Assessing the Relationship between Demographic Attributes and Patients' Views of Hospital Environment

Abstract

The objective of this study was to examine the relationship between patient demographic factors (gender, age, marital status) and their perception of a patient-friendly hospital environment. A cross-sectional study was conducted using a questionnaire to collect data from 41 patients at a hospital in Kathmandu, Nepal. The questionnaire assessed perceptions of privacy, visitation, amenities, way finding, and other aspects that contribute to a patient-friendly environment. Correlation analysis was used to analyze the relationship between demographic variables and overall satisfaction. Most respondents were younger, female patients. Descriptive analysis found neutral to average satisfaction across different environment domains. Correlation analysis showed no significant relationships between gender, age, marital status and perception of a patient-friendly environment (p>0.05 for all). Patient demographics did not appear to influence perceptions of a patient-friendly environment in this study. While most domains scored neutrally, opportunities remain to enhance certain areas like bathroom accessibility and parking. Larger studies are needed to further understand how hospitals can optimize their physical environments to better support patients.

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Baneshwor Campus Journal of Academia (BCJA)
Vol. 3, No. 1, May 2024. Pages: 108-120
ISSN: 2705-4586 (Print), ISSN:2990-7772 (Online)
DOI: https://doi.org/10.3126/bcja.v3i1.65626
108
Assessing the Relationship between Demographic Attributes and
Patients' Views of Hospital Environment
Shrijana Khadka*
Bachelor in Healthcare Management
Atharva Business College, Kathmandu, Nepal
srizanakhadka83@gmail.com
Netra Prasad Nyaupane
Baneshwor Multiple Campus, Kathmandu, Nepal
netranyaupane45@gmail.com
Chiranjibi Timalsena
Baneshwor Multiple Campus, Kathmandu,Nepal
timalcj28@gmail.com
Corresponding Author*
Received: January 23, 2024; Revised & Accepted: March 29, 2024
Copyright: Khadka, Nyaupane & Timalsena (2024)
This work is licensed under a Creative Commons Attribution-Non Commercial 4.0
International License.
Abstract
The objective of this study was to examine the relationship between patient demographic
factors (gender, age, marital status) and their perception of a patient-friendly hospital
environment. A cross-sectional study was conducted using a questionnaire to collect data from
41 patients at a hospital in Kathmandu, Nepal. The questionnaire assessed perceptions of
privacy, visitation, amenities, way finding, and other aspects that contribute to a patient-
friendly environment. Correlation analysis was used to analyze the relationship between
demographic variables and overall satisfaction. Most respondents were younger, female
patients. Descriptive analysis found neutral to average satisfaction across different environment
domains. Correlation analysis showed no significant relationships between gender, age, marital
status and perception of a patient-friendly environment (p>0.05 for all). Patient demographics
did not appear to influence perceptions of a patient-friendly environment in this study. While
most domains scored neutrally, opportunities remain to enhance certain areas like bathroom
accessibility and parking. Larger studies are needed to further understand how hospitals can
optimize their physical environments to better support patients.
Keywords: Hospital, Environment, Gender, Patient, Sex

Baneshwor Campus Journal of Academia (BCJA)
Vol. 3, No. 1, May 2024. Pages: 108-120
ISSN: 2705-4586 (Print), ISSN:2990-7772 (Online)
DOI: https://doi.org/10.3126/bcja.v3i1.65626
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Introduction
This study forms part of a broader program of research, which examined the factors that
influence the attitudes and perceptions of patients to Government hospital built environments.
Douglas & Douglas, (2004) states that there is some evidence that the built environment of the
hospital can influence the healing process and that it can have a direct impact on patient
outcomes including for example reducing levels of anxiety and stress, shortening recovery
periods following surgery through enabling views of nature, increasing social interaction
through improved positioning of furniture and significantly decreasing pathological behavior
through creation of a supportive, stabilized environment for patients. Emerging findings
appears to support the assertion of a link between good surroundings and positive patient
outcomes. There is a need to explore the issues surrounding patients’ perceptions of and
attitudes to hospital environments and to determine factors that contributed to their experience
within that environment.
Recent attention in health care has been on the actual architectural design of a hospital facility,
including its technology and equipment, and its effect on patient safety (Pokharel, Aryal,
Yadav, & Pokharel, 2021). To address the problems of errors in health care and serious safety
issues, fundamental changes of health care processes, culture, and the physical environment
are necessary and need to be aligned, so that the caregivers and the resources that support them
are set up for enabling safe care. The facility design of the hospital, with its equipment and
technology, has not historically considered the impact on the quality and safety of patients, yet
billions of dollars are and will be invested annually in health care facilities. This provides a
unique opportunity to use current and emerging evidence to improve the physical environment
in which nurses and other caregivers work, and thus improve both nurse and patient outcomes
(Reiling, Hughes, & Murphy, 2008).The role of ‘place’ in the creation and maintenance of
health has recently been acknowledged and studied. Researchers are increasingly noting that
factors such as perception of and the nature of social relationships that occur affect health. The
study suggests that the design of the built environment of the hospital can have a major effect
on the degree of ‘social k that takes place. Some describe this in relation to the importance of
the positioning of beds or furniture within a ward that make it easier for patients to interact
with each other. (Fadda, 2020) found that a successful health system has three dimensions:
outcomes— means attaining the highest level of healthcare that is effective, safe, timely,
patient-centered, and efficient; equity—meaning that treatment is applied without
discrimination or disparities to all individuals and families, regardless of age, group identity,
or place; and fairness—the system is fair to the health professionals, institutions, and
businesses supporting and delivering care (Acharya, Kharel, & Upadhyaya, 2023).
Starkey and Parsons, (2014) observed that an unexpected stay in the hospital can be a traumatic
and stressful experience. In addition to the pain and discomfort endured as a result of injury or
illness, patients often experience increased stress associated with the healthcare facility itself

Baneshwor Campus Journal of Academia (BCJA)
Vol. 3, No. 1, May 2024. Pages: 108-120
ISSN: 2705-4586 (Print), ISSN:2990-7772 (Online)
DOI: https://doi.org/10.3126/bcja.v3i1.65626
110
such as “ delirium, elevated blood pressure, increased need for pain medication and longer
hospital stays following surgery” (Ulrich, 1992, p. 20). This stress is counterproductive for both
the patient and hospital staff and may be preventable because patient centered design has been
shown to counteract negative patient reactions related to the hospital stay (Devlin & Arneill,
2003; Ulrich, 1992).
An optimal hospital environment (the “healing environment”) can enhance patients’
postoperative recovery and shorten length of stay. However, insights lack into patients’ lived
environmental needs for optimal healing after surgery and how these needs are being met.
Modern hospital indoor environment aims at fulfilling the psychological needs and preferences
of the people who use it. Nowadays, physical and non-physical and healing environments are
perceived as potential contributors to recovery processes. Unlike curing, healing relates to
aspects of health that are psychological and spiritual (Mahmood and Tayib, 2021).
Robinson, Gardiner, & Ingleton, (2018) recommended to pay attention to the things that can be
changed, such as enabling family to stay and improving the flexibility of the physical
environment while improving the social interplay between patients and health professionals,
may be a more realistic approach than replicating the hospice environment in order to reduce
the burden of hospitalizations for patients with palliative care needs.
Statement of the Problem
Patient friendly hospital environment has been achieved up-to certain extend in various private
and government hospitals like installing curtains, locating toilets correctly and common rooms
for visitors so on so forth. But if we look at a broader scenario patient friendly hospital
environment is a need rather than just a criteria which is negligible or optional since it has a
very vast and holistic impact on a patients’ health and mental wellbeing as a whole so to get
deeper into the subject matter we need to look into various issues and address it such as:
This research addresses the following issues
• What role does privacy plays in providing patients with a hospital friendly environment?
• Is there any impact of physical design on patient friendly hospital environment and what
are the physical design changes required to do so?
•
Objective of the Study
• To examine relationship between Demographic Attributes and Patients' Views of an
Hospital Environment
Research Hypothesis
 There is a significant relationship between sex and patient friendly hospital environment
 There is significant relationship age and patient friendly environment in hospitals.

Baneshwor Campus Journal of Academia (BCJA)
Vol. 3, No. 1, May 2024. Pages: 108-120
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DOI: https://doi.org/10.3126/bcja.v3i1.65626
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 There is significant relationship marital status and patient friendly environment in hospitals.
Literature Review
Douglas and Douglas, (2004) conducted a research related to patient-friendly hospital
environment. The main aim of this research was to explore patients’ feelings about the
environment, using SRHT as a case study, in order to gather information about what is best for
the patient using the service and to identify what they and their families need. The objective of
the research was to help to develop design excellence, to improve the built environment of
hospitals so as to make future hospitals places and spaces responsive to patient needs. A
number of studies, particularly from North America, have discussed the notion of healing
environments in which the influence of the immediate surroundings helps people to get better.
Such healing environments shorten people's post‐operative recovery period and help to return
them to a good state of mind and physical health. In one of the earliest studies of the important
role of hospitals as healing environments, Ulrich suggested that stress was a major obstacle to
healing and that the wellbeing and recovery of patients was directly related to the physical
environment of the hospital and its health care facilities. Later studies suggest that the hospital
environment is itself a ‘healing landscape’ that has a distinct effect on the health and recovery
of patients.
A number of authors have discussed the relationship between mental stress and the healing
effect of the natural and urban environment. Ulrich et al (2004) have shown that exposure to
natural and urban environments has a direct impact on recovery from stress. Accordingly, the
physical environment of a hospital has significant effects on patients’ mental processes and
their social wellbeing. Ulrich's ideas of supportive designs for health care environments suggest
that hospitals should take steps to enhance the features of the patients’ surroundings to hold
their attention and interest without creating further difficulties that add to their fatigue and
distress. Within the UK, Francis et al. discussed the fundamental shift that is taking place in
the way that health professionals define health and evaluate health care buildings and pointed
to the emergence of therapeutic environments as a factor which contributed positively to the
healing process. Furthermore, Francis and Glanville, in considering a vision for future health
care, pointed to the significance of the quality of design in the therapeutic environment.
Research reviewed suggests that the built environment of a hospital influences the healing
process and has a direct effect on patient health outcomes. A healing environment can help to
reduce the stress that patients encounter during a period of hospitalization and thereby help
them in their personal recovery and recuperation.
Adamson, Pow, Houston, & Redpath, (2017) conducted research on patient experience in the
rural hospital in Scotland. The findings showed that relationships with staff and other patients
were important. The patients also wanted to feel valued, and helping others was part of this.
The patients had clear expectations of the service but had an acute awareness of the benefits of

Baneshwor Campus Journal of Academia (BCJA)
Vol. 3, No. 1, May 2024. Pages: 108-120
ISSN: 2705-4586 (Print), ISSN:2990-7772 (Online)
DOI: https://doi.org/10.3126/bcja.v3i1.65626
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attending the day hospital such as coordination of their care. Overall, the patients were highly
satisfied, felt that care was person‐centered and recognized the advantages of remaining close
to home.
Chegini, Janati, Bababie, & Pouraghaei, (2019) found that the role of patients in furthering their
own safety whilst in hospital cannot be underestimated and the results from this study can be
used to support the development of practical strategies that address the delivery of safe hospital
care and which involve patients and their caregivers.
According to Franklin, Gandhi, Bates, Huancahuari, Morris, Pearson, & Goralnick, (2020),
Navigating the healthcare system is stressful and, too often, unsafe for patients, family, and
staff. Patient safety is a globally recognized concern with healthcare-associated infections
(HAIs) affecting 1 in 25 hospitalized patients and medication errors costing an estimated
US$42 billion worldwide each year. Clinician well-being and job satisfaction are growing
priorities as burnout rates rise and health information technologies pose new challenges to
providing care. Most organizations are shifting care delivery models in response to the needs
of the community and renewed patient and payer emphasis on patient experience as a key
performance indicator.
The importance of personalized and dignified care is increasingly being recognized in health
care policy and practice. Despite the known impact of clothing on social identity and self‐
expression, the impact of hospital clothing on patient well‐being has been widely overlooked.
Patients are often required to wear hospital clothing, commonly a backless gown, during
medical procedures and surgeries. The impact of wearing patient clothing on well‐being, during
this time of vulnerability, was explored (Morton, 2020).
Methodology
The research is qualitative study with descriptive design (Mahat, Neupane, & Karki, 2023).
Whoever were okay enough to attend were welcomed and given a set of questionnaires and a
pen. They were provided with brief description about the purpose or aim of research. Patients
were selected to provide diversity both in terms of their length of experience as a hospital
inpatient and the type of specialty area across the four major clinical divisions of the hospital.
These were general surgery, general medicine, care of the elderly and maternity. Patients were
eligible to take part in the study if they had a length of inpatient hospital stay of 5 days or longer
and were well enough to take part in a 15 min survey session. Of the 41 participants, 28 were
female and 12 male. Their ages ranged from 19 to 68 years. The length of time they had been
in hospital at the time of the session ranged from 5 to 60 days. Using the questionnaire survey
method we collected the patients reviews and feedbacks regarding the hospital’s environment
and its friendliness level (Mahat, 2023). The questionnaire focused on examining the various

Baneshwor Campus Journal of Academia (BCJA)
Vol. 3, No. 1, May 2024. Pages: 108-120
ISSN: 2705-4586 (Print), ISSN:2990-7772 (Online)
DOI: https://doi.org/10.3126/bcja.v3i1.65626
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aesthetic, social and internal/external hospital policies in the hospital contributing to its patient
friendly environment.
Results
In this research, new econometric model and different statistical tools was used to measure
patient friendly hospital environment in hospitals. Different statistical tools such as correlation
of coefficient, frequency were used to test hypothesis. The appropriate computer software
(SPSS) was extensively used to measure the relationship between the variables under study
(Mahat, 2024; Bhattarai, 2023; Parajuli, Mahat, & Kandel, 2023).
Data presentation and analysis
For the descriptive analysis a well-structured questionnaire was distributed to 41 respondents.
Table 1: Demographic analysis
Frequency
Percentage
Mean
Sex
Male
Female
Others
12
28.6%
30
71.4%
0
0.0%
Age
29
69.0%
27.88
Marital status
Unmarried
Married
13
31.0%
A total number of 41 respondents have been taken for conducting research in the survey for the
purpose of obtaining search results. The respondents have been representing sex, age, and
marital status from Kathmandu Valley.
Table 1 shows the respondents profile accordance with sex. Male respondent has found to be
28.6% percent and female respondents have recorded to be 71.4% percent. It can be concluded
that majority of respondents were female (71.4%).The average mean of age is found to be
27.88. There are 69 percent respondents who are single and 31 percent who are married.
According to result, the majority of respondents are single; it can be inferred (69%).
Descriptive Analysis
Table 2: Response Statistics
Count
Column N %
The conversation is highly
confidential while talking with the
doctors.
Strongly Disagree
1
2.4%
Disagree
3
7.1%
Neutral
12
28.6%

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Agree
19
45.2%
Strongly Agree
7
16.7%
You can communicate in
private with the visitors.
Strongly Disagree
3
7.1%
Disagree
Neutral
12 6
28.6%
14.3%
Agree
18
42.9%
Strongly Agree
Strongly Disagree
Disagree
3
3
7
7.1%
7.1%
16.7%
There is enough facility for
personal belongings.
Neutral
17
40.5%
Agree
14
33.3%
Strongly Agree
1
2.4%
Bathrooms and toilets are
privately accessible.
Strongly Disagree
Disagree
5
20
11.9%
47.6%
Neutral
8
19.0%
Agree
7
16.7%
There is enough space for
vehicle parking.
Strongly Agree
2
4.8%
Strongly Disagree
6
14.3%
Disagree
Neutral
8
12
19.0%
28.6%
Agree
12
28.6%
Strongly Agree
4
9.5%
Nurses are easy to reach out
and call when required.
Strongly Disagree
6
14.3%
Disagree
Neutral
11
11
26.2%
26.2%
Agree
12
28.6%
Strongly Agree
Strongly Disagree
Disagree
Neutral
2
3
8
13
4.8%
7.1%
19.0%
31.0%
There are pratical and flexible
visiting hours for patients.
Agree
16
38.1%
Strongly Agree
2
4
4.8%
9.5%
Strongly Disagree
The external and internal
ambience of the hospital is
pleasant.
Disagree
7
16.7%
Neutral
Agree
16
13
38.1%
31.0%

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Strongly Agree
2
4.8%
There is a proper mapping of
directions for all departments of
the hospital.
Strongly Disagree
Disagree
Neutral
Agree
2
5
13
15
4.8%
11.9%
31.0%
35.7%
There is enough lifts and elevator
facility for people movements as
well as equipment movements.
Strongly Agree
7
16.7%
Strongly Disagree
5
11.9%
Disagree
4
9.5%
Neutral
9
21.4%
Agree
11
26.2%
Strongly Agree
13
31.0%
This section includes the statistical analysis of the 42 respondents’ response to the different
statements relating to the dependent and independent variables. The statements were analyzed
using frequency and percentage in this section.
The respondents were asked whether, “The conversation is highly confidential while talking
with the doctor”. Out of 42 respondents 1(2.4%) responded “strongly disagree”, 3(7.1%)
responded “disagree”, 12(28.6%), “neutral”, 19(45.2%) replied that they “agreed”, 7(16.7%)
responded “strongly agreed”. It can be concluded that the majority of the respondents agree
that the conversation is confidential between patients and doctors.
The respondents were asked whether, “You can communicate in private with the visitors”. Out
of 42 respondents 3(7.1%) responded “strongly disagree”, 12(28.6%) responded “disagree”,
6(14.3%), “neutral”, 6(14.3%) replied that they “agreed”, 18(42.9%) responded “strongly
agreed. We can see that many of the respondents strongly agree that communication can be
private with the visitors.
The respondents were asked whether, “There is enough facility for personal belongings”. Out
of 42 respondents 3(7.1%) responded “strongly disagree”, 7(16.7%) responded “disagree”,
17(40.5%), “neutral”, 14(33.3%) replied that they “agreed”, 1(2.4%) responded “strongly
agreed”.
It can be concluded that majority of the respondents are neither satisfied and nor dissatisfied so
their response is neutral. The respondents were asked whether, “Bathroom and toilets art easily
accessible”. Out of 42 respondents 5(11.9%) responded “strongly disagree”, 20(47.6%)
responded “disagree”, 8(19.0%), “neutral”, 7(16.7%) replied that they “agreed”, 2(4.8%)
responded “strongly agreed”. It is estimated that nearly half of the respondents disagree to the
statement of accessible toilets and bathrooms.

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Vol. 3, No. 1, May 2024. Pages: 108-120
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The respondents were asked whether, “There is enough space for parking”. Out of 42
respondents 6(14.3%) responded “strongly disagree”, 8(19.0%) responded “disagree”,
12(28.6%), “neutral”, 12(28.6%) replied that they “agreed”, 4(9.5%) responded “strongly
agreed”. It has been found that only around 10 % strongly agreed that the parking space is
enough.
The respondents were asked whether, “Nurses are easy to reach out and when required”. Out
of 42 respondents 6(14.3%) responded “strongly disagree”, 11(26.2%) responded “disagree”,
11(26.2%), “neutral”, 12(28.6%) replied that they “agreed”, 2(4.8%) responded “strongly
agreed”. In this statement the responses were neutral while very low percentage of respondents
believed that nurses are easy to reach out when required.
The respondents were asked whether, “There are practical and flexible visiting hours for
patients”. Out of 42 respondents 3(7.1%) responded “strongly disagree”, 8(19.0%) responded
“disagree”, 13(31.0%), “neutral”, 16(38.1%) replied that they “agreed”, 2(4.8%) responded
“strongly agreed”. It shows that the minimum range of people strongly disagreed that the
hospital provides practical and flexible visiting hours for patients while around 40% were
neutral
The respondents were asked whether, “The external and internal ambience of the hospital is
pleasant”. Out of 42 respondents 4(9.5%) responded “strongly disagree”,7(16.7%) responded
“disagree”, 16(38.1%), “neutral”, 13(31.0%) replied that they “agreed”, 2(4.8%) responded
“strongly agreed”. It can be seen that 38.1% of respondents disagreed regarding the pleasant
external and internal ambience of the hospital and almost only 5% were satisfied with the
ambience of the hospital.
The respondents were asked whether, “There is proper mapping of directions for all the
departments of the hospital”. Out of 42 respondents 2(4.8%) responded “strongly
disagree”,5(11.9%) responded “disagree”, 13(31.0%), “neutral”, 15(35.7%) replied that they
“agreed”, 7(16.7%) responded “strongly agreed”. It is estimated that around 36% agreed that
there is proper mapping of directions for different departments of the hospitals.
The respondents were asked whether, “There is enough lift and elevator facility for people
movements as well as equipment movements”. Out of 42 respondents 5(11.1%) responded
“strongly disagree”,4(1%) responded “disagree”, 17(40.5%), “neutral”, 14(33.3%) replied that
they “agreed”, 14(33.3%) responded “strongly agreed”. It can be concluded that only 1%
respondents disagree on the statement that there is enough lift and elevator facility for people
as well as equipment movements while 40% were neutral.

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Correlation
This section constitutes of the correlation analysis between different independent variables and
dependent variables i.e. patient- friendly and hospital environment. The table shows the
Pearson correlation along with the significance of the independent variable on the dependent.
Table 3: Correlation between sex and patient friendly environment in hospital
Sex
Mean
Sex
Pearson Correlation
Sig. (2-tailed)
N
Pearson Correlation
Sig. (2-tailed)
N
1
.085
.595
42
.085
42 1
Mean
.595
42
42
*. Correlation is significant at the 0.05 level (2-tailed). N= 42
Table 3 shows the correlation co-efficient between sex and patient friendly hospital
environment. The correlation co-efficient between privacy and government hospital
environment was found to be 0.085 which is negatively correlated. Its p-value is 0.595 which
is more than 0.05 i.e., 0.039<0.05. Therefore, there is no significant relationship between sex
and patient friendly hospital environment (r=0085, p=0.595).
Table 4 Correlation between age and patient friendly environment in hospital
Age
Mean
Pearson Correlation
Age Sig. (2-tailed)
N
Pearson Correlation
Mean Sig. (2-tailed)
N
1
-.016
.919
42
42
-.016
1
.919
42
42
*. Correlation is significant at the 0.05 level (2-tailed). N= 42.
Table 4 result shows that there is no significant relationship between age and patient friendly
environment in hospitals (P>0.05). This result rejects the alternative hypothesis 2(H2: There is
significant relationship age and patient friendly environment in hospitals .

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Table 5: Correlation between marital status and patient friendly environment in hospital
Marital status
Mean
Marital status
Pearson Correlation
Sig. (2-tailed)
N
Pearson Correlation
Sig. (2-tailed)
N
1
-.068
.668
42
42
Mean
-.068
1
.668
42
42
*. Correlation is significant at the 0.05 level (2-tailed). N= 42.
Table 5 result shows that there is no significant relationship between marital status and patient
friendly environment in hospitals (P>0.05). This result rejects the alternative hypothesis 2(H2:
There is significant relationship marital status and patient friendly environment in hospitals
Conclusion
A central aim of this study was to explore patients’ perception and attitudes to hospital
environments and to determine the factors that contributed to their experience. Findings
revealed the breath and complexity of patient's views on the environmental surroundings and
emphasized the importance that they attributed to that setting. The research also pointed to the
vital link that exists between the environment and the organizational culture within a hospital.
Hospital environments include a coalition of values and support behaviors that reflect the
cultural norms at departmental levels and across wards. It is necessary to recognize the critical
importance of this broader context within which quality health care environments need to be
situated. The findings from this research point to the similarity of priorities and issues raised
by all patients but also highlight the importance of specific factors that immediately impacted
on patients or their families personally of particular interest is the finding that patients
perceived the built environment of the hospital as a supportive health environment.
All the null hypothesis were rejected because value of significance were less than 0.05. So, we
can infer the relationship between patient-friendly and hospital environment were highly and
moderately significant.
Three components namely privacy, physical design and social interaction statistically
significant impacts on patient-friendly hospital environment with significant level at 5%.
These findings add to the growing body of evidence that will inform the development and
creation of patient‐focused health care environments for the future and if linked to supportive
organizational behaviors can contribute to desired therapeutic outcomes for patients, and
patient and family satisfaction.

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Recommendation
After the analysis of all the collected data, we can conclude that factors affecting variables have
significant relationship with the government hospital environment. The independent variables
and the government hospital environment have low positive correlation which means there is
still room for the continuous improvements. The government hospital may try to focus and put
more effort on the variables like privacy because it has the lowest mean value.
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