Indigenous Preferences for Inpatient Rooms in Australian Hospitals: A Mixed-Methods Study in Cross-Cultural Design

Abstract

Aim: This mixed-method study aimed to establish preliminary evidence for spatial and design features that can improve the experience and participation of Indigenous inpatients in healthcare. Background: Disadvantaged across a range of health measures, a disproportionately high number of Indigenous people leave hospital without receiving appropriate medical care. Australian government policies to improve cultural safety of Indigenous patients have largely ignored physical settings and their potential to improve health outcomes. Despite increasing evidence on the potential of design to reduce patient stress, there is minimal research on cross-cultural design in health facilities, including for Indigenous Australians. Methods: A cross-sectional, area-based survey elicited design preferences of four healthcare settings from Indigenous participants ( n = 602). On the screen-based survey, participants selected from paired images that indicated their preferences for room layout and features of inpatient rooms. Semistructured in-depth interviews ( n = 55) explored meanings behind preferences. Results: Participants showed majority preferences for the two-bed patient room, for a balcony rather than a window only, Indigenous art, and view of a park over an urban environment. Analysis of qualitative data shifted the focus from Ulrich’s three supportive design components to cultural recognition, the desire for company of family members, and connection to life outdoors. Conclusions: Social and cultural factors were highly significant to patients for sense of control, family support, and positive distraction. In response, inpatient room size and type, views, access to outdoors and Indigenous art need to be considered in hospital design for Indigenous patients and families.

Patients’ and Nurses’ Experiences of All Single-Room Hospital Accommodation: A Scoping Review

“…However, we also found that some of the same elements caused experiences of boredom, loneliness, and isolation. This is in line with the findings by Nash et al (2021) who found that a majority of respondents preferred two-bed patient rooms, as the single room can exacerbate the patient’s sense of social isolation. However, Nasrallah, E. & Pati, D (2020) argue that this is especially important for the older generations when admitted to hospital).…”

“…In their cross-sectorial survey of 602 participants, Nash et al also stress the great significance of social and cultural factors to patients’ sense of control. They stress that especially women seem to prioritize access to a pleasant outdoor space as an important factor influencing their satisfaction with being admitted to hospital (Nash et al, 2021).…”

“…In recent years, single-room accommodation has received growing support and has been reported to produce a boost in the quality of hospital care (Taylor et al, 2018;Voigt et al, 2018). The main reason has been the assumption that patients prefer single rooms, and an expectation of benefits in hygiene with decreased hospital acquired infections improved levels of patient outcome and patient care (Nash et al, 2021, Ulrich, 2006. Despite these assumptions, the evidence in support of this statement is inconclusive (Glind et al, 2007;Shannon et al, 2020;Taylor et al, 2018).…”

A qualitative exploration of Indigenous patients’ experiences of racism and perspectives on improving cultural safety within health care

“…Participants also shared their perspectives of the importance of creating welcoming spaces for Indigenous Peoples and improved Indigenous representation in health care. This adds to previous research from Australia that has highlighted the importance of Indigenous-designed health care spaces, 41 though it is important to acknowledge that participants felt improving physical spaces would be futile in the absence of culturally safe health care. Additionally, increased Indigenous representation among health care providers is an important aspect of improving Indigenous Peoples’ trust in the health care system, which is supported by existing evidence that increased diversity among health care staff is associated with improved health outcomes.…”

Cross-cultural Design and Healthcare Waiting Rooms for Indigenous People in Regional Australia

“…Our research addressed this gap though a multi-disciplinary, mixedmethod study of Aboriginal and Torres Strait Islander (Indigenous) people's perceptions and experiences of healthcare settings in regional Australia (Haynes et al, 2020;Nash et al, 2021). Based on this broader study, the article identifies problems for Indigenous people in healthcare facilities which indicate design implications for waiting rooms.…”