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Pediatric Art Preferences: Countering the "One-Size-Fits-All" Approach

Originally Published:
Key Point Summary
Key Point Summary Author(s):
Deborah Wingler
Key Concepts/Context
Viewing art has been shown to enhance the recovery process in adult patients by reducing stress and anxiety. Research also suggests that nature-themed visual images are preferred in high-stress adult healthcare environments. However, minimal research exists linking the viewing of art to outcomes and preferences in children.
This study looks to gain insight into the art preferences of pediatric patients by answering the following questions: (1) Do pediatric patients across different age groups have similar art preferences? and (2) Does style or content drive pediatric art preferences?
For this study, a survey comprised of 20 images was conducted with 64 inpatients at Children's Memorial Hermann Hospital in Houston, Texas during spring 2007. The paper survey was used to collect the data and was implemented by a team of two child life specialists and two researchers who facilitated data collection. Child life specialists were used to identify eligible patients, introduce researchers to the patients and their families, and reassure parents of the study’s credibility. Researchers asked the participating children the questions from the survey.  
The first question on the survey asked patients about the existing art on the walls. Then patients were then asked the two following questions regarding a particular image from the survey: (1) How does this picture make you feel? (2) Would you put this picture up in your room? Patients ranked the first question on a five-point scale ranging from “Much better” to “Much worse..” To make the emotional rating easier, face-scales were used in addition to the verbal scale. Patients ranked the second question on a three-point scale, ranging from “yes” to “no” with “not sure” in the middle. Patient demographics such as age, gender, length of stay, and reason for visit were also collected. Comments pertaining to each question were recorded.

Images chosen for this study are from the following three style classifications: (1) realistic, (2) representational, and (3) nonrepresentational. Realistic images were considered to be images that realistically depict scenes from the world around us, and were represented through photographs of a neighborhood, a waterfall, children, and a deer. Paintings of a tree, and a garden were also used to depict realistic images. Representational images were considered to be images that represent content from the real world using artistic styles and renditions. These images consisted of an animated castle, landscape, rainbow, family, house, fish, goat, turtles, and bear. Other representational images were child art of a wall and swing, and abstract images of handprints, flowers, and animals. Nonrepresentational images were determined to be mages that are not representational in the depiction of real-life subject matter, and were represented by an abstract Gris.
Analysis was conducted using SPSS version 11.0.4. Verbal ratings for the questions regarding the images were converted to a numerical scale ranging from -2 to +2 for question 1 (How does this picture make you feel?) and -1 to +1 for question 2 (Would you put this picture up in your room?). The first step in the analysis was to perform t-tests to determine if the average ratings for each picture were significantly different from 0. Then a one-way analysis of variance (ANOVA) was conducted to determine if significant differences in rating existed among the three groups. Content analysis was conducted on the comments using the Naturalistic Inquiry paradigm, which consists of counting and comparing key words or content and interpreting the underlying context.
Design Implications
When choosing art for pediatric healthcare environments, it is essential to consider the various stages of cognitive development associated with that patient population. Design solutions that allow for a variety of engaging themes should be considered. Attention to bright colors and realistic nature-themed art may provide the most cohesive responses across all age groups. 
In response to the initial question in the survey asking children to rate the selection and their emotional response for how the existing wall art made them feel, all three groups of children rated the existing art positively and reported liking it in their rooms. While no significant differences were found among the age groups, the younger children reported a higher emotional rating for how the existing art made them feel. While 62% of respondents stated they would like to replace the existing artwork, 63% reported that the existing art made them feel better.
Overall, pediatric patients provided a positive response to all the art images. However, younger children (5- to 6-year-olds) were found to have a higher positive response overall than older children. In response to question 1 (How does this picture make you feel?) none of the images received a negative rating or made the children feel worse. However, some of the art made the children feel better than other art images.
For the emotional rating, six images had significant positive ratings across all age groups. All of the images with a significant rating contained prominent elements of nature and are as follows: castle, rainbow, waterfall, fish, deer, and flowers.  Across all age groups the images of the deer in the field, the castle with the woods, and fish underwater were rated as the top three images for the emotional selection rating. These images not only contained nature, but also were full of color. Of these three images, the picture of the deer in the field received the highest-ranking response to question 1 for children ages 5-10 years old. Younger children rated child art (drawings by children that represent specific content but have their own unique style) higher than the older two age groups. The two older groups rated the waterfall image higher than the youngest group, and the stylized picture of flowers was rated highest by the oldest group of participants.
While none of the lower ratings were statistically significant, the lowest-rated images were the landscape painting of a solitary tree, abstract painting, photograph of a shaded neighborhood street with houses on one side, and a painting in pastel shades of a couple in a garden. A deserted path occurred in two of the images, and was reported to be factor in the rating. The photograph of the neighborhood received a low rating because it reminded the children of home, which made them sad because they wanted to go home. The abstract painting was considered to be “messy” and “non-sense” by some, while a few older children reported that they liked the image and thought it looked like a puzzle.
When looking for significance between age or cognitive stage and emotional rating, younger children (5- to 6-year-olds) were found to give more positive responses than the other two age groups of children.
Several significant themes regarding how children respond to artwork were revealed through the content analysis. The most prominent theme was “Nature.” Children referred frequently to nature elements as a reason for liking a specific image. Animals and color were also common themes when describing why an image was liked. The presence of animals in an image elicited positive responses regardless of whether the animal was the prominent feature in the image. Color was positively referred to when bold, bright colors were present in an image. Blue and green were especially liked. Pastel colors were considered boring, and the color brown received consistent negative ratings. Another common theme was “Association.” Children would associate an image with a familiar place, person, or activity. Prominent associations ranged from neighborhoods and homes, to family relationships, and character/cartoon associations, such as fish being associated with the animated movie “Finding Nemo.”
Based upon these findings the following trends were observed: (1) The combination of bright colors, engaging themes, and nature content is consistently rated high in pediatric art preferences. (2) Realistic nature images with bright colors, water elements, and/or friendly wildlife may be suitable for pediatric populations. (3) Child-art, typically used in pediatric wards, is more suitable for younger children than for older children. (4) Appreciation of animated/iconic images may vary across age groups, so must be chosen carefully.
One limitation to this study was the presence of family members while the survey was being conducted. Often family members would try to “help” the child answer the question presented to them. While this input is intended to be well meaning, the influence on the child’s response and its impact on cleanliness of data must be taken into consideration.  Additionally, other environmental distractions made it difficult to sustain the child’s interest. Finally, younger children’s desire to please those in perceived authority, such as the researcher, can potentially skew the results in a positive direction. Due to this phenomenon, the personalities of the researchers and their interactions with the participants should be considered in the analysis of this data.
Outcome Category
Patient health outcomes|Patient satisfaction and comfort
Key Point Summary Author(s):
Deborah Wingler
Primary Author
Nanda, U.