Given the importance of quality healthcare scenarios, the present symposium offers a semblance of six different studies within an environmental-transitional perspective. Because of the interaction between people and environment, it is pertinent to explore if the transition to a healthier environment might be favored or hindered by the physical elements that integrate it or by the interpretation that users make about them. These studies consider different environmental levels from a macro to a micro scale; they entail the inclusion of different users and interactions with those environments; and take up the tendency to look at health-related scenarios from the interface of physical design with psychological aspects.

From inside the patient room, a set of amenities and features are included in the design intended to decrease stress and promote environmental control, social support and positive distraction. Moving forward to the waiting room of a Pediatric Intensive Care Unit, two different studies aim to reduce stress of the mother or the primary caregiver due to environmental modifications. First, three case studies contribute to understand how to improve quality of life, well-being, public health policies and health attention by humanization in a high complexity hospital, space appropriation of a public children hospital (environment disruption) and space appropriation of post-surgical patients (transitory environment). On the other hand, the positive stimulation of art based in evidence is assessed as a possibility to reduce stress and generate subsequent therapeutic benefits on primary caregivers. For that purpuse, objective and subjective indicators were considered in order to incorporate both aspects of stress.

Outside the hospital, the perceived quality indicators of external spaces, interior common spaces, and private spaces on hospices for terminally ill patients seem to affect the general users’ satisfaction towards the hospice environment. Then, this indicators should be considered in order to promote positive feelings in persons living a stressful phase. At a house environment, the management of health and wellbeing in an ageing population is relevant to support healthcare and social inclusion of elderly people. The development of a system-product concept of assisted living for elderly people through a design framework including “positive technologies” must be around user needs and integrated in the home environment. Finally, physical environment for outdoor activities in residential communities is a key for healthy communities. Thereby, the physical evaluation of the environment and the activities realized within it suggest that at least three characteristics affect outdoor activities: accessibility, affordance and comfort of the environment. More effective designs promote such activities in order to promote a healthy community.

Furthermore, this symposium is characterized by its cultural richness derived from the inclusion of proposals from European, Asian, and Latin-American countries, to ensure healthy and positive environments that provide a better quality of life for patients, families, dwellers and communities.

Hospital rooms and patients’ well-being: Psychological variables.

Cláudia Campos Andrade & Ann Sloan Devlin

The physical environment of hospitals can be a source of stress if unsupportive of patients (Ulrich, 1991). Based on Ulrich’s theory of supported design, this study examined whether the presence of certain design options in inpatient rooms have stress-reducing effects because they foster a) sense of control over physical-social surroundings, b) access to social support, and c) access to positive distractions. More specifically, we investigated whether perceptions of control, social support, and positive distractions are mediators of the effect of the hospital room environment (its features/amenities) on stress. The experiment employed a between-subjects design with participants randomly assigned to one of eight possible conditions. A scenario was presented asking participants to imagine that they had been hospitalized with symptoms of acute appendicitis. Depending on experimental condition, participants were exposed to an illustration of a hospital room accompanied by a different set of amenities and features intended to promote: a) environmental control (EC), b) social support (SS), c) positive distraction (PD), one of the possible combinations (EC+SS, EC+PD, SS+PD, EC+SS+PD), or no amenities. Results showed that the more elements presented in the hospital room (0, 4, 8 or 12), the less the stress expected (r=-.264, p<.001). Other results, including the results of the mediation analyses, will be discussed in terms of how hospital rooms can be purposely designed to improve patients’ experience, well-being, and recovery.

Environmental Psychology and Healthcare for Chronicles Diseases: Contributions from Case Study Researches in São Paulo, Brazil.

Marlise A. Bassani.

Chronicles diseases treatments usually demands severe changes in patients´ routine and environment. Some examples can be listed: a) environmental addition, patient has a new environment as part of his routine; b) environmental disruption, treatment demands total change and new alternatives in the environment; c) adaptation in everyday environmental conditions, with modifications at homecare (Bassani, 2012). High technological healthcare and staff-patients/families relationships have been developed in opposite directions. Environmental Psychology researches on space appropriation, privacy, transitory places, humanization in healthcare institutions have being providing helpful understanding to improve quality of life and suggest changes in public health policies. Three case studies exemplify these contributions in São Paulo (Brazil): humanization in a high complexity hospital from the perspective of intensive therapy pediatricians (Goldenstein & Bassani, 2012); a mother and a child from an agricultural area in Amazonia, and their process of space appropriation of a public children hospital for complexity diseases in São Paulo (the biggest city in Brazil), a complete disruption of environment (Nunes & Bassani, 2011); and space appropriation of post-surgical patients in the infirmary of a public hospital, a short-time transitory environment (Alves & Bassani, 2011).Outcomes are discussed relating health attention and sustainability perspectives for well-being and well-fare.

Positive distraction as therapeutic intervention in primary caregivers

Patricia Ortega-Andeane, Filiberto Toledano Toledano & Cesareo Estrada-Rodriguez

Prior studies (Ulrich, et. al. 2004, Ulrich, 2009; Hathorn & Nanda, 2008) have identified the impact of artistic images in hospitalized patients by offering positive stimulation during their stay, impinging in even a better and faster recovery. However, Ulrich (2009) arguments that patients with a high acute stress level can be more vulnerable to interpret art with abstract images as stressful or even as threatening. Because of the above works art pieces containing images with positive outcomes have been identified for being considered as art based in evidence and with the possibilities of offering a better hospitality stay and even a faster recovery in patients.

Regarding the content of art pieces, Nanda, Ortega-Andeane, Solovyova, Bozonic-Stamenovic & Bajena (in press) investigated the differences in the art preferences of architecture and psychology/sociology students from three universities in Mexico, United States, and Singapore based on their ratings of a set of art images. Top rated and bottom rated images were common across colleges and disciplines, which suggests that there is a certain universal appeal for restorative images of nature (top rated) that go beyond geographical and educational boundaries.

In the context of chronic pediatric diseases, the disease represents a vital event which affects the patient and his or her family, as they suffer high stress levels and in consequence there is required an important amount of time, energy and personal resources to overcome the stressors and exigencies associated to the disease, with effects on the quality of life and family functioning.

For that reason, the visual restorative stimulation is an element to distract positively the primary caregiver, allowing diminish the psychological effects that the hospital care of the patient implicates.

In this study the positive effects of the exposure to the restorative pieces of art (the top rated images from the previous study) on psychological and physiological stress was evaluated in 80 primary caregivers of chronic pediatric patients during their stage in high stress waiting rooms -intensive care units- in a hospital.

The results of this study mark the possibility of include objective indicators such as the exposure to the restorative images of nature through art, and subjective indicators such as perceived stress, in order to create hospital areas with positive stimulation, which can be traduced into a real possibility of transform a negative environment into a positive one with the subsequent therapeutic benefits and into a better quality of life perception of the primary caregivers.

Toward more “humanized” healthcare environments: The perceived quality of the Hospice structures

Ferdinando Fornara, Marino Bonaiuto & Sara Manca

This contribution presents a preliminary study concerning the perceived environmental quality of Hospices, i.e. those structures which are used by terminally ill patients receiving palliative care. Moving from a design perspective which is both “user-centered” and “evidence-based”, the study is focalized on the construct of Spatial-Physical or Design Humanization, which is particularly appropriate for the healthcare environments, since it regards the satisfaction of users’ psychological needs such as spatial and sensorial comfort, orientation, sense of welcome, and privacy.

Data were collected in nine hospices, covering all the Italian territory (i.e., North, Centre, South, and Isles), by means of a questionnaire administered mostly to the main Hospice users (i.e., patients and relatives). The questionnaire included an adapted version of Perceived Hospital Environment Indicators (PHEQIs: Fornara; Bonaiuto, & Bonnes, 2006; Andrade et al., 2012).

Results show significant relationships between most of the perceived quality indicators (regarding three different hospice sub-places, i.e. external spaces, interior common spaces, and private spaces) and the general users’ satisfaction towards the hospice environment. This would suggest to the hospice designers to pay specific attention to such indicators, in order to promote positive feelings in persons who are living a particularly stressful phase of their life.

Design for active ageing: the use of “positive technologies” in assisted living of elderly people

Marco Camilli, Arianna Salvetti, Viktor Malakuczi, Loredana Dilucchio & Antonio Paris

This study lies in two relevant research areas and societal challenges: (1) the ageing population and (2) the management of the levels of health and wellbeing. The research includes a multidisciplinary experimental activity aimed to develop a system-product concept of assisted living for elderly people through “positive technologies”. These letter, indeed, are designed around user needs and integrated in the domestic environment. Results concern with four key factors affecting on older people's lives: (1) remaining as much as possible in one's habitual setting and change as little as possible, (2) continuing being able to do and learn on one's own, (3) good opportunities to continue planning one's own life, and (4) support for memory functions. The final aim of this research project is the definition of a design framework including “positive technologies” oriented to support healthcare and social inclusion of elderly people.

Study on Health-related Outdoor Activities in Newly Developed Residential Communities of China

Qing Yin & Ryuzo Ohno

Until 1998 most urban residents in China lived in housing provided by the government organization that employed them. Because workers from the same organization usually lived together in a community, social interactions were inherently strong. However, residential communities have changed drastically since the Chinese government initiated a commodity housing policy in 1998. Although newly developed communities have improved physical attributes, such as more sophisticated building and open space designs, social interactions have become weaker due to increased diversity and unfamiliarity with neighbors. Hence, a serious issue in China is how to rebuild a strong social network in new communities.

Outdoor activities in residential communities help promote social interactions and mutual support between neighbors. In addition to maintaining residents’ physical and mental health, social interactions eventually prevent crime within a community. To promote outdoor activities, the physical environment has been highlighted as a key for healthy communities. To verify this assertion, herein the relationship between a neighborhood’s physical characteristics and outdoor activities is examined through an intensive field survey in Tianjin, China.

In a preliminary survey, we selected four residential communities, which have been established for more than ten years and built basic social networks while conforming to the commodity housing policy. For each community, we divided the outdoor open spaces into 20–30 subspaces, where each subspace was separated by buildings or wide roads. We obtained a total of 96 subspaces in the 4 communities. Each subspace was classified into 1 of 14 different categories according to its physical characteristics (e.g., size, equipment present, etc.).

For the intensive survey, 33 of these subspaces were selected as targets based on the types of observed human activities and physical characteristics. The survey involved two steps. The first recorded the physical environment of the target subspaces using a checklist and describing data on a map. The second observed and recorded outdoor activities using behavior mapping.

The relationship between the physical environment and outdoor activities suggests that there are at least three important physical characteristics that affect outdoor activities: accessibility, affordance, and comfort. Accessibility refers to the number and position of entrances into a space and their proximity to buildings entrances and the community. Accessibility affects the number of users. Affordance indicates the possibility of an activity, which influences actual activities and number of users in a space. In this case, affordance provides information about function or possible uses of the facilities, physical elements, and size of the space. While accessibility and affordance influence number of users, whether people choose to stay and use a space mainly depends on the comfort of physical environment.

Consequently, a healthy community requires more than a clean and functional environment. It requires places where people can interact with each other to enrich their social life. The present study suggests some effective designs of outdoor spaces to promote such activities.