HERD: Health Environments Research & Design Journal

To engage users in the design of a regional child and youth health center.

The perspective of users should be an integral component of a patient-centered, evidence-based approach to the design of health facilities.

We conducted a discrete choice conjoint experiment (DCE), a method from marketing research and health economics, as a component of a strategy to engage users in the preconstruction planning process. A sample of 467 participants (290 staff and 177 clients or community stakeholders) completed the DCE.

Latent class analysis identified three segments with different design preferences. A group we termed an enhanced design (57%) segment preferred a fully featured facility with personal contacts at the start of visits (in-person check-in, personal waiting room notification, volunteer-assisted wayfinding, and visible security), a family resource center with a health librarian, and an outdoor playground equipped with covered heated pathways. The self-guided design segment (11%), in contrast, preferred a design allowing a more independent use of the facility (e.g., self-check-in at computer kiosks, color-coded wayfinding, and a self-guided family resource center). Designs affording privacy and personal contact with staff were important to the private design segment (32%). The theme and decor of the building was less important than interactive features and personal contacts.

A DCE allowed us to engage users in the planning process by estimating the value of individual design elements, identifying segments with differing views, informing decisions regarding design trade-offs, and simulating user response to design options.

Multisensory environments (MSEs) for people with dementia have been available over 20 years but are used in an ad hoc manner using an eclectic range of equipment. Care homes have endeavored to utilize this approach but have struggled to find a design and approach that works for this setting.

Study aims were to appraise the evolving concept of MSEs from a user perspective, to study the aesthetic and functional qualities, to identify barriers to staff engagement with a sensory environment approach, and to identify design criteria to improve the potential of MSE for people with dementia.

Data were collected from 16 care homes with experience of MSE using ethnographic methods, incorporating semi-structured interviews, and observations of MSE design. Analysis was undertaken using descriptive statistics and thematic analysis.

Observations revealed equipment that predominantly stimulated vision and touch. Thematic analysis of the semi-structured interviews revealed six themes: not knowing what to do in the room, good for people in the later stages of the disease, reduces anxiety, it’s a good activity, design and setting up of the space, and including relatives and care staff.

Few MSEs in care homes are designed to meet needs of people with dementia, and staff receive little training in how to facilitate sessions. As such, MSEs are often underused despite perceived benefits. Results of this study have been used to identify the design principles that have been reviewed by relevant stakeholders.

The primary aim of the present study was to compare sleep characteristics pre- and post-move into a state-of-the-art mental health facility, which offered private sleeping quarters.

Significant evidence points toward sleep disruption among psychiatric inpatients. It is unclear, however, how environmental factors (e.g., dorm-style rooms) impact sleep quality in this population.

To assess sleep quality, a novel objective technology, actigraphy, was used before and after a facility move. Subjective daily interviews were also administered, along with the Horne–Ostberg Morningness–Eveningness Questionnaire and the Pittsburgh Sleep Quality Index.

Actigraphy revealed significant improvements in objective sleep quality following the facility move. Interestingly, subjective report of sleep quality did not correlate with the objective measures. Circadian sleep type appeared to play a role in influencing subjective attitudes toward sleep quality.

Built environment has a significant effect on the sleep quality of psychiatric inpatients. Given well-documented disruptions in sleep quality present among psychiatric patients undergoing hospitalization, design elements like single patient bedrooms are highly desirable.

This article reports summer verses winter seasonal variations across a suite of blue light, illuminance levels and health and well-being indicators.

The quality of lighting in care homes has been assessed previously, yet seasonal comparisons and the associations with sleep quality are limited. This exploratory study investigates light exposure in two seasons to determine the changes over time and the associations with health and well-being.

In a repeated measures design, 16 older people (aged 72–99 years) living in a care home had their personal light exposure and sleep/wake patterns monitored for 4 days. Cognitive ability, mental well-being, daytime physical activity, and visual function were assessed. Mean light levels at preset times across the day, duration in light exposure over 1,000 lux, and sleep parameters were computed. Statistical investigations included correlations exploring associations and paired means tests to detect the changes between seasons.

The mean morning illuminance level in summer was 466 lux and 65 lux in winter. Duration in bright light over 1,000 lux was 46 min in summer and 3 min in winter. Light measures were significantly higher in summer. There was no statistical difference in sleep quality parameters between seasons, but there were significant difference in daytime physical activity level (i.e., this was higher in summer).

The findings indicate low level of light exposures experienced in both seasons, with exposure levels being particularly low in winter. This provides new insights into the limited amount of light older people receive independent of season and the possible impacts on sleep and daytime physical activity level.

The focus of this research was to analyze the impact of decentralized and centralized hospital design layouts on the delivery of efficient care and the resultant level of caregiver satisfaction.

An interdisciplinary team conducted a multiphased pre- and postoccupancy evaluation of a cardiovascular service line in an academic hospital that moved from a centralized to decentralized model. This study examined the impact of walkability, room usage, allocation of time, and visibility to better understand efficiency in the care environment.

A mixed-methods data collection approach was utilized, which included pedometer measurements of staff walking distances, room usage data, time studies in patient rooms and nurses’ stations, visibility counts, and staff questionnaires yielding qualitative and quantitative results.

Overall, the data comparing the centralized and decentralized models yielded mixed results. This study’s centralized design was rated significantly higher in its ability to support teamwork and efficient patient care with decreased staff walking distances. The decentralized unit design was found to positively influence proximity to patients in a larger design footprint and contribute to increased visits to and time spent in patient rooms.

Among the factors contributing to caregiver efficiency and satisfaction are nursing station design, an integrated team approach, and the overall physical layout of the space on walkability, allocation of caregiver time, and visibility. However, unit design alone does not solely impact efficiency, suggesting that designers must consider the broader implications of a culture of care and processes.

To identify patient needs and expectations that can be utilized to inform the design or renovation of medical–surgical patient rooms in a hospital.

There is an increased interest in supportive room design to increase patient satisfaction and improve the healing process.

Patients’ and family caregivers’ reactions were elicited to intentional room elements embedded in a set of five full-scale simulated room prototypes. Small groups of patients and caregivers toured two of the five rooms and provided verbal and written evaluations of room features. A grounded theory approach was employed to generate a codebook, identify the frequency of codes, and to group codes and memos into emerging themes. Insights from emergent themes were compared with findings from written surveys on the importance of various room design elements completed at the beginning of each session.

A theoretical design framework was generated, showing patients expect a hospital room that provides them with the core components of comfort to support healing, facilitates a strong sense of connection to people and the outside world, enables quick and independent access to the patient’s things, and offers suitable levels of control to the patient throughout their hospital stay.

The implications for assisting architects, healthcare planners, and interior space designers are described using this framework, as well as its potential for design guidance. In addition, the connection between patient-centered room elements and relevant survey questions in publicly reported patient satisfaction scores for hospitals is discussed.

Research supports therapeutic use of nature scenes in healthcare settings, particularly to reduce stress. However, limited literature is available to provide a cohesive guide for selecting scenes that may provide optimal therapeutic effect.

This study produced and tested a replicable process for selecting nature scenes with therapeutic potential. Psychoevolutionary theory informed the construction of the Importance for Survival Scale (IFSS), and its usefulness for identifying scenes that people generally prefer to view and that hold potential to reduce stress was tested.

Relationships between Importance for Survival (IFS), preference, and restoration were tested. General community participants (N = 20 males, 20 females; M age = 48 years) Q-sorted sets of landscape photographs (preranked by the researcher in terms of IFS using the IFSS) from most to least preferred, and then completed the Short-Version Revised Restoration Scale in response to viewing a selection of the scenes.

Results showed significant positive relationships between IFS and each of scene preference (large effect), and restoration potential (medium effect), as well as between scene preference and restoration potential across the levels of IFS (medium effect), and for individual participants and scenes (large effect).

IFS was supported as a framework for identifying nature scenes that people will generally prefer to view and that hold potential for restoration from emotional distress; however, greater therapeutic potential may be expected when people can choose which of the scenes they would prefer to view. Evidence for the effectiveness of the IFSS was produced.

This case study explores the influence of the healthcare design studio experience on students’ short-term professional goals as measured through rates of healthcare-related certification and internship/employment.

The value and relevance of interior design is evident in the healthcare design sector. However, interior design students may not perceive this value if it is not communicated through their design education. Students’ experience in the design studio plays a crucial role in determining career choices, and students may be more committed to career goals when there is clear connection between major coursework and professional practice.

The authors compared healthcare-related certification and internship/employment levels between two student cohorts in a capstone undergraduate interior design healthcare design studio course. The first cohort was led by the existing curriculum. The second cohort was led by the revised curriculum that specifically aimed at encouraging students to commit to healthcare-related design practice.

When measured at 3 months from graduation, the second cohort, led by the revised curriculum, saw a 30% increase in Evidence-based Design Accreditation and Certification exam pass rates and a 40% increase in healthcare-related internship/employment.

The challenge of interior design education is to instill in emerging professionals not only professional competence but also those professional attitudes that will make them better prepared to design spaces that improve quality of life, particularly in healthcare environments. The results exceeded the project goals, and so this could be considered a promising practice for courses focused on healthcare design education.

This article provides critical examination and comparison of the conceptual meaning and underlying assumptions of the concepts evidence-based design (EBD) and research-informed design (RID) in order to facilitate practical use and theoretical development.

In recent years, EBD has experienced broad adoption, yet it has been simultaneously critiqued for rigidity and misapplication. Many practitioners are gravitating to the term RID to describe their method of integrating knowledge into the design process. However, the term RID lacks a clear definition and the blurring of terms has the potential to weaken advances made integrating research into practice.

Concept analysis methods from Walker and Avant were used to define the concepts for comparison.

Conceptual definitions, process descriptions, examples (i.e., model cases), and methods of evaluation are offered for EBD and RID. Although EBD and RID share similarities in meaning, the two terms are distinct. When comparing evidence based (EB) and research informed, EB is a broad base of information types (evidence) that are narrowly applied (based), while the latter references a narrow slice of information (research) that is broadly applied (informed) to create an end product of design.

Much of the confusion between the use of the concepts EBD and RID arises out of differing perspectives between the way practitioners and academics understand the underlying terms. The authors hope this article serves to generate thoughtful dialogue, which is essential to the development of a discipline, and look forward to the contribution of the readership.