Environmental psychology can be defined as the study of transactions between individuals and their physical settings to improve human well-being and human-environment relations (Gifford, 2007:1; Yalcin, 2015:3531). It considers the role of external factors on human behaviour and experiences and views the relationship between humans and their physical environment as interrelated (Grieder & Chanmugam, 2013:5; Demick & Piotrowski, 2019). This means that through the transactions that take place between individuals and the environment, individuals change the environment and their behaviour and experiences are in turn changed by the environment (Gifford, 2007:1). These transactions often have important outcomes for individuals’ thoughts and well-being and the well-being of the environment (Gifford, 2007:7).
To understand these transactions between humans and their physical settings and to improve the outcomes thereof for both individuals and the environment, environmental psychologists aim to identify processes that regulate and moderate the relationship between physical and social factors that impact individuals’ perceptions and behaviour (Uzzell & Moser, 2007:7). Formal theories that attempt to explain person-environment relationships, cultural differences that influence these relationships, and practical applications aimed at improving the interactions between humans and their physical environment, such as designing better environments, are considered too (Demick & Piotrowski, 2019).
Research in environmental psychology broadly studies the following psycho-ecological phenomena in particular: privacy, personal space, territoriality, and crowding (Yalcin, 2015:3532). These four psycho-ecological phenomena consider the ways that individuals and groups deal with limited space and the influence it has on how they structure their activities (Demick & Piotrowski, 2019). When considering all the above-mentioned, it can be summarised that studies of environmental psychology include three levels of analysis (Gifford, 2007:16):
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- Fundamental psychological processes (like perceptions and cognitions that shape human experiences of the physical environment)
- The management of social space (the four psycho-ecological phenomena)
- The physical setting aspects of everyday behaviours (such as working, living in a residence and community, and individuals’ relationship with nature)
As mentioned earlier, environmental psychology aims to enhance human well-being and improve human-environment relations, such as designing better environments and making buildings more humane (Gifford, 2007:1; Yalcin, 2015:3531). It is therefore clear that environmental psychology overlaps with many other design disciplines, including space planning, ergonomics, and interior design (Moses, 2012). Previous research proposes that there is a strong association between the health outcomes of individuals and their physical environment (Mourshed & Zhao, 2012:362). Consequently, over the last few years, the design community has been paying a lot of attention on the architectural design of healthcare facilities and the impact it has on human well-being (Mourshed & Zhao, 2012:362).
Architecture that promotes health and well-being is considered as playing an important role in creating a healthcare environment of high quality that accommodates clinical functions and facilities, meets the functional requirements of the different activities that take place in a healthcare environment, and considers both the physical and psychological needs of the environment’s users (Alalouch, 2009:2). To design more humane healthcare environments, the focus should thus be on spatial, physical, and functional design attributes that healthcare environments should possess to reduce stress levels of both patients and staff and promote environmental quality and users’ well-being (Bilotta et al., 2009:36). This review aims to investigate the second level of analysis within environmental psychology (the four psycho-ecological phenomena) and the importance and role thereof in the design of more humane healthcare environments.
PHENOMENON A: PRIVACY
The definition of the term “privacy” varies for each individual due to different personal characteristics, cultural backgrounds, sex, age, and economic, educational, and social backgrounds (Demirbas & Demirkan, 2000:54). To some, it means being apart from people and being free from observation and public attention, while others refer to privacy as people not having access to their personal information (Gifford 2007:230). In brief, privacy can be considered as the regulation/control of the interaction between the self, others, and/or environmental stimuli (Demirbas & Demirkan, 2000:54). According to Alalouch (2009:59), Irwin Altman views privacy as a dynamic process which has three conditions: ideal, desired and achieved. The ideal condition of privacy is therefore achieved when desired and achieved privacy is balanced. However, if the desired privacy is less than the achieved one, social isolation can be caused. Conversely, if the desired privacy is more than the achieved one, individuals may experience feelings of crowding (Alalouch, 2009:59).
Privacy can be categorised into four main dimensions: informational privacy (1), which concerns the amount of control an individual has over when what and how information can be released about themselves, psychological privacy (2), which relates to individuals’ ability to expose feelings and intimate information to others in a time that they prefer, social privacy (3), which describes individuals’ ability to control social interactions with others, and physical privacy (4), which concerns the role of the physical environment as a regulator for privacy (Alalouch, 2009:60). Privacy can also be categorised into different types such as conversational privacy, acoustic privacy (including speech privacy and isolation from environmental/background noise) and visual privacy (Kupritz, 1998:342). According to Gifford, (2007:231, 233) each type of privacy may be considered and measured as a behaviour, value, preference, need, or expectation. Differences in privacy behaviour, values, preferences, needs, and expectations are due to differences in factors such as personal characteristics, social situations, physical settings, and culture.
Privacy is also linked with several important behaviour processes of individuals, the main processes being communication, control, identity/self-evaluation, and emotional release (Alalouch, 2009:62). In terms of communication, people seek protected communication as they want confidentiality of their personal and important conversations (Gifford, 2007:238). According to Pable (2012:14), individuals’ perception of privacy is often related to their sense of internal and external control. Individuals who control their environment can regulate others’ access to themselves and their access to others. In contrast, individuals who have little control over their environment tend to feel deprived of independence, which consequently leads to them perceiving a heightened need for privacy (Alalouch, 2009:62). Gifford (2007:240) also states that privacy is an important part of one’s self-identity. It gives individuals time and space to integrate information from daily exchanges with others, to reflect on the meaning of events, and to formulate responses. The fourth behaviour process linked to privacy is emotional release. In general, society discourages public emotional displays, and privacy is, therefore, necessary for emotional release (Gifford, 2007:240).
Patients’ privacy has been identified as a key feature in the designing of healthcare environments as it has an important influence on their well-being and satisfaction (Alalouch, 2009:3; Alalouch et al., 2016:32). Although patients understand that caregivers need appropriate access to them, they also expect a certain degree of privacy. Staff members are aware that patients need privacy but they also need to be able to see and hear patients to ensure their safety and well-being. When designing a healthcare environment, finding the right balance between privacy and accessibility is therefore of great importance (Lu et al., 2016:37). At healthcare facilities, the primary privacy needs are acoustic and visual privacy (Bjorngaard, 2010:14). For many patients, physical privacy in terms of acoustic and visual privacy may decrease stress, benefit their physical, mental, emotional, and spiritual well-being, and increase overall satisfaction with the healthcare environment (Lu et al., 2016:38). While acoustic privacy can be controlled by technical specifications and engineering solutions, visual aspects of privacy are linked to spatial structure/arrangements of the physical environment (Alalouch et al., 2016:32). 665).
In a hospital, for example, a patient’s physical privacy may be affected by the architectural design in terms of the location and spatial characteristics of the patient’s bed, and the room design and location relative to the work stations of staff (Lu et al., 2016:38). Research by Lu et al., (2016:45) has shown that perceived privacy is higher with fewer patient beds per room and larger area per bed as the presence of more patients and closer physical proximity between patients cause a lack in acoustic and visual privacy because of the absence of physical barriers. This research also indicates that beds that are further away from staff work stations are preferred by patients as these stations are noisy and the constant presence of staff reduces perceived privacy (Lu et al., 2016:45). The above-mentioned are some of the main reasons why patients prefer single-bed rooms over multi-bed wards in hospitals (Alalouch, 2009:35).
When more space is given between individuals, their acoustic and visual privacy will be protected more sufficiently (Bjorngaard, 2010:53). According to Alalouch (2009:38), when patients are accommodated in the type of wards they prefer it gives them a feeling of having greater control over their environment, which results in a higher level of perceived privacy. Providing patients with a higher level of perceived privacy by giving them a sense of control is especially important in healthcare environments as patients are usually weak, in a vulnerable state experiencing less control over their environment, and as a consequence, are more sensitive towards their psychological needs like privacy (Alalouch, 2009:57). This can be achieved by ensuring that they can personally control their environment by giving them options to regulate aspects such as lighting, sound, temperature, and other environmental factors (Ellingsen, 2017:9).
Loss of physical privacy in healthcare environments has been shown to cause feelings of stress, which has been identified as being associated with an inability to process information (Alalouch, 2009:72). Feelings of stress due to the violation of patients’ privacy may, therefore, lead to failure in understanding physicians’ instructions or recommendations, leading to failure to comply, which may lead to lower recovery rates and less patient satisfaction (Alalouch, 2009:72). To avoid this, healthcare environments must implement various strategies to regulate and improve privacy. Aesthetics such as colours and the decoration of spaces contribute to the atmosphere of healthcare environments and has a psychological effect on patients (Ellingsen, 2017:3). Research has shown that the colours green, blue, and purple are associated with feelings of security and less awareness or concern for environmental/background noise. Using these colours in the interior design of healthcare environments could, therefore, improve acoustic privacy (Bjorngaard, 2010:16).
Using materials and objects that reduce sounds such as sound-absorbing tiling and carpeting, electric fans, or decorative fountains will also contribute to acoustic privacy and allow for private conversation (Bjorngaard, 2010:20,55). Using cubicle curtains and integrated blinds in windows will help to provide visual privacy (HMC Architects, 2015). The use of screens such as plants or glass partitions to create physical barriers and define spatial zones will also provide both acoustic and visual privacy while preserving the feeling of open space (Bjorngaard, 2010:20,114). Regarding consultation rooms, separate, private rooms should be used with floor-to-ceiling walls and solid doors for maximum privacy (Ellingsen, 2017:8; Kupritz, 1998:342).
