IPH - Institute of Hospital Research

Publications IPH Magazine IPH Magazine Nº 11 A Salutogenic Approach to the Design of the Physical Environment in Public Sector

A Salutogenic Approach to the Design of the Physical Environment in Public Sector Alan Dilani
While clinical practice focuses on treating illness, there's also a raft of research to suggest that the quality of our everyday surroundings has a highly important role to play in sustaining wellness.

Architecture and design have been influenced by industrial societies for decades, and as a result, public buildings such as airports and hospitals have often been designed to function and look like factories. Clinical practice in hospitals focuses mainly on treating illness while often neglecting a patient's psychological, social and spiritual needs. Environmental qualities that could be considered as psychosocially supportive have not been developed properly. Psychosocially supportive design stimulates and engages people, both mentally and socially, and supports an individual's sense of coherence. The basic function of psychosocially supportive design is to start a mental process by attracting human attention, which may reduce anxiety and promote positive psychological emotions. Health processes could be strengthened and promoted by implementing design that is Salutogenic - ie, that focuses on the factors that keep us well, rather than those that make us unwell. The aim of psychosocially supportive design is to stimulate the mind in order to create pleasure, creativity, satisfaction and enjoyment. There is an important relationship between an individual's sense of coherence and the characteristics of the physical environment. In this literature review we have studied more than 300 articles as well as other literature that had relevant connection to the field of physical environment, health and behavior, to shed light on psychosocially supportive design.


Picture 1- A salutogenic approach to the physical environment includes design features that support our wellbeing. (Designed by Anshen + Allen)

Theories and Perspectives on Health

According to Ewles and Simnet (1994), heath is difficult to define, since it is a subjective experience: It is affected by norms and expectations and is also formed by previous experiences (ibid.). There are a few different definitions of health. For example, Lawrence has defined health as a condition where resources are developed in the relationship between humans and their biological, chemical, physical and social environment, (Lawrence, R.J. 2002). Health can be divided into two different perspectives: the biomedical and the holistic. From a biomedical viewpoint, health is considered to be a condition without diseases (Andersen, Göransson & Petersson, 2004). In the western world, the biomedical perspective has been the leading perspective and has therefore formed the medical and healthcare field (Nordenfelt, 1991).

The holistic viewpoint emphasizes multiple dimensions of health, including the physical, psychological, emotional, spiritual and social (ibid.). From a research perspective, health can be divided into a pathogenic and Salutogenic starting point. Pathogenic research focuses on explaining why certain etiological factors cause disease and how they are developed in the physiological organism (Antonovsky, 1979). The primary aim of pathogenic research is often to find medical treatments (ibid.). Salutogenic research is based on identifying wellness factors that maintain and promote health, rather than investigating factors that cause disease (Antonovsky, 1991). Together, the Salutogenic and the pathogenic approach offer a deeper knowledge and understanding of health and disease (ibid.). To be able to answer the Salutogenic question - what is causing and maintaining healthy people? - Antonovsky (1991) developed the concept of a sense of coherence (SOC). It maintains that a person with a high sense of coherence chooses the most appropriate coping strategy in a stressful situation. For example, the person may decide to fight, flee or be quiet depending on what kind of stressor the individual is exposed to (ibid.). Research has shown that it is possible to measure a person's sense of coherence and thereby predict an individual's health (Suominen, Helenius, Blomberg, Uutela & Koskenvuo, 2001).

A strong sense of coherence predicts good health and a low sense of coherence predicts poor health (ibid.). In his study, Heiman (2004) showed that students with a high sense of coherence did not experience high levels of stress. The research also showed that coping strategies were significantly correlated with the individual's sense of coherence (ibid.). The concept of sense of coherence has three vital components: (1) comprehensibility, (2) manageability and (3) meaningfulness (Antonovsky, 1991). A person with a strong sense of coherence scores high on all three components. According to Antonovsky (1991), the term comprehensibility implies that the individual perceives the surrounding environment and that which is happening in the world as coherent. If something unexpected is happening, such as an accident or personal failure, the person who understands why they are happening has a higher sense of coherence than one who cannot. A person with a low sense of coherence perceives himself as unlucky.

Manageability means that the individual experiences, that she has all the required resources necessary to cope with a given challenge or demand. This means that the individual feels that she is influencing that which is happening around her and does not perceive herself as a victim of circumstance. Antonovsky (1991), believes that a person's sense of meaningfulness is connected to his or her perception that there are important and meaningful phenomena in life. Meaningfulness is the component that motivates a person's sense of coherence (ibid.).


Picture 2: Wellness factors in the environment, such as daylight and nature, are evident in the radiology bunker at the Thunder Bay Regional Health Sciences Centre in Canada, designed by Farrow Partnership Architects

The Impact of Built Environment on Health and Wellbeing

There is an interaction between human's health and the built environment. According to Dilani (2006), the physical environment is not only vital for good health, but can also be a critical stressor for the individual. Physical elements in an organization can contribute to stress and are therefore essential factors for increasing comfort (Dilani, 2001). Despite that, the majority of humans in the western world spend most of their time in indoor environments; there is a lack of knowledge about how these environments affect a person's health and wellbeing. There is a general belief that humans are always adapting to the environment (ibid.). Often called the theory of adaptation, this belief indicates that people become less conscious of the environment the longer they reside or work in that given environment (Carnvale, 1992). A general belief is that if one lets oneself be affected by the physical surroundings then it is a sign of weakness.

In order to create supportive physical environments it is crucial to understand an individual's fundamental needs (Heerwagen et al., 1995). It is also necessary for different professional disciplines to willingly cooperate in creating the best conditions for humans (Heerwagen et al. 1995; Lawrence, 2002). Before a zoo is built, it is common practice for architects, designers, biologists, landscape architects, animal psychologists and building specialists to collaborate in creating an environment that optimizes the living conditions for the animals (Heerwagen et al., 1995). Factors such as materials, vegetation and lighting are taken into consideration; animals need enough space to eat, sleep and decide when to be social or seek solitude, and even their need for control and choice have been noticed. The aim is to create an environment that will support the animal's physical, psychological and social wellbeing. Ironically, humans do not seem to make the same demands when a workplace is going to be designed. 

Heerwagen et al. (1995), created a framework and guidelines for a Salutogenic design, which highlighted the following factors: (1) Social cohesion, both formal and informal meeting points; (2) Personal control for regulating lighting, daylight, sound, temperature, and access to private rooms; (3) Restoration and relaxation with quiet rooms, soft lighting, access to nature and a good view. Stokols (1992) also contributed with design suggestions for health-promoting environments that stem from three different dimensions of health: physical, mental and social. Physical health can be promoted by an ergonomic design with non-toxic environments. Mental health can be promoted by personal control and predictability as well as aesthetic, symbolic and spiritual elements. Social health can be promoted by access to a social support network, and participation in the design process. However, within health research, it is not a new idea to view the physical environment as a health-promoting factor. Already during the nineteenth century, Florence Nightingale developed a theory of health care, which emphasizes that physical elements are vital for an individual's health (SHSTF, 1989). Noise, lighting and daylight were, for example, considered as vital factors for affecting a person's mood (ibid.).

Figure3: Theory Model for Psychosocially Mediated Disease, by L. Levi, 1972.


During the 20th century, different researchers developed stress models that illustrate how the physical environment may affect human health and wellbeing (Levi, 1972; Kagan & Levi, 1975; Dilani, 2001; Dilani 2006b). Levi (1972) founded the stress theory, which was later developed by Kagan and Levi (1975). The model describes how the physical environment is the foundation on which the societal organisation, structure and function is built and, in the long run, is critical to the promotion of health or disease (Dilani, 2001). The model is based on a system that points to a deeper understanding between the physical environment and different human components (Kalimo, 2005). The model describes that the physical environment is the basis for creating social organization, structure and function in society. According to Dilani (2001), the model (see Figure above) describes how the physical environment is the foundation on which the social organization, structure and function is built and, in the long run, promote health or disease. The model is used within the field of architecture to integrate design elements with health and wellbeing.

The model is used within the field of architecture to integrate design elements with health and well being (ibid.). According to Kalimo (2005) the theory has developed a deeper understanding for the physical environment´s effect on humans. Emdad (2005) has developed a model called Instability of Pyramids of Stress, where architecture and art are measurable variables. Emdad presents a new framework, which, in relation to health in the workplace, has taken neuroergonomics into consideration. For example, there is a risk that the employee will develop stress related symptoms and disease if he or she experiences high demands from the surrounding environment but does not receive any reward. Furthermore, the employee will experience stress if the reward is too low or inadequate. The employee will also experience stress if they do not have any suitable effort strategies in relation to psychosocial factors, home and family factors or neuroergonomics. The model integrates all of these factors and focuses on health, burnout, cardiovascular disease and short-term memory (ibid.).

Picture 4: Research suggests that barn theatres, such as this one at Broadgreen Hospital, Liverpool, designed by Nightingale Associates, enhance surgical performance by providing social and professional support to staff.

Social Support and Crowding in Relation to the Physical Environment

Social support is an important factor when the aim is to promote an individual´s health and wellbeing (Costa, Clarke, Dobkin, Senecal, Fortin, Danoff and Esdaile, 1999; Saito, Sagawa, Kanagawa, 2005; Jacoby and Kozie-Peak, 1997; Oginska-Bulik, 2005). The knowledge and consciousness of social support and its relation to health increased in the 1950's (Fleming, Baum and Singer, 1985). At the same time researchers established that the physical environment and how it influences people´s emotions, behaviours and motivation are important to take into consideration when the aim is to promote health and well being (ibid.). It is therefore essential to identify factors in the physical environment and, through design and architecture, create meeting points that can promote spontaneous social interaction and social support (Fleming et al. 1985, Conners, 1983).

Crowding

Crowding is closely linked to social support and is often defined as the number of persons in a certain area or how much space every individual has received in a certain area (Geas, 1994). Altman (1975) describes crowding as a condition where a person's private sphere is trespassed, for example, when a person or group is exposed to more social interaction than desirable. If there is too much undesirable contact, an individual may experience a sense of crowding. On the other hand, if an individual experiences too little contact, there is a risk that he or she may feel lonely and isolated (ibid.). This balance between social interaction and desired loneliness can be regulated and achieved if one can control his or her own levels of social interaction (Maxwell, 2006).

Crowding can be reduced by creating buildings and space, where the individual can control and decide if they would like to be in privacy or participate in social interactions (Altman, 1975). For example, research has shown that a certain length and layout of student dormitories can increase the number of social activities and promote social interaction, create a higher sense of control and reduce a sense of crowding (Baum & Davis, 1980). Even a high ceiling can contribute to a reduced sense of crowding. Even though the area of the room is the same, people perceive a room with a high ceiling as lighter and more spacious.

Therefore, if architecture and design can create space that minimises crowding it can reduce the experience of stress and promote social interaction (Baum & Valins, 1977). Crowding can also constrain social interaction and social support (Geas, 1994), which are closely linked to health and well being (Costa, Clarke, Dobkin, Senecal, Fortin, Danoff & Esdaile, 1999; Saito, Sagawa & Kanagawa, 2005; Jacoby & Kozie-Peak, 1997; Oginska-Bulik, 2005). This illustrates the importance of identifying factors in the physical environment that promote spontaneous social interaction and social support (Fleming et al., 1985).

Nature and its Meaning for Health

Most people have some kind of relationship to nature and there are many people who greatly value diverse natural environments. There are also many people who want to get away from everyday life, during weekends and holidays, and regain their strength in relaxing and natural recreational areas. What is it that makes people feel at ease in nature? Does the natural environment affect people in different ways? Is it possible to draw any general conclusions about nature's influence on the human being?

Kaplan and Kaplan (1989) have developed the Attentional Restorative Theory (ART), which identifies two attention systems and how they are related. The researchers have chosen to call them direct and indirect attention. Indirect attention does not demand any energy or effort from the person and it is activated when something exciting suddenly happens or when one does not have to focus on something in particular. Direct attention is activated as soon as a person needs to concentrate and focus on a task and simultaneously block other disturbing stimuli. After an intense period of direct attention, a person is in need of restoration; otherwise they will easily become mentally exhausted. People, who have been using their direct attention without resting, often become impatient and irritated and it has been shown that a mentally exhausted person often commits so called "human errors" (ibid). A person who does not have the capacity to concentrate often becomes careless, less cooperative and less competent (Kaplan & Kaplan 1989; Kaplan 1995; Herzog, Maguire, & Nebel, 2003). Therefore, in order to work efficiently, it is vital to have a well functioning attention system and find time for restoration.

In their studies, Kaplan and Kaplan (1989; 1995) have been able to distinguish the following four needs when individuals are in need of restoration and recreation. (1) The need for being away from everyday life and its surrounding routines, sounds and crowding, etc. (2) The need for fascinating stimuli, which effortlessly stimulate the individual, and diminish the risk of boredom. (3) The need for extent (breathing space) which at the same time can create a feeling of being in a completely different world. (4) The need for compatibility while performing ones tasks (ibid.).

The restorative environment should be inviting and well balanced with an aesthetic beauty that allows people to reflect (Herzog, et al. 2003). Nature offers various colors, forms and scents, which can encourage humans to forget about their everyday life (Kaplan & Kaplan, 1989; Kaplan 1995; Herzog et al. 2003). Natural environments often offer an atmosphere where the individual´s needs for harmony and compatibility are met. It is therefore very important that natural environments are accessible at the workplace (ibid.). The ART has been tested and confirmed by different researchers (Herzog et al. 2003; Tennessen and Cimprich, 1995). One of the studies (Herzog et al., 2003) showed that three of the four components: being away; extent; and compatibility, are seen as measurable indicators of how to create a restorative environment. Several studies have also confirmed that human beings perceive natural environments as more restorative than urban environments (Van den Berg, Hartig and Staats, 2007). Therefore, when human beings are tired and mentally exhausted, nature is the appropriate place for restoration. Other studies have shown that viewing nature through a window has positive health outcomes (Moore, 1981-1982; Ulrich, 1984; Leather, Beale and Lawrence, 1998; Frumkin, 2001).

Daylight, Sunlight, Windows and Lighting´s Effect on Health


There is a great deal of research on daylight´s positive effects on humans´ psychological wellbeing (Evans, 2003). A lack of daylight can lead to both physiological and psychological difficulties (Janssen & Laike, 2006). Another researcher studied a correctional institution in Michigan and the results proved that inmates who had their windows facing the prison yard were visiting the health care facility more often than inmates who had windows facing the forest and farming fields (Moore, 1981-1982). Ulrich & Lundén (1984) showed that hospital patients who were staying in rooms with windows viewing nature were rehabilitated faster than patients who viewed a brick wall. Research has also shown that daylight in a classroom is necessary for the pupils to maintain a balanced hormone level (Küller & Lindsten, 1992).

Windows can also have positive health outcomes on patients (Verderber, 1986; Lawson, 2001). For example, the window can contribute to improved health by allowing fresh air and daylight to enter, by providing a view and a link to the outer world, thus satisfying a patient´s or prisoner´s need for viewing the seasonal variations (Verderber, 1986; Lawson, 2001). Another study showed that exposure to direct sunlight via windows in a workplace increased the workers´ well being and had a positive impact on their attitudes and job satisfaction (Leather et al., 1998).

Rooms without a window can affect human health and well being negatively (Janssen & Laike, 2006; Küller & Lindsten, 1992; Verderber, 1986). One of the studies showed that blue collar workers who worked in rooms without windows experienced more tension and were more negative towards their physical working conditions than workers who had offices with windows (Heerwagen & Orians, 1986). Patients who are staying in rooms without windows can develop sensory deprivation and depressive reactions and exacerbate perception, cognition and attention (Verderber, 1986).

Since daylight positively impacts human physiology, it should be considered rather than artificial daylight which claims to have the same affect. According to some research, artificial daylight can positively affect pupils´ cortisol levels and perhaps contribute to fewer sick days (Küller and Lindsten, 1992). Lack and Wright (1993) showed that exposure to lighting at certain times during a 24-hour period can prolong sleep and improve the quality of sleep. Energy consumption and costs can decrease if the individual has the ability to control the lighting levels (ibid.), which also has positive effects on environmental resources (Moore, Carter and Slater, 2004). Furthermore, an individual´s general satisfaction was higher when they had the ability to control the lighting levels themselves (ibid.). Küller´s (2002) conclusion suggests that lighting will become more important in the future, especially since it is becoming more common with buildings without windows that have no access to daylight.

Picture 5 Color, and form as landmark to facilitate orientation! Designed by BMJ Architects Glasgow-Scotland

Colour, Space and Landmarks for Well-Being

Colours can possibly affect the brain´s activity and create a sense of well-being and originality within architecture (Janssen, 2001). Colours can also have symbolic value and in that way contribute to the building´s identity and/or cultural meaning. Colours should be of high interest to city planners, mainly because of the aesthetic values, but also because of their symbolic values, which can reflect the organisation´s philosophy (ibid.). The so-called warm colours (red, yellow and orange) are considered to have an activating affect, while the so-called cold colours (blue, purple and green) are considered to have a calming affect (Küller, 1995). Küller (1995) refers to a well-known colour study from 1958 in which researchers conducted different physiological tests to investigate the brain´s activity during exposure to different colours. When the participants were exposed to the colour red, their brain activity increased more than when exposed to the colour blue. The results showed differences in blood pressure, breathing, and blinking frequencies (ibid.). Another study showed that restoration was more complete when the participants were exposed to blue light, which confirms that colours do affect brain activity (Ali, 1972).

Goldstein (1942) calls attention to an important viewpoint, which asserts that an individual´s former experiences can affect their emotions, actions and behaviour, depending on what colour they are exposed to. There are geographical, cultural and historical factors that may affect a person´s colour choice and some colours have a religious meaning (ibid). Berlyne (1971) and Janssen (2001) highlight that colours should suit the contextual environment and it is important that colour activation should be well balanced to match the environment.

Space is both what separates people from one another and bonds them together (Lawson, 2001). It is the architecture, with its buildings, rooms, surfaces, dormitories and facilities, that create the prerequisites for individuals to cooperate, work in privacy, create relationships and fulfill their general social, psychological and physiological needs (ibid.). According to Vischer (2005), the organisation´s image and identity are viewed and expressed through the architectural facilities. Vischer (2005) also maintains that the employee´s working identity and role are associated with the working environment and therefore the architectural design partly forms the employee´s identity. Furthermore, the physical work environment´s design has a pronounced effect on worker performance and in the long run affect the organisation´s productivity. Physical, psychological and functional comfort can have positive outcomes on employee performance and morale (ibid.).

Other factors for well-being are landmarks in buildings (Dilani, 2004; 2006b). Landmarks are closely related to the perception of stress (Dilani, 2004), serving as reference points in the buildings for easy orientation and helping to create cognitive maps of the environment (Dilani, 2006b). These landmarks could be objects such as sculptures, paintings, aquariums or different colours in different rooms.

Noise


Noise is one of the most evident problems within correctional institutions. High noise levels can disturb sleep, increase stress and complicate communication (Janssen & Laike, 2006). Studies have shown that noise can contribute to irritation, which can lead to stress and cause stress related diseases (Dijk, Souman, De Vires, 1987). Research has also shown that noise can lead to increased levels of cortisol (Brandenberger, Follenius, Wittersheim & Salame, 1980; Evans, Bullinger & Hygge, 1998). Other researchers proved that noise can increase an individual´s blood pressure (Lang, Fouriaud & Jacquinet-Salord, 1992; and Evans et al., 1998). Noise can also negatively influence the healing process (Fife & Rappaport, 1976) and contribute to mental exhaustion, which in turn may affect the amount of medication that a patient takes (Persinger, Tiller & Koren, 1999; Yoshida, Osada, Kawaguchi, Hosuhiyama, Yoshida & Yamamoto, 1997). Investigations have also established the connections between noise, irritation and lack of concentration (Dijk et al., 1987). Finally, other studies indicate that the perception of life quality decreases in a noisy environment (Evans et al., 1998) and high noise levels can also inhibit social interaction (Mathewes & Canon, 1975).

Leather, Beale and Sullivan (2003) have shown that noise can have a significant relationship to working demands, where the workers´ perception of work stress decreases with lower noise levels. The researchers explain that workers in a less noisy environment need fewer coping strategies for adapting to the physical environment and can therefore focus their energy and coping strategies on other stressful events. In that way, the physical auditory environment can be a vital factor in helping individuals cope with other stressors (ibid.). It is also important to realise that the experience of sound is highly individual (Staples, 1996). Kryter (1994) describes three variables that affect an individual´s sound experience: volume, predictability, and possibilities for control.

Health Promoting Sounds

There are sounds that can promote health and Lai, Chen, Chang, Hseih, Huang, Chang and Peng (2006) maintain that music is one of these factors, since it may contribute to a decreased activation in the sympathetic nervous system. Music has psychological affects and can unite people, open their senses and help them cope with difficulties and trauma. Music may also lead to lower heart and breathing frequencies and increased body temperature (ibid.). Lee, Chung, Chan and Chan (2005) conclude that music can be an effective method for decreasing negative physiological effects, when people are suffering from anxiety and stress. Music, either by itself or in combination with therapeutic treatment, can improve a patient´s healing process (Nilsson, 2003). For example, McCaffrey and Good (2000) showed that patients who listened to music after surgery, experienced less pain, anxiety and fear than those who did not. The patients claimed that, instead of being frustrated over pain and fear, music helped them to focus on healing (ibid.). In her research, Spychiger (2000) showed that more music lessons in school had positive emotional, social and cognitive affects and that the pupils with more music education cooperated better and had greater motivation for learning than pupils who had fewer lessons.

Picture 6 Research suggests that the sound of music can decrease stress and anxiety

Music - A Health Promoting Activity

Participation in cultural activities has positive effects on human health (Koonlaan, 2001). His study showed that individuals who did not participate in cultural activities had a 57 percent higher mortality risk compared to those who participated in cultural activities. The research showed that those who had not been participating in cultural activities, but who changed their behaviour to become active cultural consumers, had almost as good health at the end of the study as those who had been participating in cultural activities from the beginning. In his study, Koonlan (2001) proved the close connection between being an active cultural consumer and being able to increase one´s health status rating. Koonlan also found support for his hypothesis that if a person is changing her behaviour to participate in cultural activities her health perception becomes more positive. Another study showed that people who participate in cultural activities have the potential to live a longer life (Bygren, Benson & Johannson, 1996). Theorell (2000) concludes that cultural consumption is very important from a public health perspective.

Music can be a health promoting activity in a built environment. Silber (2005) studied a choir project in an Israeli correctional institution for women, where the results indicated that participation in a choir had positive effects. For example, the choir became a new social platform, where the participants created social bonds with one other. The inmates learned to listen to each other, receive criticism and express themselves in a different way. Silber´s (2005) research emphasises the value of choirs in prisons and explains that the choir can help the inmates improve their perceptions and relationships to others, including authoritative persons (ibid.). In a choir, the members have to follow and trust the conductor, which can be a good training for inmates, who often have difficulty with authoritative figures. In a prison, conflicts can arise regarding power and control between inmates and employees, the latter representing authority. With the conductor the inmates have to cooperate and together strive for a common goal, which does not imply power or control (ibid.). Furthermore, the choir generates a dynamic interrelation between its members. Every member has to control their own voice and at the same time listen and cooperate.

To achieve this, the members train their self control, patience, intuition and trust, which can strengthen the inmates´ self-esteem and give them a more positive self-image. Pratt (1990) considers that music can create a new reality, which can make it possible for an inmate to find herself/himself in another context. Music can create a sense of freedom, which can give the inmates new inspiration and strength to change their behaviour. It can help the individual to survive, grow and create both a personal and a collective identity. Pratt also explains that the space created by the music reminds people about their fundamental and psychological need for freedom. Music can make the person forget about worrisome thoughts and emotions, allowing them to temporarily live in the present moment (ibid.). The research on the choir´s positive, social and therapeutic affects in prison environments is limited (Silber, 2005). However, there are several reasons why it is worth investigating how a choir can be a good method for helping inmates change their criminal behaviour, such as increasing the inmate´s self-esteem, empathy, self control, and decreasing aggression and the need for immediate acknowledgment (ibid.).

Art, Healing and Well-Being

According to art historians, humans live today in a more aesthetic world, where art, fashion and design offer countless aesthetic experiences (Leder, Belke, Oeberst and Augustin, 20004). When a person observes and appreciates different visual scenes, such as a piece of art, complex cognitive and emotional processes arise (Keith, 2001). In order to understand the meaning of a painting it is important to understand its different parts before it is possible to understand the whole. During the observation of a painting and in the process of understanding it, a person can for example experience joy, participation, discomfort or interest. These emotional and cognitive responses are called aesthetic experiences (ibid.) and often lead to positive, satisfying and rewarding experiences for the viewer (Leder et al., 2004).

According to Kreitler and Kreitler (1972), art psychology is an empirical, scientific discipline that focuses on a person´s internal and external behaviour and how they are related to art. There are several psychological theories that try to explain and describe an individual´s experience of art. In summary, Kreitler and Kreitler believe that psychological models regarding art perception should be based on the homeostatic behaviour model, which suggests that there is an optimal physical condition in which humans strive to reach the balance between tension and relaxation. This condition of homeostasis can explain some parts of the individual´s relationship to art, and that the art experience can help an individual restore the homeostatic balance (ibid.). 

Art therapy (music, dance, painting and drama therapy) has a unique potential to reach patients with psychosomatic diseases, who are otherwise difficult to reach with traditional therapeutic methods (Theorell & Konarski, 1998). For example, Argyle (2003) showed how a group of people, identified as being in the risk zone for mental disease, participated in different art projects and improved their social and mental well being. The participants testified that the project had strengthened their self-esteem and given them a sense of belonging to a social group. This health promoting art project is considered to be cost effective (ibid.). Gardner (1994) also maintains that participation in different art processes can give the individual the tools to express feelings and experiences in a way that is nonverbal.

The Physical Environment and Productivity

When an organisation´s management wants to increase productivity they often focus on employee competence and personal motivation rather than the physical environment and design (Heerwagen et al., 1995). In his study, Herzberg (1966) observed employee motivation and the relationship between worker behaviour and the physical environment. When the physical environment is perceived as disturbing it can negatively affect employee motivation and thereby decrease productivity. Herzberg emphasised that it is necessary to have access to a physically supportive environment, which can contribute to employee motivation (ibid.). Maslow´s (1987) theory of motivation is one of the most well known theories related to human need and motivation. Maslow´s theory was developed to analyse and explain the social environment, but it can also be applicable to the physical environment (Heerwagen et al. 1995). For instance, the need for safety can be achieved through designed environments that allow people to have a good visual overview (ibid.). If humans are not stimulated by their surroundings, they can easily lose interest and this can result in reduced performance (Lawson, 2001). On the other hand, too much stimulation can lead to stress, since a person may not have the capability to deal with the stimulation (ibid.).

Increased knowledge and consciousness about the relationship between improved health and increased profitability would affect how designers, architects and managers design, build and maintain buildings (Fisk, 2000). For instance, improved indoor climate can improve employee health, decrease the amount of sick days, reduce healthcare needs and increase productivity, which in turn strengthens the human capital and leads to higher company profitability. Ergonomic improvement for employees has also been proven to increase a company´s profitability (ibid.). For example, IBM invested $186,000 in ergonomic education and implemented extended ergonomic changes, whereby they changed the design of the workplace and various working tools (Helander & Burris, 1995). The improvements contributed to better working positions, improved lighting, lower noise levels and better support with heavy work routines. The project decreased sick days by 19 percent, which generated an annual profit of $68,000. In addition, the changes contributed to higher productivity and improved quality, which led to an annual profit of $7,400,000. In other words, investments and changes within the physical environment led to profits through an increase in health conditions and productivity (ibid.).

Discussion and Conclusion

The aim of this study was to illustrate how different wellness factors in the physical environment can be psychosocially supportive and health promoting. The research has shown that the Salutogenic perspective forms a theoretical framework for psychosocial supportive design, since it can stimulate, engage and improve an individual´s sense of coherence and thereby strengthen their coping strategies and promote health. To implement psychosocially supportive design it is necessary that the whole organisation understands the meaning of a Salutogenic perspective. Knowledge of which environment factors contribute to health and well-being can thereafter be guidelines in making political decisions. In the process of making decisions it is important to have an interdisciplinary perspective where different individuals with different backgrounds and knowledge work together in this field - people such as psychologists, architects, landscape architects, doctors, behavioural scientists and health promoters. Fortunately it is becoming more common to use an interdisciplinary perspective as a central strategy (Barry, 2007). For example, the Internet technology sector recruits sociologists, anthropologists and psychologists who can study and explain how a product will be used in different cultural contexts. The application of an interdisciplinary approach to work may challenge existing ways of thinking and may also make research and innovation more democratic and receptive to public input (ibid.).

Decision makers should take the following factors into consideration during the process of building a prison: good lighting; positive interior distractions; and access to daylight, nature, art, symbolic and spiritual objects. Other important factors to take into consideration are the individual´s need for control over lighting, noise, indoor temperature and the possibility of choosing when to seek social interaction or solitude. It is also important to create attractive and inviting spaces that promote social interaction and social support as well as creating spaces for restoration and private conversations. In order to motivate people to change their lifestyle it is necessary to offer them activities that strengthen their self-esteem and self-efficacy. This can partly be achieved by participating in different cultural activities.

In summary, this study has shed light on factors in the physical environment that can promote health, well-being and increase productivity and profitability. Secondly, we have shown that there is a need for more empirical studies that verify, investigate and identify psychosocially supportive and health promoting wellness factors. Thirdly, we encourage decision makers to implement psychosocially supportive design that in turn promotes health and well-being. Finally, we would like to emphasize Churchill´s belief that the buildings we design have a significant impact on human behavior.

References

Ali, M.R. (1972). Patterns of EEG recovery under photic stimulations by light of different colours. Electroencephalography and Clinical Neurophysiology, 33, 332-335.

Altman, I. (1975). The environment and social behaviour: privacy, personal space, territory, crowding. Monterey, California: Brooks/Cole Publishing Company.

Andersen, P., Göransson, A., Petersson, C. (2004). Hälsa och hälsofrämjande arbete - en studie av vårdpersonalen och landstingspolitikers uppfattningar. [Health and health promoting work - a study of care employees and political decision makers´ opinions]. FoU-rapport 2 004:2. Landstinget Kronoberg. 

Antonovsky, A. (1991). Hälsans mysterium [The Mystery of Health]. Stockholm: Natur och Kultur. 

Antonovsky, A. (1979). Health, stress and coping. San Francisco: Jossey-Bass. 

Barry, A. (2007). The meeting of disciplines- why interdisciplinary is a central strategy. Britain today, 72.

Baum, A., & Davis, G.E. (1980). Reducing the stress of high-density living: An architectural intervention. Journal of Personality and Social Psychology, 38 (3) 471-481. 

Berlyne, D.E. (1971). Aesthetics and psychobiology. New York: Appleton-Century-Crofts.

Brandenberger G, Follenius M, Wittersheim G, Salame P. (1980). Plasma catecholamines and pituitary adrenal hormones related to mental task demand under quiet and noise conditions. Biological Psychology, 10, 239-252.

Bygren, L. O., Benson, B. & S. E. Johansson (1996). Attendance at cultural events, reading books or peri-odicals and making music or singing in a choir as determinants for survival. British Medical Journal 313, 1577-1580.
Carnevale, D.G. (1992). Physical settings of work: A theory of the effects of environmental form. Puplic Productivity & Management Review, 15(4), 423-436.
Connors, D.A. (1983). The school environment: A link to understanding stress. Theory into Practice, 22, (1), 5-20.

Costa, D.D., Clarke, A.E., Dobkin, P.L., Senecal, J-L., Fortin, P.R., Danoff, D.S., & Esdaile, J.M. (1999). The relationship between health status, social support and satisfaction with medical care among patients with systemic lupus erythematosus. International Journal of Quality in Health Care, 2 (3) 201-207.

Dijk, F.J.H Van, Souman, A.M., & De Vires, F.F. (1987). Non-auditory effects of noise in industry. VI. A final field study in industry. International Archives of Occupational and Environmental Health, 59, 133-145.

Dilani, A. (2006). A new paradigm of design and health in hospital planning. World Hospitals and Health Services, 41 (4) 17-21.

Dilani, A. (2006b). A new paradigm of design and health in hospital planning. World Hospitals and Health Services, 41(4), 17-21.

Dilani, A. (2001). Psychosocially supportive design - Scandinavian healthcare design. I: Dilani, A (Ed). Design and health - The Therapeutic Benefits of Design (pp. 31-38). Stockholm: AB Svensk Byggtjänst.

Dilani, A. (Editor) 2004. ( pp. 300) Design and Health III - Health Promotion through Environmental Design, Proceeding Book of the 3rd International Conference on Design and Health, in Montreal, Canada (English).

Emdad, R. (2005). Comparison of the "Instability of Pyramids of Stress (IPS)", Occupational Health and Work Environment Stressors in Dentists and Cleaners. CEJOEM, 1 (1) 33-71.

Evans, G. W. (2003). The build environment and mental health. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 80 (4) 536-555.

Evans, G.W., Bullinger, M., & Hygge, S. (1998). Chronic noise exposure and physiological response: A prospective study of children living under environmental stress. Psychological Science, 9 (1) 75-77.

Ewles, L & Simnett, I. (1994). Hälsoarbete [Health work]. Lund: Studentlitteratur.

Fife, D. & Rappaport, E. (1976). Noise and hospital stay. American Journal of Public Health, 66 (7) 680-681.

Fisk, W.J. (2000). Health and productivity gains from better indoor environments and their implications for the U.S. Department of Energy. Annual Review of Energy and the Environment, 25, 537-566.

Fleming, R., Baum, A., & Singer, J.E. (1985). Social support and the physical environment. I: Cohen, S. & Syme, S.L. (Ed.). Social Support and Health (s. 327-345). Orlando, Florida: Academic Press.

Frumkin, H. (2001). Beyond toxicity. Human health and the natural environment. American Journal of Preventive Medicine, 21 (3) 234-240.

Geas, G.G. (1994). Prison Crowding Research Re-examined. Federal Bureau of Prisons.

Goldstein, K. (1942). Some experimental observations concerning the influence of colors on the function of the organism. Occupational Therapy and Rehabilitation, 21, 147-151.

Gardner, H. (1994) The Arts and Human Development (2nd Edition) New York: Basic Books.

Heerwagen, J.H., Haubach, J.G., Montgomery, J., & Weimer, W.C. (1995). Environmental design, work, and well being: managing occupational stress through changes in workplace environment. Official Journal of the American Association of Occupational Health Nurses, 43 (9) 458-468. 

Heiman, T. (2004). Examination of the salutogenic model, support resources, coping style, and stressors among Israeli University students. The Journal of Psychology, 138 (6) 505-520.

Helander, M., & Burri, G. (1995). Cost effectiveness of ergonomics and quality improvements in electronics manufacturing. International Journal of Industrial Ergonomics, 15, 137-151.

Herzberg, F. (1966). Work and the Nature of Man. New York: Crowell.

Herzog, T. R., Maguire, C. P., and Nebel, M. B (2003). Assessing the Restorative Components of Environments. Journal of Environmental Psychology, 23, 159-170.

Jacoby, J.E., & Kozie-Peak, B. (1997). The benefits of social support for mentally ill offenders: prison-to-community transitions. . Behavioral Sciences and the Law, 15 (4) 483-501. 

Janssens, J. (2001). Facade colors, not just a matter of personal taste: A psychological account preferences for exterior building colors. Nordic Journal of Architectural Research, 14, 17-21.

Janssen, J., & Laike, T. (2006) Rum för återanpassning- den fysiska miljöns betydelse för ungdomsvården - en miljöpsykologisk översikt [Rooms for readapting - a physical environment´s meaning for youth care - an environmental psychological review]. Statens institutionsstyrelse (SIS). Rapport 2/06, Edita Stockholm 2006.

Kagan, A. R., & Levi, L. (1975). Health and environment - psychosocial stimuli: a review. I: Levi, L. (Ed.). Society, stress and disease: childhood and adolescence; Ed. 2 (pp. 241-268). London, New York & Toronto: Oxford University Press. 

Kalimo, R. (2005). Reversed causality: a need to revisit systems modelling of work-stress-health relationships. Scandinavian Journal of Work, Environment & Health, 31 (1)1-2.

Kaplan, R., & Kaplan, S. (1989). The Experience of Nature: A psychological perspective. New York: Cambridge University Press.

Kaplan, S. (1995). The Restorative Benefits of Nature: Toward an Integrative Framework. Journal of Environmental Psychology, 15, 169-182.

Keith, M. (2001). Making Meaning Brings Pleasure: The Influence of Titles on Aesthetic Experiences. Emotion 1(3) 320-329.

Konlaan, B. B. (2001). Cultural experience and health: The coherence of health and leisure time activities. (Doktorsavhandling) Umeå universitet.
Kreitler, H., & Kreitler, S. (1972). Psychology of the Arts. Durham: Duke University Press.

Kryter, K.D. (1994). The handbook of learning and effects of noise. San Diego: Academic Press.

Küller, R. (1995). Färgens inverkan på människan [The color´s affect on humans]. In: Hård, A., Küller, R., Sivik, L., Svedmyr, Å (E.d.). Upplevelse av färg och färgsatt miljö [Experience of colour and painted environments] (pp. 13-30) Stockholm: Byggnadsforskning.

Küller, R. (2002). The influence of light on circa rhythms in humans. Journal of Physiological Anthropology, 21(2) 87-91.

Küller, R., & Lindsten, C. (1992). Health and Behaviour of Children in Classrooms with and without Windows. Journal of Environmental Psychology, 12, 305-317.

Lack, L., & Wright, H. (1993). The effect of evening bright light in delaying the circadian rhythms and lengthening the sleep of early morning awakening insomniacs. Sleep, 16, 436-443.

Lai, H-L., Chen, C-J., Peng, T.C., Chang, F-M., Hseih, Huang, M-L., & Cang, S-C. (2006). Randomized controlled trial of music during kangaroo care on maternal state anxiety and preterm infants´ response. International Journal of Nursing Studies, 43, 139-146.

Lang, T., Fouriaud, C., & Jacquinet-Salord, M-C. (1992). Length of occupational noise exposure and blood pressure. International Archives of Occupational and Environmental Health, 63, 369-372.

Lawrence, R.J. (2002). Healthy Residential Environments. In: T. Bechtel, R.B., & Churchman, A. (Ed.). Handbook of Environmental Psychology (pp. 394-412). New York: Wilyes & Sons.

Lawson, B. (2001). The language of space. Oxford: Architectural Press.

Leather, P. Beale, D., & Sullivan, L. (2003). Noise, psychosocial stress and their interaction in the workplace. Journal of Environmental Psychology, 23, 213-222.

Leder,H., Belke, B., Oeberst, A., & Augustin, D. (2004). A model of aesthetic appreciation and aesthetic judgements. British Journal of Psychology. 95, 489-508.

Lee, O.K.A., Chung, Y.F.L., Chan, M.F., & Chan, W.M. (2005). Music and its effect on the physiological responses and anxiety levels of patients receiving mechanical ventilation: a pilot study. Journal of Clinical Nursing, 14, 609-620.

Levi, L. (1972). Stress and Distress in Response to Psychosocial Stimuli (Avhandling för doktorsexamen). Karolinska institutet.

McCaffrey, R, G., Good, M. (2000). The Lived Experience of Listening to Music while Recovering from Surgery. Journal of Holistic Nursing, 18, 378-390.

Maslow, A.H. (1987). Motivation and personality (3th Ed). Longman.

Mathewes, K.E. & Canon, L.K. (1975). Environmental noise level as determinant of helping behavior. Journal of Personality and Social Psychology, 32, 571-577.

Maxwell, L.E. (2006). Crowding, class size and school size. In: Frumkin, H., Geller, R. J., 
Rubin, I: L (Ed). Safe and healthy school environments (pp.13-19). Oxford: University Press.

Moore, T., Carter, D.J., & Slater, A. (2004). A study of opinion in offices with and without user controlled lightning. Lighting Research and Technology, 36 (2)131-146.

Moore, E.O. (1981-82). A prison environment´s effect on health care service demands. Journal of Environmental Systems, 11, 17-34. 

Nilsson, U. (2003). The effect of music and music in combination with therapeutic suggetstions on postoperative recovery (Avhandling för doktorsexamen) Linköpings universitet. 

Nordenfelt, L. (1991). Hälsa och värde [Health and Value]. Stockholm: Thales.

Oginska-Bulik N. (2005). The role of personal and social resources in preventing adverse health outcomes in employees of uniformed professions. International Journal of Occupational Medicine and Environmental Health, 18 (3) 233-240. 

Persinger, M.A., Tiller, S.G., & Koren, S.A. (1999). Background sound pressure fluctuations (5dB) from overhead ventilations systems increase subjective fatigue on university students during three-hour lectures. Perceptual and Motor Skills, 88, 541-456.
Pratt, R. (1990). Rhythm and Resistance: The Political Uses of Popular Music. Washington DC: Smithsonian Institution Press.

Saito, E., Sagawa, Y., & Kanagawa, K. (2005). Social support as a predictor of health status among older adults living alone in Japan. Nursing and Health Science, 7 (1) 29-36.

Silber, L. (2005). Bars behind Bars: The impact of a women´s prison choir on social harmony. Music Educa-tion Research, 7, 251-271.
SHSTF. (1989). Florence Nightingales anteckningar om sjukvård - ur vårt tidsperspektiv. (Svensk översättning av Florence Nightingales Notes on Nursing - what it is and it is not). FoU rapport 31. Skellefteå: Artemis Bokförlag.

Spychiger, M.B. (2000). Music Education is Important - Why? In: Matell, G., & Theorell, T. (Red.). Musikens roll i barns utveckling [The role of music in children´s development] (pp.110-122). Institutet för psykosocial medicin. Karolinska Institutet. 

Staples, S. L. (1996). Human response to environmental noise. American Psychologist, 51 (2) 143-150.

Stokols, D. (1992). Establishing and Maintaining Healthy Environments. American Psychologist, 47 (1) 6-22.

Suominen, A., Helenius, H., Blomberg, H., Uutela, A., & Koskenvuo, M. (2001). Sense of coherence as a predictor of subjective state of health results of 4 years of follow-up of adults. Journal of Psychosomatic Research, 50, 77-86.

Tennessen, C.M., & Cimprich, B (1995). Views to nature: effects on attention. Journal of Environmental Psychology, 15, 77-85.
Theorell, T. & Konarski, K. (1998). I: Theorell, T. (Red.). När orden inte räcker (s.13-22). Stockholm: Natur och Kultur.

Ulrich, R.S. (1984). View through a window may influence recovery from surgery. Science, 224, 420-421.

Van den Berg, A. E., Hartig, T., & Staats, H. (2007). Preference for Nature in Urbanized Societies: Stress, Restoration, and the Pursuit of Sustainability. Journal of Social Issues, 63 (1) 79-96.

Verderber, S. (1986). Dimensions of person- window transactions in the hospital environment. Environment and Behaviour, 18, 450-466. 

Vischer, J.C. (2005). Space Meets Status - designing workplace performance. New York: Routledge. 

Yoshida, T., Osada, Y., Kawaguchi T., Hosuhiyama, Y., Yoshida, K, & Yamamoto, K. (1997). Effects of road traffic noise on inhabitants of Tokyo. Journal of Sound and Vibration, 205, 517-522.



Share
« back
Send by e-mail: