Improving wayfinding in hospitals for people with diverse needs and abilities: An exploratory approach based on multi-criteria decision making

Why does this study matter?
Decreased physiological and cognitive functioning increases the difficulty in accessing, identifying, and interpreting wayfinding communication cues in the built environment. Hospital wayfinding systems that are based solely on signage do not adequately support the wayfinding needs of vulnerable users with wide-ranging impairments. It is important for “wayfinding” to find its way to a solution now in anticipation of the surge of aging and disabled populations that will increase the proportion of hospital users with impaired orientation and navigation capacities.

How was the study done?
In order to model the relationship between the structure of the physical environment and an individual’s behavior, this study employed a multi-criteria decision-making approach in an effort to construct a 3-dimensional map of architectural features based upon decision-making points along routes and their interconnecting paths, corridors, and changes between levels. 28 participants in their mid-20s were recruited from a college’s service for students with disabilities. Subjects were categorically assigned to either a cognitively or physically impaired wayfinder group. The research setting was a hospital at an undisclosed location. While 22 orientation and navigation features were identified from a review of the literature, the research team selected 5 architectural features in order to limit the number of comparisons at wayfinding decision points, including the 1) number of directional choices, 2) visual affordances, 3) lighting intensity, 4) presence of obstacles along the route, and differentiation between elements. Members of the research team accompanied and documented participants' choices at decision points along one of six pre-selected routes from the hospital’s main entrance to a destination on the 2nd floor. Wayfinders were asked to identify decision points, indicate the architectural features being compared, their actual comparison, and their choice for the most beneficial.     

What do we learn from the study?
Architectural features were assigned a “usefulness” value by wayfinders relative to every other architectural feature using Saaty’s relative importance scale where 1 signified equal importance through 9 indicating that the difference between the features was extremely strong. Pairwise comparisons were made between each feature and the values were normalized in order to perform equivalency ranking and calculate feature weights from 1 to 0. The cumulative architectural feature weights of each examined route were aggregated and compared in order to identify the optimal route based on the highest score. Neither lighting intensity nor the number of directional choices at each decision point was highly rated by either the mobility or the cognitive wayfinding groups. The presence of obstacles along the route, however, was perceived by the mobility group to have a slight difference in their decision-making. Both the mobility and the cognitive groups indicated that the differentiation between objects had a slight difference for their decision-making. Visual affordances were the most highly rated between both groups, making a moderate to fairly strong difference in their decision-making along routes.

Can we say the results are definitive?
While the strengths of the study include theoretical and practical contributions, it is worth noting that the approach used in this study is resource-intensive and the small sample size poses challenges for generalizing findings more broadly. That being said, the biggest challenge in my opinion is that the population sample used college-age participants who were singularly assigned to either a cognitive or a mobility-impaired group; this binary assignment fails to account for co-occurrences of impairments, which is especially prevalent in older adult populations. 

What’s the takeaway?
In order to put wayfinding on the road to recovery, we have to cater to the full range of cognitive and physiological abilities of healthcare user groups through the provision of clear, consistent and coordinated communication cues, chief among them the provision of staged bridges between visual affordances.             
                            

Summary of:
Morag, I., Sonmez, V., Van Puyvelde, A., & Pintelon, L. (2024). Improving wayfinding in hospitals for people with diverse needs and abilities: An exploratory approach based on multi-criteria decision making. Applied Ergonomics, Volume 114, Pages 104-149.

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