Inconsistencies in the drawing and interpretation of smiley faces: an observational study
Clarke et al. BMC Res Notes
Inconsistencies in the drawing and interpretation of smiley faces: an observational study
Mike Clarke 0 2
Helen McAneney 0 2
Fiona Chan 0 2
Lisa Maguire 0 1 2
0 Northern Ireland Methodology Hub, Centre for Public Health, Queen's University Belfast , Belfast, Northern Ireland BT12 6BJ , UK
1 MRC North West Hub for Trials Methodology Research, University of Liverpool , Liverpool , UK
2 Northern Ireland Methodology Hub, Centre for Public Health, Queen's University Belfast , Belfast, Northern Ireland BT12 6BJ , UK
Objectives: Pre-prepared smiley face symbols are used widely to gather information on, for example, satisfaction with services or health and well-being. We investigated how women and men of different ages respond when asked to draw a smiley face for themselves. Our objectives were to investigate how they differ by generating a unique set of data to explore this simple human behaviour and to illustrate the importance of considering gender and age mix in any study. Results: We collected 723 drawings, in a variety of settings. Gender and age were provided for 676 drawings (women: 511; men: 165; ≤ 30 years: 335; > 30 years: 341). Although similar proportions of women and men drew some features, such as closed mouths; women and those aged ≤ 30 were less likely to draw noses and outlines around the faces, and more likely to draw a classic smiley face. Our analyses provide a novel way to highlight that whenever self-reported outcomes are compared between groups, the group composition for characteristics such as gender and age may need to be considered carefully to explore whether differences in outcomes might simply arise from imbalances in those characteristics.
Smiley faces; Drawing; Draw-A-Man Test; Facial recognition
Whether it’s a baby looking at its parents [
], a glance of
someone we think we know, a study of the prevalence of
moustaches in medical leaders [
] or a computer allowing
us access into a country [
], facial recognition is common
in our daily lives. Furthermore, patients and the public
are increasingly prompted to provide feedback on their
health and well-being or their satisfaction with services
by selecting from a series of faces, at least one of which
will be smiling.
These images are usually pre-prepared but we wished
to investigate whether there would be differences in how
women, men and different age groups respond when
asked to draw a smiley face for themselves. This allowed
us to investigate the question of how different genders
and age groups would complete this simple task and to
provide a novel way to show that if differences do exist
between genders or age groups, this might suggest a need
to consider such factors carefully in instances such as
questionnaire design and analysis. This might be
necessary, for instance, when surveys use scales that
incorporate a range of faces (from happy through neutral to sad
looking), or when something such as the Wong-Bakes
scale is used for pain rating using facial images [
these are not gender or age neutral for gathering data,
variation in these facial pictures (e.g. the inclusion of a
boundary; circles, dots or dashes for eyes, etc.) might bias
the responses received. Exploring what people regard
as the key features of a face, allows one to consider the
implications of any potential for bias and, consequently,
the interpretation of data gathered using facial prompts.
Therefore, we investigated these issues in a large
observational study in which participants at a variety of events
were asked to draw a smiley face. Although this does not
necessarily reveal how different groups would react to
different pre-prepared images, it provides insight into
what they themselves would regard as a smiley face.
The use of drawing within health research is not new.
For example, the Drawing a Man test by Goodenough
in 1926 provided a score based on the features drawn by
children aged 4–10 years as a means to assess the child’s
intelligence. The human figures drawn were scored based
on the presence and number of details in the drawing, as
well as the accuracy of placement of each body part [
The test has been revised and extended, with the 2004
version by Reynolds and Hickman requiring children,
adolescents and adults to draw themself [
In this paper, we report results from the Smiley Faces
study, an observational study of how different types
of people draw smiley faces, exploring the differences
between genders and ages. We believe that this is the first
study of its kind, although there are earlier examples of
research into the relationship between, for example, age
and mental health and the drawing of human figures [
Our objectives were to investigate how women, men and
different age groups differ in the simple task of drawing a
smiley face by generating a unique set of data to explore
this simple human behaviour and to illustrate the
importance of considering gender and age mix in any study.
We collected data for the Smiley Faces study at a variety
of conferences, meetings and teaching sessions, partly
as a tool to illustrate key points in the design of clinical
]. There was heterogeneity across these settings
in relation to other aspects of the events, but we
standardised our activity and presented it in a serious manner
each time. All participants were first asked to write the
title and date of the relevant event on a piece of paper.
They were then told that they would be given a simple
instruction, which would be said once and would not
be expanded upon or explained, before being given the
instruction: “draw a smiley face”. Participants usually
took less than 1 min to do their drawing and were then
asked to write their name, age and gender on the paper, if
they wished to do so, before the drawings were collected.
Although it was suggested at the end of some of the
sessions that the use of the term “smiley face” might lead
everyone to produce a classic smiley face, as originally
drawn by Harvey Ball in 1963 [
], we always used this
same instruction to standardise it across the events. And,
as shown below, a variety of faces were drawn (see Fig. 1).
Drawings were coded to categorise the faces and to
record the presence of specific features. The faces were
categorised as one of the following:
• Classic smiley face: dots or dashes representing eyes
and a line for a closed mouth (with or without an
outline around the facial features).
• Adapted smiley face: a classic smiley face with added
features, such as hair.
• Schematic face: a more natural representation of a
Specific features on each drawing were coded as
present or absent, consistent with the scoring system
developed by Goodenough for drawings of the whole body
]. In the Goodenough system, an outline of the head,
the presence of eyes, nose, mouth, hair, and ears, as well
as further details of the eyes such as brow, lashes, and
the pupil, each receive a point if present. In our system,
we also recorded additional items and fine details.
Specifically, we recorded the presence of elements such as a
defined outline for the face, eyes, mouth, nose, cheeks,
chin, ears, hair, eyebrows [
], freckles, teeth, tongue,
eyelashes, moustaches [
], and other features (e.g. glasses
or hat). Finer detail was recorded for some of these
elements to distinguish, for example, open and closed
mouths; and the use of dots, open or filled circles, dashes
or richer depictions (e.g. with irises and pupils) for eyes.
The coding was done by two authors (FC and LM)
independently, with discrepancies resolved by consensus
between them. No disagreements remained after these
discussions. If there had been discrepancies, the other
authors would have determined the final coding.
The coded data were analysed using SPSS (v22) giving
a combination of descriptive and comparative statistics:
principally, odds ratio (OR) and the associated 95%
confidence intervals (CI) to investigate differences between
the participant subgroups. The pre-specified analyses
compared drawings by women versus men and between
different age groups (determined by dividing the data
into two similarly sized age groups) for:
• Category of face
• Presence of a nose
• Type of mouth
• Outline around the face.
From 2013 to 2016, a total of 723 drawings were collected
at events in Canada, England, Ireland, Italy, and
Northern Ireland; overseen by two authors (MC and HM). The
events ranged from less than 10 participants in each of
several small group teaching sessions, to 136 in a lecture
to nursing and midwifery students in Ireland. Using the
baseline characteristics of the participants as given by the
information they wrote on the drawings, the total sample
included more women than men (530 vs. 175) and
dividing the data at age 30 years produced similar numbers of
people below (335) and above (341) this age. Data for the
676 participants who provided both age and gender were
used for the analyses presented in this paper (women:
511; men: 165; ≤ 30 years of age: 335; > 30 years of age:
341). This excludes 29 drawings with gender but not age,
and 18 with neither age nor gender.
Among the 676 included drawings, there were 371
(54.9%) classic smiley faces, 273 (40.4%) adapted smiley
faces and 32 (4.7%) schematic faces (see Fig. 1 for
illustrative examples). Considering the specific features for
all participants combined, a minority drew a nose (261,
38.6%), most drew a closed mouth (572, 84.6%) and most
drew an outline around the features (479, 70.9%) (Table 1).
a A total of 676 participants were included in the analysis, having provided both
age and gender. The remaining 47 (6.5%) drawings were excluded because age
and or gender were missing
Some of the rarest features were a chin (1, 0.1%), freckles
(2, 0.3%), a moustache (3, 0.4%) and a neck (6, 0.9%).
There were some significant differences in our primary
comparisons (Table 2). Women were much less likely
than men to draw noses (OR: 0.55, 95% CI: 0.38–0.78,
p = 0.0008) and outlines around the face (OR: 0.55,
95% CI 0.36–0.84, p = 0.006), but much more likely to
draw a classic smiley face (OR: 1.95, 95% CI 1.36–2.78,
p = 0.0002). On the other hand, similar proportions of
women and men drew some features, such as closed
mouths (84.9% vs. 83.6%).
People aged 30 years and under (both men and women)
were less likely than older participants to draw noses
(OR for both genders combined: 0.44, 95% CI 0.32–0.60,
p < 0.0001) and outlines around the face (OR for both
genders combined: 0.32, 95% CI 0.22–0.45 p < 0.0001),
and more likely to draw a classic smiley face (OR for both
genders combined: 2.73, 95% CI 2.00–3.74, p < 0.0001)
(Table 2). These relationships with age are similar for
men and women.
Our study revealed interesting differences and
similarities between the types of participant in how they
interpret the instruction to draw a smiley face and the features
that they include in their drawings. This variety may be
due to the characteristics of the participants, bearing
in mind that we found significant differences between
women and men, and between younger and older
participants. Women, and those aged 30 years or younger were
more likely to draw a classic smiley face, and to avoid
drawing both noses and outlines around the faces.
On the dozens of occasions that we have conducted
the Smiley Faces study, it has generated a variety of
interpretations and conclusions amongst those who did the
drawings, and we are grateful to them for their insights
and suggestions. With this analysis, we are able to
confirm some of the differences, but not necessarily explain
them and they generate many questions that may be
relevant when faces are used to gather health or other
information. For example, do women pay less attention
to fine detail, such as noses, than men? Are men more
constrained in their thinking than women and less of a
“free spirit” because they draw their faces with an
outline around, setting a boundary? Should these be seen as
positive or negative traits in the types of people who have
taken part in the Smiley Faces study?
In today’s society, facial recognition is used in many
areas of our lives. Yet little research is available on how
different people draw or interpret faces. Our analyses
support some of the interpretations suggested by
participants in the dozens of events at which we have
conducted this study, but do not necessarily explain them.
However, they do show that if such drawings are to be
used in research or in psychological assessments (such
as with the Goodenough’s Draw a Man Test), or for
obtaining feedback on satisfaction, health or well-being,
possible differences by gender and age may need to be
considered when gathering, interpreting and comparing
data from different settings. The Smiley Faces study has
also used a novel approach to highlight the general point
that whenever self-reported outcomes are compared
between groups, the composition of those groups in
relation to characteristics such as gender and age might need
to be considered carefully to ensure that any differences
in outcomes are not simply due to imbalances in those
We realise that the differences we found between genders
and age groups may be a result of confounding, which is
not within our ability to investigate, but the findings are
of interest. The participants were all given the same
simple task but it produced a wide variety of different
drawings. The reasons for the differences may never truly be
known or understood, but this study reveals how people
may unknowingly interpret day-to-day tasks differently.
MC conceived the study. MC and HM collected the drawings of smiley faces.
LM and FC coded the data. HM and FC did the statistical analyses. MC drafted
the manuscript. All authors commented on the final manuscript. MC is the
guarantor for this paper. All authors read and approved the final manuscript.
We are grateful to the organisers of the relevant events for allowing us to
conduct the Smiley Faces study at these events, to the hundreds of participants
for providing the data for this study and suggestions for its meanings, and to
the three participants who agreed to the use of their drawings in this paper.
The authors declare that they have no competing interests.
Availability of data and materials
The datasets generated and analysed for this study (relating to the codes
assigned to each drawing of a smiley face) are available from the
corresponding author. This will require the removal of any information that would identify
the participant. The drawings of the smiley faces have been retained by the
corresponding author and will be available at his work location for viewing
upon reasonable request and for a reasonable period of time into the future.
There are no immediate plans to destroy these drawings but they will not be
retained for ever. The authors do not have sufficient resources to scan and
upload the drawings to a data repository, which would also require the
redaction of information that would identify the participant.
Consent to publish
Consent for publication was obtained by email from the participants of the
three drawings presented in this article.
Ethics approval and consent to participate
Ethics approval is not applicable for this study. Participants were aware that
they were taking part in a study that used the drawing of smiley faces to
stimulate discussion about research design. They were informed that they did
not need to provide the optional information about their name, gender and
age if they did not wish to do so, and that by drawing a smiley face and
handing it in they were consenting to be included within the study.
There was no dedicated funding for this project, apart from a Centre for Public
University Belfast 2016 summer studentship for one of the authors (FC).
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
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