Designing well-being: A qualitative investigation of young patients’ perspectives on the material hospital environment

Why does this study matter?
Children who have physical challenges, developmental delays, behavioral problems, and chronic health conditions, often spend significant time in healthcare facilities. While the body of evidence related to healing environments is growing, most studies focus on adults and may not be generalizable to children and adolescent patients who are in various developmental phases. Additionally, environmental needs across developmental stages differ and may vary depending on the child’s particular condition. Researchers aimed to study young patients’ views on their physical surroundings with a specific focus on the lobby and inpatient hospital room.  

How was the study done?
In preparation for the remodel of a pediatric facility in Germany,  patients were asked to either draw a picture or write a letter about their preferred lobby and/or hospital room. These works were used as the focus of individual, semi-structured interviews where patients were asked questions about their experiences and perspectives.  Older patients (above 12 years of age) preferred to just participate in interviews either due to physical limitations or because they felt it was more mature. Interviews were recorded and when artistic work was included, photos were taken of the works so patients could keep the originals. While patients selected the location for the interviews, most interviews about the hospital room occurred in a model room that had been mocked up by construction managers. Qualitative analysis for this study focused on explanation and congruence with existing literature rather than elaborate description.     

So what do we learn from the study?
37 patients participated in total of which 13 characterized both the lobby and an inpatient room. Researchers identified 3 themes:

• First – Pediatrics is Not a typical hospital environment – children, early adolescents and older patients with cognitive delays desired spaces for play and familiar, distracting and entertaining surroundings throughout the facility. Participants desired accessible distractions in the lobby such as aquariums or other living elements and shared a preference for distractions in their rooms indicating a dislike of medicalized features and spaces - as an example, one patient desired a “princess bed” vs a hospital or “sick bed”.
• Next - An overwhelming and confined space – Overall, the lobby was depicted as confusing and overwhelming with all participants over the age of 6 describing wayfinding issues. Participants recommended well-lit, open, and inviting lobbies to facilitate autonomy and ease the transition from the outside world to the more constricting inpatient setting.
• Finally - A practical room to fit everyone’s needs – A majority of participants across age groups indicated wheelchair accessibility, easy to use furniture, and personalization as important to inpatient room design. Some participants also recommended automation to ease the parental burden of opening fold-away beds and to customize sink and counter heights for children, adolescents, and wheelchair users.

Can we say the results are definitive?
The decision to not collect demographic data to preserve participant confidentiality created a limitation, such that conclusions could not be drawn based on socioeconomic status or cultural background. Additionally, generalization is somewhat limited by the small sample, and the focus on only two areas in one facility; however, it is important to recognize that these findings represent often overlooked perspectives.

What’s the takeaway?
Design recommendations identified from this study include:

• Pediatric patients with multiple and even severe physical disabilities are competent and helpful research participants who can provide meaningful insight into facility design.
• They need health-promoting facilities that are open and include comforting and distracting features resembling homes, hotels, and fun places.

Pediatric facilities need to accommodate a wide variety of users of different abilities and developmental stages such that the environment needs to be practical and might include automated customization to support both patients and families.

Summary of:

Payam, S., Hossaini, J., Zaschka, K., Friedmann, A., Mall, V. (2023) Designing well-being: A qualitative investigation of young patients’ perspectives on the material hospital environment. HERD: Health Environments Research & Design Journal, Issue 3, Volume 16, Pages 168-181. https://doi.org/10.1177/19375867231165763

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