PurposeThis review aimed to identify the environmental factors impacting wayfinding by people with sensory impairment (SI) and the perceived barriers and facilitators of those factors. In addition, the review explored design recommendations to improve the accessibility of built environments for this population.BackgroundWayfinding design is frequently misconceived as the implementation of signage, whereas it also involves spatial planning to facilitate intuitive navigation. Individuals with visual and hearing impairments face multiple accessibility challenges that could be tackled through user-centered design.MethodsA scoping review was conducted using standard methodology. Electronic databases were searched (Medline, Embase, APA PsycINFO, SCOPUS, Web of Science) from January 2000 to August 2023. Independent duplicate screening was performed for 10% of sources. The extracted data was analyzed using content analysis. A conceptual framework was developed to map the key environmental factors impacting the individual's wayfinding with SI.ResultsFrom the 3,716 records identified, 41 studies were included. Results were categorized into three domains of architectural, graphical, and sensory elements. Frequently cited architectural barriers included complex layouts, unclear circulation, nonstandard stairs, and the presence of obstacles. Regarding graphical elements, the nonstandard design or placement of signage was common. Key sensory challenges were related to insufficient lighting, low visual contrast, and the inappropriate selection of materials.ConclusionsThis review highlighted multiple environmental factors that influence wayfinding for people with SI. Policymakers, architects, and designers could use these results to eliminate barriers in the built environment and develop evidence-based design interventions addressing the access needs of this population.

Objectives, Purpose, or AimThis study evaluates the effectiveness of three innovative design strategies implemented in a hospital-based maternity unit 3 years post-occupancy. It aims to identify areas for improvement and demonstrate how a perception-based Post-Occupancy Evaluation (POE) can yield actionable insights in the absence of baseline data.BackgroundAs maternity units strive to balance clinical efficiency with family-centered care, few long-term evaluations of design performance have been conducted. This study addresses this gap by using a perception-based POE to assess design outcomes over time.MethodsA convergent mixed-methods approach was employed, combining structured observations, ambient noise level measurements, focus group interviews, and an online staff survey. Participants were nursing staff, who have direct and ongoing engagement with the unit. Quantitative and qualitative data were analyzed separately and then integrated through triangulation to develop a comprehensive understanding of the facility's performance.ResultsDecentralized nursing stations improved staff responsiveness and patient proximity but reduced informal peer communication. Integrated Labor-Delivery-Recovery-Postpartum/Neonatal Intensive Care Unit rooms supported care continuity and family involvement, though some ergonomic challenges in staff workspaces were reported. Lighting design fostered a calming, residential atmosphere. Acoustic outcomes were mixed-overall noise levels decreased, but localized disturbances remained.ConclusionsThe maternity unit met key design goals in lighting, spatial efficiency, and family-centered care. Yet, improvements in communication, workspace ergonomics, and supply accessibility are needed. This study highlights the value of POE methods rooted in perception and triangulation to inform future evidence-based design improvements in healthcare environments.

ObjectiveThe purpose of this study was to investigate how environmental affordances in the behavioral health inpatient milieu affect a patient's sense of autonomy.BackgroundPatients who feel empowered are more likely to participate in their care, which can, in turn, improve the quality of care (Ippolito et al. 2020). However, the lack of patient empowerment can have negative consequences in behavioral health facilities such as intensified physical violence, aggression, and loneliness in the milieu (Bellman et al., 2022; Dell et al., 2019; Hickmann et al. 2022). Research has also demonstrated that patient empowerment is closely linked to patient autonomy (Gagné, 2003; Hodgins et al., 2006). However, there is little insight as to how milieu spaces can foster patient autonomy.MethodsThis study utilizes a triangulated methodology to conduct a post occupancy evaluation through an on-site environmental assessment and behavioral observations within key milieu spaces.ResultsThe results demonstrated that access to scenic views, tactile features, patient's ability to move freely throughout the unit, and access to immediate provider care were significant indicators that differentiated patient autonomy between facilities. The behavioral observations showed that negative behaviors occurred around the edges of the milieu as well as when external stressors were involved. The autonomy score findings encapsulated by the designer evaluation were also closely associated with the frequency of positive behaviors observed by staff.ConclusionOutcomes include responsive design recommendations for design implementation.

This systematic literature review, following the PRISMA statement, aims to review the knowledge of how the indoor lighting environment and color palettes impact individuals living with Autism Spectrum Disorders (ASD), particularly their behavior and lighting and/or color preferences. A supportive built environment is crucial for persons with ASD. Lighting design (daylight and electrical lighting) and color schemes significantly impact their behavior, information processing, and overall well-being. Despite its importance, lighting design for autism has received limited attention in architecture and design research. A comprehensive search across seven electronic databases (PubMed, CINAHL, SveMed+, and four library databases including Oria, Regina, the British National Bibliography, and the Royal Danish Library), followed by a thorough review and critical appraisal, resulted in seven (7) high-quality studies with moderate to low risk of bias. Articles were assessed using three standardized checklists, for example, JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies, JBI Critical Appraisal Checklist for Qualitative Research, and Mixed Methods Appraisal Tool (MMAT). The findings are consistent with previous research and confirm that light and color influence ASD individuals' behavior and sensitivity. However, there is a substantial gap in understanding practical applications, as most studies are descriptive or exploratory rather than experimental. Future research should emphasize experimental approaches to develop evidence-based guidelines for designers.

ObjectivesOur study examines experiences of patients admitted to multibedded patient rooms in a former hospital building, compared to patients' experiences in single-occupancy patient rooms (SPRs) in a new hospital building, designed according to principles of a healing environment.BackgroundTo improve patients' privacy, comfort and infection control, newly built hospitals increasingly accommodate patients in SPRs.MethodsIn a single-center, before-after study, patients completed a questionnaire of 40 items in four domains: privacy, sanitary facilities, patient room and ward layout. This substudy was embedded within the WELCOME study.ResultsA total of 227 participants were involved in the before-measurement and 416 in the after-measurement. Patients considered the SPRs better in terms of privacy; more than 90% of participants (strongly) agreed with the privacy-related questionnaire items. Sanitary facilities, patient rooms and ward layout were also rated higher in the new hospital building. For most questionnaire items pertaining to these domains, more than 80% of patients in the new facility (strongly) agreed. 23.5% of respondents in the new building reported missing the companionship of fellow patients.ConclusionsPatients rated the 100% single-occupancy ward configuration more favorably than the former multi-occupancy layout, with enhanced privacy emerging as an important advantage. However, this same privacy can leave some patients feeling isolated. Future studies should explore targeted interventions-such as structured social activities or volunteer-led engagement-to mitigate loneliness and promote mobilization, while preserving the established benefits of SPRs.

ObjectivesThis study quantified the total time required by staff to complete intrahospital transfers (IHTs) and identified key activities and facility attributes affecting efficiency.BackgroundIHTs, which involve moving patients between rooms or units, place significant demands on healthcare staff and facility resources. While previous studies have explored the impact of IHTs on patient safety and clinical efficiency, few have assessed the specific tasks and time demands on all staff members involved.MethodsFifty IHTs (39 between-unit, 11 within-unit) were observed at a 718-bed level-1 trauma hospital. Transfer tasks were categorized into 13 activity types. These included managing equipment, belongings, and supplies (EBS), handoff communication, and patient transport.ResultsIHTs required a mean of 77 min of staff time, 53 min (75%) of which was nursing time. EBS management accounted for the largest share of transfer time, followed by handoff communication. Transfers with an increase in acuity level required more staff and additional total time. Elevator use was associated with a significant increase in nursing time. Issues that added to transfer time included miscommunication about room readiness and the need to acquire or transport specialized equipment.ConclusionsStreamlining EBS processes, optimizing staffing for acuity-related transfers, and improving elevator availability could reduce IHT times and alleviate workload on nurses. Enhanced coordination during shift changes, better communication about room readiness, and support for non-clinical tasks offer further opportunities to improve efficiency. These findings underscore the role of facility design and operations management in enhancing hospital efficiency, reducing nursing burden, and improving patient care.

Objectives, Purpose, or AimThis study investigates how physical environmental features influence balance loss and falls among women in their third trimester of pregnancy. It aims to identify environmental affordances that contribute to or mitigate fall risks.BackgroundFalls during pregnancy pose significant risks to maternal and fetal health. Understanding interactions between pregnant women and home environments is essential for effective fall prevention. This study employs ecological and dynamic systems theories to explore these interactions.MethodsWeekly interviews were conducted with 13 pregnant women in their third trimester. Participants documented real-world incidents of falls and near-falls within home environments. Data were analyzed to identify patterns in environmental affordances and behaviors linked to balance loss and fall prevention.ResultsFindings identified three types of affordances:• supporting behavior (e.g., sufficient lighting levels to navigate spaces).• increasing risks, such as low furniture, slippery surfaces, and inadequate supports.• used to avoid falls.Behaviors linked to falls included rising from low furniture, descending stairs, navigating cluttered spaces, and entering bathtubs. Environmental factors like slippery surfaces and open furniture layouts were key contributors.ConclusionsFalls during late pregnancy result from complex interactions between environmental and behavioral constraints. This study offers insights into designing safer environments tailored to pregnant women's needs. Limitations include recall bias and limited generalizability due to the small sample size. Despite these, the study provides a strong foundation for future research and fall prevention strategies.

To clarify the influence of daylight access on patients' and their companions' stress perception and coping behavior (communication) in cancer hospital waiting areas. In patient care, managing stress and encouraging effective coping strategies are essential. Daylight has shown as a modulator of stress responses and coping behaviors. Limited research has been done regarding the impact of daylight access on the waiting experience of cancer patients and their companions. Empirical data were collected through on-site observations and questionnaire surveys in 30 waiting areas across seven cancer hospitals in China. Based on responses from 419 patients and 371 family companions, we examined differences in stress and communication between groups in the areas with and without daylight access. Multivariate logistic regression models were used to assess the significance of daylight access and communication in predicting stress. Patients and families in the areas with daylight access communicated more with peers ( ≤ 0.05) and perceived less stress ( ≤ 0.10) compared to those in windowless areas. They also communicated more with nurses, though this difference was not statistically significant ( > 0.10). Participants who engaged in more peer communication reported less stress ( = 0.00). Daylight access and peer communication significantly contributed to stress reduction, explaining over 15% of the variance in stress, along with personal and social variables in modeling. Access to daylight in the waiting areas of cancer hospitals reduces stress and promotes communication among patients and family companions. Healthcare facilities should provide daylight access in their waiting areas to reduce stress and encourage communication.

This study explores how future-proofing is understood and applied in hospital building design, focusing on the perspectives of experienced architects. It aims to examine the practical implications of future-proofing and to identify key barriers to its implementation within contemporary healthcare infrastructure projects. Existing literature often focuses on the general benefits, such as cost savings and sustainability, but lacks detailed analysis of the multifaceted implications and obstacles encountered in real-world projects. This study addresses this gap by directly examining architects' perspectives, offering critical insights into the practical realities and complexities of future-proofing hospital buildings, thereby contributing to a more nuanced understanding and informed decision-making in this field. Sixteen semistructured interviews were conducted with experienced hospital architects based in Australia. Data were analyzed using a combination of deductive and inductive thematic analysis. The results of thematic analysis have been categorized under three overarching categories: perceived benefits, perceived drawbacks, and implementation challenges. The findings highlight that future-proofing is neither inherently beneficial nor burdensome, but rather a context-sensitive strategy that must be tailored to each project's evolving operational, economic, and policy. The study underscores the need for more systematic, longitudinal evaluation of future-proofing strategies, as well as greater integration of advanced futures methodologies into healthcare planning and design processes. A more structured and evidence-based approach to future-proofing can support the development of hospital infrastructure that is both resilient and responsive to the long-term evolution of healthcare systems.

ObjectivesThis study aims to explore how architects perceive their role in designing Extra Care Housing (ECH) environments in the UK, focusing on the impact of architectural design on the quality of life (QoL) for older residents.BackgroundECH represents a housing model for older adults that emphasizes independence, community integration, and access to care services. While existing literature examines ECH from healthcare and policy perspectives, little is known about how architects approach its design. This study addresses that gap by investigating architects' perspectives on designing ECH to enhance residents' autonomy, safety, and social inclusion.MethodsSemi-structured interviews were conducted with 12 architects across seven UK locations who specialize in ECH projects. Data were analyzed using thematic analysis, supported by qualitative software tools (Atlas.ti and NVivo), applying a primarily deductive coding approach based on six QoL domains. Code concurrence was assessed through cross-tabulations to explore interconnections between sub-themes.ResultsFindings reveal three overarching themes--each encompassing subthemes that illustrate how design supports autonomy, social interaction, and spatial orientation. Additionally, the study identifies a cross-cutting theme, , as a critical yet often overlooked dimension in ECH design. Participants also highlighted persistent challenges, including regulatory constraints and limited financial resources.ConclusionsArchitects view ECH design as a balance between promoting independence and accommodating care needs. Their insights underline the importance of community-connected design, flexible spaces, and unobtrusive safety features. These findings inform future ECH practices and underscore the need for interdisciplinary collaboration in housing design for older adults.

BackgroundPediatric patients increasingly seek care for mental and behavioral health (MBH) conditions in Emergency Departments (EDs). Yet, ED environments are poorly designed, organized, and equipped to deliver safe, effective care to these patients. There is an urgent need for solutions that improve safety and care quality and support provider wellbeing. To address this need, our team brought together experts from across the United States to identify and prioritize the most urgent challenges for further study and design intervention.MethodsA workshop held in September 2023 brought together 61 multidisciplinary experts and clinical stakeholders to identify, prioritize, and brainstorm solutions for the most urgent challenges facing EDs in providing care to pediatric MBH patients. Breakout groups built upon presentations from leaders in pediatric emergency healthcare and the research team's study findings to identify the six most critical challenges and brainstorm possible systems-based interventions to solve them.ResultsKey challenges included accommodating families, supporting flexibility and adaptability, respecting patient dignity and humanity, optimizing communication, minimizing the psychological effects of boarding, and safely supporting coping. The ideas generated in this workshop indicate that built environment interventions that facilitate flexible caregiving, support sensory environment control, and balance patient privacy with staff monitoring and ED policy and process interventions that clarify care team roles and standardize processes may support pediatric MBH care better.ConclusionsThe ideas generated in this serve as a framework and catalyst for researchers and health systems interested in developing systems-based solutions to the complex challenges of pediatric emergency mental healthcare.

AimThe study aims to explore and preliminarily address the needs of users in the diagnostic imaging departments. The identified needs have been translated into initial design concepts for a proposed layout of diagnostic imaging departments, informed by systematic literature review to address the requirements of patients, nurses, technologists, and radiologists. The research examines the potential influence of these design concepts on fulfilling users' needs.BackgroundThe imaging department is recognized as a main diagnostic unit in hospitals. Nearly all patient categories, including inpatients, outpatients, and emergency patients, utilize this department, as do its staff members.MethodsA proposed layout for the department has been designed to address the demands of patients and staff while simplifying the flow of various patient kinds. Fifty experts, including healthcare designers, technologists, and radiologists in Saudi Arabia, evaluated this proposal through a questionnaire survey.ResultsThe findings demonstrate that the proposal could fulfill patients' requirements for flow organization (88%), privacy (78%), and reduced travel distance (70%), while also addressing staff demands for patient observation in waiting rooms (88%), travel efficiency (82%), and confidentiality (94%). This layout additionally supports family presence (78%), can improve the acoustic environment (86%), and enables daylight (92%).ConclusionThis study presents a layout for the imaging department that would potentially address the requirements of patients and staff; hence, it can enhance the healthcare environment within these facilities.

The present case study explores insights related to navigating biophilic design innovation in public healthcare using the Outdoor Care Retreat at Oslo University Hospital and the Hospital of Southern Norway as a case. Available research from environmental psychology proposes an association between access to biophilic design, well-being, health, and hospitalization satisfaction. Still, integrating this research into public healthcare is challenging and there is a need for research that builds on innovative examples of biophilic design integration in this context. Study findings are based on eight individual interviews with people involved in project initiation and development of the Outdoor Care Retreat, in addition to online public records and other digital documents related to the case study. The qualitative materials were analyzed according to reflexive thematic analysis and categorized into themes. Findings illustrate how moving beyond conventional healthcare practices can support the implementation of biophilic design. Specifically, the findings suggest that biophilic design in healthcare benefits from an appealing story, individual contributions, and an organizational and environmental context that challenges common conventions. Drawing from research from public healthcare innovation and biophilic design, the study outlines key insights for implementation. This study contributes to bridging the gap between theory and practice in a public healthcare context. It offers key insights for implementing biophilic design in healthcare environments, with the potential to ensure valuable improvements in the hospitalization experience for patients and their families in future developments of public healthcare facilities.

The delivery of preventive and primary care has evolved through various physical environments, from early twentieth-century house calls to centralized settings like physician offices and hospitals, and more recently, through rapid adoption of telehealth. This shift occurred amidst an increasing emphasis on patient/person-centered care models. This article conceptually examines the role of the physical environment in optimizing patient/person-centered care within telehealth, focusing on preventive and primary care in the pre-acute stages. A rapid scoping review was conducted to identify key underlying dimensions of patient/person-centered care. Each dimension was further examined to identify theoretical background and measurement instruments used in the field, to obtain a detailed comprehension of the concepts. A series of brainstorming sessions among contributing authors, in association with logical theory-supported arguments, were conducted to articulate conceptual associations and detect the potential role of the physical environment. An articulation of the relationships between six underlying dimensions of patient/person-centered care is proposed: Shared Decision-Making, Autonomy, Communication, Empathy, Trust, and Privacy. Furthermore, the potential role of the physical environment in the pathway to patient outcomes is posited. Physical separation of providers and patients may present challenges to achieving optimal performance in key dimensions of patient/person-centered care. The physical environment of telehealth care has a potential role to play in care optimization.

Children scheduled for surgery and anesthesia often experience fear and anxiety before the procedure, as well as pain afterward. While medical treatments are essential for managing these challenges, design strategies that positively influence environmental and psychological factors can significantly improve children's experiences and their overall subjective well-being. This narrative literature review examines "design for well-being" strategies that support the subjective well-being of children undergoing surgical procedures. According to the World Health Organization, health is defined not merely as the absence of disease but as a state of complete physical and mental well-being. Achieving such well-being requires not only medical care but also the optimization of environmental and psychological conditions that impact emotional states. Today, evidence-based, multidisciplinary approaches are recommended to promote well-being. In health-related design, one focus is on improving the quality of medical care, while another addresses non-medical factors that influence subjective well-being. This research employs a non-systematic literature review methodology, utilizing existing literature and evidence-based approaches to synthesize relevant strategies. Enhancing subjective well-being-through evidence-based design strategies such as age-appropriate environmental modifications, sensory-friendly elements, and interactive distraction tools-alongside optimized medical practices in pediatric surgeries contributes to improved clinical outcomes and reduced perioperative stress. The review highlights "design for well-being" strategies, which effectively support the subjective well-being of children undergoing surgical procedures. Emphasizing "design for well-being" strategies is crucial for enhancing the overall experiences and well-being of children undergoing surgery. Future research should focus on the implementation and long-term impact of these design interventions to further validate their effectiveness and scalability.

AimThis study aimed to examine the factors influencing leisure walking intention among older adults in urban residential areas, analyze their interrelationships, and propose strategies for promoting walking activities.BackgroundUnderstanding the factors influencing walking intentions among older adults is essential for developing interventions that enhance physical activity levels in an ageing society. A comprehensive approach that integrates psychological and environmental factors provides deeper insight into these influences.MethodsData were primarily obtained from older adults aged 60 years and older residing in five residential areas in Guilin, China, selected based on construction time, population density, available facilities, and aesthetic design. Participants were recruited through assistance from residential management. After excluding questionnaires with ineligible ages, excessively short completion times, or uniform responses, 527 valid questionnaires were retained. Data analysis was constructed using structural equation modeling, integrating the Theory of Planned Behavior and the Health Belief Model. Reliability and validity of the questionnaire were evaluated through Cronbach's alpha, composite reliability, factor loadings and average variance extracted.ResultsThe findings of this study revealed that among the factors influencing walking behavior intention, attitudes towards walking had the strongest positive effects. Perceived environmental barriers have a stronger negative impact on walking intention than perceived personal barriers.ConclusionsImproving residential walking facilities to reduce environmental barriers and enhancing community health education to reinforce health beliefs are effective strategies for promoting physical activity among older adults. These findings provide practical guidance for urban planning and public health initiatives.

Environmental design in palliative care settings receives increasing attention, yet methodologies for studying such environments often lack interdisciplinary integration. Traditional research designs may overlook the lived expertise of clinicians and designers. This article describes a collaborative, cross-disciplinary communities-of-practice model developed as a methodological framework to enable effective environmental evaluation and design processes in healthcare settings. Its application is illustrated through a case study in a palliative care unit. A co-designed, multi-methods approach was developed by a team of clinicians, facility managers, and academic researchers. The methodology included a scoping review, site-specific environmental data logging (sound, temperature, lighting), and co-created survey tools for staff and patients or proxies. Data were collected over two phases, following ethically approved protocols to protect privacy and support data validity. The communities-of-practice model successfully integrated cross-sector expertise, improved the contextual relevance of study instruments, and enabled real-time, context-sensitive data collection in a high-acuity clinical setting. The method supported context-aware adaptations that would not have emerged from conventional top-down research approaches, effectively bridging academic inquiry and practical clinical application. The communities-of-practice model offers a replicable, interdisciplinary method for researching complex healthcare environments. Its case study in a palliative care unit demonstrates its capacity to generate actionable insights aligned with patient-centred outcomes. As health architecture increasingly intersects with evidence-based care delivery, such methodological approaches are vital for aligning design decisions with clinical and human-centred goals.

With the growing demand for dementia-friendly care environments, existing smart room designs often lack systematic methods to translate user needs into functional solutions. This study proposes an integrated Kano Model, Analytic Hierarchy Process, and Quality Function Deployment (Kano-AHP-QFD) framework to optimize the design of smart living rooms for dementia patients in nursing homes. Through literature reviews and user interviews, 22 user requirements were identified and categorized using the Kano model. The AHP was then employed to prioritize these requirements, with "behavior recognition (e.g., falls, wandering)" emerging as the top priority, assigned a weight of 0.3622. Subsequently, the QFD method translated these weighted requirements into design functions via the House of Quality, resulting in a set of optimized smart living room designs. The study demonstrates that the integration of Kano-AHP-QFD provides a structured and data-driven approach to systematically address the complex needs of dementia patients, enhancing the scientific rigor and practicality of smart room design. User satisfaction scores improved from 61.655 to 80.663 after implementing the optimized smart living room designs. The proposed framework offers valuable insights for designers, care providers, and policymakers aiming to improve the quality of life for elderly individuals with dementia. It is also applicable to various cognitive impairment care scenarios such as rehabilitation centers and assisted living facilities, and can provide scientific references for the environmental design of other special user groups.