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Users' Evaluative Responses to Spatio-Physical Humanization: the Case of Hospital Environment

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  • Environmental Evaluation
  • Health-Care Environments
  • Perceived Qualities
  • Spatio-Physical Humanization
  • User-Centered Design
  • Design
  • Ecology
  • Education
  • Geography
  • Medicine


"IntroductionThe present contribution regards a study on the relationship among spatio-physical humanization, specific indicators of perceived environmental quality and molar evaluative responses such as environmental satisfaction and dimensions of perceived affective quality. Hospital environment represents the typology of place selected as research target for model-testing. In the field of environmental evaluation, a main broad distinction (e.g., see Gifford, 2002) has been done between: a) "expert" evaluation, based on either objective physical measures or expert judgements; b) "lay" evaluation, based on users' observation and perception and influenced by place experience. The research literature on environmental lay evaluation has mainly reported a distinction (see Gifford, 2002; Bonnes, Secchiaroli, 1995) between environmental appraisal, which is more "person-focused", and environmental assessment, which is more "place-focused”. The research approaches on affective qualities of places (Russell, Lanius, 1984) - regarding the field of environmental appraisal - and on indicators of perceived environmental quality (Craik, Zube, 1976) - regarding the field of environmental assessment - were applied in the light of spatio-physical humanization of built environment. This refers to design attributes such as light, colors, materials, views on the outside, furniture, lay-out, spatial configuration, orienteering. Attention and care toward these features may contribute to make an health care setting "more humane" (Nagasawa, 2000), i.e. healthier. The satisfaction of needs such as perceptual consistence, control over space, clear affordance, and restorativeness (Evans, McCoy, 1998) may moderate the stress level and produce an healing effect on users of hospital environments. With reference to healthcare settings, spatio-physical humanization represents a component of the broader concept of healthcare humanization, which includes organizational, relational and therapeutic aspects.Objective and hypothesesThis study aims at verifying the relationship among different typologies of environmental evaluation in the hospitals. Such typologies include: a) degree of Spatio-physical Humanization (SH), concerning the "expert" evaluation; b) Indicators of Perceived Hospital Humanization (IPHHs), concerning the environmental assessment; c) Perceived Affective Qualities (PAQs), concerning the environmental appraisal, and Satisfaction toward the ward (S), which are here considered as more molar evaluative responses. The following hypotheses were tested:1) the higher the degree of SH, the higher the scores of positive PAQs and S;2) the higher the degree of SH, the higher the scores of IPHHs (this would mirror a congruence between "expert" and "lay" evaluation);3) the relationships between i) SH and ii) PAQs and S are mediated by IPHHs;4) socio-demographics have poor weight on PAQs and S.MethodThe research was led in a medium-large hospital of an Italian town (about 50.000 inhabitants). On the basis of an expert evaluation, two more humanized units and two less humanized units were selected. Participants (N = 156) were sampled among the three main categories of hospital users ( i.e. patients, staff and visitors) and contacted directly in the hospital units. Tools included: 1) an "expert" evaluation grid (to measure SH), filled in by 2 graduated in Architecture,; 2) a self-report questionnaire, including the Scale of Affective Quality of Places (to measure QAPs), a series of scales concerning spatial-physical, social-relational and organizational-functional features of hospital environment (to measure IPHHs), and a three-item scale of satisfaction toward the hospital unit (to measure S)Statistical analyses include ANOVAs (DVs: PAQs, S and IPHHs; IV: SH) and hierarchical regression models (criteria: PAQs and S; predictors: gender, age and education at I step; SH at II step; IPHHs) at III step.ResultsResults confirm the hypotheses. More specifically:1) the more humanized units get significantly higher scores in PAQs and S;2) the more humanized units get significantly higher scores in IPHHs;3) the (significant) positive relationship between i) SH and ii) PAQs and S becomes non-significant if IPHHs are added in the predictive model;4) socio-demographics are not significantly influent in almost all cases.ConclusionsThese results on one side provide empirical evidence about the importance of spatio-physical features of places on users' satisfaction responses; on the other side, they show a prominent role of perceived quality of specific environmental features (based on users' place experience) if compared to expert judgements (based on professional background, knowledge and competence). "

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