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Research
An Exploratory and
Comparative Evaluation on the
Spatial Perception of Two
Densities of Multioccupancy
Hospital Rooms
Kemal Yildirim, PhD
1
and Meryem Yalcin, BA, MA, PArt
2
Abstract
Objective: The objective of this article was to explore interior spatial qualifications on patient
perception of two densities of multioccupancy hospital rooms. Background: The research setting of
this study was the three- and six-person capacity hospital rooms used for treatment of patients at a
large hospital in a major metropolitan city in Turkey. Method: The subjects used in the study were
randomly selected from among patients treated in the surgical medical sciences’ departments of the
hospital. Accordingly, a research questionnaire was applied to a total of 101 subjects. Results: Results
have shown that the three-person rooms were assessed more positively for privacy, functional, and
perceptual qualifications compared to the six-person rooms. An increase in the number of persons and
interior units of rooms affects negatively the auditory privacy and privacy areas of other patients.
Conclusion: Consequently, although these rooms with different spatial sizes were very similar for
concentration of persons and commodities, six-person rooms were perceived to be more crowded
than three-person rooms.
Keywords
hospital, patient room, interior space, spatial perception, privacy
Introduction
The transformation from a ‘‘care-centered’’ to a
‘‘patient-centered’’ health system is valid in the
present day and shapes the social and technolo-
gical environment. However, it is only one of the
changes in many paradigms that are connected to
each other (Connellan et al., 2013; Douglas &
Douglas, 2004; Ergenoglu & Tanrıtanır, 2013;
Harris, McBride, Ross, & Curtis, 2002; Lawson
& Phiri, 2000; Mikesell & Bromley, 2012; Ulrich,
2003). Presently, healthcare facility designers
and planners are confronted with tremendous
challenges. Success depends upon providing com-
plex medical technology and high-level clinical
interventions as well as assuring a therapeutic and
1
Department of Furniture and Decoration, Gazi University,
Ankara, Turkey
2
Department of Interior Architecture and Environmental
Design, TOBB ETU University, Ankara, Turkey
Corresponding Author:
Kemal Yildirim, PhD, Department of Furniture and
Decoration, Gazi University, Ankara, Turkey.
Email: kemaly@gazi.edu.tr
Health Environments Research
&DesignJournal
2016, Vol. 9(3) 212-227
ªThe Author(s) 2015
Reprints and permission:
sagepub.com/journalsPermissions.nav
DOI: 10.1177/1937586715599651
herd.sagepub.com
humane environment (Gallant & Lanning, 2001;
Mikesell & Bromley, 2012; Ulrich, 2003; Ulrich,
Zimring, Quan, Joseph, & Choudhary, 2004).
Furthermore, healthcare facility designers and
planners have to act at multiple levels in response
to rapid changes in technology, care, and treat-
ment methods. They are also responsible for
reimbursement, regulation, and demographic
trends in health status (Connellan et al., 2013;
Mikesell & Bromley, 2012). There are many dif-
ferentiations for interior space conditions, per-
ception, and satisfaction of patients related to
patient care issues of care settings in multioccu-
pancy hospital rooms (Bobrow & Thomas, 2000;
Douglas & Douglas, 2004; Ulrich, Zimring, Zhu,
et al., 2008).
Purpose
The purpose of this study was to investigate the
interior spatial qualifications of patient rooms in
two different densities (three and six occupancy),
including diverse variables, such as physical, psy-
chosocial, and perceptual factors. Studies reveal
that patients’ outcomes can be positively affected
by additions and changes in the physical and
social environment at healthcare facilities by
taking into consideration the patients (Douglas
& Douglas, 2004; Pati, Harvey, & Cason, 2008;
Ulrich, Zimring, et al., 2004). It is necessary to
determine this spatial setup, which includes very
complicated and controversial variables (Pati
et al., 2008; Stevens, 2010; Ulrich, Zimring,
et al., 2004; Ulrich, Zimring, Zhu, et al., 2008).
Theoretical Framework That Guides
the Study
Likewise, Shumaker and Reizenstein (1982) in
their description of the physical dimensions of
hospital environments, suggested that patient
experiences could be influenced by both type and
layout of equipment and furniture (see also:
Douglas & Douglas 2004; Fottler, Ford, Roberts,
Ford, & Spears, 2000). Furnishings could be com-
fortable or uncomfortable. Layout can interfere or
facilitate comfortable body positions. Environ-
mental psychology studies propose that a moder-
ate degree of positive stimulation in physical
surroundings can usually foster human well-
being (Douglas & Douglas, 2004; Lambert, Coad,
Hicks, & Glacken, 2014). According to Malkin
(1991), scale, relationship between interior and
exterior space, materials, acoustics, lighting, leg-
ibility, variety of space, and special population
needs are important dimensions in healthcare
design. According to healthcare design profes-
sionals, planners, and administrators, private
patient rooms reduce the possibility of infection,
decrease patient stress levels, make it possible for
nurses and healthcare workers to perform their
jobs efficiently, enable adequate space for partic-
ipation of family members in patients’ healing
processes, and give more privacy for administra-
tion of bedside treatments and for detailed discus-
sions with healthcare personnel (Ajiboye, Dong,
Moore, Kallail, & Baughman, 2015; Bobrow
& Thomas, 2000; Gallant & Lanning, 2001;
Heikkinen, Wickstro¨m, & Leino-Kilpi, 2006;
Hill-Rom, 2002; Ulrich, 2003; Ulrich, Zimring,
et al., 2004). However, this study tries to identify
and collect these issues, since scant attention has
been given to the two different densities of multi-
occupancy hospital rooms.
Review of the Literature
The concept of privacy is utilized in many disci-
plines and is accepted to be one of the most
important issues in healing environments with
multioccupancy hospital rooms. The various
dimensions of the concept of privacy have also
been described (Glind, Roode, & Goossensen,
2007; Heikkinen et al., 2006; Leino-Kilpi et al.,
2001; Verderber & Todd, 2012). Burgoon (1982)
and Parrott, Burgoon, Burgoon, and LePoire
(1989) have identified the dimensions as physical,
social, psychological, and informational privacy.
The following discussion is based on these
dimensions.
Physical privacy serves as a kind of surround-
ing with the concept of personal space and terri-
toriality with an invisible surrounding. It unites
the physical space and behavior of human beings.
Territories are used for regulating collaboration
and for maintaining social order. Territoriality
imparts autonomy, privacy, security and self-
identity (Glind et al., 2007; Heikkinen et al.,
Yildirim and Yalcin 213
2006; Woogara, 2001). One’s own territory plays
a role in a feeling of relaxation, which is crucial
for well-being. The psychological dimension is
closely related to definitions of privacy as a need
or right. It concerns the ability of human beings
to control cognitive and effective inputs and out-
puts, for values and the right under certain cir-
cumstances when they will share thoughts or
reveal intimate information (Connellan et al.,
2013; Douglas & Douglas, 2004; Stevens, 2010).
The social dimension includes an effort to con-
trol social contacts. It can be both an individual
and a group state. Social privacy has a strong
connotation, since it involves being free not only
for actual interaction with others, but also from
any perceived pressure on one’s own course of
action (Glind et al., 2007; Verderber & Todd,
2012). Consequently, it is a requirement that has
to be handled mainly in multioccupancy hospital
rooms, which affect patients’ perceptions in
hospitals.
Psychologically, supportive designs are assis-
tive elements that are developed in the healing
process through being able to assist the patient
in coping with the stress known to accompany a
disease. Lack of control is a major problem that
can increase problems and affect wellness in a
hospital setting (Heikkinen et al., 2006; Verder-
ber & Todd, 2012; Woogara, 2001) and has also
been associated with depression, passivity, ele-
vated blood pressure, and reduced immune sys-
tem functioning. Factors contributing to a loss
in sense of control in hospitals are confusing
wayfinding cues, lack of privacy, noise, lack of
personal control, or lack of window view
(Connellan et al., 2013; Stevens, 2010). Williams
(1988) provided an overview of the supportive
healthcare elements, such as unit design, spatial
considerations, sound, light, color, thermal consid-
erations, and weather.
In summary, due to all of the aforemen-
tioned reasons, needs and expectations are fac-
tors that affect the formation of interior spaces
and they also affect health conditions in patient
rooms. Consequently, it has become unavoid-
able to consider the criteria in the inevitable
multioccupancy hospital rooms, due to the gra-
dually increasing number of patients in the
present day.
Development of Hypotheses
The problems and hypotheses determined in the
multioccupancy hospital rooms are as follows.
Problem sentence. There are many factors that
negatively influence the functional and percep-
tional evaluations of patients in multioccupancy
hospital rooms, such as the fact that privacy is
limited, the functional deficiencies for space and
equipment elements, and there is a high density
of persons furnishings. The problems related to
interior space, especially in two different den-
sities, have not been taken into consideration
previously.
Subproblems. The interior space design character-
istics in multioccupancy hospital rooms limit
being able to meet in a healthy manner the basic
requirements, such as the hygiene of health per-
sonnel and patients and visual, aural, and social
privacy.
Studies on privacy and crowdedness of hospi-
tal rooms are generally about single or multioccu-
pancy hospital rooms. The number of studies in
which design and space factors of multioccu-
pancy hospital rooms with different densities of
human belongings are compared is quite limited.
Therefore, there are many uncertainties in this
area.
As the physical conditions of the density of
persons furnishings increase in multioccupancy
hospital rooms, it negatively affects the spatial
perception of patients.
Despite the fact that multioccupancy hospital
rooms are a requirement of daily life, the negative
influence that emerges connected to a density of
persons furnishings is an important interior space
design problem, and it can reduce the alternative
solutions for the space.
Hypotheses
Hypothesis 1: Despite the fact that the ratio
of densities of persons furnishings will be
very close in value according to the space
sizes of the rooms where the study will be
conducted, it will be evaluated that patients
staying in three-person rooms will be more
positive for the functional sufficiencies of the
214 Health Environments Research & Design Journal 9(3)
rooms compared to patients staying in six-
person rooms.
Hypothesis 2: An increase in the densities of
persons furnishings in patient rooms will
negatively affect aural, visual, and social
privacy.
Hypothesis 3: Despite the fact that the ratio
of densities of persons furnishings will be
very close in value according to the space
sizes of the rooms where the study will be
conducted, it will be perceived that six-
person rooms are more crowded compared
to three-person rooms.
Hypothesis 4: In general, it will be evaluated
that young patients will perceive the physical
environmental factors of rooms as more pos-
itive compared to elderly patients.
Hypothesis 5: In general, it will be evaluated
that male patients will perceive the physical
environmental factors of rooms as more pos-
itive compared to female patients.
Method
The following methods were employed to test the
hypotheses.
Selection of subjects. This research was carried out
at a large hospital in a major metropolitan city in
Turkey. The subjects used in the study were ran-
domly selected from among patients treated in the
surgical medical sciences’ departments (general
surgery, breast surgery, and cardiovascular sur-
gery) of the hospital. Accordingly, a research
questionnaire was filled out by a total of 101 sub-
jects, with 52 males (51.5%) and 49 females
(48.5%). In addition, 59 (58.4%) subjects were
between18and35yearsofageand42
(41.6%) subjects were between 36 and 55 years
of age. Of the subjects who participated in the
questionnaire, 62%had secondary and 38%had
higher education. The questionnaire was filled
out between 2.30 p.m. and 4.00 p.m. during the
weekdays. The subjects completed their ques-
tionnaires in approximately 15 min. The data
on the questionnaires were obtained through
face-to-face interviews in the hospital rooms
during a period of 15 days at the beginning
of 2014.
Environmental setting. Two widely distributed
three- and six-person capacity rooms used for
treatment of patients at a large hospital in a major
metropolitan city in Turkey were used as the
research setting in this study. The different-floor
patient rooms were adjacent to one another in the
same building and each room faced southwest.
Details, such as lighting, color, materials, and
accessories, have a significant effect on the per-
ception and evaluation of an interior space (Miwa
& Hanyu, 2002; Yildirim & Akalin-Baskaya,
2007; Yildirim, Akalin-Baskaya, & Hidayetoglu,
2007; Yildirim, Capanoglu, & Cagatay, 2011).
Consequently, it was decided that the patient
rooms used as research environments must have
a similar plan type and physical settings (i.e., day-
light, artificial light, and air temperature) to accu-
rately measure the differential effect of interior
design elements (i.e., room size and bed number).
The environmental settings of these two differ-
ent patient rooms were as follows:
Six-person rooms (43 m
2
) used in the study
were about twice the size of three-person
rooms (24 m
2
). The main difference between
these rooms was the number of beds.
The density of furnishings in the three-
person rooms was 44.6%(furnished area
was approximately 10.7 m
2
and circulation
area was 13.3 m
2
). The density of furnish-
ings in the six-person rooms was 47.9%
(furnished area was approximately 20.7 m
2
and circulation area was 22.3 m
2
).
The three-person rooms had a square win-
dow (174 174 cm
2
) and the six-person
rooms had two square windows (174
174cm
2
2 pieces).
The use of artificial light inside the rooms
was unavoidable. Fluorescent light fittings
were mounted in the 2.90-m high suspended
ceilings, with 216 W (2 36 W ¼3 pieces)
in the three-person rooms and with 432 W
(2 36 W ¼6 pieces) in the six-person
rooms, which provided sufficient general
illumination at the floor and bed level.
The internal air temperature—with the help
of panel heaters in winter—was maintained
between 22C and 24C in both sizes of
patient rooms.
Yildirim and Yalcin 215
The architectural floor plans and photographs
of the two sizes of patient rooms used in the study
have been given in Figures 1a and b and 2.
The interior design characteristics of the two
sizes of patient rooms (three- and six-person
capacity) have been given in Table 1.
Design of the questionnaire. The questionnaire con-
sisted of four parts: The first part was composed
of questions aimed at determining general infor-
mation for the age and gender of the subjects.
The second part consisted of a 5-point Likert-
type scale for the evaluation of functional qualifi-
cations of the rooms. Subsequently, the subjects
had to evaluate the functional properties such as
‘‘size of the room’’ on a Likert-type scale from 1
(completely adequate)to5(completely inadequate).
The third part consisted of a 5-point Likert-
type scale for the evaluation of the privacy condi-
tions of the rooms. Next, the subjects had to
evaluate the importance of each of the privacy
conditions such as ‘‘the room also provides the
necessary privacy area for accompanying per-
sons’’ on a Likert-type scale from 1 (completely
agree)to5(completely disagree).
The fourth part consisted of a 7-point semantic
differential scale about the perception of the room
atmospherics. The subjects had to evaluate the
importance of each of the bipolar adjective pairs
on a 1–7 semantic differential scale where 1 ¼
roomy (positive) and 7 ¼cramped (negative).
The following 16 bipolar adjective pairs were
evaluated by the subjects: happy/unhappy,
roomy/cramped, peaceful/unpeaceful, warm/
cold, light/dark, attractive/unattractive, pleasant/
unpleasant, exciting/unexciting, dynamic/static,
calm/restless, comfortable/uncomfortable, quiet/
noisy, tidy/untidy, safe/unsafe, uncrowded/
crowded, and fragrant/smelly.
The technique of altering the sets of items
from positive to negative, as carried out by pre-
vious studies (Kaya & Weber, 2003; Yildirim
et al., 2007; Yildirim & Akalin-Baskaya, 2007;
Yildirim & Akalin, 2009; Yildirim, Hidayetoglu,
& Capanoglu, 2011), was adopted to reduce the
probability of subjects simply marking the scale
on either of the extremes. In compiling the initial
list of items, the researchers tried not to be too
specific but rather to develop a list of general
attributes that would fit the research subject of
indoor atmospherics.
Evaluation of the data. It was necessary to summar-
ize and present the data obtained from the ques-
tionnaires for understanding and comparing
them with other results. For this, the evaluations
of the atmospheric attributes of the rooms by the
subjects were accepted to be ‘‘dependent vari-
ables’’ (Tables 2, 3, and 4), whereas the types
of rooms, age, and gender of the subjects were
accepted to be ‘‘independent variables.’’ After
conducting reliability tests on the data obtained
with the Cronbach’s amethod, the categorical
means and standard deviations were determined.
Subsequently, the appropriate techniques of the
t-test were used to examine the effect of differ-
ences in the room types, age, and gender variables
on the perceptual evaluations of the atmospheric
attributes of the rooms in the hospital context.
The data are given in graphs for comparing
the significant means of the variance in the
analysis.
Results
The reliability of the atmospheric attributes,
including subjects’ evaluations about functional
qualifications, privacy conditions, and percep-
tions of the rooms, was tested using the Cron-
bach’s atest. The Cronbach’s acoefficient
estimates of internal consistency for the three
main scales, including the average scores for nine
qualification elements are given in Table 2. The
seven privacy elements are given in Table 3. The
16 bipolar adjective pairs grouped together in
Table 4 were as follows: functional qualifica-
tions: 0.78, privacy conditions: 0.67, and percep-
tual quality: 0.84. The acoefficient of all items
was above 0.60, representing acceptable reliabil-
ity according to some researchers (Grewal, Krish-
nan, Baker, & Borin, 1998; McKinley, Manku-
Scott, Hastings, French, & Baker, 1997).Therefore,
these scales may be considered to be reliable.
Research results for reliable systematic sequences
are shown below.
First of all, subjects were asked about their
preference for room capacity in which they would
like to stay. Of a total of 58 persons, 13 (22.5%)
216 Health Environments Research & Design Journal 9(3)
Figure 1. a. Layout of three-person rooms. b. Layout of six-person rooms.
Yildirim and Yalcin 217
indicated that they would like to stay in three-
person rooms, 35 (60.3%) preferred two-person
rooms, and 10 (17.2%) preferred one-person
rooms. Of the 43 persons staying in six-person
rooms, 7 (16.3%) indicated that they would like
to stay in four-person rooms, 27 (62.8%) indi-
cated their preference for three-person rooms, 8
(18.6%) indicated their preference for two-
person rooms, and 1 (2.3%) preferred to stay in
a one-person room. Accordingly, it was observed
that subjects staying in three-person rooms and
six-person rooms mostly stated a preference to
stay in one/two-person rooms and two/three
person rooms, respectively.
Table 1. The Characteristics of the Two Types of Patient Rooms Used in the Study.
Interior Design
Characteristics
Three-Person Room Six-Person Room
Dimension Color Material Dimension Color Material
Fine structure
Wall covering — Champagne Plastic paint — Champagne Plastic paint
Floor covering — Cream Vinyl flooring — Cream Vinyl flooring
Ceiling covering — White Plastic paint — White Plastic paint
Entrance door 95 210 Cream Laminate
covered
chipboard
95 210 Cream Laminate
covered
chipboard
Window frame 174 174 Claret red Aluminum 174 174 Claret red Aluminum
Furniture
Patient bed 215 100 80 Off-white Metal þplastic 215 100 80 Off-white Metal þplastic
Wardrobe 70 60 280 Lilac Melamine
covered
chipboard
140 65 280 Pink Melamine
covered
chipboard
Commode 50 50 90 Beech Melamine
covered
chipboard
50 50 90 Beech Melamine
covered
chipboard
Food service
desk
80 40 80-105 Beech Metal þplastic 80 40 80-105 Beech Melamine
covered
chipboard
Accompanying
chair
48 48 45þ77 Black Metal þfabric 48 48 45 þ77 Black Metal þfabric
Radiator
enclosure
384 32 85 Cream Laminate
covered
chipboard
568 32 85 Cream Laminate
covered
chipboard
Trash can
ø
40 60 Off-white Plastic
ø
40 60 Off-white Plastic
Figure 2. Photographs of the different types of patient rooms used in the study.
218 Health Environments Research & Design Journal 9(3)
Table 2. Means of the Dependent Variables for Adequacy Evaluations.
Dependent Variables
Room Types Age Gender
Three-Person Room Six-Person Room Younger Older Male Female
Mean
a
(SD) Mean (SD)t-Value
b
Mean (SD) Mean (SD)t-Value Mean (SD) Mean (SD)t-Value
Size of the room 3.01 (1.17) 3.34 (1.11) 1.434 3.04 (1.12) 3.23 (1.17) 0.812 3.05 (1.09) 3.26 (1.22) 0.902
Window size of the room 2.48 (0.97) 2.69 (1.08) 1.044 2.61 (1.01) 2.54 (1.03) 0.370 2.42 (0.89) 2.73 (1.13) 1.540*
Cabinet storage capacity 3.29 (1.16) 3.79 (1.05) 2.199* 3.45 (1.10) 3.54 (1.17) 0.387 3.44 (1.05) 3.57 (1.24) 0.564
Number of sitting elements 3.31 (1.12) 3.44 (1.11) 0.556 3.64 (1.00) 3.16 (1.24) 2.031* 3.28 (1.09) 3.44 (1.25) 0.686
Features of hospital bed 2.20 (1.08) 2.18 (1.15) 0.093 2.21 (1.13) 2.18 (1.10) 0.123 2.21 (1.17) 2.18 (1.05) 0.125
Companion area 3.98 (1.16) 3.97 (0.93) 0.028 3.92 (1.04) 4.01 (1.09) 0.408 4.00 (1.12) 3.95 (1.01) 0.191
Visiting area 2.74 (1.10) 2.95 (1.04) 0.978 2.78 (1.04) 2.86 (1.10) 0.360 2.86 (1.04) 2.79 (1.11) 0.322
Ventilation of the room 3.24 (1.27) 3.69 (1.26) 1.785 3.40 (1.23) 3.45 (1.33) 0.230 3.42 (1.31) 3.44 (1.25) 0.101
Room lighting 2.13 (0.98) 2.16 (1.11) 0.119 2.21 (0.97) 2.10 (1.07) 0.538 2.15 (1.01) 2.14 (1.06) 0.053
a
Variable means ranged from 1 to 5, with higher numbers representing more negative responses.
b
t-value is the result of comparison of adequacy evaluations with type of room, age,
and gender variables.
*p<.05.
Table 3. Means of the Dependent Variables for Privacy Evaluations.
Dependent Variables
Room Types Age Gender
Three-Person Room Six-Person Room Younger Older Male Female
Mean
a
(SD) Mean (SD)t-Value
b
Mean (SD) Mean (SD)t-Value Mean (SD) Mean (SD)t-Value
Companion privacy 3.79 (1.41) 3.81 (1.51) 0.071 3.76 (1.46) 3.83 (1.45) 0.233 3.67 (1.55) 3.93 (1.32) 0.920
Doctors/nurses privacy 3.10 (1.57) 3.30 (1.67) 0.621 3.35 (1.51) 3.06 (1.63) 0.903 3.07 (1.61) 3.30 (1.55) 0.724
Auditory privacy 3.46 (1.57) 3.96 (1.22) 1.792* 3.69 (1.40) 3.79 (1.41) 0.373 3.75 (1.42) 3.75 (1.39) 0.018
Privacy of other patients 3.58 (1.49) 4.04 (1.27) 1.626* 3.78 (1.29) 3.77 (1.50) 0.021 3.73 (1.41) 3.83 (1.43) 0.374
Sleeping with other people 3.50 (1.59) 3.72 (1.46) 0.712 3.07 (1.52) 3.96 (1.44) 2.995* 3.53 (1.50) 3.68 (1.50) 0.373
The hygienic status 3.56 (1.54) 3.76 (1.47) 0.650 3.50 (1.62) 3.76 (1.43) 0.859 3.71 (1.44) 3.59 (1.59) 0.396
a
Variable means ranged from 1 to 5, with higher numbers representing more negative responses.
b
t-value is the result of comparison of privacy evaluations with type of room, age, and
gender variables.
*p< .05.
219
The statistical relationships between subjects’
evaluations for functional adequacies of the
rooms were analyzed in the next phase of the
analysis. The results of the study questionnaire
have been given in Table 2, including the means,
standard deviations, and t-values for each of the
items under the dependent variables. The differ-
ences in the design characteristics of the rooms
seem to have had positive/negative effects on the
functional adequacy evaluations of subjects when
the means and t-values in Table 2 were considered.
When we examined the results given in Table
2, it was observed that subjects staying in three-
person rooms displayed a more positive attitude
in the qualification evaluations for size of the
room, window size, storage capacity of cabinets,
visiting area and ventilation of the room com-
pared to subjects staying in six-person rooms.
When these variables were compared with the
t-test, it was observed that there was a statistically
significant difference at the level of p< .05 only
for evaluations of the subjects on the storage
capacity of cabinets. On the other hand, in both
rooms, window size, features of hospital bed, and
room lighting were positively evaluated by the
participants, although the size of the room, win-
dow size, storage capacity of cabinets, number
of sitting elements, companion area, visiting area,
and ventilation of the room were negatively eval-
uated. Furthermore, it was observed that there
was a statistically significant difference at the
level of p< .05 for the qualification evaluations
of the number of sitting elements in the room for
younger subjects (18–35 years of age) compared
to older subjects (36–55 years of age) and the
window sizes for females compared to males.
Therefore, although the number and concentra-
tion of commodities, number of lighting ele-
ments, and ratio of window size to the floor was
the same/very similar for the architectural sizes
of both rooms, it has been determined that the
three-person rooms were assessed more posi-
tively for functional qualifications compared to
the six-person rooms. This finding supports the
first hypothesis (Hypothesis 1).
The statistical relationships of subjects’ pri-
vacy evaluations of the rooms were examined in
the second part of the analysis. The results of the
questionnaire are given in Table 3, including the
means, standard deviations, and t-values for each
of the items under the dependent variables. The
differences in the design characteristics of the
rooms seem to have had positive/negative effects
on subjects’ privacy evaluations when the means
and t-values in Table 3 were considered.
When we examined the results given in Table
3, subjects staying in three-person rooms dis-
played a more positive attitude for privacy eva-
luations, such as companion privacy, doctor/
nurse privacy during treatment and care, auditory
privacy, privacy of other patients, presence of
other people while sleeping, and the hygienic sta-
tus of the room compared to subjects staying in
six-person rooms. When these variables were
compared with the t-test, it was observed that
there was a statistically significant difference at
the level of p< .05 for subjects’ evaluations on
auditory privacy and privacy of other patients.
There seems to be a statistically significant differ-
ence at the level of p< .05 for the t-test compar-
isons of age-groups for evaluations related to the
presence of others while sleeping for younger
subjects (18–35 years of age) compared to older
subjects (36–55 years of age). Consequently, it
has been determined that an increase in the num-
ber of persons and interior elements inside a room
negatively affects auditory privacy and privacy
areas of other patients. This finding supports the
second hypothesis (Hypothesis 2).
The statistical relationships among the number
of persons using three- and six-person hospital
rooms with age (younger, older) and gender
(male, female) groups and subjects’ perceptions
of atmospheric attributes were analyzed. The
results of the questionnaire have been given in
Table 4 as the means, standard deviations, and
t-values for each of the dependent variable items.
It was observed that subjects had more posi-
tive perceptions about atmospheric attributes of
three-person rooms than six-person rooms from
the evaluation of the means and t-values. More-
over, when younger and male subjects were com-
pared with older and female subjects, the younger
and male subjects had a more positive perception
of the three- and six-person hospital room inter-
iors for most of the attributes.
The graph of differences for perceptual items
between subjects’ evaluations of three- and
220 Health Environments Research & Design Journal 9(3)
Table 4. Means of the Dependent Variables for the Perception Evaluations.
Dependent Variables
Room Types Age Gender
Three-Person Room Six-Person Room Younger Older Male Female
Mean
a
(SD) Mean (SD)t-Value
b
Mean (SD) Mean (SD)t-Value Mean (SD) Mean (SD)t-Value
Happy/unhappy 5.39 (1.77) 5.48 (2.00) 0.243 5.33 (1.93) 5.50 (1.83) 0.463 5.19 (1.83) 5.69 (1.88) 1.354
Roomy/cramped 4.87 (1.92) 5.18 (2.07) 0.765 4.92 (1.99) 5.06 (1.99) 0.345 4.88 (1.98) 5.14 (2.00) 0.651
Peaceful/unpeaceful 5.18 (1.70) 5.16 (2.13) 0.070 4.97 (1.98) 5.32 (1.82) 0.906 5.03 (1.93) 5.32 (1.83) 0.764
Warm/cold 2.84 (2.01) 2.60 (2.10) 0.581 2.90 (1.98) 2.62 (2.10) 0.670 2.40 (1.74) 3.10 (2.29) 1.730
Light/dark 2.74 (1.75) 2.13 (1.75) 1.706 2.66 (1.72) 2.35 (1.80) 0.869 2.30 (1.51) 2.67 (2.00) 1.038
Attractive/unattractive 5.50 (1.72) 5.44 (1.81) 0.164 5.50 (1.75) 5.45 (1.77) 0.119 5.32 (1.71) 5.63 (1.81) 0.872
Pleasant/unpleasant 5.37 (1.74) 5.23 (1.84) 0.407 5.19 (2.00) 5.40 (1.62) 0.599 4.92 (1.75) 5.73 (1.72) 2.337*
Exciting/unexciting 5.67 (1.64) 5.58 (1.74) 0.267 5.47 (1.90) 5.74 (1.51) 0.792 5.32 (1.72) 5.95 (1.59) 1.911*
Dynamic/static 3.74 (2.25) 3.62 (2.54) 0.236 3.52 (2.27) 3.81 (2.45) 0.603 3.00 (2.11) 4.42 (2.43) 3.155*
Calm/restless 4.65 (1.87) 5.27 (1.91) 1.635 5.04 (1.83) 4.83 (1.97) 0.561 4.86 (1.83) 4.97 (2.00) 0.299
Comfortable/uncomfortable 4.63 (1.92) 5.04 (1.71) 1.103 4.90 (1.92) 4.74 (1.74) 0.426 4.75 (1.72) 4.87(1.97) 0.346
Quiet/noisy 4.13 (2.27) 4.26 (2.16) 0.302 4.22 (2.07) 4.16 (2.32) 0.137 4.35 (2.05) 4.00 (2.38) 0.783
Tidy/untidy 4.27 (2.02) 4.06 (2.17) 0.490 3.90 (2.28) 4.38 (1.92) 1.156 3.67 (2.04) 4.73 (1.99) 2.636*
Safe/unsafe 3.37 (2.07) 3.81 (1.91) 1.074 3.69 (2.07) 3.47 (1.97) 0.530 3.46 (1.88) 3.67 (2.15) 0.527
Uncrowded/crowded 3.94 (2.30) 4.82 (1.93) 2.035* 3.81 (2.38) 4.67 (1.98) 1.953* 4.58 (2.07) 4.03 (2.29) 1.281
Fragrant/smelly 4.98 (1.84) 5.00 (1.93) 0.045 4.80 (1.92) 5.11 (1.84) 0.814 4.48 (1.90) 5.53 (1.70) 2.909*
a
Variable means ranged from 1 to 7, with higher numbers representing more negative responses.
b
t-value is the result of comparison of perception evaluations with type of room, age,
and gender variables.
*p< .05.
221
six-person rooms, depending on their perceptions
of the rooms’ atmospheric attributes, is given in
Figure 3.
As can be observed in Figure 3, the relation-
ship between the independent variables (three-
and six-person rooms) and the dependent vari-
ables (16 bipolar adjective pairs) for the item
‘‘uncrowded/crowded’’ (t-value ¼2.035, df ¼
99, p< .05) was found to be significant. On the
other hand, for the roomy/cramped, warm/cold,
light/dark, calm/restless, comfortable/uncomfor-
table, and safe/unsafe elements, although a statis-
tically significant difference at the level of p<.05
could not be detected, it was observed that three-
person rooms were assessed more positively
compared to six-person rooms. It is understood
that the uncrowded/crowded scale was the most
effective factor among the variables on subjects’
perceptions of three- and six-person rooms.
Accordingly, although both rooms were perceived
as warm and light, the six-person rooms were eval-
uated in general as unhappy, cramped, unpeaceful,
unattractive, unpleasant, unexciting, restless,
uncomfortable, crowded, and smelly. Conse-
quently, although these rooms with different archi-
tectural sizes were very similar for concentration of
persons and commodities, six-person rooms were
perceived to be more crowded than three-person
rooms. This finding supports the third hypothesis
(Hypothesis 3). However, the assessment results
for components, such as roomy/cramped, warm/
cold, light/dark, calm/restless, comfortable/
uncomfortable, and safe/unsafe, showed that
despite the concentration of persons and com-
modities being the same, as the size of the space
and the number of equipment elements with the
same features increase, the environment tends
to be perceived in a more negative manner. In
conclusion, the differences among the number
of persons in the rooms had a statistically signi-
ficant effect on subjects’ perception of the density
of human and interior elements of the rooms, which
is a result that supports the main hypothesis of this
study. According to these results, it can be observed
that three-person rooms were partially perceived
more positively compared to six-person rooms.
Figures 4 and 5 show the differences in per-
ceptual items between age-groups and gender
groups regarding subjects’ perception of the
atmospheric attributes of rooms.
As can be observed in Figure 4, younger sub-
jects (18–35 years of age) reported the lowest
2
2,5
3
3,5
Semantic Differantial Scale
4
4,5
5
5,5
6
Means of the Items
Three-Person Room
Six-Person Room
Figure 3. Effects of the patient room types on dependent variables.
Note. Means of the variables listed between 1-7 (large numbers are negative responses).
222 Health Environments Research & Design Journal 9(3)
values (positive), while older subjects (36-55
years of age) reported the highest values (nega-
tive) for 9 items for each of the dependent vari-
ables. Consequently, the atmospheric attributes
for the dependent variable uncrowded/crowded
(t-value ¼1.953, df ¼99, p<.05) was found
to be significant. On the other hand, it was
observed that younger subjects have perceived
2
2,5
3
3,5
4
Semantic Differantial Scale
4,5
5
5,5
6
Means of the Items
Younger Older
Figure 4. Effects of the subjects’ age-groups on dependent variables.
Note. Means of the variables listed between 1-7 (large numbers are negative responses).
2
2,5
3
3,5
Semantic Differantial Scale
4
4,5
5
5,5
6
Means of the Items
Male Female
Figure 5. Effects of the subjects’ gender groups on dependent variables.
Note. Means of the variables listed between 1-7 (large numbers are negative responses).
Yildirim and Yalcin 223
and evaluated room atmosphere more positively
for nine elements, whereas, evaluations of both
age-groups were the same for two elements. This
finding supports the fourth hypothesis (Hypoth-
esis 4). Accordingly, there seems to be a statisti-
cally significant relationship among subjects of
different age-groups and their perception of
atmospheric attributes. It appears that the study’s
expectations were basically confirmed on the
effect of age on subjects’ perceptions of room
atmospheric attributes.
As can be observed in Figure 5, male subjects
received the lowest values (positive), while
female subjects received the highest values (neg-
ative) for 14 items of the dependent variables.
Consequently, the atmospheric attributes for the
dependent variables of ‘‘pleasant/unpleasant’’
(t-value ¼2.337, df ¼99, p< .05), ‘‘exciting/
unexciting’’ (t-value ¼1.911, df ¼99, p< .05),
‘‘dynamic/static’’ (t-value ¼3.155, df ¼99, p<
.05), ‘‘tidy/untidy’’ (t-value ¼2.636, df ¼99,
p< .05) and ‘‘fragrant/smelly’’ (t-value ¼2.909,
df ¼99, p<.05) were found to be significant. This
finding supports the fifth hypothesis (Hypothesis
5). Accordingly, there seems to be a statistically
significant relationship among subjects of different
gender groups and their perceptions of atmo-
spheric attributes. Therefore, those attributes noted
for their perceptual items were supported based on
the results of the effect of gender groups on sub-
jects’ perceptions of atmospheric attributes.
Limitations
Some limitations of this study should be noted
that may have potential implications on the inter-
pretation of the findings. First, the three-person
rooms used in the study were one of the critical
limitations. Dissatisfaction increased depending
on the increase in the number of patients who
remained in the rooms. Second, these studies
were performed on the three- and six-person
rooms. Since patients’ functional and perceptual
evaluations vary depending on the number of
patients staying in the room, there may be some
limitations on the generalizability of the findings.
Third, when younger, male subjects were com-
pared with older, female subjects, the younger,
male subjects had a more positive perception of
the three- and six-person hospital room interiors
for most of the attributes.
Conclusions
In this study, the impact of differences on the sub-
jects’ age and gender with two densities of multi-
occupancy hospital rooms on three environmental
quality measures (functional qualifications, pri-
vacy, and perception) was investigated.
First of all, subjects were asked their prefer-
ence for the rooms in which they would like to
stay. Of a total of 58 persons, 13 (22.5%) indi-
cated that they would like to stay in three-
person rooms, 35 (60.3%) preferred two-person
rooms, and 10 persons (17.2%) preferred one-
person rooms. Of a total of 43 persons staying
in six-person rooms, 7 (16.3%) indicated that they
would like to stay in four-person rooms, 27
(62.8%) indicated their preference for three-
person rooms, 8 (18.6%) stated their preference
for two-person rooms, and 1 (2.3%) preferred to
stay in a one-person room. It can be observed that
subjects staying in three- and six-person rooms
mostly stated a preference to stay in one-/two-
person rooms and two-/three-person rooms,
respectively.
Subjects staying in three-person rooms dis-
played a more positive attitude for the qualifica-
tion evaluations of the room size, window size,
storage capacity of cabinets, visiting area, and
ventilation of the room compared to subjects stay-
ing in six-person rooms. Moreover, it was
observed that qualification evaluations of sub-
jects staying in both rooms were very similar to
each other for sitting element quantity, features
of hospital bed, companion area, and room light-
ing. Although the number and concentration of
commodities, number of lighting elements, and
ratio of window size to the floor were the same/
very similar for architectural sizes of both rooms,
it has been determined that three-person rooms
were assessed more positively for functional qua-
lifications compared to six-person rooms.
Similarly, subjects staying in six-person rooms
displayed a more positive attitude than subjects
staying in three-person rooms for privacy evalua-
tions on companion privacy, doctor/nurse privacy
during treatment and care, auditory privacy,
224 Health Environments Research & Design Journal 9(3)
privacy of other patients, presence of other people
while sleeping and hygienic status of the room.
Inferentially, it has been determined that an
increase in the number of persons and interior ele-
ments inside rooms negatively affects auditory
privacy and privacy areas of other patients. Eva-
luation of the means and t-values showed that
subjects had more positive perceptions for atmo-
spheric attributes of three-person rooms than for
six-person rooms.
Accordingly, despite both room types being
perceived as warm and light, the six-person
rooms were evaluated in general as unhappy,
cramped, unpeaceful, unattractive, unpleasant,
unexciting, restless, uncomfortable, crowded, and
smelly. Although rooms with different architec-
tural sizes were very similar for concentrations
of persons and commodities, six-person rooms
were perceived to be more crowded than three-
person rooms. However, the assessment results for
components such as roomy/cramped, warm/cold,
light/dark, calm/restless, comfortable/uncomforta-
ble, and safe/unsafe showed that despite concen-
trations of persons and commodities being the
same, as size ofthe space and number of the equip-
ment elements with the same features increases,
the environment tends to be perceived in a more
negative manner. This conclusion supports the
claim, ‘‘When density of humans-belongings
increases in interior spaces, perceptual perfor-
mance of users is also affected negatively’’
stated in the research study by Yildirim and
Akalin-Baskaya (2007, p. 3414).
Moreover, younger and male subjects had a
more positive perception of the interiors of
three-/six-person hospital rooms for most of the
attributes of three environmental quality mea-
sures (functional qualifications, privacy, and per-
ception) compared to older and female subjects.
These conclusions support the results of other
studies made by Yildirim, Akalin-Baskaya, and
Hidayetoglu (2007), Yildirim and Akalin-
Baskaya (2007), and Yildirim, Hidayetoglu, and
Capanoglu (2011).
In summary, the original purpose of this study
was to examine the relationships between multi-
occupancy hospital rooms with different densities
rather than between single-bed and multibed
patient rooms. Thus, the findings clearly revealed
that an increase in density of humans furniture
affects the perception of patients negatively, even
if the per capita area of the space is constant.
Moreover, these effects vary due to differences
in age and gender. As it has been observed in the
results of this study, there is a tendency toward
multioccupancy hospital rooms due to reasons,
such as population growth, economical reasons,
insufficiencies in the number of doctors and
nurses and increasing illnesses and it mostly
becomes an issue of interior design.
Recommendations for Future Results
These and other similar studies can develop
design solutions (such as dividers, position of ele-
ments, illumination, color, materials, etc.) to
improve the conditions created by existing prob-
lems. It is possible to propose dividing into half
the six-person patient rooms within the scope of
the research and converting them into triple
rooms. Consequently, it would be beneficial to
make space analyses by taking into account the
psychosocial and physical needs of patients and
by determining the design criteria peculiar to
patient rooms.
Implications for Practice
Study the effects of multioccupancy patient
room with different densities of human
belongings on the improvement process of
patients.
The effects on the functional and perceptual
evaluations of patients could be studied on
the transformation with moveable divider
panels of the large volume rooms into
rooms where a fewer number of patients
could stay.
Acknowledgments
We would like to extend our gratitude to the
Dean’s Office of the Gazi University, School of
Medicine, and the Chief Physician’s Office of the
Gazi Hospital for giving permission to conduct
this study; to the doctors, nurses, patients, and
relatives for their invaluable support; to Ellen
Andrea Yazar for her careful proofreading of the
Yildirim and Yalcin 225
English text; and to Mehmet Das¸do¨g
˘en and
Ahmet Yılmaz for conducting the questionnaire
survey.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of
interest with respect to the research, authorship,
and/or publication of this article.
Funding
The author(s) received no financial support for
the research, authorship, and/or publication of
this article.
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