The aesthetics and architecture of care environments : a Q methodological study of ten care environments in Japan and the European countries of Finland, Sweden, the UK, France and Austria

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School of Arts, Design and Architecture | Doctoral thesis (monograph) | Defence date: 2019-11-01
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Aalto University publication series DOCTORAL DISSERTATIONS, 175/2019
This study explores the aesthetic dimensions of the care environment as experienced by the users and stakeholders of ten case studies in Japan and the European countries of Finland, Sweden, the UK, France and Austria. The evaluation of the built environment in a comprehensive manner is both challenging and topical. The surrounding environment influences us in a multitude of ways and healthcare buildings, in particular, are complicated and their effects on the users difficult to estimate. To overcome these problems the study applies experimental Q methodology for this context in search of a new way of evaluating care environments. The aims are to increase our understanding of care environment aesthetics and architecture, and thus contribute to the design of future care buildings that fulfil the values and expectations of the users. In previous research, first-hand user experiences have been overlooked in favour of comparing medical reports, survey questionnaires or environmental features, thereby leaving many of the underlying reasons unaccounted for. The aesthetic is often reduced to the appearance of things, assessed by random respondents reacting to photographs. This study instead approaches the aesthetics of care environments in a holistic manner, founded in the multisensory experience of architecture, and affected by contextual, social and functional considerations. The study compares different types of healthcare buildings; hospitals, clinics, rehabilitation centres and facilities for the elderly, by asking users and stakeholders to react to their actual environment. Differences are explored in the aesthetic definitions and solutions of the different building types, the cultural contexts and the user groups. In a broader sense, the study touches on the role of care environment aesthetics in users’ perceptions of wellbeing and quality of life. To operationalize this framework, a Q methodological study was conducted on ten case studies in Japan and five European countries. Q methodology is a qualitative method used for systematically analysing human subjectivity. In accordance with Q methodology, I invited 45 respondents – including patients and residents, family members and visitors, care staff, administration and architects – to arrange a set of 48 statements describing the aesthetic features of the care environment on a scale of preference. These preferences were statistically analysed, identifying five aesthetic discourses: the ‘putting patients first’ (ADI), the Nightingale discourse (ADII), the nature – wellbeing – personalization (ADIII), the ‘my home is my castle’ (ADIV) and the rational wayfinding system (ADV). The findings show that although some aesthetic values and solutions stem from building type specific and cultural considerations and that they reflect users’ and stakeholders’ backgrounds, there also exist shared aesthetic values that transcend the specific. A set of consensus statements was uncovered revealing aesthetic preferences shared by all discourses. As a synthesis, best-practice features are put forward as lessons learnt from the case studies. In the future, reconciliation between the various aesthetic discourses is called for in order to respect the values of all stakeholders and users.
Supervising professor
Sanaksenaho, Pirjo, Prof., Aalto University, Department of Architecture, Finland
Thesis advisor
Vauramo, Erkki, Prof., Aalto University, Sotera Institute, Finland
Kjisik, Hennu, Prof., University of Oulu, Finland
care environments, healthcare buildings, aesthetics, architecture, evaluation
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