Thesis submitted in partial fulfillment of the requirements for the degree of Doctor in Psycholog... more Thesis submitted in partial fulfillment of the requirements for the degree of Doctor in Psychology Specialty in Clinical and Health Psychology / PsycINFO Codes: 3365 Promotion & Maintenance of Health &Wellness 3371 Outpatient Services 3379 Inpatient & Hospital Services 4000 Engineering & Environmental Psychology
In this chapter, we examine which qualities and characteristics of hospital environments result i... more In this chapter, we examine which qualities and characteristics of hospital environments result in positive outcomes, with a particular focus on the patient. Specifically, we explore what fundamental psychological needs the physical environment of the hospital should address. We begin with two principles that guide research on the quality of the hospital experience: patient-centered care and evidence-based design. We then examine the effects of positive distraction, perceived control, and social support, elements from Ulrich’s (J Healthcare Inter Des 3:97–109, 1991) theory of supportive design. Within the realm of positive distraction, we review the effects of views of nature, healing gardens, live plants, art and simulated nature, television, and music. We include a section on the ecological validity of simulation techniques such as virtual reality. Within perceived control, we discuss opportunities for control (e.g., adjustable temperature), and the impact of single-occupancy rooms. Within social support, we examine the spatial arrangement of the hospital clinic and the availability of seating and other accommodation for family and visitors. We conclude with recommendations to continue research of high methodological quality, including more randomized controlled trials. In addition, we recommend exploring cultural variables that may moderate the relationship between the physical environment of the hospital and positive outcomes for patients.
Corrigendum to “Users’ views of hospital environmental quality: Validation of the Perceived Hospi... more Corrigendum to “Users’ views of hospital environmental quality: Validation of the Perceived Hospital Environment Quality Indicators (PHEQIs)” [J Environ Psychol 32 (2012) 97e111] Claudia Andrade *, Maria Luisa Lima , Ferdinando Fornara , Marino Bonaiuto d Centre for Psychological Research & Social Intervention (CIS), Lisbon University Institute (ISCTE-IUL), Av. das Forcas Armadas, 1649-026 Lisboa, Portugal Department of Social and Organizational Psychology, Lisbon University Institute (ISCTE-IUL), Av. das Forcas Armadas, 1649-026 Lisboa, Portugal Department of Psychology, University of Cagliari, Via Is Mirrionis, 1, 09123 Cagliari, Italy Department of Developmental and Social Psychology, University of Rome “La Sapienza”, Italy
RESUMOEste estudo desenvolve e valida duas escalas de medida da percepção da qualidade do ambient... more RESUMOEste estudo desenvolve e valida duas escalas de medida da percepção da qualidade do ambiente hospitalar: físico e sócio-funcional. Participaram 122 utilizadores de Unidades de Dor Portuguesas. Os resultados de Análises Fatoriais Confirmatórias atestam a validade fatorial da escala de percepção de qualidade do ambiente físico composta por cinco fatores: Conforto físico-espacial, Orientação, Tranquilidade, Vista e iluminação e Temperatura e qualidade do ar; e da escala de percepção de qualidade do ambiente sócio-funcional composta por dois fatores: Relações sociais e organizacionais e Privacidade. Sendo a qualidade do ambiente hospitalar um importante fator para o bem-estar, a demonstração da validade fatorial dessas escalas é útil para o estudo e promoção da qualidade de ambientes hospitalares saudáveis.
Environmental Quality Perception (EQP) is an important construct used to help to understand the r... more Environmental Quality Perception (EQP) is an important construct used to help to understand the relationship between people and the hospital environment. From a patient-centered care perspective, it is important that hospital design take into account the patients’ (and other users’) point of view. This paper presents the adaptation and validation of a measure of hospital EQP, the Perceived Hospital Environment Quality Indicators (PHEQIs; Fornara, Bonaiuto, & Bonnes, 2006), and seeks to confirm the factor structure of this construct in a different cultural context. Three scales, two focusing on physical environments and one evaluating the social environment, were completed by 562 users of four orthopedic units in Portuguese hospitals, two older and two recently built or renovated. To assess criterion validity, hospital physical environments were also objectively evaluated by two architects. Using a confirmatory factor analysis the three validation procedures produced acceptable fit i...
Hearing loss is frequent in old age and has been associated with fewer social activities and depr... more Hearing loss is frequent in old age and has been associated with fewer social activities and depression. However, hearing problems have also been associated with other comorbidities, which prevent more definitive conclusions about the unique role on older people's wellbeing. Moreover, little attention has been paid to the psychological processes through which this relationship occurs. This study aims to investigate the effect of hearing loss on older adults' wellbeing from a longitudinal perspective. Using data from three points in time, we investigated the mutual relationship between hearing loss, depression and social activities. Based on longitudinal data of the Survey of Health, Ageing and Retirement in Europe (SHARE) from ten European countries, we conducted the test of competing auto-regressive cross-lagged theoretical models. Results show that hearing loss reduces social activity, which is mediated by depression. The adequacy of this model (versus a model proposing that social activity restriction mediates the relationship between hearing loss and depression) was supported in each of the countries of the sample. Findings showing that hearing loss can contribute to depression and, subsequently, to restriction in social activities have implications for early detection and clinical interventions on hearing loss.
The physical environment of healthcare settings can contribute to preventing or reducing patients... more The physical environment of healthcare settings can contribute to preventing or reducing patients' stress. Using Ulrich's theory of supportive design (1991), this study tested whether this relationship occurs because the physical environment promotes perceptions of control, positive distractions, and social support. The research disentangles the contribution of the objective qualities of physical environment to stress, over and above patients' perceptions about the environment. In a multi-site field study (five hospital units from two countries), 57 hospital rooms were assessed in terms of the number of favorable design features, and 187 patients responded to a questionnaire after surgery. Multilevel regression analysis showed that the greater the number of favorable design features, the less the patients' stress, that positive perceptions about the room qualities in terms of how much social support and distraction they provide explain this effect, and that the relative importance of these dimensions may differ between cultures.
Perceived control is a desirable quality in the healthcare environment to increase patients' well... more Perceived control is a desirable quality in the healthcare environment to increase patients' well-being. However, recent research has demonstrated that perceived control did not predict stress. Based on the hypothesis that control does not always lead to better adjustment, and that it may depend on whether people want to have control, the aim of the current research was to examine the moderating role of individual differences in terms of desire for control. In an experiment, 150 participants were randomly assigned to one of two conditions. First we measured desirability of control; next we presented a scenario of a hypothetical hospitalization. Perceived control was manipulated by the stated presence or absence of an integrated remote device that allows adjustment of environmental features in the room. Results showed that having control over the room positively predicts stress reduction among people with high desirability for control, whereas among people with low desirability for control this relationship was not significant.
This paper addresses the influence of the physical environment on patients’ responses to healthca... more This paper addresses the influence of the physical environment on patients’ responses to healthcare experiences. We advocate that the accumulated evidence showing the effect of the objective features of the hospital physical environment on patients’ well-being and recovery is compelling, and that the current shift to a patient-centered care model– stressing the importance of understanding the patient as a whole person in a wider psychological and social context, including needs and preferences – must include moving towards more supportive and favorable health care facilities. Although the impact of healthcare environments is widely recognized, there are still several avenues to explore. We describe the latest research that our team has been conducting on the topic, and we argue that our understanding of the role of the hospital physical environment is incomplete without a more thoughtful account of the underlying psychological mechanisms and moderators involved – such as culture, as but one example. Taken together, our work suggests the need for a more comprehensive approach to improve the understanding of the influence of the hospital physical environment.
Hospital rooms may exacerbate or reduce patients' stress. According to Ulrich's (1991) theory of ... more Hospital rooms may exacerbate or reduce patients' stress. According to Ulrich's (1991) theory of supportive design, the hospital environment will reduce stress if it fosters perceptions of control (PC), social support (SS), and positive distraction (PD). An experimental study was conducted to test this theory. Participants were asked to imagine a hospitalization scenario and were exposed to one of 8 lists of elements that the hospital room would provide selected to facilitate PC, SS, PD, or 1 of all the possible combinations of these elements. Results confirmed Ulrich's theory. Participants expected significantly less stress in the situations where all (or only PD and SS) elements were present. Meditational analyses confirmed that the number of elements in the hospital room affects expected stress through the perceptions of how much positive distraction and social support it is perceived to provide, but not through the perception of the level of perceived control available.
Evidence points to the role of the physical environment on patient well- being, but its specific ... more Evidence points to the role of the physical environment on patient well- being, but its specific contribution is not clear. Two experimental studies were conducted. First, we investigated the inferences people make about the physical environment given information about the social environment, and vice versa. In 6 conditions participants were exposed to information about an inadequate, neutral, or good hospital physical environment; or about a negative, neutral, or positive hospital social environment. Results showed that people associate the quality of hospitals’ physical and social environments, and the corresponding expected well-being. Study 2 sought to disentangle the independent effect of the physical and social dimensions. Levels of quality of the physical and social environments were crossed in a 3x3 between-subjects design. Results showed that both dimensions have a specific significant effect. In particular, the physical environment seems unable to improve satisfaction when its quality is high, but is able to reduce satisfaction when its quality is low.
This study analyses the processes through which the physical environment of health care settings
... more This study analyses the processes through which the physical environment of health care settings
impacts on patients’ well-being. Specifically, we investigate the mediating role of perceptions of the
physical and social environments, and if this process is moderated by patients’ status, that is, if the
objective physical environment impacts inpatients’ and outpatients’ satisfaction by different social–
psychological processes. Patients (N=206) evaluated the physical and social environments of the care unit where they were receiving treatment, and its objective physical conditions were independently evaluated by two architects. Results showed that the objective environmental quality affects satisfaction through perceptions of environmental quality, and that patients’ status moderates this relationship. For inpatients, it is the perception of quality of the social environment that mediates the relationship between objective environmental quality and satisfaction, whereas for outpatients it is the perception of quality of the physical environment. This moderated mediation is discussed in terms of differences on patients’ experiences of health care environments.
"Physical working conditions have potential effects on health, and play an important role in qual... more "Physical working conditions have potential effects on health, and play an important role in quality of life,
and job satisfaction, yet most studies on the direct or indirect consequences of physical environmental conditions
on healthcare professionals’ focus on outcomes such as performance, efficiency, and error. The objective of this
study was to analyze the effects of the physical environment quality of healthcare settings on professionals’ wellbeing.
The sample comprised 148 healthcare professionals working in inpatient or outpatient care units from
four different hospitals. Two independent variables were used: Objective environmental quality (high/low) and
Type of care unit (inpatient/outpatient); and three well-being indicators were analyzed: Job satisfaction,
Perception of the care unit as close to an ideal care unit, and Subjective stress. Results show that healthcare
professionals working in hospitals with better physical conditions feel more satisfied with their job, and perceive
the care unit as closer to the ideal. Stress levels were not affected by physical environment quality or the type of
care unit."
Thesis submitted in partial fulfillment of the requirements for the degree of Doctor in Psycholog... more Thesis submitted in partial fulfillment of the requirements for the degree of Doctor in Psychology Specialty in Clinical and Health Psychology / PsycINFO Codes: 3365 Promotion & Maintenance of Health &Wellness 3371 Outpatient Services 3379 Inpatient & Hospital Services 4000 Engineering & Environmental Psychology
In this chapter, we examine which qualities and characteristics of hospital environments result i... more In this chapter, we examine which qualities and characteristics of hospital environments result in positive outcomes, with a particular focus on the patient. Specifically, we explore what fundamental psychological needs the physical environment of the hospital should address. We begin with two principles that guide research on the quality of the hospital experience: patient-centered care and evidence-based design. We then examine the effects of positive distraction, perceived control, and social support, elements from Ulrich’s (J Healthcare Inter Des 3:97–109, 1991) theory of supportive design. Within the realm of positive distraction, we review the effects of views of nature, healing gardens, live plants, art and simulated nature, television, and music. We include a section on the ecological validity of simulation techniques such as virtual reality. Within perceived control, we discuss opportunities for control (e.g., adjustable temperature), and the impact of single-occupancy rooms. Within social support, we examine the spatial arrangement of the hospital clinic and the availability of seating and other accommodation for family and visitors. We conclude with recommendations to continue research of high methodological quality, including more randomized controlled trials. In addition, we recommend exploring cultural variables that may moderate the relationship between the physical environment of the hospital and positive outcomes for patients.
Corrigendum to “Users’ views of hospital environmental quality: Validation of the Perceived Hospi... more Corrigendum to “Users’ views of hospital environmental quality: Validation of the Perceived Hospital Environment Quality Indicators (PHEQIs)” [J Environ Psychol 32 (2012) 97e111] Claudia Andrade *, Maria Luisa Lima , Ferdinando Fornara , Marino Bonaiuto d Centre for Psychological Research & Social Intervention (CIS), Lisbon University Institute (ISCTE-IUL), Av. das Forcas Armadas, 1649-026 Lisboa, Portugal Department of Social and Organizational Psychology, Lisbon University Institute (ISCTE-IUL), Av. das Forcas Armadas, 1649-026 Lisboa, Portugal Department of Psychology, University of Cagliari, Via Is Mirrionis, 1, 09123 Cagliari, Italy Department of Developmental and Social Psychology, University of Rome “La Sapienza”, Italy
RESUMOEste estudo desenvolve e valida duas escalas de medida da percepção da qualidade do ambient... more RESUMOEste estudo desenvolve e valida duas escalas de medida da percepção da qualidade do ambiente hospitalar: físico e sócio-funcional. Participaram 122 utilizadores de Unidades de Dor Portuguesas. Os resultados de Análises Fatoriais Confirmatórias atestam a validade fatorial da escala de percepção de qualidade do ambiente físico composta por cinco fatores: Conforto físico-espacial, Orientação, Tranquilidade, Vista e iluminação e Temperatura e qualidade do ar; e da escala de percepção de qualidade do ambiente sócio-funcional composta por dois fatores: Relações sociais e organizacionais e Privacidade. Sendo a qualidade do ambiente hospitalar um importante fator para o bem-estar, a demonstração da validade fatorial dessas escalas é útil para o estudo e promoção da qualidade de ambientes hospitalares saudáveis.
Environmental Quality Perception (EQP) is an important construct used to help to understand the r... more Environmental Quality Perception (EQP) is an important construct used to help to understand the relationship between people and the hospital environment. From a patient-centered care perspective, it is important that hospital design take into account the patients’ (and other users’) point of view. This paper presents the adaptation and validation of a measure of hospital EQP, the Perceived Hospital Environment Quality Indicators (PHEQIs; Fornara, Bonaiuto, & Bonnes, 2006), and seeks to confirm the factor structure of this construct in a different cultural context. Three scales, two focusing on physical environments and one evaluating the social environment, were completed by 562 users of four orthopedic units in Portuguese hospitals, two older and two recently built or renovated. To assess criterion validity, hospital physical environments were also objectively evaluated by two architects. Using a confirmatory factor analysis the three validation procedures produced acceptable fit i...
Hearing loss is frequent in old age and has been associated with fewer social activities and depr... more Hearing loss is frequent in old age and has been associated with fewer social activities and depression. However, hearing problems have also been associated with other comorbidities, which prevent more definitive conclusions about the unique role on older people's wellbeing. Moreover, little attention has been paid to the psychological processes through which this relationship occurs. This study aims to investigate the effect of hearing loss on older adults' wellbeing from a longitudinal perspective. Using data from three points in time, we investigated the mutual relationship between hearing loss, depression and social activities. Based on longitudinal data of the Survey of Health, Ageing and Retirement in Europe (SHARE) from ten European countries, we conducted the test of competing auto-regressive cross-lagged theoretical models. Results show that hearing loss reduces social activity, which is mediated by depression. The adequacy of this model (versus a model proposing that social activity restriction mediates the relationship between hearing loss and depression) was supported in each of the countries of the sample. Findings showing that hearing loss can contribute to depression and, subsequently, to restriction in social activities have implications for early detection and clinical interventions on hearing loss.
The physical environment of healthcare settings can contribute to preventing or reducing patients... more The physical environment of healthcare settings can contribute to preventing or reducing patients' stress. Using Ulrich's theory of supportive design (1991), this study tested whether this relationship occurs because the physical environment promotes perceptions of control, positive distractions, and social support. The research disentangles the contribution of the objective qualities of physical environment to stress, over and above patients' perceptions about the environment. In a multi-site field study (five hospital units from two countries), 57 hospital rooms were assessed in terms of the number of favorable design features, and 187 patients responded to a questionnaire after surgery. Multilevel regression analysis showed that the greater the number of favorable design features, the less the patients' stress, that positive perceptions about the room qualities in terms of how much social support and distraction they provide explain this effect, and that the relative importance of these dimensions may differ between cultures.
Perceived control is a desirable quality in the healthcare environment to increase patients' well... more Perceived control is a desirable quality in the healthcare environment to increase patients' well-being. However, recent research has demonstrated that perceived control did not predict stress. Based on the hypothesis that control does not always lead to better adjustment, and that it may depend on whether people want to have control, the aim of the current research was to examine the moderating role of individual differences in terms of desire for control. In an experiment, 150 participants were randomly assigned to one of two conditions. First we measured desirability of control; next we presented a scenario of a hypothetical hospitalization. Perceived control was manipulated by the stated presence or absence of an integrated remote device that allows adjustment of environmental features in the room. Results showed that having control over the room positively predicts stress reduction among people with high desirability for control, whereas among people with low desirability for control this relationship was not significant.
This paper addresses the influence of the physical environment on patients’ responses to healthca... more This paper addresses the influence of the physical environment on patients’ responses to healthcare experiences. We advocate that the accumulated evidence showing the effect of the objective features of the hospital physical environment on patients’ well-being and recovery is compelling, and that the current shift to a patient-centered care model– stressing the importance of understanding the patient as a whole person in a wider psychological and social context, including needs and preferences – must include moving towards more supportive and favorable health care facilities. Although the impact of healthcare environments is widely recognized, there are still several avenues to explore. We describe the latest research that our team has been conducting on the topic, and we argue that our understanding of the role of the hospital physical environment is incomplete without a more thoughtful account of the underlying psychological mechanisms and moderators involved – such as culture, as but one example. Taken together, our work suggests the need for a more comprehensive approach to improve the understanding of the influence of the hospital physical environment.
Hospital rooms may exacerbate or reduce patients' stress. According to Ulrich's (1991) theory of ... more Hospital rooms may exacerbate or reduce patients' stress. According to Ulrich's (1991) theory of supportive design, the hospital environment will reduce stress if it fosters perceptions of control (PC), social support (SS), and positive distraction (PD). An experimental study was conducted to test this theory. Participants were asked to imagine a hospitalization scenario and were exposed to one of 8 lists of elements that the hospital room would provide selected to facilitate PC, SS, PD, or 1 of all the possible combinations of these elements. Results confirmed Ulrich's theory. Participants expected significantly less stress in the situations where all (or only PD and SS) elements were present. Meditational analyses confirmed that the number of elements in the hospital room affects expected stress through the perceptions of how much positive distraction and social support it is perceived to provide, but not through the perception of the level of perceived control available.
Evidence points to the role of the physical environment on patient well- being, but its specific ... more Evidence points to the role of the physical environment on patient well- being, but its specific contribution is not clear. Two experimental studies were conducted. First, we investigated the inferences people make about the physical environment given information about the social environment, and vice versa. In 6 conditions participants were exposed to information about an inadequate, neutral, or good hospital physical environment; or about a negative, neutral, or positive hospital social environment. Results showed that people associate the quality of hospitals’ physical and social environments, and the corresponding expected well-being. Study 2 sought to disentangle the independent effect of the physical and social dimensions. Levels of quality of the physical and social environments were crossed in a 3x3 between-subjects design. Results showed that both dimensions have a specific significant effect. In particular, the physical environment seems unable to improve satisfaction when its quality is high, but is able to reduce satisfaction when its quality is low.
This study analyses the processes through which the physical environment of health care settings
... more This study analyses the processes through which the physical environment of health care settings
impacts on patients’ well-being. Specifically, we investigate the mediating role of perceptions of the
physical and social environments, and if this process is moderated by patients’ status, that is, if the
objective physical environment impacts inpatients’ and outpatients’ satisfaction by different social–
psychological processes. Patients (N=206) evaluated the physical and social environments of the care unit where they were receiving treatment, and its objective physical conditions were independently evaluated by two architects. Results showed that the objective environmental quality affects satisfaction through perceptions of environmental quality, and that patients’ status moderates this relationship. For inpatients, it is the perception of quality of the social environment that mediates the relationship between objective environmental quality and satisfaction, whereas for outpatients it is the perception of quality of the physical environment. This moderated mediation is discussed in terms of differences on patients’ experiences of health care environments.
"Physical working conditions have potential effects on health, and play an important role in qual... more "Physical working conditions have potential effects on health, and play an important role in quality of life,
and job satisfaction, yet most studies on the direct or indirect consequences of physical environmental conditions
on healthcare professionals’ focus on outcomes such as performance, efficiency, and error. The objective of this
study was to analyze the effects of the physical environment quality of healthcare settings on professionals’ wellbeing.
The sample comprised 148 healthcare professionals working in inpatient or outpatient care units from
four different hospitals. Two independent variables were used: Objective environmental quality (high/low) and
Type of care unit (inpatient/outpatient); and three well-being indicators were analyzed: Job satisfaction,
Perception of the care unit as close to an ideal care unit, and Subjective stress. Results show that healthcare
professionals working in hospitals with better physical conditions feel more satisfied with their job, and perceive
the care unit as closer to the ideal. Stress levels were not affected by physical environment quality or the type of
care unit."
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Papers by Cláudia Campos Andrade
impacts on patients’ well-being. Specifically, we investigate the mediating role of perceptions of the
physical and social environments, and if this process is moderated by patients’ status, that is, if the
objective physical environment impacts inpatients’ and outpatients’ satisfaction by different social–
psychological processes. Patients (N=206) evaluated the physical and social environments of the care unit where they were receiving treatment, and its objective physical conditions were independently evaluated by two architects. Results showed that the objective environmental quality affects satisfaction through perceptions of environmental quality, and that patients’ status moderates this relationship. For inpatients, it is the perception of quality of the social environment that mediates the relationship between objective environmental quality and satisfaction, whereas for outpatients it is the perception of quality of the physical environment. This moderated mediation is discussed in terms of differences on patients’ experiences of health care environments.
and job satisfaction, yet most studies on the direct or indirect consequences of physical environmental conditions
on healthcare professionals’ focus on outcomes such as performance, efficiency, and error. The objective of this
study was to analyze the effects of the physical environment quality of healthcare settings on professionals’ wellbeing.
The sample comprised 148 healthcare professionals working in inpatient or outpatient care units from
four different hospitals. Two independent variables were used: Objective environmental quality (high/low) and
Type of care unit (inpatient/outpatient); and three well-being indicators were analyzed: Job satisfaction,
Perception of the care unit as close to an ideal care unit, and Subjective stress. Results show that healthcare
professionals working in hospitals with better physical conditions feel more satisfied with their job, and perceive
the care unit as closer to the ideal. Stress levels were not affected by physical environment quality or the type of
care unit."
impacts on patients’ well-being. Specifically, we investigate the mediating role of perceptions of the
physical and social environments, and if this process is moderated by patients’ status, that is, if the
objective physical environment impacts inpatients’ and outpatients’ satisfaction by different social–
psychological processes. Patients (N=206) evaluated the physical and social environments of the care unit where they were receiving treatment, and its objective physical conditions were independently evaluated by two architects. Results showed that the objective environmental quality affects satisfaction through perceptions of environmental quality, and that patients’ status moderates this relationship. For inpatients, it is the perception of quality of the social environment that mediates the relationship between objective environmental quality and satisfaction, whereas for outpatients it is the perception of quality of the physical environment. This moderated mediation is discussed in terms of differences on patients’ experiences of health care environments.
and job satisfaction, yet most studies on the direct or indirect consequences of physical environmental conditions
on healthcare professionals’ focus on outcomes such as performance, efficiency, and error. The objective of this
study was to analyze the effects of the physical environment quality of healthcare settings on professionals’ wellbeing.
The sample comprised 148 healthcare professionals working in inpatient or outpatient care units from
four different hospitals. Two independent variables were used: Objective environmental quality (high/low) and
Type of care unit (inpatient/outpatient); and three well-being indicators were analyzed: Job satisfaction,
Perception of the care unit as close to an ideal care unit, and Subjective stress. Results show that healthcare
professionals working in hospitals with better physical conditions feel more satisfied with their job, and perceive
the care unit as closer to the ideal. Stress levels were not affected by physical environment quality or the type of
care unit."