Health-Promotive Building Design - Exploring perspectives on building design for health promotion in healthcare settings
Doctoral thesis, 2020

This thesis explores perspectives on health promotion in healthcare settings from a building design perspective, i.e., health-promotive building design (HPBD). The results may contribute to discussions of the role of healthcare building design to support health promotion in healthcare (HPH) and thereby contribute to the development of healthier and more equitable communities.
Currently, healthcare organisations are encouraged to introduce health promotion approaches and develop HPH. The research suggests that the introduction of new healthcare procedures, such as health promotion, can lead to new demands for the built environment. The previous research also shows that the design aspects of healthcare buildings can actively support treatment, protect health, and prevent disease for diverse building users. However, there is limited research with a particular focus on healthcare building design in relation to health promotion or HPH. It is thus crucial that those involved in the design process become familiar with health promotion and HPH and be able to design high-quality healthcare buildings.
Health promotion can be defined as ‘the process of enabling people to increase control over and improve their health’. Nevertheless, there are many definitions and interpretations of health promotion that depend on the context in which it is used as well as the disciplines of the people involved. While health promotion has gained attention from healthcare architects, it is unclear how health promotion is actually understood by those involved in the healthcare building design process and how they translate health promotion goals into design objectives.
The first two studies in this thesis therefore explored descriptions of health promotion in the context of the healthcare building design literature (study 1) and practice (study 2). Health promotion in healthcare settings generally refers to organisations expanding their traditional focus on the treatment of disease to include a focus on the health development of all building users, the local population and the environment. The development of HPH involves diverse practices such as changes in the built environment. However, a small number of studies have focused particularly on the built environment in relation to HPH. The last two studies in this thesis therefore focused on exploring descriptions of the built environment in the context of HPH.
For this thesis, an explorative research design was adopted based upon a multi-perspective approach including (1) a literature perspective, (2) a design practice perspective, (3) an HPH network perspective and (4) an HPH organisation perspective. The data were collected through literature reviews, documentation, semi-structured interviews and online surveys.
The combined work revealed diverse descriptions of health promotion in relation to healthcare building design in terms of (1) definitions of health promotion, (2) health-promotive perspectives, and (3) different targeted populations. The results also showed multiple descriptions of the built environment as a factor for health promotion including (4) expressions related to the built environment, (5) indications of places where health promotion can happen, (6) design features characterising HPBDs, and (7) design strategies to develop HPBDs.
The findings show that the research on the design of health-promotive built environments is in its early stage of development. The results indicate that the vocabulary for describing building design, health promotion and healthcare settings is diverse and inconsistent and that none of the health-promotive perspectives considers all dimensions of health promotion or HPH. What is more problematic is that the diverse health-promotive descriptions have led to different, even conflicting, demands for building design.
Based on the results, I suggest that project groups should specify and reflect upon their interpretation of the built environment, health promotion, HPH and HPBD. I recommend that HPBD should (1) focus on individuals and (vulnerable) communities; (2) focus on the different factors that improve health, not only those that prevent illness and disease; (3) consider environmental impacts; (4) involve collaboration with others; and (5) utilise the best available research. More research is needed to explore solutions in other countries, in other settings, or with other stakeholders, and it should include analysis of best-practices.

building design

built environment



health promotion

healthcare organisations

Opponent: Anne Kathrine Frandsen, Senior researcher at Danish Building Research Institute, Aalborg University Copenhagen


Elke Miedema

Chalmers, Architecture and Civil Engineering, Building Design

Health promotive ambitions related to building design – the case of Angered Nearby Hospital

ARCH 17 - 3rd international conference on architecture, research, care and health,; Vol. 1 edition(2017)p. 331-344

Paper in proceedings

Miedema, E., Lindahl, G., & Elf, L. M. (forthcoming). Health promotion and the built environment – a study of the Swedish health-promotive healthcare network

Healthcare building design that inspires people to take control over their health.
It was already known that the design of hospitals is important for healthcare. Plus, the built environment is important for a society that focuses on health promotion. However, this thesis showed that it is not clear what health promotion means in the field of healthcare building design. The results also showed that it is unclear, for people who work with health promotion in healthcare, how the built environment can contribute to health promotion. This makes it difficult to understand as a designer what you should think of in terms of health promotion. This can even lead to buildings that hinder health promotion approaches in the future.
The dissertation collected different ideas about the design of health-promoting hospitals. More precisely, we have studied health promotion and care architecture as presented in the literature and with people involved in a building design project with the goal of marketing hazel. We have also studied what the built environment means for health promotion among the network that supports hospitals to become health promotion and in hospital organizations for health promotion. The studies have been done using literature studies, interviews, surveys and document analyses.
This research is particularly important now as many healthcare buildings need to be renovated or rebuilt, often with public funds. This makes it important to publicly discuss what these healthcare buildings should look like, how they can support healthcare, and how they can contribute to healthier communities. The primary audience are the people who are involved in the design of healthcare buildings. The results can support people who work with health promotion to incorporate the built environment in their ideas. The results hopefully result in improved healthcare buildings that play a role in the development of healthier communities. Future research should focus on the testing these health-promotive perspectives and linking them to different building design approaches.
The research was financed by FORMAS, part of AIDAH project (2013-2019) and in collaboration with the Centre for Healthcare Architecture.

Integrative Ways of Residing: Health and Quality of Residence Architectural Inventions for Dwelling, Ageing and Healthcaring AIDAH

Formas, 2013-11-12 -- 2019-12-31.

Driving Forces

Sustainable development

Subject Categories



Public Health, Global Health, Social Medicine and Epidemiology

Areas of Advance

Building Futures (2010-2018)

Health Engineering



Doktorsavhandlingar vid Chalmers tekniska högskola. Ny serie: 4737


Chalmers University of Technology


Opponent: Anne Kathrine Frandsen, Senior researcher at Danish Building Research Institute, Aalborg University Copenhagen

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Latest update

6/4/2020 2