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Effective Environmental Factors for Reducing Children's Fear in Children's

Hospital: Using Parent's Attitudes

Article · June 2020

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 ICONARP

ICONARP
International Journal of Architecture and Planning
Received: 27.05.2018 Accepted: 24.04.2020
Volume 8, Issue 1, pp: 01-19/ Published: 25.06.2020
Research Article DOI: 10.15320/ICONARP.2020.102 E- ISSN:2147-9380

Effective Environmental
Factors for Reducing
Children's Fear in
Children's Hospital: Using Sara Nourmusavi Nasab*
Amir Reza Karimi Azeri **
Parent's Attitudes Seyedjalil Mirbazel***

Abstract
Purpose Keywords: Children, children's
Getting sick and getting into an unfamiliar environment in the hospital hospital, fear reduction,
makes children fear, discomfort and is considered as a very common environmental factors
stressor in such setting. Poor design of hospital environments can
*Architecture and Art Faculty, University
exacerbate behavioral disorders, as well as fear and anxiety in
of Guilan, Rasht, Iran. (Principal contact
individuals. The main purpose of this study is to investigate and for editorial correspondence.)
address the needs and preferences of children regarding the design of Email:[email protected]
m
therapeutic environments. ORCID No: https://orcid.org/0000-
Design/Methodology/Approach 0002-1883-8042
The desk research method was used and data was collected through a **Associate Professor, Architecture and
questionnaire given to the parents of children in 17th Shahrivar art faculty, University of Guilan, Rasht,
Children's Hospital in Rasht city, Northern Iran. After the data of the Iran.
Email: [email protected]
questionnaires was collected, it was analyzed through spss22 software. ORCID No: https://orcid.org/0000-
Descriptive statistics (charts, mean ...) were used to analyze the data. 0002-1551-8895
Due to the nonparametric nature of the data, Spearman test was used in ***Lecturer. Architecture and art faculty,

order to measure the correlation of variables. University of Guilan, Rasht, Iran.

Email: [email protected]
Findings ORCID No: https://orcid.org/0000-
The results showed that the components of entertainment and play, 0002-5202-7964
natural light, the presence of green space, cheerful atmosphere and the
presence of family are among the most important environmental
Sara Nourmusavi Nasab & Amir Reza Karimi Azeri & Seyedjalil
Mirbazel

elements affecting the reduction of children's fears from the

perspective of their parents.
Research Limitations/Implications
the lack of direct involvement of the child in the study process as well
as the cultural and economic differences are the main limitation of this
study.
Originality/Value
This study is the first study on the design of children's medical
environment using the opinion of their parents in Iran and in this
regard.

INTRODUCTION
Common stressors during childhood are sickness and
hospitalization (Del Nord, 2006). For children, hospital settings
stimulate different emotions, such as fear, anxiety, anger,
sadness, loneliness, which can have adverse effects on children's
physical, mental and social health (Birch et al.,2007; Bsiri-
Moghaddam et al., 2011; Norton-Westwood, 2012; Wilson et al.,
2010). There is ample evidence that children's anxiety increases
during hospitalization and, in consequence, their health can be
subconsciously affected (Dise-Lewis, 1988; Varni & Katz, 1997).
Children suffer from a variety of considerable concerns and fears
during their stay: fear of being away from family; fear of being in
an unknown place; treatment stage's fear as well as loss of
privacy (Coyne, 2006). Anxiety and fear, in terms of children' 02
unconsciousness can affect the children's behavior throughout
their life. As e result, researchers are more interested to study
negative emotions, such as fear, anxiety, and stress-related
concerns which occur during illness (Thompson & Venon, 1993).
According to previous researches, being a fun place, Hospital can
attract children. children want an environment where they can
make friends and engage in entertaining activities (Fletcher et al.,
2011). In addition, the presence of peers and parents alongside
sick children gives them a sense of security and comfort (Norton-
Westwood, 2012). Previous studies about parents' perceptions of
children's hospital environments have shown that one of the key DOI: 10.15320/ICONARP.2020.102 E-ISSN: 2147-9380
elements is the physical quality of that environment, which
should be quiet, clean and convenient while also providing
adequate space and privacy (Pelander et al.,2007).
In the last fifty years, advances in medical technology have
increased the level of design competence in the therapeutic
spaces. Complexity in such buildings have increased. This
complexity is the result of the multiplicity of units, abundance
and the diversity of users and increase in the quality of medical
technologies (Aydın, 2009). Now, in Iran, the situations of
children's hospitals present a number of problems including lack
of environmental facilities, inattention to the needs of children
and the impact of the environment on their health condition.
 Effective Environmental Factors for Reducing Children's Fear in
Children's Hospital: Using Parent's Attitudes

Today, children's hospitals acknowledge that they must provide

support for the whole family. Compared to adult patients, the
whole family will be involved when the child is hospitalized.
Parents suffer as a result of their role as guardians and
supporters of their child. Brothers and sisters of the child will
also suffer because parents' attention is focused on the other.
Since the mental state of children in the hospital is very
important to help the healing process, identifying the elements of
the children's hospital environment that lead to stress reduction
can be an effective step in their recovery as well. Additionally, as
the parents of children are directly involved in the treatment of
their children, the purpose of this paper is to ask parents'
opinions about their children's preferences for the ideal physical
design of hospital built environments. The knowledge generated
from this study helps designers and healthcare creators
providing data that can be used in their design and operations
decisions. And also it may improve the ability of healthcare
providers to create environment that is congruent with the
needs of parents and their children. This study will therefore
address the following research questions.
• How important is the existence of environmental factors,
such as; color, light, spatial layout, green space, scale and

03 shape of hospital?
• How effective is the existence of amusement spaces in
reducing child's fear?
• How important is the presence of the family next to the
child?

LITERATURE REVIEW
By the 1960s, hospital buildings had focused more on hospital
performance than patient experience (De Wilde & Muylle, 2012).
Until the 1990s, little information was available about hospital
design, but through the decade, architects and interior designers
ICONARP – Volume 8, Issue 1 / Published: 25.06.2020

tended to design based on existing information and knowledge

based on research achievements in this field (Rubin, 1998).
Kellman (1987), focuses on the scale structure (outer structure
and interior design, vertical dimensions, furniture size and
handle height), play areas, environmental issues (color, texture,
light and acoustic). Eriksen (2000), reviewed some children's
opinions about the hospital environment during study at a
children Hospital. In this study, factors such as the ability to play,
the use of cheerful colors, attractive decoration, the presence of
green space, the proper dimensions of the furniture, the
presence of private space are considered. Previous studies
illustrated the influence of Parental involvement and partnership
in healthcare environment on treatment of child patients as
assistants (Coyne, 1995; Dudley & Carr, 2004; Ygge &Arnetz,
Sara Nourmusavi Nasab & Amir Reza Karimi Azeri & Seyedjalil
Mirbazel

2004). Ha and Park (2016) worked on a study with the aim of

designing user-oriented children's hospital. In this study, user's
needs were examined, especially by the help of their mothers
and the nurses. The findings indicated that to improve the
satisfaction of the mothers of ill children and the nurses, factors
such as privacy, safety, accessibility should be considered.
In another study, children who used deviant techniques such as
watching cartoons or listening to music reported less pain and
anxiety (Sinha et al., 2006). A joint study about group play
therapy impact on the rate of depression in children with cancer
in Mahak Hospital in Tehran, showed that the game could be
used as an effective solution by healthcare team members to help
hospitalized children so that they could be helped in order to be
prepared and tuned with the process of difficult treatments and
tension associated with hospitalization procedure (Zareapour et
al., 2009). In another research in a children hospital in Iran,
children perspectives about ideal physical environment were
extracted. The results of this article expressed that ill children
prefer a hospital environment that provides appropriate
recreational facilities for them. And at the same time, other
environmental design factors such as light, green space,
appropriate color and the possibility of parent's presence were
important (Nasab et al.,2020). Below, some factors influencing
children's perceived stress and fear in the environment of the 04
hospital are summarized with their sources (Table 1).

Table 1: Factors influencing children's environment and stress in hospital

References Factors
(Rollins, 2015)- (Shirani et al., 1986) Family Partnership
(Malkin, 1992) - (Bettelheim, 1976) Access to the outside
environment

(Carpman & Grant, 2001) - (Topf, 2000) Routing and Readability

(Kellman, 1987) Scale

(Malkin, 1992) - (Bettelheim, 1976) Feel under control and care
(Rubin, 1998) - (Kellman, 1987) - (Rollins, light
DOI: 10.15320/ICONARP.2020.102 E-ISSN: 2147-9380
2015) -(Lee et al., 2007)
(Rollins, 2015) - (Topf, 2000)- (Ulrich et al., Effect of green space design
2008) - (Mour, 2010)
(Shirani et al., 1986) - (Lee et al., 2007) Create privacy controls and
(Barlas et al., 2001) privacy
Malkin, 1992) - (Bettelheim, 1976) Coordination
(Frampton & Charmel, 2009) See artistic and positive
images
(Lee et al., 2007) Availability and order
(Shirani et al., 1986)- (Rollins, 2015) Human interactions
(Topf, 2000) - (Kellman, 1987) Prevent unwanted sounds

In the following, the theoretical framework is expressed, on

which the research method is written.
 Effective Environmental Factors for Reducing Children's Fear in
Children's Hospital: Using Parent's Attitudes

Stress and Child's Fear in the Hospital

Seeing hospital settings of any size and form provides a
frightening experience for each person (El Marsafawy, 2006).
The unfamiliar environment of hospitals can be destructive and
harmful to children which, in consequence, causes stress. For
example, the problem of losing privacy due to the presence of
multiple room (Larsen et al., 2014). According to Lee et al.
(2007), “the physical environment affects the person’s behavior,
and positive experiences can help the person to overcome
stress”. The outcome of admission to hospital is anxiety for
children, in which case, children react in three ways: protest,
disappointment, and denial. Reduced interest in playing and
collective activities, avoiding collapse and isolation, mischief,
anger and lack of satisfaction are the responses of children
admitted to hospital (Malkin, 1992). For children, stress signifies
by stomach pain, sleeping problems, stools and infections
(DeBord & Sawyers, 1996). The following five main factors can
boost stress in a child: 1- Disease, 2- Hospital admission, 3-
Physical – social environment of the hospital, 4- repetitive
treatment processes, 5- pain Experience (Del Nord, 2006). A
research in the environmental psychology field indicates that
architectural factors such as motivation, plurality, diversity,

05 complexity, novelty, sound, light, odor, colorization, crowding,

apparent, visual, proximity, neighborhood, communication,
readability, organization, Predictability, Signs, Paths,
Distinctions, External Perspectives, Land Operations,
Ambiguities, coordinated alignment of furniture and refreshment
are perceptually related to both positive and negative stresses
(Lee et al., 2007).

Desirable Environmental Components for Children in

Hospital Environment
In the context of effective factors in the design of medical
ICONARP – Volume 8, Issue 1 / Published: 25.06.2020

environments, in 1859, Florence Nightingale, in her book entitled

"Hospital Writings," stated that design, lighting, ventilation are
critical elements for accelerating patient recovery and reducing
pressure (Ebneshahidi et al., 2011). In 1960, interior design was
introduced as a major factor in hospital environmental planning
(Morelli et al., 2007). The needs of hospitalized children include
healthy eating, proper sleep in good conditions, and basic needs
such as personal hygiene and physical care. Hospitalized children
may not feel comfortable not only because of their illness, but
also because of being away from their families. Also, they may
respond to their disagreement over their age group (SilavUtkan,
2012).
Sara Nourmusavi Nasab & Amir Reza Karimi Azeri & Seyedjalil
Mirbazel

The Importance of Light and Color in Children's Hospital

Design
Factors such as color and light can affect people's perceptions
and responses to the environment in which they are present. In
particular, these factors are important in the treatment
environment and the patient's recovery process. Light can
improve the quality of the overall experience of staff, visitors and
especially patients in the hospital environment (Dalke et al.,
2006). Kellman in his research emphasized on the effect of
natural light on children's recovery and the reduction of effective
feelings (Ebneshahidi et al., 2011). A research showed that the
proper coloring of the environment is effective in creating a
person's positive mood and comfort (Tofle et al., 2004). J. Coad
and N. Coad (2008), conducted a research through interviews on
children's preferences in the design and color of the hospital
environment. They questioned some children's views in three
color ranges: Pink-purple, Blue-Green and Orange-Yellow. The
color mostly selected by children was between the color range of
green and blue. Children over the age of 11 years had a darker
range. Warm yellow-orange colors as well as the pink-purple
colors had the lowest number of choices. Park (2009), in his
research, concluded that, based on gender, girls were more likely

06
to enjoy red and purple colors. Apart from the gender
perspective, sick children often preferred blue and green, and
had the slightest tendency to the white color.

Positive Distractions' Role in Children's Hospital

Positive distractions are related to environmental features that
create "positive emotion and attract people's attention and their
disturbing thoughts may be declined by that" (Devlin & Arneill,
2003). Positive distractions help people overcome their stresses
and tensions. Positive distraction involves distraction potential,
including static stimuli such as pictorials, posters or nature
paintings, active stimuli such as animals, music and elements
that make people happy (Berman et al., 2008). The impact of DOI: 10.15320/ICONARP.2020.102 E-ISSN: 2147-9380
positive distraction on the activity of children in two clinic
waiting areas is examined by Pati and Nanda (2011). They
concluded that distraction leads to a gentler behavior of children,
which reflects its significant sedative effects. Also, the data
indicated that the waiting time for children in hospitals can be
risen by improving the environmental attractiveness.

The Effect of Green Space in Children's Hospital

A research has shown that the simulation of nature creates
stress-reducing effects similar to what there is in nature
(Berman et al., 2008). The most effective of these distractions is
the ability of nature to improve and repair stress (Raanaas, 2012;
 Effective Environmental Factors for Reducing Children's Fear in
Children's Hospital: Using Parent's Attitudes

Salonen et al., 2013). It was shown in a study that patients

undergone surgery who could see the plants through window,
when compared to those who couldn't, had a shorter hospital
stay and reported more positive hospital experience (Ulrich et
al., 2008). Also, the views of the windows that opened to the
green space could have reduced the hospital's post-operative
stay by 8.5 percent. In US hospitals, they are increasingly
focusing on trees and taking care of them in order to improve
their patients' recovery faster (Mour, 2010).

The Importance of Way Finding in Children's Hospital

Researchers found that stress due to losing one's path loss can
contribute to frustration, increased blood pressure, headache,
physical stress and fatigue (Carpman & Grant, 2001). Hence,
creating a readable environment can enhance the cognitive
inhibition of users in terms of perceiving environmental results
in better treatment outcomes. Due to complexity of their paths,
hospitals, as a public place, have problems about way finding
(Rousek & Hallbeck, 2011). Proper way-finding in hospital
design can be effective in increasing user satisfaction such as
employees, visitors and, most importantly, the patient (Cooper,
2010). Being aware of surrounding environment leads to ease
and safety (Cutting, 1996). By utilizing graphics and tactile
07 communication way finding can be improved (Arthur & Passini,
1992).

The importance of family presence

For decades, parental involvement has been considered as a
supported philosophy for the continuity of care for children
(Power & Franck, 2008). The presence of parents can grow the
sense of security of children (Norton-Westwood, 2012).
Children's resources point to the fact that if one parent or both
can be with their children, it is the most important factor that
ICONARP – Volume 8, Issue 1 / Published: 25.06.2020

helps children to cope with a mental illness due to

hospitalization. Parental presence also helps the child to more
easily accept the daily work process of the hospital (Malkin,
1992).

RESEARCH METHOD
This research is purpose-oriented, applied. In terms of collecting
data, it is a non-test descriptive study. Also, it was carried out as
a sample case study. The measurement tools include:
questionnaire and the software of social package for statistical
analysis (SPSS22). The questionnaire consisted of 26 questions
classified into 5 categories entitled "Mental relaxation, comfort,
attractiveness, positive distraction and security." When
developing the questionnaire, it was tried not to make them
 Sara Nourmusavi Nasab & Amir Reza Karimi Azeri & Seyedjalil
Mirbazel

unobtrusive, ambiguous, directional, complex, duplicate,

negative, and the concept of questions was completely clear.
Hivdah Shahrivar Hospital which is the only specialized pediatric
children hospital in Rasht, is selected for this research. To
estimate the sample size for the questionnaire the Morgan table
is used (Krejcie & Morgan,1970). Given the fact that about 140
people were visiting Hivdah Shahrivar hospital every day, and
with respect to this table, 103 parents were being examined. The
type of questionnaire is Questions in Closed Ended Format. This
is an ideal format for calculation of statistical information which
can be helpful in obtaining opinions about a subject. The format
of Questions is Likert Questions which is helpful in analyzing
Customers' feelings about a topic. Based on the theoretical
foundations of the study, the effective variables in reducing
environmental stress in hospital such as color, light, structure,
green space, presence of parents, etc., were selected and used in
designing the questions. After the questionnaire was developed
and the sample size was determined, next step was to enter the
field. After entering the field to reach the best solution and
generalizability of the responses, 103 parents of the patients
were randomly selected. In this way, first they were given a
letter in which the purpose of data collection, needs for their
cooperation in providing the required data, and confidentiality of
the responses, were expressed. Then the questionnaires were 08
distributed and each respondent helped in the response process.

RESULTS
Shahrivar Hospital is a Children's Specialized Hospital located in
Rasht. This hospital has 170 beds. The only specialized medical
unit of Rasht is this hospital. The spatial relationships and
positioning of the building are shown in Figures 1, 2, and 3.

DOI: 10.15320/ICONARP.2020.102 E-ISSN: 2147-9380

Figure 1. Ground floor space

relations diagram (Authors).
 Effective Environmental Factors for Reducing Children's Fear in
Children's Hospital: Using Parent's Attitudes

Figure 2. First floor space relations

diagram (Authors).

Figure 3. Second floor space

relations diagram (Authors).

09
The current visual form of this hospital is illustrated in Figures 4,
5 and 6. No use of happy colors and green space in the
environment, scattered space layout and inappropriate furniture
can be seen in the pictures.
ICONARP – Volume 8, Issue 1 / Published: 25.06.2020

Figure 4. Waiting room (Authors).

Figure 5. Patient room (Authors).

 Sara Nourmusavi Nasab & Amir Reza Karimi Azeri & Seyedjalil
Mirbazel

Figure 6. Patient room (Authors.)

In order to measure the reliability of the research tool, the most

popular instrument used by many researchers to assess the
validity of the questionnaire is the Cronbach's alpha coefficient.
Cronbach's alpha is one of the best analyzes for the reliability of
research in the social and organizational sciences (Bonett &
Wright, 2015). This criterion was calculated by SPSS22 software
and the questionnaire had a reliability of more than 70 % which
indicates a satisfactory level of reliability. So, it can be said that
the questionnaire has been able to measure the subject.
Therefore, the research has a good internal consistency.
Depending on the type of research and its data, the method for
data analysis is logically based on inductive method. Descriptive
statistics (charts, mean ...) were used to analyze the data. For this 10
purpose, the answers of the questions were entered into SPSS22
software and the graphs and statistical results were extracted
and analyzed. The most important option in the subset of the
factors are the question 2 and the 21st question, namely the
presence of at least one of the parents at full time (question 2)
and the possibility of having a game room in each part of the
hospital (question 21) with an average of 4.5. The least
important question is question 5 expressing presence of
religious elements with an average of 3.2 (Table 2).

Table 2: The effect of environmental components on reducing children's fear in

DOI: 10.15320/ICONARP.2020.102 E-ISSN: 2147-9380
the hospital from parents' perspectives, with the questions separated
Factor: Mental relaxation
Question 1 Average= 4.6 Mode=5
Question 2 Average= 4.6 Mode=5
Question 3 Average= 4.6 Mode=5
Question 4 Average= 4.6 Mode=4
Question 5 Average= 4.6 Mode=3
Factor: comfort
Question6 Average= 4.3 Mode=4
Question7 Average= 4.4 Mode=4
Question8 Average= 4.3 Mode=4
Question9 Average= 4.3Mode=4
Question10 Average= 4.3 Mode=4
Factor: attractiveness
 Effective Environmental Factors for Reducing Children's Fear in
Children's Hospital: Using Parent's Attitudes
Question11 Average= 4.3 Mode=4
Question12 Average= 4.2 Mode=4
Question13 Average= 4.3 Mode=4
Question14 Average= 4.3 Mode=4
Question15 Average= 4.1Mode=4
Question16 Average= 4.2 Mode=4
Factor: Positive distraction
Question17 Average= 4.4 Mode=4
Question18 Average= 4.2 Mode=4
Question19 Average= 4.4 Mode=4
Question20 Average= 4.4 Mode=4
Question21 Average= 4.5 Mode=5
Question22 Average= 4.4 Mode=4
Factor: security
Question17 Average= 4.3 Mode=4
Question17 Average= 4.2 Mode=4
Question17 Average= 4.2 Mode=4
Question17 Average= 4 Mode=4

According to the descriptive statistics, among five factors of

mental relaxation, comfort, attractiveness, positive distraction
and security, comfort and positive distraction with the average of
4.3 were more important than other factors (Table 3 and Figure
7).

11 Table 3: The effect of environmental components on reducing children's fear in

the hospital from parents' perspectives
Factor: Mental relaxation Average=4.1 mode=4
Factor: comfort Average=4.3 mode=4
Factor: attractiveness Average=4.2 mode=4
Factor: Positive distraction Average=4.3 mode=4
Factor: security Average=4.2 mode=5
ICONARP – Volume 8, Issue 1 / Published: 25.06.2020

Figure 7. The average impact of

environmental factors on reducing
the children's fears in the hospital
from the perspective of parents
(Authors).

The Kolmogorov–Smirnov test which is a much used goodness-

of-fit test, is often employed to test normality (Steinskog et al.,
2007). In the following, with the Kolmogorov-Smirnov test, the
value of "P" was less than 5 hundred, suggesting that the
distribution of data is not normal. Hence nonparametric testing
should be used. Due to the rank of variables, Spearman test is
used to measure the correlation of variables. Spearman's Rho is a
Sara Nourmusavi Nasab & Amir Reza Karimi Azeri & Seyedjalil
Mirbazel

non-parametric test which is appropriate method to examine the

strength of association between two variables, where the value r
= 1 means a perfect positive correlation and the value r = -1
means a perfect negative correlation (Allen, 2017). According to
Spearman's analysis, by which the correlation between the
variables is determined, there is a high correlation between the
mental relaxation factor of the happy colors and the green space,
which means that the more increase the values of these two
factors, the more increases the calmness. The factor of religious
elements has had the least correlation value (Table 4). For
comfort element, the presence of sufficient lightning had the
highest correlation (Table 4). For the factor of attractiveness,
elements hanging from the ceiling and the Hospital Curve
structure were highly correlated, which suggest these factors are
more important (Table 5). For distraction, the presence of
artificial light had a high degree of correlation, and the creation
of art workshops and the existence of television had a small
correlation. For security, the readability was more correlated
(Table 6). In general, the factors of artificial light, play room,
water elements, elements hanging from the ceiling, outdoor play,
hospital curve structure, ventilation, adequate lighting, green
spaces and happy colors were more important ones. The factors
of religious elements, noise reduction, television and art
workshops were weaker factors. 12
Table 4: Correlation between variables of mental relaxation and standard
spaces factors
Factor: Mental relaxation
Religious elements correlation coefficient= 0.043
sig= 0.666
Happy colors correlation coefficient= 0.8
sig= 0.003
green space correlation coefficient= 0.73
sig= 0.002
The presence of family correlation coefficient= 0.212
sig= 0.032
Factor: comfort
Proper ventilation correlation coefficient= 0.64
DOI: 10.15320/ICONARP.2020.102 E-ISSN: 2147-9380
sig= 0.046
Enough lighting correlation coefficient= 0.71
sig= 0.032
Furniture with scale and size of correlation coefficient= 0.523
the child sig= 0.063
Noise reduction correlation coefficient= 0.186
sig= 0.06
 Effective Environmental Factors for Reducing Children's Fear in
Children's Hospital: Using Parent's Attitudes
Table 5: Correlation between variables of attractiveness and positive factors
Factor: attractiveness
Children Handcrafted correlation coefficient= 0.601
sig= 0.051
Hospital Curve structure correlation coefficient= 0.854
sig= 0.018
The playing field is outdoors correlation coefficient= 0.666
sig= 0.044
Elements hanging from the correlation coefficient= 0.842
ceiling sig= 0.020
Water elements correlation coefficient= 0.665
sig= 0.041
Factor: Positive distraction
Art workshops correlation coefficient= 0.154
sig= 0.141
Game room correlation coefficient= 0.627
sig= 0.048
Computer Game Features correlation coefficient= 0.512
sig= 0.065
Existence of television correlation coefficient= 0.141
sig= 0.138
Artificial light correlation coefficient= 0.954
sig=- 0.06

Table 6: Investigating the correlation between security factor variables

Factor: Security
Readability and wayfinding correlation coefficient=0.334
sig= 0.094
13 The closeness of the nursing
station to the hospital room
correlation coefficient= 0.206
sig= 0.037

Independent admission room correlation coefficient= 0.214

sig= 0.117

DISCUSSION
The findings demonstrate that factors like adequate lighting, play
room, water elements, outdoor play, hospital structure,
ventilation, green spaces and happy colors, can be ideal
environmental elements providing suitable environment for
ICONARP – Volume 8, Issue 1 / Published: 25.06.2020

children.
In this study, comfort and positive distraction with an average of
4.3 are more important than other ones. Previous studies have
also highlighted the significance of positive distraction. Other
research done by Pati and Nanda (2011), has also expressed that
positive distraction leads to gentle behavior of children.
The use of happy colors is the most important factor for the
subjective sense of mental relaxation. Other studies have also
suggested that the use of happy color in the environment can
lead to positive effect on children's mood (J. Coad and N. Coad,
2008).
Lighting as an environmental factor in this research, is indicted
by other researchers in hospital environment as well. Light
improves the quality of patients, staff and visitor's overall
Sara Nourmusavi Nasab & Amir Reza Karimi Azeri & Seyedjalil
Mirbazel

experience in the hospital environment (Dalke et al., 2006).

Readability is another important environmental element. Other
studies have also suggested that readability have positive effect
on stress reduction in hospital environment (Lee et al., 2007).

CONCLUSION
This study was conducted as a scientific research to transform
children's needs into design by examining their parents'
responses about their children's needs in hospital setting.
Considering the results of the attitude screening questionnaire
from the parents of the sick children as well as library studies
done through desk research method, the elaboration of the
features that can be considered for designing children's hospital
environments is as follows:

• Of the four factors of mental relaxation, attractiveness,

positive distraction and security, comfort and positive
distraction with an average of 4.3 are more important
than other ones.
• The most important factor for the subjective sense of
mental relaxation is the use of happy colors in the
environmental design of hospital.
• The most important factor for the environmental comfort
is the presence of adequate light in the environment. 14
• The most important factor for the subset of
attractiveness is the use of curve structures in the design
of the environment.
• The most important factor for the subset of positive
distraction is the use of artificial light.
• The most important factor for the security subset is
readability in routing.

In conclusion, according to the findings, the presence of happy

colors, sufficient lighting, elements hanging from the ceiling,
hospital curve structure and artificial light, had a correlation of
more than 0.7, suggesting that these factors are more important. DOI: 10.15320/ICONARP.2020.102 E-ISSN: 2147-9380
However, the relative importance of factors may vary (for
example, by culture).
This study provides nurses, architects, clinicians and other
stakeholders with insight into what an ideal healthcare
environment should constitute, from the perspective of parents.
And if these design strategies are used, it seems to affect the
quality of life of hospitalized children.
An important limitation of this research is the lack of direct
involvement of the child in the study process. In other words,
there may be differences between parents and children view.
Another major limitation of this study is the cultural and
 Effective Environmental Factors for Reducing Children's Fear in
Children's Hospital: Using Parent's Attitudes

economic differences as well as the existence of different living

conditions in different societies. Each of these factors can be
effective in prioritizing environmental factors. It seems that in
future research, the impact of culture, economy and living
conditions of people in different geographical areas can be
examined.

ACKNOWLEDGMENT
This article is an excerpt from Sara Nourmusavi nasab's Master
Dissertaion titled " The design of the children specialist health
center in Rasht with an approach to reduce the fear of the
environment utilizing user opinions ", directed by Dr Amir Reza
Karimi Azeri, Seyedjalil Mirbazel at Gilan University.

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ICONARP – Volume 8, Issue 1 / Published: 25.06.2020

Resume
SaraNourmusavi Nasab received her B.Arch and M.Arch from Guilan
University in the major of Architecture. She currently works as a
researcher.
Amir Reza Karimi Azeri currently works at Guilan University,
Department of Architecture, as an associate Prof. He received his
M.Arch and PhD in Architecture from Iran University of science and
technology.
Seyedjalil Mirbazel currently works at Guilan University, Department of
Architecture, as a lecturer. He received his M.Arch in Architecture from
Iran University of science and technology.

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