Hospitals, with high psychological stress and cognitive load, are challenging for wayfinding. Although pictograms aid visual guidance, the influence of their semantic content—tools, body parts, or actions—on attention and perception is underexplored. This study examines how hospital wayfinding pictogram content affects fixation count (attentional index) and gaze duration (cognitive processing).

Pictograms were chosen from a large pool of hospital signs (domestic and international) based on content (action, tool, body part) and visual criteria (consistency, contrast, color removal, simplicity). Warning, general (e.g., stairways), staff-specific, culturally dependent, and patient-specific signs were excluded to reduce confounds. Fifty-three healthy adults (18–35 years) participated. From thousands, 15 standard hospital pictograms across three content categories were presented in five clinical settings (neurology, emergency, injection, radiology, CT scan). Eye movements were recorded with an SMI‑250 tracker at 250 Hz and analyzed using repeated‑measures ANOVA with Bonferroni post‑hoc tests.

Results showed a significant main effect of location on fixation count (p < 0.001, η² = 0.361) and a marginally significant location × content interaction (p = 0.050, η² = 0.106). In neurology, tool pictograms attracted more fixations than body‑part pictograms (p = 0.042); in injection settings, body‑part pictograms drew more fixations than action pictograms (p = 0.048). The main effect of content on gaze duration was significant (p = 0.033, η² = 0.181), with action‑oriented pictograms yielding the longest gaze durations in neurology and emergency settings (p > 0.042).

The findings identify tool‑based pictograms as the most efficient design model for hospital wayfinding. Compared to body‑part or action‑based models, this approach offers more fluent cognitive processing and effective attentional capture when defined around specific technology (e.g., radiology). In essence, pictogram design should be guided by context and the brain's attentional mechanisms, not merely visual aesthetics.