Toward Salutogenic Hospital Design for Health Promotion: A Mixed-Methods Study of Environmental Factors and Their Relationship with Patients’ Sense of Coherence
نویسندگان
1 Faculty of Architecture and Urban Planning, Shahid Rajaee Teacher Training University, Tehran, Iran
2 Faculty of Architecture and Urban Planning, Shahid Rajaee Teacher Training University, Tehran, Iran
3 Faculty of Humanities, Shahid Rajaee Teacher Training University, Tehran, Iran
doi
10.30483/rjm.2026.254721.1485چکیده
Background: Health promotion emphasizes reducing stress and strengthening individual coping mechanisms. Hospitals, as pivotal healthcare settings, can advance this objective through salutogenic design, which targets the enhancement of patients' Sense of Coherence (SOC)—comprising comprehensibility, manageability, and meaningfulness. However, empirical evidence linking architectural design to SOC remains limited.Objectives: This study aimed to identify key architectural components supporting salutogenic hospital design and model their interrelationships with patients' SOC.Methods: An exploratory mixed-methods design was utilized. A qualitative phase involving documentary analysis and a Delphi expert panel identified initial factors. Subsequently, a 45-item questionnaire was administered to 210 inpatients at Shahid Rajaei Heart Hospital (January–March 2024). Validity and reliability were confirmed via expert review, Cronbach's alpha, and exploratory factor analysis. Data were analyzed using SPSS-27 and structural equation modeling (SEM) in AMOS.Results: Expert consensus refined seven initial factors into a six-factor user-validated model: legibility and functional performance, environmental comfort, naturalness, safety and hygiene, psycho-social comfort, and aesthetics. Reliability was acceptable (α = 0.726), and sampling adequacy was confirmed (KMO = 0.907). Correlation analysis revealed distinct associations: legibility correlated strongly with comprehensibility; environmental comfort and safety with manageability; and naturalness, aesthetics, and psycho-social comfort with meaningfulness. SEM confirmed significant interrelationships among all six factors with good model fit.Conclusion: The findings indicate the complexity of patient safety challenges during the COVID-19 pandemic and the need for comprehensive approaches to improve safety conditions in healthcare systems.Specific environmental design factors significantly contribute to patients' perceptual and psychological well-being. The six-factor model validates a salutogenic design approach, demonstrating that environmental quality can enhance comprehensibility, manageability, and meaningfulness in healthcare contexts.
