By Ruth Brent Tofle, Ph.D., Benyamin Schwarz, Ph.D, So-Yeon Yoon, MA, Andrea Max-Royale, M.E.Des
Published and funded by the Coalition for Health Environments Research (CHER), July 2004
The purpose of this study was to review the literature on color in healthcare environments in order to separate among common myths and realities in the research and application of color in healthcare design. Utilizing online searches of existing bibliographies and databases in multiple disciplines, we reviewed more than 3000 citations to identify theories, which could have had supportable design implications for the use of color in healthcare design. We sought to determine which issues and concepts in the literature might contribute to the knowledge of architects, interior designers, researchers, healthcare providers, and users of healthcare environments.
Color is a fundamental element of environmental design. It is linked to psychological, physiological, and social reactions of human beings, as well as aesthetic and technical aspects of human-made environments. Choosing a color palette for a specific setting may depend on several factors including geographical location, characteristics of potential users (dominant culture, age, etc.), type of activities that may be performed in this particular environment, the nature and character of the light sources, and the size and shape of the space.
The evidence-based knowledge, however, for making informed decisions regarding color application has been fragmented, sporadic, conflicting, anecdotal, and loosely tested. Many healthcare providers, designers and practitioners in the field have questioned the connections between color and behavior of people, suspected the value of color as a psychotherapeutic aid, and searched for empirical reasoning for the various color guidelines in healthcare settings.
The results of the critical review of the pertinent literature produced no reliable explanatory theories that may help to predict how color influences people in healthcare settings.
Regrettably, much of the knowledge about the use of color in healthcare environments comes from guidelines that are based on highly biased observations and pseudo-scientific assertions. It is this unsubstantiated literature that serves color consultants to capriciously set trends for the healthcare market.
The collective lessons of the numerous studies reviewed in this manuscript can be summarized in the following:
There are no direct linkages between particular colors and health outcomes of people. No sufficient evidence exists in the literature to the causal relationship between settings painted in particular colors and patients’ healthcare outcomes.
Specifying particular colors for healthcare environments in order to influence emotional states, or mental and behavioral activities is simply unsubstantiated by proven results. It is not enough to claim what color can do for people; it is important to distinguish between the explicitly stated aim of such assertions and their latent function. Spaces do not become “active”, “relaxing”, or “contemplative” only because of their specific color.
There are demonstrable perceptual impressions of color applications that can affect the experience and performance of people in particular environments. There are indications in the research literature that certain colors may evoke senses of spaciousness or confinement in particular settings. However, the perception of spaciousness is attributed to the brightness or darkness of color and less by its hue. The sense of spaciousness is highly influenced by contrast effects particularly brightness distinctions between objects and their background.
While studies have shown that color-mood association exists, there is no evidence to suggest a one-to-one relationship between a given color and a given emotion. In spite of contradictory evidence, most people continue to associate red tones, for example, with stimulating activities, and blue tones with passivity and tranquility. Clearly, colors do not contain inherent emotional triggers. Emotional responses to colors are caused by culturally learned associations and by the physiological and psychological makeup of people.
The popular press and the design community have promoted the oversimplification of the psychological responses to color. Many authors of color guidelines tend to make sweeping statements that are supported by myths or personal beliefs. Likewise, most color guidelines for healthcare design are nothing more than affective value judgments whose direct applicability to the architecture and interior design of healthcare settings seems oddly inconclusive and nonspecific. The attempt to formulate universal guidelines for appropriate colors in healthcare settings is ill advised. The plurality, or the presence of multiple user groups and subcultures, and the complexity of the issues of meaning and communication in the environment make efforts to prescribe universal guidelines a futile endeavor. Consider, as an example, the issue of weak communication in the context of color specification in present healthcare settings: designers may attempt to endow the settings with cues that the users may not notice. If the users notice the cues, they may not understand their meaning, and even if they both notice and understand the cues they may refuse to conform as predicted.
The study of color in healthcare settings is challenging because it occurs in the context of meaningful settings and situations. When people are exposed to a color in a certain setting, their judgment is a result of a reciprocal process that involves several levels of experience. People first acquire direct information through their visual perception. This input is analyzed against their background of cognitive information regarding that environment and that particular color which they have obtained from their culture. The consequence of this process is dialectical because cultural standards modify perceptions and these perceptual inputs, in turn, modify a human’s aesthetic response. But this process does not take place in a vacuum. It occurs within a web of experiential conditions, which inevitably modify people’s judgmental processes. Thus, if the healthcare setting is too noisy, or too cold, or the place is cluttered with an array of medical equipment and bad odors, the aesthetic experience of an individual’s response to its color will be affected, regardless of its “objective” meaning. In addition, the response is influenced by the person’s role in the settings (whether he or she is a patient, a staff member or a visitor to the facility). Furthermore, a large host of internal forces are involved in the act of reaching aesthetic conclusions. Among them are the person’s physical condition (whether he or she feels sick or suffers from pain, how tired he or she is, whether he or she lays in bed or works out as part of their physiotherapy, etc.) as well as the person’s psychological state (whether he or she is aware of his or her surroundings or he or she is under the influence of drugs, or anxious about medical procedures, or suffers from dementia, etc.).
In conclusion, we want to reiterate that currently the use of color in healthcare settings is not based on a significant evidence-based body of knowledge. Second, we suggest that the attempt to formulate universal guidelines for appropriate colors in healthcare settings is ineffectual. The multiple user groups and subcultures, and the complexity of the issues of meaning and communication in the healthcare environment make the efforts to prescribe universal guidelines an unproductive undertaking. Our efforts need to concentrate on the particular through the formulation of explanatory theories and empirical studies with the aim to give attention to specific and concrete problems rather than abstract and universal questions.
Clearly, the research of color in healthcare environments is an important endeavor. Yet, the subject matter is complex and multifaceted. Furthermore, mastering this knowledge for the application of research findings in healthcare settings requires caution and sensitive creativity is paramount.