Hospital Greenspaces and the Impacts on Wayfinding and Spatial Experience: An Explorative Experiment Through Immersive Virtual Environment (IVE) Techniques
Restricted accessResearch articleFirst published online July, 2022
Hospital Greenspaces and the Impacts on Wayfinding and Spatial Experience: An Explorative Experiment Through Immersive Virtual Environment (IVE) Techniques
Navigating large hospitals can be very challenging due to the functional complexity as well as the evolving changes and expansions of such facilities. Hospital wayfinding issues could lead to stress, negative mood, and poor healthcare experience among patients, staff, and family members.
Objectives:
A survey-embedded experiment was conducted using immersive virtual environment (IVE) techniques to explore people’s wayfinding performance and their mood and spatial experience in hospital circulation spaces with or without visible greenspaces.
Methods:
Seventy-four participants were randomly assigned to either group to complete wayfinding tasks in a timed session. Participants’ wayfinding performances were interpreted using several indicators, including task completion, duration, walking distance, stop, sign-viewing, and route selection. Participants’ mood states and perceived environmental attractiveness and atmosphere were surveyed; their perceived levels of presence in the IVE hospitals were also reported.
Results:
The results revealed that participants performed better on high complexity wayfinding tasks in the IVE hospital with visible greenspaces, as indicated by less time consumed and shorter walking distance to find the correct destination, less frequent stops and sign viewing, and more efficient route selection. Participants also experienced enhanced mood states and favorable spatial experience and perceived aesthetics in the IVE hospital with visible greenspaces than the same environment without window views. IVE techniques could be an efficient tool to supplement environment-behavior studies with certain conditions noted.
Conclusions:
Hospital greenspaces located at key decision points could serve as landmarks that positively attract people’s attention, aid wayfinding, and improve their navigational experience.
AllisonD. (2007). Hospital as city: Employing urban design strategies for effective wayfinding. Health Facilities Management, 20(6), 61–65.
2.
AppleyardD. (1969). Why buildings are known: A predictive tool for architects and planners. Environment and Behavior, 1(2), 131–156.
3.
ArthurP.PassiniR. (1992). Wayfinding: People, signs and architecture. McGraw-Hill Inc.
4.
BaskayaA.WilsonC.ÖzcanY. Z. (2004). Wayfinding in an unfamiliar environment: Different spatial settings of two polyclinics. Environment and Behavior, 36(6), 839–867.
5.
BlascovichJ.LoomisJ.BeallA. C.SwinthK. R.HoytC. L.BailensonJ. N. (2002). Immersive virtual environment technology as a methodological tool for social psychology. Psychological Inquiry, 13(2), 103–124.
6.
BrownB.WrightH.BrownC. (1997). A post-occupancy evaluation of wayfinding in a pediatric hospital: Research findings and implications for instruction. Journal of Architectural and Planning Research, 35–51.
7.
BubricK.HarveyG.PitamberT. (2021). A user-centered approach to evaluating wayfinding systems in healthcare. Health Environments Research & Design Journal, 14(1), 19–30.
8.
CalogiuriG.LitleskareS.FagerheimK. A.RydgrenT. L.BrambillaE.ThurstonM. (2018). Experiencing nature through immersive virtual environments: Environmental perceptions, physical engagement, and affective responses during a simulated nature walk. Frontiers in Psychology, 8, 2321.
9.
CarlsonL. A.HölscherC.ShipleyT. F.DaltonR. C. (2010). Getting lost in buildings. Current Directions in Psychological Science, 19(5), 284–289.
10.
CarpmanJ. R.GrantM. A.SimmonsD. A. (1985). Hospital design and wayfinding: A video simulation study. Environment and Behavior, 17(3), 296–314.
11.
ChiP.GutbergJ.BertaW. (2020). The conceptualization of the natural environment in healthcare facilities: A scoping review. Health Environments Research & Design Journal, 13(1), 30–47.
12.
ChiricoA.YadenD. B.RivaG.GaggioliA. (2016). The potential of virtual reality for the investigation of awe. Frontiers in Psychology, 7. https://doi.org/10.3389/fpsyg.2016.01766
13.
CohenJ. W. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Lawrence Erlbaum Associates.
14.
CooperR. (2010). Wayfinding for health care: Best practices for today’s facilities. AHA Press/Health Forum.
15.
Cooper MarcusBarnesCM. (Eds.). (1999). Healing gardens: Therapeutic benefits and design recommendations. John Wiley & Sons.
16.
Cooper MarcusCSachsN. A. (2013). Therapeutic landscapes: An evidence-based approach to designing healing gardens and restorative outdoor spaces. John Wiley & Sons.
17.
DoguU.ErkipF. (2000). Spatial factors affecting wayfinding and orientation: A case study in a shopping mall. Environment and Behavior, 32(6), 731–755.
18.
FaithV.HadjriK.RooneyC.CraigC.McAllisterK. (2015). Finding a way: Long-term care homes to support dementia. Proceedings of the Institution of Civil Engineers-Urban Design and Planning, 168(4), 204–217.
19.
GallupA. C.VasilyevD.AndersonN.KingstoneA. (2019). Contagious yawning in virtual reality is affected by actual, but not simulated, social presence. Scientific Reports, 9(1), 1–10.
20.
GeorgeD.MalleryP. (2003). SPSS for windows step by step: A simple guide and reference. 11.0 update (4th ed.). Boston: Allyn & Bacon.
21.
GotoS.ParkB. J.TsunetsuguY.HerrupK.MiyazakiY. (2013). The effect of garden designs on mood and heart output in older adults residing in an assisted living facility. Health Environments Research & Design Journal, 6(2), 27–42.
22.
HaqS.LuoY. (2012). Space syntax in healthcare facilities research: A review. Health Environments Research & Design Journal, 5(4), 98–117.
23.
HaqS.ZimringC. (2003). Just down the road a piece: The development of topological knowledge of building layouts. Environment and Behavior, 35(1), 132–160.
24.
HejtmanekL.StarrettM.FerrerE.EkstromA. D. (2020). How much of what we learn in virtual reality transfers to real-world navigation?. Multisensory Research, 33(4–5), 479–503.
25.
IvarssonC. T.GrahnP. (2010). Patients’ experiences and use of a therapeutic garden: From a designer’s perspective. Schweizerische Zeitschrift für Forstwesen, 161(3), 104–113.
26.
JamshidiS.PatiD. (2021). A narrative review of theories of wayfinding within the interior environment. Health Environments Research & Design Journal, 14(1), 290–303.
27.
Jansen-OsmannP.FuchsP. (2006). Wayfinding behavior and spatial knowledge of adults and children in a virtual environment: The role of landmarks. Experimental Psychology, 53(3), 171–181.
28.
JiangS.VerderberS. (2017). On the planning and design of hospital circulation zones: A review of the evidence-based literature. Health Environments Research & Design Journal, 10(2), 124–146.
29.
JosephA.BrowningM. H. E. M.JiangS. (2020). Using immersive virtual environments (IVEs) to conduct environmental design research: A primer and decision framework. Health Environments Research & Design Journal, 13(3), 11–25. https://doi.org/10.1177/1937586720924787
30.
KuligaS. F.NelliganB.DaltonR. C.MarchetteS.SheltonA. L.CarlsonL.HölscherC. (2019). Exploring individual differences and building complexity in Wayfinding: The case of the Seattle central library. Environment and Behavior, 51(5), 622–665.
31.
LeeS.DazkirS. S.PaikH. S.CoskunA. (2014). Comprehensibility of universal healthcare symbols for wayfinding in healthcare facilities. Applied Ergonomics, 45(4), 878–885.
32.
LiR.KlippelA. (2016). Wayfinding behaviors in complex buildings: The impact of environmental legibility and familiarity. Environment and Behavior, 48(3), 482–510.
33.
LloydJ.PersaudN. V.PowellT. E. (2009). Equivalence of real-world and virtual-reality route learning: A pilot study. Cyberpsychology & Behavior, 12(4), 423–427.
34.
LoomisJ. M.BlascovichJ. J.BeallA. C. (1999). Immersive virtual environment technology as a basic research tool in psychology. Behavior Research Methods, Instruments, & Computers, 31(4), 557–564.
35.
LynchK. (1960). The image of the city. The MIT Press.
36.
MadsonM.GoodwinK. (March10, 2021). Color coding the “labyrinth”: How staff perceived a two-part intervention to improve wayfinding in an adult emergency department. Health Environments Research & Design Journal. https://doi.org/10.1177/1937586721994593
37.
McNairD. M.LorrJ.DropplemanL. F. (2003). POMS brief form. Multi-Health Systems Inc.
MengF.ZhangW. (2014). Way-finding during a fire emergency: An experimental study in a virtual environment. Ergonomics, 57(6), 816–827.
40.
MillerC.LewisD. (2000). Wayfinding in complex healthcare environments. Information Design Journal, 9(2–3), 129–160.
41.
MontelloD. R. (2001). Spatial cognition. In SmelserN. J.BaltesP. B. (Eds.), International encyclopedia of the social & behavioral sciences (pp. 14771–14775). Elsevier.
42.
MourshedM.ZhaoY. (2012). Healthcare providers’ perception of design factors related to physical environments in hospitals. Journal of Environmental Psychology, 32(4), 362–370.
MurakoshiS.KawaiM. (2000). Use of knowledge and heuristics for wayfinding in an artificial environment. Environment and Behavior, 32(6), 756–774.
45.
O’NeillM. J. (1991a). Effects of signage and floor plan configuration on wayfinding accuracy. Environment and Behavior, 23(5), 553–574.
46.
O’NeillM. J. (1991b). Evaluation of a conceptual model of architectural legibility. Environment and Behavior, 23(3), 259–284.
47.
Ortega-AndeaneP.Urbina-SoriaJ. (1988). A case study of wayfinding and security in a Mexico City hospital. EDRA: Environmental Design Research Association, 19, 231–236.
48.
PallantJ. F. (2000). Development and validation of a scale to measure perceived control of internal states. Journal of Personality Assessment, 75(2), 308–337.
49.
PatiD.HarveyT. E.JrWillisD. A.PatiS. (2015). Identifying elements of the health care environment that contribute to wayfinding. Health Environments Research & Design Journal, 8(3), 44–67.
50.
PerskyS.McBrideC. M. (2009). Immersive virtual environment technology: A promising tool for future social and behavioral genomics research and practice. Health Communication, 24(8), 677–682.
51.
QuesnelD.RieckeB. E. (2018). Are you awed yet? How virtual reality gives us awe and goose bumps. Frontiers in Psychology, 9, 2158. https://doi.org/10.3389/fpsyg.2018.02158
52.
ReadM. A. (2003). Use of color in child care environments: Application of color for wayfinding and space definition in Alabama child care environments. Early Childhood Education Journal, 30(4), 233–239.
53.
RodriguesR.CoelhoR.TavaresJ. M. R. (2020). Users’ perceptions of signage systems at three Portuguese hospitals. Health Environments Research & Design Journal, 13(3), 36–53.
54.
RousekJ. B.HallbeckM. S. (2011). Improving and analyzing signage within a healthcare setting. Applied Ergonomics, 42(6), 771–784.
55.
SchubertT.FriedmannF.RegenbrechtH. (2001). The experience of presence: Factor analytic insights. Presence: Teleoperators & Virtual Environments, 10(3), 266–281.
56.
SloneE.BurlesF.RobinsonK.LevyR. M.IariaG. (2015). Floor plan connectivity influences wayfinding performance in virtual environments. Environment and Behavior, 47(9), 1024–1053.
57.
SmithJ. W. (2015). Immersive virtual environment technology to supplement environmental perception, preference and behavior research: A review with applications. International Journal of Environmental Research and Public Health, 12(9), 11486–11505.
58.
SpiersH. J.MaguireE. A. (2008). The dynamic nature of cognition during wayfinding. Journal of Environmental Psychology, 28(3), 232–249.
59.
StreinerD. L. (2003). Being inconsistent about consistency: When coefficient alpha does and doesn’t matter. Journal of Personality Assessment, 80(3), 217–222.
60.
TabachnickB. G.FidellL. S. (2013). Using multivariate statistics (6th ed). Boston: Pearson Education.
61.
TaberK. S. (2018). The use of Cronbach’s alpha when developing and reporting research instruments in science education. Research in Science Education, 48(6), 1273–1296.
UlrichR. S.ZimringC.ZhuX.DuBoseJ.SeoH. B.ChoiY. S.QuanX.JosephA. (2008). A review of the research literature on evidence-based healthcare design. Health Environments Research & Design Journal, 1(3), 61–125.
64.
VilarE. (2012). Using virtual reality to study the influence of environmental variables to enhance wayfinding within complex buildings. Universidade Técnica de Lisboa.
65.
VincentE.BattistoD.GrimesL.McCubbinJ. (2010). The effects of nature images on pain in a simulated hospital patient room. Health Environments Research & Design Journal, 3(3), 42–55.
66.
VogelsI. (2008). Atmosphere metrics: Development of a tool to quantify experienced atmosphere. In WesterinkOuwerkerkJ. H. D. M.OverbeekM.PasveerT. J. MRuyterW. FB. D. (Eds.), Probing experience: From assessment of user emotions and behaviour to development of products. Springer Netherlands, 25–41.
67.
WallerNadelD.L. (Eds.). (2013). Handbook of spatial cognition. American Psychological Association. https://doi.org/10.1037/13936-000
68.
WeismanJ. (1981). Evaluating architectural legibility: Way-finding in the built environment. Environment and Behavior, 13(2), 189–204.
69.
WienerJ. M.HölscherC.BüchnerS.KoniecznyL. (2012). Gaze behaviour during space perception and spatial decision making. Psychological Research, 76(6), 713–729.
70.
YesiltepeD.DaltonR. C.TorunA. O. (2021). Landmarks in wayfinding: A review of the existing literature. Cognitive Processing, 22, 369–410.
71.
ZamaniZ. (2019). Effects of emergency department physical design elements on security, wayfinding, visibility, privacy, and efficiency and its implications on staff satisfaction and performance. Health Environments Research & Design Journal, 12(3), 72–88.
72.
ZijlstraE.HagedoornM.KrijnenW. P.van der SchansC. P.MobachM. P. (2016). Route complexity and simulated physical ageing negatively influence wayfinding. Applied Ergonomics, 56, 62–67.
73.
ZimringC. (1990). The costs of confusion: Non-monetary and monetary costs of the Emory University Hospital wayfinding system. Georgia Institute of Technology.
