2022. The data was collected using four search terms in English, German, and Mandarin. A categorial analysis was conducted across five categories: People, Objects, Settings, Activities, and Context, focusing on the representation of healthcare workers, elected officials, and the general public. The manual coding process involved regular discussions between coders to ensure consistency, and data visualization was done using R. The study also cross-references national public health measures, policies, and key declarations from China and Germany, as well as guidance from the World Health Organization (WHO).

The study found variations in image use across different platforms and languages. The English-language outlets exhibited the highest image count in China (4239 images), while Mandarin outlets showed a lower count (1634 images). German-language outlets posted 2833 images, with English-language outlets in Germany having the lowest count (1183). Analysis reveals differences in the proportion of various image elements across languages and countries. Mandarin-language outlets in China tended to feature more politician images, while German and English-language outlets prioritized healthcare workers and civilians. China/English outlets used civilian images 22% more than China/Mandarin outlets, and healthcare worker images appeared in 37% of China/English communications vs. 18% in China/Mandarin. Germany/English used civilian images 10% more than Germany/German. China/Mandarin outlets prioritized Context images (49% of all images), while Germany/English outlets used people images more frequently (39%). These variations suggest different communication strategies across outlets and languages, influenced by cultural and linguistic contexts.

The findings suggest that cultural and linguistic contexts significantly influence the visual representation of health messages on social media. The differences observed in image use across platforms and languages highlight the importance of tailoring visual communication strategies to specific cultural and linguistic contexts. The study's focus on the endemic phase provides unique insights into how communication strategies evolve beyond the acute crisis phase. The variations observed in image types (e.g., politicians versus civilians or healthcare workers) may reflect differing public health priorities and messaging approaches in the two countries. Further research is needed to explore the causal relationships between image types and their impact on public perception and behavior.

This study reveals distinct national visual communication strategies used by news media outlets in Germany and China during the COVID-19 endemic phase. Although descriptive rather than statistically conclusive due to limitations in sample size, the findings highlight the influence of cultural and linguistic context on visual public health communication. The study's emphasis on the understudied endemic phase contributes valuable insights into the adaptability of public health communication. Future research should focus on quantitative analysis to determine the efficacy of these strategies and their impact on public health outcomes.

The study's limitations include the relatively small sample size and high variance in image counts, especially between Mandarin and English-language outlets, which prevents strong inferential claims. The descriptive nature of the analysis limits the ability to draw definitive conclusions about causal relationships between image use and public health outcomes. Other factors, such as political climates and socioeconomic conditions, could have influenced the visual content.