HEALTH PROMOTION AND HEALTHCARE ARCHITECTURE - Conceptualizations of Health Promotion in relation to Healthcare Building Design

Licentiate thesis, 2017

Background: Today's healthcare system is under development and reorienting and adapting to embrace a person centred and holistic perspective on health, including a focus on health promotion. This reorientation results in changes in the healthcare models, processes as well as it sets new requirements for healthcare building design. A vast majority of research has been devoted to the relation between inpatient healthcare building design and individual health, e.g. how our hospitals affects treatments and patient outcomes. Less attention has been paid to the relation between outpatient healthcare building design and public or population health and wellbeing, e.g. healthcare in the community to lessen the load on large hospitals. At the same time as the aforementioned development is happening there is a growing body of research emphasizing the importance of the built environment for public health. Objective: This licentiate thesis aim to explore conceptualizations of health promotion in the context of outpatient healthcare building design, the aim is to enable a broader platform to enable incorporation of several health promotion perspectives into future healthcare building design. The main research question is: How is health promotion conceptualized in the context of outpatient healthcare building design? In addition, several other questions emerged in the research process: What aspects of building design result in health-promoting building design? How is health-promoting building design conceptualized in the literature and in practice? What tools and outcomes are referred to when evaluating health-promoting building design? Methods: The research included two studies with an explorative approach: a scoping review and a content analysis of interviews. Results: The results present different conceptualizations of health promotion in the context of healthcare building design. In addition, the results provide an interpretation of health-promoting building design. The results also relate to health promotion strategies, perspectives on health-promoting building design and some aspects of building design that can contribute to, or prevent, health promotion. Discussion: The discussion emphasizes challenges related to developing health-promoting building design, such as vague and contradicting definitions and interpretations of core concepts as health promotion and itís interpretation in the built environment. In addition, the discussion highlights the challenges associated with evaluating health-promoting building design. Conclusions: Health promotion perspectives, have been shown to influence healthcare building design through altered implications for the built environment. As shown, healthcare building design thus seems to have the opportunity to promote the health and wellbeing of patients, staff, visitors and the community. However, the vocabulary used to address health promotion, the different perspectives and health-promotion is weak and inconsistent. The thesis therefore proposed definitions for health promotion and health-promoting building design, that might guide future research and discussions on health promotion vocabulary. Future research should focus on developing the health-promoting building design vocabulary, collecting examples of health-promoting building design, relating health promotion theory to existing architecture theory, and methods and outcomes to evaluate health-promotion building design.