The Center For Health Design
Why does this study matter?
Healthcare facilities are notoriously complex spaces, and wayfinding is a common challenge. There is evidence from previous studies that certain design interventions can improve wayfinding, such as environmental cues and clear signage. But people from different backgrounds interpret signage differently, and so we need to think about other ways design can support navigation. Research on wayfinding at the city scale shows that landmarks and green spaces can serve both therapeutic and navigational purposes. Considering this, Jiang and colleagues decided to find out if greenspace in hospital circulation might provide wayfinding cues to better support the wayfinding experience.
How was the study done?
The researchers observed participants in an immersive virtual environment – or IVE. Seventy-four college students were randomly assigned to one of two IVEs.
The two environments were the same, except that in the “greenspace group,” courtyard gardens were visible at four key decision points in the circulation space, whereas in the control group, circulation consisted of solid walls with no window views. Both spaces had typical ceiling and door signage pointing to departmental units.
Participants were given a survey with demographic questions, and then after a quick look at a floor plan of the IVE hospital, they began five wayfinding tasks. They could physically move and turn as they navigated this virtual environment. They had 15 minutes to complete the tasks, and researchers assessed their wayfinding performance, which included measures such as walking distance, task completion, and route selection. Afterwards, they were given another survey regarding their mood states, preferences, and demographic questions.
So what do we learn from the study?
In terms of wayfinding performance, participants in the greenspace group spent less time in each of the five wayfinding task than those in the control group, but the difference was only statistically significant for one task (which analysis later showed to be the most complex task).
Total walking distance was lower for the greenspace group, but it was not statistically different. However, there was a significant difference between the number of times participants stopped to look around, and in the number of times participants in the greenspace group looked at signage.
The greenspace group participants experienced significantly less anger and confusion than the control group. Additionally, total mood the disturbance score – measuring tension, depression, anger, fatigue, and confusion – showed the greenspace group had significantly less TMD than the control group.
As one might expect, researchers found the worse the mood, the fewer number of wayfinding tasks were completed, and the longer time spent on tasks. And higher levels of depression and confusion correlated with less efficient route selection.
Not surprisingly, the greenspace group’s preference scores regarding aesthetics were significantly higher.
Can we say the results are definitive?
The most obvious limitation to a study using VR is that it is not the real world, but it does of course give us a good place to start in our exploration of how design impacts behavior. Future research could take these methods and easily translate them into a study in a real world setting.
I would also be curious to dive further into the specific elements of the greenspace, and tease out the effects. For instance, could it be the daylight of these exterior spaces that helps with orientation? Or the fact that these were views of exterior greenspace rather than interior nature features?
What’s the takeaway?
Spatial cognition and wayfinding are complex mental processes that involve information processing, developing a plan, and making a decision about what to do. All of this can be especially stressful for patients who aren’t feeling well – or staff who are under pressure to quickly find their destination. Results show that visual access to the exterior natural environment seems to help support recognition, orientation, and mood – all of which can set visitors up for better wayfinding, and ultimately – for a better healthcare experience.
It’s exciting to see yet another study showing promising results that views of nature can have positive effects in healthcare design.
Interested in the topic? Visit The Center for Health Design Knowledge Repository for more.
Summary of:
Jiang, S., Allison, D., & Duchowski, A. T. (2022). Hospital greenspaces and the impacts on wayfinding and spatial experience: An explorative experiment through immersive virtual environment (IVE) techniques. HERD: Health Environments Research & Design Journal, 15(3), 206–228. https://doi.org/10.1177/19375867211067539
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As a part of The Center's research team, Melissa focuses her efforts on grant-funded research initiatives, as well as supporting ongoing work of The Center, such as the Affiliate+ program, the Knowledge Repository, and the Evidence Based Design Accreditation and Certification (EDAC) program. She examines the impact of the built environment on health through the development of conceptual models that link design and outcomes and by evaluating the effects of evidence-based design innovations and by disseminating research findings through tools, presentations, and publications.
Melissa was previously a senior design researcher for Davis Partnership Architects and prior to that she served as a researcher with the OMNI Institute and the Center for Children, Youth & Environments at the University of Colorado. With a background in both architecture and social science, Melissa describes her research style as “boots on the ground with a knack for rigor.”
Melissa graduated from Cornell University with a Masters of Science, Applied Research in Environmental Psychology and received her Bachelors of Environmental Design, Emphasis in Architecture from University of Colorado, Boulder.