The potential for urban open spaces to convey therapeutic benefits is increasingly substantiated. More work is needed to specifically consider how low impact designs to manage stormwater such as ecoroofs perform in this context. Here, we report on a pilot study addressing: (1) factors determining whether a hospital has an ecoroof, and (2) how ecoroofs might convey therapeutic benefits. We utilized a mixed methods approach which encompassed phone interviews of hospital ecoroof managers as well as analysis of national hospital databases. We also conducted a local case study which compared cortisol samples and stress indicators from patients, staff, and caregivers visiting an ecoroof to those waiting indoors at the Oregon Health and Sciences University in Portland OR. Behavioral observations took place at this same location. In 2017, we identified 105 hospitals with ecoroofs in the contiguous United States. Our analysis of a national hospital database found two factors that significantly increased the likelihood of a hospital having an ecoroof: Medicaid discharges per year; and non-profit status. Interviews with practitioners nationally revealed a wide range of motivations but that therapy was a consideration for a majority, but notably not all, of the hospitals surveyed. They similarly noted variation in roof design, maintenance, and programming around horticultural therapy; we highlight some best practices here. Our physiological case study was limited in sample size. Preliminary findings showed that salivary cortisol levels varied by ecoroof visitor type, ranging on average from 0.09 μg/ml for caregivers to 0.30 μg/ml for patients. We did not observe any significant changes in visitor cortisol. This could be explained by low replication or the short treatment duration. Alternatively, these pilot data may indicate a gap in horticultural therapy theory vs. practice. Behavioral observations demonstrated a wide array of different uses of the ecoroof space such as cell phone use and passing by. Though preliminary, our findings suggest that therapeutic effects may vary by user type and activity and depend on roof design and goals. This study offers both information on the therapeutic potential of hospital ecoroofs as well as lessons learned regarding different approaches to researching this somewhat new topic.

Plants and planted landscapes have been recognized for their therapeutic benefits. Hospitals are increasingly adopting therapeutic landscapes like healing gardens, horticultural therapy gardens, and memory gardens. Despite this increase in the installation of healing landscapes at hospitals, the research on the therapeutic benefits of green roofs in hospital settings is limited. The primary objective of this project is to understand the current and potential uses of hospital green roofs and associated motivations for their installation. We have documented 105 hospitals nationwide which have green roofs. Of the 105 hospitals, 76 were general care. We found that 63 hospitals have accessible green roofs. Phone interviews were conducted with key stakeholders who played a major role in the planning and maintenance of these hospital green roofs. The questions focused on motives behind green roof installation, accessibility, and therapeutic benefits. A modified grounded theory approach was taken to analyze the qualitative portion of the surveys where both inductive coding and a priori codes were used. Themes emerging from the interviews suggest that stormwater management, energy savings, and therapeutic benefits were primary motivations for installation. The interviews also suggest that green roofs are actively being used by patients, staff, and visitors.Ongoing site use mapping and staff surveys will build on these interview findings. This information will be useful for determining how future green roofs can be designed for hospital settings to promote horticultural therapy.

In April 2020, at the onset of COVID-19 in the U.S., we implemented a weekly survey of underrepresented undergraduate students participating in a biomedical research training program. The 10-week survey collected qualitative and quantitative data on mental health, physical health, and financial health. Responses indicated high stress during the pandemic, particularly during the survey’s final weeks which occurred during a period of social unrest. Physical health declined throughout the survey, stabilizing in its final weeks. Financial health declined initially and stayed low throughout. Students from certain demographic groups, such as first generation college students and those with dependents were disproportionately impacted. Qualitative responses highlighted the intersectionality of the three constructs and illustrated the impacts of these events.