Does Perceived Control Matter in the Outpatient Waiting Room?

OBJECTIVE: The study examined perceived control in the context of the outpatient waiting room to further understand the extent to which patients want to exercise control in that environment. Background: In Ulrich's theory of supportive design, research shows more evidence for positive distraction and social support than for perceived control; its role in outpatient settings has not been examined. METHOD: This between-subjects experimental design, in which participants read a written scenario varying the number of patients waiting (1 or 5) and the control available (no information provided, personal controls, and room controls), examined the effect of those variables on stress, satisfaction with the environment, extent of perceived control, and participants' schema of who should control the environment of the waiting room. RESULTS: Having individual controls available in the waiting room favorably impacted the perception of the environment but did not significantly impact stress. The data show that people likely have a schema of appropriate behavior in a doctor's waiting room, which does not encourage manipulation of environmental elements. CONCLUSIONS: In the doctor's office waiting room, having individual controls, such as on-off knobs on table lamps next to each chair, can improve evaluation of the environment and increase people's perception of control.

Seating in Doctors' Waiting Rooms: Has COVID-19 Changed Our Choices?

OBJECTIVE: This study investigates preference for five different seating arrangements (e.g., rows, clusters) in a doctor's office waiting room, whether these reduce stress and improve judgments of medical care, and how such choices may have changed over the pandemic (2013 vs. 2021). BACKGROUND: What is called the doctor's office layout, with chairs lining the perimeter of the waiting room, is criticized by designers, yet little empirical evidence exists to support that assessment. METHOD: Data collected in 2013 and 2021 used sketches of five different seating arrangements; people saw just one of these. The study examined the effect of time and seating arrangement on anxiety, need for privacy, situational awareness, evaluation of the environment, and perception of the doctor. RESULTS: There was no significant impact of the seating arrangement on any of the dependent variables, but ratings were higher for situational awareness, need for privacy, evaluation of the environment, and aspects related to the physician in 2021. In addition, seating preferences favored end, not middle seats, and chair selections with the chair back to a wall. CONCLUSION: In this study, no evidence exists that the doctor's office layout is less preferred than four other seating arrangements, but seat choice shows people prefer end seats (not middle seats) across arrangements. The doctor's office layout may offer a supportive familiarity to people; also, given the percentage of people who visit the doctor unaccompanied, layouts designed to encourage social interaction may not always be appropriate.

The Display of Medical Information: Content, Format, and Subjective Experience.

OBJECTIVES: To address a gap in the literature by investigating the subjective experience of participants to the form and content of medical information displayed in a healthcare setting. BACKGROUND: Artwork can enhance the experience of patients, but much less is known about how individuals react to displays of medical information in the form of posters or pamphlets, especially those about unsettling conditions (e.g., skin cancer). METHODS: In a 2 × 2 × 2 between-subjects design, researchers investigated the content of medical information (skin cancer vs. skin care) that was on display in a simulated exam room, whether the form was a pamphlet or a poster, and reason for the visit (routine annual skin check or evaluating a mole) on measures of subjective experience, including anxiety. RESULTS: Viewing material about skin cancer produced greater anxiety and greater arousal than did viewing material about sunscreen, and given the choice of four images (pamphlet and poster for sunscreen, pamphlet and poster for skin cancer), the sunscreen poster was recommended to improve the patient's experience and lower stress. In terms of display format, posters are judged to provide more visual engagement than are pamphlets. CONCLUSIONS: Exam rooms should offer multiple opportunities for visual engagement without images that produce anxiety. More research is needed to understand the subjective experience of the patient's interaction with the content and format of medical information.

Perceptions of Psychotherapy Waiting Rooms: Design Recommendations.

OBJECTIVE: This study fills the gap in literature by examining the design elements preferred in psychotherapy waiting rooms. BACKGROUND: Studies have examined waiting rooms in hospitals and doctors' offices, but there is little published literature on waiting rooms in psychotherapy offices. Waiting rooms in psychotherapy offices may affect clients' perceived quality of care and their comfort level. METHOD: Psychotherapists in Connecticut and Rhode Island were interviewed and agreed to have the waiting rooms (20 in total) of their practices photographed. Then, in a within-subjects design, 250 participants (225 retained for analyses) from MTurk answered questions about the quality of care and comfort in the environment expected in those 20 waiting rooms. RESULTS: Factor analytic results showed that waiting rooms that were welcoming and comfortable as well as large and spacious rated higher for the quality of care and comfort in the environment anticipated by the participant; those that were cramped and crowded rated lower. Few therapists reported any design education about counseling environments and none about the waiting room. CONCLUSION: Information from this study can guide the design of psychotherapy waiting rooms and enhance healthcare experience.

Magnitude Matters: Art Image Size and Waiting Time Impact Perceived Quality of Care.

OBJECTIVE: The study fills a gap in the literature by examining the size of the art displayed and waiting time in an exam office on patients' judgments of the quality of care they are likely to receive. BACKGROUND: A body of research shows that the content of art in healthcare settings has an impact on patients' well-being, yet no work has empirically systematically examined the size of the art displayed on perceived healthcare outcomes. METHOD: A fully crossed 4 ×2 between-subjects experimental design examined the impact of exposure to images in an outpatient exam room that varied in the size of what was displayed (a landscape scene: small, medium, large, and control-blank wall) crossed by the time waiting for the physician (10 vs. 45 min). The Dependent Variables were the reported anxiety and various measures of satisfaction with the healthcare visit. RESULTS: The size of the art had a significant effect on the majority of the dependent variables; specifically, the large image had a more positive impact than the other sizes; longer waits were also negatively evaluated by patients and affected anxiety and judgments of room spaciousness. CONCLUSIONS: Identifying the recommended content of art displayed is necessary but not sufficient; the size of the art in its context has the potential to impact a range of important perceptions related to healthcare. When the size does not match the available wall space (i.e., the canonical size was not utilized), a variety of ratings of the healthcare environment (including the practitioner) were negatively affected.

Qualities of Inpatient Hospital Rooms: Patients' Perspectives.

OBJECTIVES: The aim of this qualitative study was to investigate what design features of hospital rooms are valued by inpatients. BACKGROUND: Little research has explored how patients evaluate the physical environment of their hospital rooms. Most responses are captured by the Hospital Consumer Assessment of Healthcare Providers and Systems survey, which includes only two questions about the physical environment. METHOD: Two hundred thirty-six orthopedic patients (78 in the United States and 158 in Portugal) listed three features of their hospital room that influenced their level of satisfaction with their hospital stay, indicating whether the feature was positive or negative. RESULTS: The comments were more positive (71.4%) than negative (28.6%). Using the framework of supportive design from Ulrich, over half the comments (64.31%) could be categorized in one of the three dimensions: 33.2% (positive distraction), 22.4% (perceived control), and 6.0% (social support). This total includes Internet (2.7%), which could be categorized as either social support or positive distraction. Comments called "other aspects" focused on overall environmental appraisals, cleanliness, and functionality and maintenance. CONCLUSIONS: The majority of comments could be accommodated by Ulrich's theory, but it is noteworthy that other aspects emerge from patients' comments and affect their experience. Cross-cultural differences pointed to the greater role of light and sun for Portuguese patients and health status whiteboard for U.S. PATIENTS: Qualitative research can add significantly to our understanding of the healthcare experience and may inform design decisions.

Wayfinding in healthcare facilities: contributions from environmental psychology.

The ability to successfully navigate in healthcare facilities is an important goal for patients, visitors, and staff. Despite the fundamental nature of such behavior, it is not infrequent for planners to consider wayfinding only after the fact, once the building or building complex is complete. This review argues that more recognition is needed for the pivotal role of wayfinding in healthcare facilities. First, to provide context, the review presents a brief overview of the relationship between environmental psychology and healthcare facility design. Then, the core of the article covers advances in wayfinding research with an emphasis on healthcare environments, including the roles of plan configuration and manifest cues, technology, and user characteristics. Plan configuration and manifest cues, which appeared early on in wayfinding research, continue to play a role in wayfinding success and should inform design decisions. Such considerations are joined by emerging technologies (e.g., mobile applications, virtual reality, and computational models of wayfinding) as a way to both enhance our theoretical knowledge of wayfinding and advance its applications for users. Among the users discussed here are those with cognitive and/or visual challenges (e.g., Down syndrome, age-related decrements such as dementia, and limitations of vision). In addition, research on the role of cross-cultural comprehension and the effort to develop a system of universal healthcare symbols is included. The article concludes with a summary of the status of these advances and directions for future research.

Impressions of psychotherapists' offices.

For counseling settings, research suggests that softness, personalization, and order might affect the experience and the perceived expertness, trustworthiness, and social attractiveness of the therapist. This article discusses exploratory studies on college students' perception of the counseling office environment and whether the likely client experience was associated with the softness/personalization and order of the office. As stimuli, the studies used 30 color photographs of psychotherapists' offices viewed from the client's perspective. After obtaining ratings of the characteristics of each office, we obtained ratings from different groups of students of the quality of care and comfort expected in each office (Study 1) and how qualified, bold, and friendly the therapist in the office would be (Study 2). Additional studies examined the likelihood of choosing a therapist based on the office, and the first thought or feeling that came to mind about the office, the therapist, and the patient experience. There were strong correlations in response between groups (by whether they had experienced therapy; their level in school; their gender; and their major, location, and school size). The quality of care, comfort, therapist boldness, qualifications of the therapist, and the likelihood that one would choose a therapist based on the office improved with increases in the office's softness/personalization and order. Friendliness improved with increases in softness/personalization. The office choices, open-ended responses, and reported reasons for the ratings confirmed the importance of softness (comfort) and order. Research should test longer term exposure and behavior.

Sailing experience and sex as correlates of spatial ability.

The relationship between sailing experience and men's and women's spatial ability was examined by assessing the sailing history and Mental Rotations Test scores of 230 participants. The 102 men and 128 women came from three groups: college sailors (n =65), members of the general student body (n= 110), and college crew team members (n=55). Participants completed the Vandenberg and Kuse Mental Rotations Test and Lawton's Way-finding Strategy Scale and Spatial Anxiety Scale. Demographic variables and sailing experience were also assessed. Men scored significantly higher on the Mental Rotations Test than did women, and sailing team members scored significantly higher on that test than did student body members and crew team members. Results are discussed in terms of current explanations for sex differences in spatial ability.