| 1. |
- Andersson, C A Morgan, 1965, et al.
(författare)
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Aging-in-Place: Residents’ Attitudes and Floor Plan Potential in Apartment Buildings From 1990 to 2015
- 2021
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Ingår i: HERD. - : SAGE Publications. - 2167-5112 .- 1937-5867. ; 14:4, s. 211-226
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: We investigated apartment designs in apartment blocks built 1990-2015 in Gothenburg, Sweden. We investigated the residents' attitudes toward their previous, present, and future housing and their perceived possibilities for aging-in-place. We analyzed their apartments, focusing on the possibilities for aging-in-place in future care situations concerning bedroom capacity in a care situation; spatial proximity between bathroom, bedroom, storage, and entrance; and functional autonomy in a care situation without too much disturbance for a partner. Background: Since the 2000s, the ambition in Sweden is to enable older people to remain in ordinary housing. The possibilities for aging-in-place should therefore be considered already in the design stage, also when producing standard apartments. Methods: Semi-structured interviews were made with 30 households, with one or more resident 65 years or older. Floor plan analyses were made of their present apartments. Results: The majority displayed a pragmatic attitude toward aging, high satisfaction with their present housing situation, and good chances for aging-in-place in future homecare scenarios. The floor plan analysis shows that the three concepts of bedroom capacity, spatial proximity, and functional autonomy can be used to determine the potential for aging-in-place. Conclusions: The results suggest that architectural qualities related to aging-in-place are not automatically connected to floor size or number of rooms. Small apartments can perform better than larger ones, depending on spatio-functional organization and connections between different functions. The residents' perceived chances for aging-in-place confirm this relation. Future studies should compare different locations, production periods, and relations between size, space efficiency, and accessibility.
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| 2. |
- Andersson, Morgan, 1965, et al.
(författare)
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Exploring the Function and Use of Common Spaces in Assisted Living for Older Persons
- 2014
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Ingår i: HERD. - : SAGE Publications. - 2167-5112 .- 1937-5867. ; 7:3, s. 98-119
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This exploratory study examines the function and use of common spaces in assisted living facilities (ALFs) from the residential and workplace perspectives.BACKGROUND: The impact of the physical environment on human activities in healthcare settings has been emphasized in many studies. Few studies, however, have explored the daily use of common spaces and theimpact on the usability of ALFs.METHODS: Four explorative methods–observation, group interviews, individual interviews, and questionnaires—were used to investigate 14 ALFs in Sweden. The study involves residents, staff, relatives, architects, and people responsible for planning and construction of eldercare.This research strategy combines quantitative and qualitative methods to enhance the validity of the results. Method triangulation and data triangulationwere used and the data were analyzed using Qualitative Content Analysis (QCA).RESULTS: The results show that residents and staff have different objectives for use and these differences affect usability, although explicit conflicts are rare. The residents, staff, and other stakeholders have differentviews about the demarcation of home and workplace and the role of common spaces as venues for social interaction.CONCLUSIONS: Both the residential and the workplace perspective must be considered when planning assisted living facilities. Otherwise, inherent conflicts between these perspectives will manifest as a result of thephysical design. Common spaces have diverse functions that are reflected in their spatial organization. Therefore, ALFs should be designed so the intended function of a specific space is apparent to all users.
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| 3. |
- Anåker, Anna, et al.
(författare)
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Design quality in the context of healthcare environments: a scoping review
- 2017
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Ingår i: Health Environments Research & Design Journal. - : SAGE Publications. - 1937-5867 .- 2167-5112. ; 10:4, s. 136-150
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Tidskriftsartikel (refereegranskat)abstract
- Objective:We explored the concept of design quality in relation to healthcare environments. In addition, we present a taxonomy that illustrates the wide range of terms used in connection with design quality in healthcare.Background:High-quality physical environments can promote health and well-being. Developments in healthcare technology and methodology put high demands on the design quality of care environments, coupled with increasing expectations and demands from patients and staff that care environments be person centered, welcoming, and accessible while also supporting privacy and security. In addition, there are demands that decisions about the design of healthcare architecture be based on the best available information from credible research and the evaluation of existing building projects.Method:The basic principles of Arksey and O’Malley’s model of scoping review design were used. Data were derived from literature searches in scientific databases. A total of 18 articles and books were found that referred to design quality in a healthcare context.Results:Design quality of physical healthcare environments involves three different themes: (i) environmental sustainability and ecological values, (ii) social and cultural interactions and values, and (iii) resilience of the engineering and building construction. Design quality was clarified herein with a definition.Conclusions:Awareness of what is considered design quality in relation to healthcare architecture could help to design healthcare environments based on evidence. To operationalize the concept, its definition must be clear and explicit and able to meet the complex needs of the stakeholders in a healthcare context, including patients, staff, and significant others.
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| 4. |
- Anåker, Anna, et al.
(författare)
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Enriched Environments in Stroke Units : Defining Characteristics and Limitations
- 2024
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Ingår i: Health Environments Research & Design Journal. - 1937-5867 .- 2167-5112. ; 17:2, s. 344-359
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: Individuals with stroke rehabilitated in an enriched environment (EE) compared to a non-EE are more likely to participate in cognitive and social activities, promoting their rehabilitation and well-being. There is a need for a more comprehensive understanding of methods to implement EEs within complex health systems, particularly in stroke units.OBJECTIVE: The aim of this systematic review was to compile the concept of an EE in stroke units.METHODS: The literature was sourced from CINAHL, Embase, and Medline databases. A detailed screening and sifting process was used to identify relevant literature. Multiple reviewers independently appraised the identified literature using a Mixed-methods Appraisal Tool. After screening 336 studies, 11 were included.RESULTS: This review reveals an EE is challenging to define and almost exclusively about activities based on access to individual and communal equipment. Generally, there are no common descriptions or conceptual agreements.CONCLUSIONS: To the best of our knowledge, this is the first study to systematically review the concept of an EE in stroke units and shows that more studies on EEs are needed. The weak definitions and unclear theoretical backgrounds of an EE in the included studies could challenge operationalization. Future research should be based on more precise definitions of an EE and broader interventions that include changes to built and natural environments.
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| 5. |
- Anåker, Anna, et al.
(författare)
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“It’s Lonely”: Patients’ Experiences of the Physical Environment at a Newly Built Stroke Unit
- 2019
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Ingår i: HERD. - : SAGE Publications. - 2167-5112 .- 1937-5867. ; 12:3, s. 141-152
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to explore patients’ experiences of the physical environment at a newly built stroke unit. Background: For a person who survives a stroke, life can change dramatically. The physical environment is essential for patients’ health and well-being. To reduce infections, a majority of new healthcare facilities mainly have a single-room design. However, in the context of stroke care, knowledge of how patients experience the physical environment, particularly their experience of a single-room design, is scarce. Method: This study used a qualitative design. Patients (n = 16) participated in semistructured individual interviews. Data were collected in December 2015 and February 2017 in Sweden; interviews were transcribed verbatim and analyzed using content analysis. Results: Two main themes were identified: (i) incongruence exists between community and privacy and (ii) connectedness with the outside world provides distraction and a sense of normality. In single rooms, social support was absent and a sense of loneliness was expressed. Patients were positively distracted when they looked at nature or activities that went on outside their windows. Conclusions: The physical environment is significant for patients with stroke. This study highlights potential areas for architectural improvements in stroke units, primarily around designing communal areas with meeting places and providing opportunities to participate in the world outside the unit. A future challenge is to design stroke units that support both community and privacy. Exploring patients’ experiences could be a starting point when designing new healthcare environments and inform evidence-based design.
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| 6. |
- Apple, Michael, 1983
(författare)
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A Comparative Evaluation of Swedish Intensive Care Patient Rooms
- 2014
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Ingår i: HERD. - : SAGE Publications. - 2167-5112 .- 1937-5867. ; 7:3, s. 78-93
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study investigates how design strategies in three recent intensive care units in Sweden impact patients, families, and staff. The area of focus is the patient room "module," usually consisting of a pair of patient rooms and a joint location for monitoring and documentation. BACKGROUND: Many countries are expanding their number of intensive care beds and are also in the process of incorporating evidence-based design strategies such as single-bed patient rooms and access to daylight and nature. This situation provides a significant opportunity to review and learn from facilities leading the way in these areas. METHODS: Three intensive care units completed since 2010 were evaluated in relation to a combination of criteria. Methods included plan drawing analysis, staff questionnaires (n = 72), staff interviews (n = 9), and systematic observation (6 hours). RESULTS: In some patient rooms, access to daylight and/or outdoor views was excellent, while in other rooms such access was hindered by frosted glass or adjacent bushes or buildings. Single-bed rooms gave family members improved privacy and greater ability to stay in the patient room. Some patient room modules provided efficient patient observation and staff collaboration, but more noise and reduced patient privacy. Other modules provided a calm patient room environment, but caused some staff to feel isolated and have difficulty in getting assistance.CONCLUSIONS: The evaluation of the three projects reveals variation in whether design strategies successfully achieve their desired outcomes. Varying designs of the patient room module affect users in unique ways and must balance privacy, visibility, quietness, and staff access to assistance.
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| 7. |
- Björnson Skogström, Lisa, 1980, et al.
(författare)
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Women’s Experiences of Physical Features in a Specially Designed Birthing Room: A Mixed-Methods Study in Sweden
- 2022
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Ingår i: HERD. - : SAGE Publications. - 2167-5112 .- 1937-5867. ; 15:3, s. 193-205
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To explore women’s experiences of physical features in a birthing room designed to be adaptable to personal wishes and needs during labor and birth. Background: Childbirth is a central life event influenced by numerous factors, including the healthcare environment; however, there is insufficient knowledge on how the physical design affects women during birth. Methods: This study was part of a randomized controlled trial in the Room4Birth research project, including women randomized to receive care in a new birthing room designed with physical features changeable according to personal wishes. Data consisted of responses to two questions analyzed with descriptive statistics (n = 202) and semi-structured interviews analyzed for content (n = 19). Results: A total of 93.6% (n = 189) assessed the physical features in the birthing room as meaningful to a very high or high extent. The overall impression of the room was positive and exceeded women’s expectations. They felt welcomed and strengthened by the room, which shifted the focus to a more positive emotional state. The room differed from traditional hospital birthing rooms, contained familiar features that maintained integrity, and had space for companions. The variety of physical features was appreciated. Of nine listed physical features, the bathtub was ranked most important, followed by the projection of nature scenery, and dimmable lighting, but the room as a whole appeared most important. Conclusions: When planning and designing hospital-based birthing rooms, it is crucial to offer possibilities to adapt the room and physical features according to personal wishes.
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| 8. |
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| 9. |
- Elf, Lena Marie, 1962, et al.
(författare)
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Space Planners' Perception of an Assessment Instrument for Briefs in the Pre-Design Phase of New Healthcare Environments
- 2014
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Ingår i: HERD. - : SAGE Publications. - 2167-5112 .- 1937-5867. ; 8:1, s. 67-80
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The main purpose of the study was to investigate the usability of a newly developed instrument designed to assess the content and quality briefs (CQB-I) in programs for new healthcare environments. We studied the perception of using the instrument on a group of space planners.BACKGROUND: The study is part of a larger project designed to ensure the quality of the planning of new healthcare environments with a focus on documents (programs or briefs) created in the early phases of the planning process. In this study, we used an instrument that measures the clarity of the mission statement for the project based on user needs and care activities that will take place in the new healthcare environment. The instrument further evaluates whether there are clear patient-related outcome measures specified and whether the information in the documents is person-oriented and evidence-based.METHODS: The study used a mixed-method design where the relevance and usability of the instrument was estimated and a focus group interview was conducted.RESULTS: The study showed that a CQB-I is perceived to be a relevant instrument primarily as a guide for programming, but also for monitoring the produced programs.CONCLUSIONS: Instruments like CQB-I can help to bring research results into planning and contribute to dialogue and collaboration in the early phases of a planning process by orienting planning participants to user needs and facilitating the discussion and articulation of clear performance indicators.
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| 10. |
- Elf, Marie, 1962-, et al.
(författare)
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A study of relationships between content in documents from the health service operational plan and documents from the planning of new healthcare environments
- 2019
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Ingår i: Health Environments Research & Design Journal. - : SAGE Publications. - 1937-5867 .- 2167-5112. ; 12:3, s. 107-118
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim was to investigate the content and quality of the governing documents created in the planning and design phase of new healthcare environments and in the related healthcare strategic and operational plans.Background: Quality deficits in buildings can often be traced back to the initial stages in the planning and design phase. Although, large investments have been made to improve the process of planning new healthcare environments and linking the requirements to health service strategies, healthcare organizations rarely relate their strategy goals to the built environment.Methods: A retrospective review of documents created in the planning and design stages of new healthcare environments and the operational plans of the target organizations was conducted.Results: The organizational operational plans did not contain any statements or information about the built environment or how a building could or should support the organization's goals. Important information was frequently absent from the documents governing the planning and design of buildings. The documents lacked information about what and how to follow-up and what to measure once a construction project had been completed. There were no references to evidence.Conclusions: Poor documentation might undermine the quality of the planning and design phase and ultimately the opportunity to create environments that support health outcomes. Therefore, more emphasis must be placed on the importance of documentation but above all to strengthen and clarify the relationship between the healthcare organization strategy to achieve an effective and efficient care process and the intention made in the planning and design process.
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| 11. |
- Elf, Marie, 1962-, et al.
(författare)
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A Systematic Review of Research Gaps in the Built Environment of Inpatient Healthcare Settings
- 2024
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Ingår i: Health Environments Research & Design Journal. - 1937-5867 .- 2167-5112.
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVE: This study utilized the evidence-gap map method and critically examined the scope, methodologies, and focus of the studies that investigated the influence of the built environment on inpatient healthcare settings over a decade (2010-2021).METHODS: We conducted a systematic review per the preferred reporting items for systematic reviews and meta-analyses guidelines and surveyed 406 articles, primarily from North America and Europe.RESULTS: Our findings revealed a dominant focus on architectural features (73%), such as room design and ward layout. Comparatively, there was less emphasis on interior-, ambient-, social-, and nature-related features. Most previous studies explored multiple environmental features, which indicated the intricacy of this field. Research outcomes were diverse, with person-centered care (PCC) being the most frequently investigated, followed by safe care, emotional well-being, activity, and behavior. Furthermore, research methods varied considerably based on the study's outcomes and features. Clinical outcomes and safe care favored quantitative methods, activity and behavior favored mixed methods, and PCC favored qualitative research.CONCLUSION: This review provides an in-depth overview of the existing studies on healthcare design research and sheds light on the current trends and methodological choices. The insights garnered can guide future research, policy-making, and the development of healthcare facilities.
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| 12. |
- Elf, Marie, et al.
(författare)
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Development of the Content and Quality in Briefs Instrument (CQB-I)
- 2012
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Ingår i: Health Environments Research & Design Journal. - New York : Vendome Group LLC. - 1937-5867 .- 2167-5112. ; 5:3, s. 74-88
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The Content and quality of Briefs Instrument (CQB-I) was designed to develop a valid and reliable audit instrument to examine the content and quality of information in documents (briefs) created in the early stages of designing healthcare environments.Background: The importance of effective briefing has been emphasised in many research studies during the past two decades. However, there is no developed instrument for auditing the content and quality of the documents, which makes this paper interesting.Methods: The study had a methodological and developmental design based on an established methodology for instrument development and validation. The development process consisted of three main phases: item generation and scale construction, assessment of face and content validity, and finally, testing of the reliability. To obtain face and content validity, expert panels reviewed the CQB-I. Content validity was assessed by using the Content Validity Index (I-CVI=item level, S-CVI=scale level). The reliability was tested by test-retest and inter-rater reliability. Results: CQB-I was found to have good content validity (I-CVI =0.78 – 1.0 and S-CVI=0.98). Inter-rater reliability was acceptable (Spearman’s correlation = 0.62) and the stability was considered high for both raters (83% respectively 88%).Conclusions: The instrument can be used as a guide for the work process in the design team and contribute to the ongoing development of making the design process more user-oriented with the ultimate goal of healthcare environments designed for a patient-centered care.
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| 13. |
- Elf, Marie, 1962-, et al.
(författare)
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Housing Accessibility at Home and Rehabilitation Outcomes After a Stroke : An Explorative Study
- 2023
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Ingår i: Health Environments Research & Design Journal. - 1937-5867 .- 2167-5112. ; 18:3, s. 237-237
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To explore if aspects of the physical home environment are related to rehabilitation outcomes among community-living persons poststroke.BACKGROUND: Research demonstrates that healthcare environments are important for high-quality care and that the design of the physical environment is associated with improved rehabilitation outcomes. However, relevant research focusing on outpatient care settings, such as the home, is sparse.METHODS: In this cross-sectional study, data on rehabilitation outcomes, physical environmental barriers, and housing accessibility problems were collected during home visits of participants (N = 34), 3 months poststroke. Data were analyzed with descriptive statistics and correlation analysis.RESULTS: Few participants had adapted their homes, and the relevance of the physical environment was not always discussed with the patient during discharge from the hospital. Accessibility problems were associated with suboptimal rehabilitation outcomes such as worse perceived health and recovery after stroke. Activities most restricted by barriers in the home concerned hand and arm use. Participants who reported one or more falls at home tended to live in houses with more accessibility problems. Perceived supportive home environments were associated with more accessible dwellings.CONCLUSIONS: Many face problems adapting their home environments poststroke, and our findings highlight unmet needs that should be considered in the rehabilitation practice. These findings could be used by architectural planners and health practitioners for more effective housing planning and inclusive environments.
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| 14. |
- Elf, Marie, et al.
(författare)
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Space planners' perception of an assessment instrument for briefs in the pre-design phase of new healthcare environments
- 2014
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Ingår i: Health Environments Research & Design Journal. - 1937-5867 .- 2167-5112. ; 8:1, s. 67-80
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: The main purpose of the study was to investigate the usability of a new developed instrument designed to assess the content and quality in programs for new healthcare environments (CQB-I). We studied the perception of using the instrument on a group of space-planners. The study is part of a larger project designed to assure the quality of early and main stages of the planning of new care environments with a focus on policy documents (programs or briefs), created in the early phases of the planning process. The instrument measures whether there is a clear mission statement for the project based on user needs and care activities that will take place in the new healthcare environment. Furthermore, the instrument measures if there are clear patient-related outcome measures specified and if the information in the documents is person-oriented and knowledge-based.Method: The study used a mixed method where the relevance and usability of the instrument was estimated and a focus group interview was conducted.Findings: The study showed that CQB-I perceived to be a relevant instrument primarily as a guide for programming, but also for monitoring the produced programs. Instruments can help to bring research results into planning and contribute to dialogue and collaboration in the early stages by orienting process of user needs, discuss and write down clear performance indicators and related quality assurance process.
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| 15. |
- Elf, Marie, et al.
(författare)
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Using of Group-Modeling in Predesign Phase of New Healthcare Environments: Stakeholders Experiences
- 2016
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Ingår i: HERD. - : SAGE Publications. - 2167-5112 .- 1937-5867. ; 9:2, s. 69-81
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Tidskriftsartikel (refereegranskat)abstract
- Background: Current research shows a relationship between healthcare architecture and patient-related outcomes. The planning and designing of new healthcare environments is a complex process. The needs of the various end users of the environment must be considered, including the patients, the patients' significant others, and the staff. The aim of this study was to explore the experiences of healthcare professionals participating in group modeling utilizing system dynamics in the predesign phase of new healthcare environments. We engaged healthcare professionals in a series of workshops using system dynamics to discuss the planning of healthcare environments in the beginning of a construction and then interviewed them about their experience. Methods: An explorative and qualitative design was used to describe participants' experiences of participating in the group-modeling projects. Participants (N = 20) were recruited from a larger intervention study using group modeling and system dynamics in planning and designing projects. The interviews were analyzed by qualitative content analysis. Results: Two themes were formed, representing the experiences in the group-modeling process: Participation in the group modeling generated knowledge and was empowering and Participation in the group modeling differed from what was expected and required the dedication of time and skills. Conclusions: The method can support participants in design teams to focus more on their healthcare organization, their care activities, and their aims rather than focusing on detailed layout solutions. This clarification is important when decisions about the design are discussed and prepared and will most likely lead to greater readiness for future building process.
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| 16. |
- Engwall, Marie, et al.
(författare)
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Patients' Self-Reported Recovery After an Environmental Intervention Aimed to Support Patient's Circadian Rhythm in Intensive Care
- 2021
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Ingår i: Herd-Health Environments Research & Design Journal. - : SAGE Publications. - 1937-5867 .- 2167-5112. ; 14:4, s. 194-210
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients in intensive care units (ICUs) are among the most vulnerable, and they require support to start their recovery. The design of the patient area in the ICU can play a prominent role in both the quality of care and patients' recovery. The lighting environment has the opportunity to restore and strengthen the natural human circadian rhythm and health. Aim: To evaluate patients' self-reported recovery after being cared for in an ICU room rebuilt according to evidence-based design principles that promote recovery. Method: An intervention was set up in a two-bed patient room including a cycled lighting system. Self-reported recovery was reported at 6 and 12 months after discharge. Data were analyzed using a 2(mechanically ventilated, nonmechanically ventilated) x 2(intervention room, ordinary room) analysis of covariance (ANCOVA) and 2(male, women) x 2(intervention room, ordinary room) ANCOVA. Results: Data from the different rooms showed no significant main effects for recovery after 6 months, p = .21; however, after 12 months, it become significant, p. < .05. This indicated that patient recovery was positively influenced for patients cared for in the intervention room (M = 8.88, SD = 4.07) compared to the ordinary room (M = 10.90, SD = 4.26). There were no interaction effects for gender or if the patients had been mechanically ventilated either at 6 or 12 months' postdischarge. Conclusions: A cycled lighting system may improve patient self-reported recovery after ICU care; however, more research on the topic is needed.
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| 17. |
- Fröst, Peter, 1954
(författare)
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A design manual : Hospitals
- 2019
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Ingår i: HERD. - : SAGE Publications. - 2167-5112 .- 1937-5867. ; 12:2, s. 168-171
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 18. |
- Goldkuhl, Lisa, 1983, et al.
(författare)
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Impact of Birthing Room Design on Maternal Childbirth Experience: Results From the Room4Birth Randomized Trial
- 2023
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Ingår i: HERD. - : SAGE Publications. - 2167-5112 .- 1937-5867. ; 16:1, s. 200-218
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To study the effect of the birthing room design on nulliparous women’s childbirth experience up to 1 year after birth. Background: Although it is known that the birth environment can support or hinder birth processes, the impact of the birthing room design on maternal childbirth experience over time is insufficiently studied. Methods: The Room4Birth randomized controlled trial was conducted at a labor ward in Sweden. Nulliparous women in active stage of spontaneous labor were randomized (n = 406) to either a regular birthing room (n = 202) or a new birthing room designed with more person-centered considerations (n = 204). Childbirth experiences were measured 2 hr, 3 months, and 12 months after birth by using a Visual Analogue Scale of Overall Childbirth Experience (VAS-OCE), the Fear of Birth Scale (FOBS), and the Childbirth Experience Questionnaire (CEQ2). Results: Women randomized to the new room had a more positive childbirth experience reported on the VAS-OCE 3 months (p =.002) and 12 months (p =.021) after birth compared to women randomized to a regular room. Women in the new room also scored higher in the total CEQ2 score (p =.039) and within the CEQ2 subdomain own capacity after 3 months (p =.028). The remaining CEQ2 domains and the FOBS scores did not differ between the groups. Conclusions: These findings show that a birthing room offering more possibilities to change features and functions in the room according to personal needs and requirements, positively affects the childbirth experience of nulliparous women 3 and 12 months after they have given birth.
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| 19. |
- Hagerup, Anne, et al.
(författare)
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Toward a Future Orientation: A Supportive Mental Health Facility Environment
- 2024
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Ingår i: HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL. - 1937-5867 .- 2167-5112. ; 17:2, s. 38-56
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Tidskriftsartikel (refereegranskat)abstract
- Background: The provision of supportive environments is essential in clinical and environmental psychology. Mental health disorders are a major issue, and the experience of being at a mental health facility is affected by numerous factors related to the building's design. Aim: The aim of this study is to explore the expectations of a mental health facility planning group regarding the potential impact of a supportive design on patients' mental health and staff's therapeutic practices when planning and designing a new mental health facility. Methods: The new mental health facility is a case study and data were collected through qualitative in-depth interviews with nine participants and analyzed using a thematic analysis. The participants came from a mental health facility planning group in a new mental health facility in Norway. Results: The overall expectation of the new building was related to a future orientation to support patients' mental health and therapeutic practices. Three main themes were identified: toward a future orientation, supportive building design, and work environment. Conclusions: Supportive environments are expected to influence patients' mental health and staff's therapeutic practices, including providing options for novel treatment needs in contrast to older and more outdated buildings that are perceived as hindering appropriate treatment conditions.
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| 20. |
- Lindahl, Jeanette, et al.
(författare)
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Assessing the Supportiveness of Healthcare Environments' Light and Color : Development and Validation of the Light and Color Questionnaire (LCQ)
- 2021
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Ingår i: Health Environments Research & Design Journal. - : Sage Publications. - 1937-5867 .- 2167-5112. ; 14:2, s. 130-144
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of this study was to develop and evaluate a self-report instrument measuring patients', family members', and staff's perceived support from light and color in the physical environment of an emergency department (ED)-the Light and Color Questionnaire (LCQ). Background: The physical care environment is an important part of a comprehensive caring approach in all levels of care not only for patients but also for family members and staff. However, no existing self-report questionnaire assessing the extent to which light and color are perceived as being supportive in the physical care environment from the users' perspective was found. Method: The LCQ was developed as part of a pre-post study in which an ED serving 125,000 people was refurbished and remodeled using evidence-based design. The LCQ consists of six items for light and five items for color and assesses awareness/orientation, safety/security, functional abilities, privacy, personal control, and stimulation. The study was carried out in four steps: constructions of items, assessment of face validity, data collection, and data analysis. Result/Conclusion: Psychometric evaluation of the two versions, LCQ-Patient/Family member and LCQ-Staff, showed satisfactory content and internal validity (>90%) and high internal consistency (Cronbach's coefficient alpha = .9) to support the use of the questionnaire for research and development purposes. Explorative factor analysis of a total of 600 questionnaire responses confirmed light and color as distinctive and independent dimensions creating perceptions of more or less supportiveness for respondents. The LCQ instrument may be useful for architects, administrators, and researchers of healthcare environments.
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| 21. |
- Lindahl, Jeanette, et al.
(författare)
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The Perceived Support From Light and Color Before and After an Evidence-Based Design Intervention in an Emergency Department Environment: A Quasi-Experimental Study
- 2023
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Ingår i: HERD. - : SAGE Publications. - 2167-5112 .- 1937-5867. ; 16:2, s. 109-124
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To evaluate patients’ and family members’ perceived support from light and color before, compared with after an evidence-based design (EBD) intervention at an emergency department (ED) using a validated instrument—the Light and Color Questionnaire (LCQ). Background: EDs offer acute care day and night. Thus, a supportive physical environment where light and color is crucial for how the milieu is experienced is vital. Research is limited on how care settings are perceived as supportive by users. Methods: Quasi-experimental evaluation of the refurbishing and remodeling of an ED by an expert group of nurse managers, nursing staff, nursing researchers and architects in south Sweden. LCQ includes dimensions “maximizing awareness and orientation,” “maximizing safety and security,” “supporting functional abilities,” “providing privacy,” “opportunities for personal control” (not for LCQ-Color), and “regulation and quality of stimulation.” LCQ was analyzed and compared in 400 surveys from 100 patients and 100 family members before the intervention and 100 patients and 100 family members after the intervention. Results: The LCQ total score significantly improved after the intervention for both patients and family members. Four of the six dimensions of LCQ Light subscale scores were significantly higher for family members, and three of the six dimensions were significantly higher for patients after the intervention. The LCQ Color subscale score showed significant improvements for all five dimensions for both patients and family members after the intervention. Conclusion: This study showed improved perceived support from light and color in the physical environment for patients and family members after an EBD intervention at an emergency department using a validated instrument—the Light and Color Questionnaire.
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| 22. |
- López-Tarruella, J, et al.
(författare)
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Influence of Color in a Lactation Room on Users’ Affective Impressions and Preferences
- 2019
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Ingår i: Health Environments Research & Design Journal. - : SAGE Publications. - 1937-5867 .- 2167-5112. ; 12:2, s. 55-70
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The present study aims to examine the influence of environmental color hue in a lactation room at a health center on users' affective response and preference. BACKGROUND: Hospital design plays an important role in the emotional experience of patients. In this regard, many studies have attempted to find relationships between design variables and healthcare facilities users' response. Color has been frequently examined because it is always present in the environment and can be easily changed. However, most of the studies dealing with color-emotion relationships acquire users' affective response by questionnaires developed by experts which could lead to inaccurate results since nonexperts may misunderstand concepts set by experts and use nonimmersive images to simulate the environments to assess. METHODS: To overcome these limitations, a Kansei Engineering-based approach was proposed. In the first phase, users' specific affective factors for lactation rooms were determined using Semantic Differential. In the second phase, the influence of nine different color hues on users' affective factors was obtained. An immersive display system was used to visualize the room altering hues in an isolated and controlled way. RESULTS: (1) Six user's affective factors connected to the lactation rooms were discovered: safety, elegance, coziness, spaciousness, simplicity, and luminosity, of which coziness has the most impact on the assessment of the room. (2) Warm colors like orange and yellow tend to score highly for coziness which puts them in leading positions when users' assess lactation rooms. CONCLUSIONS: Results provide recommendations for designers and show the advantages of using semantic differential and immersive displays to analyze user's affective response to environments.
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| 23. |
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| 24. |
- Miedema, Elke, 1985, et al.
(författare)
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Conceptualizing health promotion in relation to outpatient healthcare building design: a Scoping review
- 2019
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Ingår i: HERD. - : SAGE Publications. - 2167-5112 .- 1937-5867. ; 12:1, s. 69-86
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Forskningsöversikt (refereegranskat)abstract
- Objective: This review explored different conceptualizations of health promotion in the context of, and in relation to, outpatient building design. Background: Today’s healthcare organizations are implementing holistic healthcare approaches such as health promotion, while simultaneously increasing their outpatient services. These health promotion approaches, focused on empowering people to take control of their health, are expected to have implications for the outpatient healthcare building design. Yet, there is limited knowledge on what these may be. A review of the literature on the current state of the art is thus needed to enable and support dialog on future healthcare building design. Method: A scoping review of 4506 papers, collected from 4 databases and 3 scientific journals in 2015, resulted in 15 papers relating health promotion to building design and outpatient healthcare. From the subsequent content analysis multiple common themes and subthemes emerged. Results: The review reveals diverse range of health promotion interpretations, three health promotion perspectives (health behavior, health equity and sense of coherence), associated design approaches, design objectives, health-related outcomes, building features and solutions. Conclusions: While diverse health promotion perspectives might merely represent variations in focus, these differences become problematic when relating to building design. To support further dialogs on development of health promotion in, and in relation to, the built environment, there is a need to strengthen the health promotion vocabulary. Further research is needed to compare different design approaches, and how these can be combined to minimize contradicting implications for building design.
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| 25. |
- Nilsson, Christina, et al.
(författare)
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Effects of Birthing Room Design on Maternal and Neonate Outcomes: A Systematic Review
- 2020
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Ingår i: Herd-Health Environments Research & Design Journal. - : SAGE Publications. - 1937-5867 .- 2167-5112. ; 13:3, s. 198-214
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To summarize, categorize, and describe published research on how birthing room design influences maternal and neonate physical and emotional outcomes. Background: The physical healthcare environment has significant effects on health and well-being. Research indicates that birthing environments can impact women during labor and birth. However, summaries of the effects of different environments around birth are scarce. Methods: We conducted a systematic review, searching 10 databases in 2016 and 2017 for published research from their inception dates, on how birthing room design influences maternal and neonate physical and emotional outcomes, using a protocol agreed a priori. The quality of selected studies was assessed, and data were extracted independently by pairs of authors and described in a narrative analysis. Results: In total, 3,373 records were identified and screened by title and abstract; 2,063 were excluded and the full text of 278 assessed for analysis. Another 241 were excluded, leaving 15 articles presenting qualitative and quantitative data from six different countries on four continents. The results of the analysis reveal four prominent physical themes in birthing rooms that positively influence on maternal and neonate physical and emotional outcomes: (1) means of distraction, comfort, and relaxation; (2) raising the birthing room temperature; (3) features of familiarity; and (4) diminishing a technocratic environment. Conclusions: The evidence on how birthing environments affect outcomes of labor and birth is incomplete. There is a crucial need for more research in this field.
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| 26. |
- Nilvér, Helena, 1980, et al.
(författare)
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The Birth Companions' Experience of the Birthing Room and How It Influences the Supportive Role: A Qualitative Study
- 2023
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Ingår i: Herd-Health Environments Research & Design Journal. - 1937-5867 .- 2167-5112. ; 16:3, s. 156-167
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To explore birth companions' experience of the birthing room and how it influences their role supporting the woman during labor and birth. Background: Although support from a birth companion positively affects the outcome of labor and birth, limited research explores how the birthing room influences the companion. This study identifies elements of the birthing room essential for the birth companion to offer optimal support to the woman during labor and birth. Methods: Fifteen birth companions were individually interviewed 2 weeks to 6 months after birth using a semi-structured interview guide. Transcribed interviews were analyzed based on reflexive thematic analysis. Results: The findings are captured by one overall theme: creating a supportive birth space in an unfamiliar environment. This creation process is further described by three subthemes: not being in the way, finding one's role, and being close to the birthing woman. Conclusions: The findings illustrate how the birthing room was an unfamiliar environment for the birth companions, but one that they needed in order to give the required support. With slight changes in physical design, the birthing room can become calmer and more private and better help the birth companion fulfill the supportive role.
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| 27. |
- Nordin, Susanna, et al.
(författare)
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Exploring Environmental Variation in Residential Care Facilities for Older People
- 2017
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Ingår i: Health Environments Research and Design Journal. - : SAGE Publications. - 1937-5867 .- 2167-5112. ; 10:2, s. 49-65
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to explore variation in environmental quality in Swedish residential care facilities (RCFs) using the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM). Background: Well-designed physical environments can positively impact on health and well-being among older persons with frail health living in RCFs and are essential for supporting person-centered care. However, the evidence base for informing the design of RCFs is weak, partly due to a lack of valid and reliable instruments that could provide important information on the environmental quality. Methods: Twenty RCFs were purposively sampled from several regions, varying in their building design, year of construction, size, and geographic location. The RCFs were assessed using S-SCEAM and the data were analyzed to examine variation in environmental quality between and within facilities. Results: There was substantial variation in the quality of the physical environment between and within RCFs, reflected in S-SCEAM scores related to specific facility locations and with regard to domains reflecting residents’ needs. In general, private apartments and dining areas had high S-SCEAM scores, while gardens had lower scores. Scores on the safety domain were high in the majority of RCFs, whereas scores for cognitive support and privacy were relatively low. Conclusions: Despite high building standard requirements, the substantial variations regarding environmental quality between and within RCFs indicate the potential for improvements to support the needs of older persons. We conclude that S-SCEAM is a sensitive and unique instrument representing a valuable contribution to evidence-based design that can support person-centered care.
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| 28. |
- Shannon, Michelle M, et al.
(författare)
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Application of Theory in Studies of Healthcare Built Environment Research
- 2020
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Ingår i: Health Environments Research & Design Journal. - : SAGE Publications. - 1937-5867 .- 2167-5112. ; 13:3, s. 154-170
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Tidskriftsartikel (refereegranskat)abstract
- We aimed to examine the nature and extent of theory application in studies of built environment attributes and impact on adults in healthcare facilities. Many varied theories are described when providing the rationale for research into built environments in healthcare. Uncertainty exists around the right theory to frame a research question, alignment with measurement tools, and whether healthcare setting makes a difference. This poses challenges to researchers seeking to build the evidence base for built environment design that benefits patients and staff. Our multidisciplinary review team scoped the literature to determine how theories are used to inform research investigating the impact of the built environment of healthcare on adults. When researchers recorded theory at development of the study question, in data collection, and in data analysis/interpretation, we called this explicitly theory-based application. Synthesis occurred using a narrative approach. Overall, we found 17 diverse theories named in studies. Explicitly theory-based use occurred with eight theories, comprising 47% of all theories used. Five theories were named more frequently in studies out of all theories identified. In 20% of studies, theory was not used explicitly during the research inquiry. We argue that researchers must continue to strive toward explicit use of theories, similar to development of other health interventions that employ multifactorial components.
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| 29. |
- Sjölander, Annica, 1969, et al.
(författare)
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Hospital Design with Nature Films Reduces Stress-Related Variables in Patients Undergoing Colonoscopy
- 2019
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Ingår i: Herd-Health Environments Research & Design Journal. - : SAGE Publications. - 1937-5867 .- 2167-5112. ; 12:4, s. 186-196
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To examine whether patients' experiences could be improved during colonoscopy by designing the examination room to include a digital screen showing calm nature films. Background: Colonoscopy is the gold standard for examination of the large intestine and the rectum. Around 50% of individuals invited for colorectal cancer screening choose to refrain from the screening due to fear and anxiety. It is therefore important to improve patients' comfort during the procedure. Method: One of the four endoscopy rooms was rebuilt to include a large digital screen showing calm nature films. Patients were randomized to intervention (i.e., the room showing films) or control. During the colonoscopy, pulse and oxygen saturation were measured and the patients graded the intensity of pain and anxiety. Blood samples were taken regularly during the examination and were analyzed for glucose, cortisol, and prolactin. Results: The presence of calm nature films during colonoscopy decreased the release of cortisol, increased prolactin levels, and enhanced oxygen saturation. These effects were more apparent in patients who were unfamiliar with the procedure and the environment, patients who underwent the examination without analgesics or sedation, and patients whose examination procedure was relatively difficult and took a long time. Conclusions: The intervention described in this study is easy to implement and might help improve the patient experience during colonoscopy. However, this study was performed in a single health institution, and more studies are needed to further explore the role of film interventions in endoscopic and other medical procedures.
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| 30. |
- Sundberg, Fredrika, et al.
(författare)
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Visitor’s Experiences of an Evidence-Based Designed Healthcare Environment in an Intensive Care Unit
- 2021
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Ingår i: Health Environments Research & Design Journal. - : SAGE Open. - 1937-5867 .- 2167-5112. ; 14:2, s. 178-191
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The objective of the research was to study the visitors’ experiences of different healthcare environment designs of intensive care unit (ICU) patient rooms.Background: The healthcare environment may seem frightening and overwhelming in times when life-threatening conditions affect a family member or close friend and individuals visit the patient in an ICU. A two-bed patient room was refurbished to enhance the well-being of patients and their families according to the principles of evidence-based design (EBD). No prior research has used the Person-centred ClimateQuestionnaire—Family version (PCQ-F) or the semantic environment description (SMB) in the ICUsetting.Methods: A sample of 99 visitors to critically ill patients admitted to a multidisciplinary ICU completed a questionnaire; 69 visited one of the two control rooms, while 30 visited the interventionroom.Results: For the dimension of everydayness in the PCQ-F, a significantly better experience was expressed for the intervention room (p<.030); the dimension regarding the ward climate general was also perceived as higher in the intervention room (p<.004). The factors of pleasantness (p<.019), and complexity (p<0.049), showed significant differences favoring the intervention room in the SMB, with borderline significance on the modern factor (p<.061).Conclusion: Designing and implementing an enriched healthcare environment in the ICU setting increases person-centered care in relation to the patients’ visitors. This could lead to better outcomes for the visitors, for example, decreasing post-traumatic stress disorder symptoms, but this needs further investigations
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| 31. |
- Ulrich, Roger, 1946, et al.
(författare)
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A Conceptual Framework for the Domain of Evidence-Based Design
- 2010
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Ingår i: HERD. - : SAGE Publications. - 2167-5112 .- 1937-5867. ; 4:1, s. 95-114
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Tidskriftsartikel (refereegranskat)abstract
- The physical facilities in which healthcare services are performed play an important role in the healing process. Evidence-based design in healthcare is a developing field of study that holds great promise for benefiting key stakeholders: patients, families, physicians, and nurses, as well as other healthcare staff and organizations. In this paper, the authors present and discuss a conceptual framework intended to capture the current domain of evidence-based design in healthcare. In this framework, the built environment is represented by nine design variable categories: audio environment, visual environment safety enhancement wayfinding system, sustainability, patient room, family support spaces, staff support,spaces, and physician support spaces Furthermore a series of matrices is presented that indicates knowledge gaps concerning the relationship between specific healthcare facility design variable categories and participant and organizational outcomes. From this analysis, the authors identify fertile research opportunities from the perspectives of key stakeholders.
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| 32. |
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| 33. |
- Ulrich, Roger, 1946, et al.
(författare)
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ICU Patient Family Stress Recovery During Breaks in a Hospital Garden and Indoor Environments
- 2020
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Ingår i: HERD. - : SAGE Publications. - 2167-5112 .- 1937-5867. ; 13:2, s. 83-102
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Tidskriftsartikel (refereegranskat)abstract
- Objectives : Measure the immediate change in intensive care unit (ICU) family members’ state stress levels from the beginning to the end of a person’s visit to a hospital garden and compare the changes produced by the garden with those associated with spending time in indoor hospital environments intended for respite and relaxation. Background : No previous research has compared the efficacy of different physical environments as interventions to foster stress reduction in family members of ICU patients, a group of hospital visitors known to experience high levels of distress. Method : A convenience sample of 42 ICU patient family (from 42 different families) completed the Present Functioning Visual Analogue Scales (PFVAS) before and after each visit (128 total visits) to a garden, an atrium/café, or ICU waiting room. Results : Stress scores significantly declined (i.e., improved) from the start to the end of a break on all PFVAS subscales (p <.0001) in both the garden and indoors locations. However, it is noteworthy that garden breaks resulted in significantly greater improvement in the “sadness” scale than breaks in indoor locations (p =.03), and changes in all five other PFVAS scores showed somewhat more reduction of stress for breaks spent in the garden than indoors, although these differences were not statistically significant. Conclusion : Creating an unlocked garden with abundant nature located close to an ICU can be an effective intervention for significantly mitigating state stress in family members of ICU patients and can be somewhat more effective than indoor areas expressly designed for family respite and relaxation.
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| 34. |
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| 35. |
- Viergutz, Hannah-Kathrin Silja, et al.
(författare)
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Benchmarking Relevance for Hospital Design and Planning: An International Web-Based Survey
- 2024
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Ingår i: HERD. - 2167-5112 .- 1937-5867. ; In Press
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The study aims to investigate what design practitioners and healthcare facility managers deem as important benchmarking metrics worldwide, investigating country differences in benchmarking usage and which metrics are prioritized.Background: Benchmarking is a regular practice in the healthcare sector, both for clinical and managerial aspects to compare, measure, and improve standardized processes. However, limited knowledge is available about benchmarking procedures in hospital planning, design, and construction.Methods: A web-based survey was designed, revised, and pilot-tested in five countries; it was adjusted according to local experts' suggestions and submitted globally via SoSci multilingual platform to persons involved in hospital design, research, construction, and facility management. It was composed of closed questions on 5-point Likert-type scale ranking frequency or importance and open-ended questions divided into six sections. Two hundred and eighty full responses have been collected. Statistical analysis was performed via PowerBI and R-Studio, while qualitative analysis was performed via MAXQDA.Results: The findings reported allow for both specific insights per each country or category as well as enabling general considerations of a practice that is becoming always more international with 30%-50% of respondents working in the international context. The evaluation of the survey highlights the most important benchmarks, among others. For example, for respondents from the top five countries (Sweden, Spain, Germany, Italy, and the United States), the most important metric for benchmark comparability is whether the project was new construction, new construction attached to an existing hospital, or interior renovation. Construction date, client type (public vs. private), and country of location were also generally rated as the most important metrics by respondents. Other metrics that were consistently rated as important globally included inpatient unit layout, walking distances, number of floors, and whether all patient rooms are private. Space-related metrics are considered very important elements in the design and planning of healthcare facilities worldwide. Regarding cost-related metrics, all countries consider the ratio construction cost per building gross area as the most important.Conclusions: Benchmarking emerges as a relevant tool for hospital design and planning as it can support efficiency, standardization, and confidence; currently, benchmarking is still underutilized due to the challenge of international comparison, access to data outside each specific company, and variation design metrics nationally. Benchmarking strategies should be further investigated to support knowledge exchange and to ensure reliable and comparable information globally.
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| 36. |
- Zborowsky, Terri, et al.
(författare)
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Centralized vs. Decentralized Nursing Stations : Effects on Nurses' Functional Use of Space and Work Environment
- 2010
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Ingår i: Health Environments Research & Design Journal. - : SAGE Publications. - 1937-5867 .- 2167-5112. ; 3:4, s. 19-42
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Evidence-based findings of the effects of nursing station design on nurses' work environment and work behavior are essential to improve conditions and increase retention among these fundamental members of the healthcare delivery team. The purpose of this exploratory study was to investigate how nursing station design (i.e., centralized and decentralized nursing station layouts) affected nurses' use of space, patient visibility, noise levels, and perceptions of the work environment. Background: Advances in information technology have enabled nurses to move away from traditional centralized paper-charting stations to smaller decentralized work stations and charting substations located closer to, or inside of, patient rooms. Improved understanding of the trade-offs presented by : centralized and decentralized nursing station design has the potential to provide useful information for future nursing station layouts. This information will be critical for understanding the nurse environment "fit." Methods: The study used an exploratory design with both qualitative and quantitative methods. Qualitative data regarding the effects of nursing station design on nurses' health and work environment were gathered by means of focus group interviews. Quantitative data-gathering techniques included, place- and person-centered space use observations, patient visibility assessments, sound level measurements, and an online questionnaire regarding perceptions of the work environment. Results: Nurses on all units were observed most frequently performing telephone, computer, and administrative duties. Time spent using telephones, computers, and performing other administrative duties was significantly higher in the centralized nursing stations. Consultations with medical staff and social interactions were significantly less frequent in decentralized nursing stations. There were no indications that either centralized or decentralized nursing station designs resulted in superior visibility. Sound levels measured in all nursing stations exceeded recommended levels during all shifts. No significant differences were identified in nurses' perceptions of work control-demand-support in centralized and decentralized nursing station designs. Conclusions: The "hybrid" nursing design model in which decentralized nursing stations are coupled with centralized meeting rooms for consultation between staff members may strike a balance between the increase in computer duties and the ongoing need for communication and consultation that addresses the conflicting demands of technology and direct patient care.
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| 37. |
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| 38. |
- Persson, Johanna, et al.
(författare)
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Informing Hospital Change Processes Through Visualization and Simulation: A Case Study at a Children's Emergency Clinic
- 2014
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Ingår i: Health Environments Research & Design Journal. - 2167-5112. ; 8:1, s. 45-66
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To demonstrate the use of visualization and simulation tools in order to involve stakeholders and inform the process in hospital change processes, illustrated by an empirical study from a children's emergency clinic. BACKGROUND: Reorganization and redevelopment of a hospital is a complex activity that involves many stakeholders and demands. Visualization and simulation tools have proven useful for involving practitioners and eliciting relevant knowledge. More knowledge is desired about how these tools can be implemented in practice for hospital planning processes. METHODS: A participatory planning process including practitioners and researchers was executed over a 3-year period to evaluate a combination of visualization and simulation tools to involve stakeholders in the planning process and to elicit knowledge about needs and requirements. RESULTS: The initial clinic proposal from the architect was discarded as a result of the empirical study. Much general knowledge about the needs of the organization was extracted by means of the adopted tools. Some of the tools proved to be more accessible than others for the practitioners participating in the study. The combination of tools added value to the process by presenting information in alternative ways and eliciting questions from different angles. CONCLUSIONS: Visualization and simulation tools inform a planning process (or other types of change processes) by providing the means to see beyond present demands and current work structures. Long-term involvement in combination with accessible tools is central for creating a participatory setting where the practitioners' knowledge guides the process.
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