Health-Promotive Building Design - Exploring perspectives on building design for health promotion in healthcare settings

Sammanfattning: This thesis explores perspectives on health promotion in healthcare settings from a building design perspective, i.e., health-promotive building design (HPBD). The results may contribute to discussions of the role of healthcare building design to support health promotion in healthcare (HPH) and thereby contribute to the development of healthier and more equitable communities. Currently, healthcare organisations are encouraged to introduce health promotion approaches and develop HPH. The research suggests that the introduction of new healthcare procedures, such as health promotion, can lead to new demands for the built environment. The previous research also shows that the design aspects of healthcare buildings can actively support treatment, protect health, and prevent disease for diverse building users. However, there is limited research with a particular focus on healthcare building design in relation to health promotion or HPH. It is thus crucial that those involved in the design process become familiar with health promotion and HPH and be able to design high-quality healthcare buildings. Health promotion can be defined as ‘the process of enabling people to increase control over and improve their health’. Nevertheless, there are many definitions and interpretations of health promotion that depend on the context in which it is used as well as the disciplines of the people involved. While health promotion has gained attention from healthcare architects, it is unclear how health promotion is actually understood by those involved in the healthcare building design process and how they translate health promotion goals into design objectives. The first two studies in this thesis therefore explored descriptions of health promotion in the context of the healthcare building design literature (study 1) and practice (study 2). Health promotion in healthcare settings generally refers to organisations expanding their traditional focus on the treatment of disease to include a focus on the health development of all building users, the local population and the environment. The development of HPH involves diverse practices such as changes in the built environment. However, a small number of studies have focused particularly on the built environment in relation to HPH. The last two studies in this thesis therefore focused on exploring descriptions of the built environment in the context of HPH. For this thesis, an explorative research design was adopted based upon a multi-perspective approach including (1) a literature perspective, (2) a design practice perspective, (3) an HPH network perspective and (4) an HPH organisation perspective. The data were collected through literature reviews, documentation, semi-structured interviews and online surveys. The combined work revealed diverse descriptions of health promotion in relation to healthcare building design in terms of (1) definitions of health promotion, (2) health-promotive perspectives, and (3) different targeted populations. The results also showed multiple descriptions of the built environment as a factor for health promotion including (4) expressions related to the built environment, (5) indications of places where health promotion can happen, (6) design features characterising HPBDs, and (7) design strategies to develop HPBDs. The findings show that the research on the design of health-promotive built environments is in its early stage of development. The results indicate that the vocabulary for describing building design, health promotion and healthcare settings is diverse and inconsistent and that none of the health-promotive perspectives considers all dimensions of health promotion or HPH. What is more problematic is that the diverse health-promotive descriptions have led to different, even conflicting, demands for building design. Based on the results, I suggest that project groups should specify and reflect upon their interpretation of the built environment, health promotion, HPH and HPBD. I recommend that HPBD should (1) focus on individuals and (vulnerable) communities; (2) focus on the different factors that improve health, not only those that prevent illness and disease; (3) consider environmental impacts; (4) involve collaboration with others; and (5) utilise the best available research. More research is needed to explore solutions in other countries, in other settings, or with other stakeholders, and it should include analysis of best-practices.