Indigenous Preferences for Inpatient Rooms in Australian Hospitals: A Mixed-Methods Study in Cross-Cultural Design.

AIM: This mixed-method study aimed to establish preliminary evidence for spatial and design features that can improve the experience and participation of Indigenous inpatients in healthcare. BACKGROUND: Disadvantaged across a range of health measures, a disproportionately high number of Indigenous people leave hospital without receiving appropriate medical care. Australian government policies to improve cultural safety of Indigenous patients have largely ignored physical settings and their potential to improve health outcomes. Despite increasing evidence on the potential of design to reduce patient stress, there is minimal research on cross-cultural design in health facilities, including for Indigenous Australians. METHODS: A cross-sectional, area-based survey elicited design preferences of four healthcare settings from Indigenous participants (n = 602). On the screen-based survey, participants selected from paired images that indicated their preferences for room layout and features of inpatient rooms. Semistructured in-depth interviews (n = 55) explored meanings behind preferences. RESULTS: Participants showed majority preferences for the two-bed patient room, for a balcony rather than a window only, Indigenous art, and view of a park over an urban environment. Analysis of qualitative data shifted the focus from Ulrich's three supportive design components to cultural recognition, the desire for company of family members, and connection to life outdoors. CONCLUSIONS: Social and cultural factors were highly significant to patients for sense of control, family support, and positive distraction. In response, inpatient room size and type, views, access to outdoors and Indigenous art need to be considered in hospital design for Indigenous patients and families.

Aboriginal and Torres Strait Islander preferences for healthcare settings: effective use of design images in survey research.

Objective The aim of this study was to develop an effective digital survey instrument incorporating images to investigate Aboriginal and Torres Strait Islander preferences for health clinics and hospitals, design of healthcare settings and the differences between inner regional and remote locations. Methods Design-related constructs developed from qualitative interviews informed the construction of healthcare setting images. These images were embedded in an online survey instrument to elicit data on design preferences and an area-based recruitment strategy ensured participation by Indigenous Australians from three Queensland locations. Logistic regression analyses were used to estimate the odds of preference for a healthcare setting design by location. Results Statistical analysis of data from 602 participants showed a preference for health care at an Aboriginal and Torres Strait Islander clinic. The odds of preference for an in-patient room with a two- versus single-bed design was greater for participants with less education, and lower for participants with a long-term health problem. Conclusions The multidisciplinary approach to developing an online survey instrument with images and the willingness of Indigenous people of all ages to engage with the images demonstrated the effectiveness of this method in providing robust evidence for the design of culturally appropriate healthcare spaces for Indigenous users. What is known about the topic? Evidence-based research influences the design of healthcare buildings, yet the field currently provides negligible evidence on cross-cultural perceptions or experiences of conventional modern hospitals and clinics. Although recent healthcare buildings show signs of acknowledging Indigenous users, general principles in the Australian Health Facility Guidelines give limited specific information about how cultural requirements may translate into architectural design. What does this paper add? The multidisciplinary approach to research design has enabled the development of healthcare design-related constructs from consultation with Indigenous people, the presentation of these constructs as images and the inclusion of these images for comparison and selection in a digital survey instrument. Combined with a culturally appropriate recruitment strategy, this survey provides evidence from a large sample of the Indigenous population. Selected results from analyses of survey responses show the capacity of the methodological approach to address broader questions about Indigenous preferences for healthcare settings by location, age and sex. What are the implications for practitioners? A focus on individual preferences related to healthcare clinics and the combined significance of design and setting can give practitioners a better understanding of Aboriginal and Torres Strait Islander people's preferences and suggest ways to reduce the incidence of poor engagement with healthcare services.