Visual and Environmental Stimuli Preferences in Pediatric Spaces ^†

Abstract

Interior design is considered and practiced as a visual discipline in architecture. The environment and buildings are appreciated through visual representations. We explored how sensory interactions shape a genuine multisensory experience with visual stimulation as a primary focus in architecture and interior design. It is important to consider different factors that contribute to visual stimulation when designing spaces. Visual stimulation is experienced differently, depending on the observer, and it is important to understand how children perceive stimuli. Therefore, we determined the visual factors captured by children. The embedded design method was used for qualitative mapping of visual factors and 3D animation creation for visualization. Eye-tracking experiments were conducted to examine the factors that captured the attention of children. Children were attracted to moving objects such as videos, followed by images on walls, playgrounds, windows, and furniture. Fostering positive distraction is important in designing spaces for children.

1. Introduction

Vision is a predominant sense that extracts information about the nature, location, and movement of objects through the eyes and subsequent cognitive processes [1]. As humans spend 95% of their time indoors, human-centric architecture prioritizes visual aspects, overshadowing sensitivity to hearing, smell, touch, and taste [2]. A doctrinal criticism by Attoe (1989), adapted by Juhani Pallasmaa, stated that architecture is not just a building, but a mediation of both the significant and the trivial because buildings have a specific meaning concerning the human body and emotions [3]. Architecture is created to be enjoyed through the lens of a camera or a sequence of eyes, referred to as ocular-centric or retinal architecture [4]. Multisensory experiences are inherent in architectural works. In this context, there is an interaction between users and architecture which activates all senses. The results of these sensory experiences provide cognitive information and also influence users’ emotions, such as a sense of renewal or therapeutic relief [3,4].

Architecture has been considered, theorized, taught, and practiced as a visual discipline. Hence, environments and buildings are developed through images, means, and visual representations [5]. Vision is the sense that captures temporal information [6,7], and the visual information helps understand the meaning and evaluate the aesthetic value of the environment. The visual system largely operates with contrast values such as lighting and color, but not with absolute values. For example, when a product needs to attract attention, its contrast needs to be increased in comparison to its environment [6]. Guided by organizing laws such as the Gestalt Principles, the visual system aims to create an understanding of the surrounding environment, where visual images are organized into the simplest and most easily understood forms [6,8].

In a healthcare facility, the visual environment is important. In total, 30% of related research emphasized the benefits of the visual environment to users, followed by the audio environment (20%), patient rooms (20%), increased security (17%), wayfinding (17%), family support spaces (17%), staff support spaces (14%), and sustainability (9%) [9]. Such a result illustrates that the visual environment is related to human behavior, interior science, and aesthetics.

Architecture influences human psychology [10,11]. Thus, the connection between the architectural environment and human psychology has been extensively studied, specifically regarding human health [12,13,14]. A study on interior design elements and accessories in space showed that the more favored interior design elements and accessories, the lower the stress levels [12]. To explain the atmosphere of a space, three types of environmental characteristics are determined: ambient/atmosphere, architecture, and interior design [15,16]. Ambience is an intangible atmosphere, including elements like lighting, noise levels, and temperature. Meanwhile, the architectural aspects tend to be permanent in the physical environment, such as room layout, size, shape, and window placement. The interior design is not as entirely permanent as furniture, color, plants, and aesthetic elements. Hence, the most mentioned and analyzed variables are nature and its elements [17,18].

Interior design and aesthetic elements are captured by the eyes as visual stimulation. In a space, visual factors observed by users include aesthetic elements in the space, television, and a window view [15,17]. Therefore, in a room, visual factors include TV, furniture, windows, the presence of images on the walls, prominent facilities, and aesthetic elements [12,13,18].

2. Environment Planning for Children

Designing architecture and interior spaces requires understanding the needs of users, particularly children. In America and Europe, since the 1980s and 1990s, there has been an increasing concern in society about the vulnerability of children in public spaces. Researchers have explored the paradoxical meaning of home as a public space and the street as a private space for children. Since they are compelled to use facilities designed for adults, these areas become vulnerable [19]. Therefore, it is crucial to have architectural and interior planning that caters to the physical and psychological needs of children. It is necessary to create enabling environments from a child’s perspective as space is significant for them. A space is experienced as comforting, becoming part of a child’s memories and influencing their character [20]. Children spend much time playing indoors, coinciding with increasing mental health issues. A literature review was conducted to explore the relationship between access to green spaces and mental health in children. The results showed that access to open green spaces, such as nature, was associated with improved mental well-being, overall health, and cognitive development [21]. For this reason, a deeper analysis of the spatial needs of children, in both architectural and interior design contexts, is needed. One aspect to consider is the visual environment, which is most often perceived by children.

Therefore, we investigated how visual factors were perceived by children who were receiving medical treatment as architecture plays an important role in the patient’s healing process through multisensory stimulation obtained from the spatial atmosphere [9,12,13,18].

Over the past decade, there has been a significant increase in psychosocial research on cancer patients in developed countries. However, many clinical and psychosocial needs remain unmet and unaddressed [22]. Improving the quality of life for pediatric cancer patients is currently an international priority. Thus, we analyzed visual sensors in space connected to patient recovery. Pediatric cancer patients were surveyed as they are vulnerable and their sensory responses are at a lower limit.

3. Methods

Embedded design is a combined qualitative and quantitative method [23]. Collecting and analyzing more than one data type is necessary for a framework associated with various data by incorporating qualitative strands into a quantitative experiment. Randomized controlled trials are experimental designs commonly used in evidence-based medicine, although adjustments may be necessary for specific cases [23]. The embedded design method is appropriate for extracting information from qualitative data and obtaining measurement results to find connections at each stage. In this study, a literature review was conducted to seek theoretical foundations and understand the related theories. Afterward, the spaces were defined visually based on identified visual parameters and tested for children through videos by measuring through eye tracking and reinforcing the results with Likert scale interviews.

Based on the literature review, it was found that space affected human psychology [9,11,14,17]. Thus, we explored visual factors and their effects on human psychology, visual factors captured by the human eye in space, and the visual factors preferred by children. The result can be used as a guide in designing children’s spaces.

4. Results and Discussion

Visual elements, including color, aesthetics, and distractions such as TVs and windows, contribute to the overall interior design experience [15,17]. Visual factors include visual distractions through audiovisual elements in the space, and aesthetic elements [12,13,18]. After identifying these factors, experiments were conducted by incorporating all these factors in this study. The color factor was neglected in this study because the previous literature found that calming colors were preferred by children [24].

To create space visualizations, a study on the visualization of space was needed. Interior architecture is supported by immersive technology that facilitates design visualization to make virtual spaces real spaces [25]. Visual displays through video, virtual, or immersive experiences are categorized as positive distractions that help users, including patients, overcome pain and traumatic experiences during treatment. These are often combined with relaxation, imagery, and captivating visual compositions [25].

In research on health, randomized control groups or trials are commonly used to gather evidence to link certain features or interventions [25,26]. To enrich and deepen the analysis, experiments were conducted on healthy children and those who were receiving medical treatment (pediatric cancer patients) in this study. Pediatric cancer patients were selected due to their limitations in the sensory response. The result was compared using the embedded method and randomized control trial. Children who could express their opinions were selected and categorized into preschoolers aged 4–6 years, school-age children aged 7–10 years, and teenagers aged 11–17 years [25]. The number of participants was 15 healthy preschoolers, 15 healthy school-age children, 15 healthy teenagers, and 45 cancer patients with the same age classifications.

The visualization of the space in this study was the children’s chemotherapy room at X Hospital in Surabaya. This room was selected to investigate the correlation between architectural environments and pediatric cancer patients. The healthy children observed visualizations of the chemotherapy room with TV, furniture, natural imagery on the walls, the other facilities in the room, and the window. Pictures of the original condition of the room before the redesign were shown to them to compare the original room and the one stimulated by visual factors. Interviews were conducted with the pediatric cancer patients who had undergone chemotherapy in that room to see whether they preferred to undergo chemotherapy in a newly designed room. Figure 1 and Figure 2 display room visualizations, with circles representing screenshots from participants eye tracking.

Visual factors such as natural imagery were tailored to the children’s characteristics. However, aesthetics was not included in the experiment because there were none in the existing building. According to the interior design theory, aesthetic elements can be substituted with natural imagery ornamentation. The need for health facilities in the space prohibits the presence of aesthetic elements, serving as a basis for consideration. Also, the positioning of windows above the room is a determining factor in the selection of visual factors.

A total of 90 children from each category were shown videos with eye-tracking equipment, and the results are shown in

Table 1. Experiment results.

		Children				Patients
No	Visual Factor	Preschool	School	Adolescent	Total	Preschool	School	Adolescent	Total
1	Natural Imagery	51	62	63	176	48	63	66	177
2	Television	72	68	70	210	75	70	67	212
3	View to window	15	15	21	51	15	15	22	52
4	Furniture	30	37	46	113	30	37	40	107
5	Another Facility (Playground)	58	42	26	126	53	40	36	129

. These results were derived from the association of eye tracking with interviews during the experiment. The participants filled out a questionnaire on a five-point Likert scale (score of 1–5) based on their choices, showing what was most and least observed. The overall preference order for visual factors of the participants was (1) audiovisual elements, including both TV and handheld gadgets, (2) natural imagery such as murals on the walls, (3) other room facilities like the playground, (4) furniture such as chairs within the room, and (5) a view to the window.

There were differences in preferences among preschoolers, school-age children, and teenagers in the prioritization of viewing other room facilities compared to the dominance of furniture. For teenagers, the dominance of furniture was more prominent than the playground. Also, there was no difference in visual preferences among children who are healthy and those diagnosed with cancer. The view from the window became the last preference not as a point of interest in the room. This showed the significant role of design elements, particularly the position and dominance of visual factors in the space, which need further investigation.

5. Conclusions

In this study, it was found that visual factors affected human psychology, and patients preferred the designed room to the original one. Visual factors were determined from the literature review, and an experiment was conducted to determine the preference levels of children. The existing conditions affected the space visualization. The order of visual preferences changed according to the existing conditions of the room. Hence, further study is needed on design principles related to visuals, such as proportion, dominance, and the positioning of visual factors. Health conditions do not show significant differences in the visual factor preferences of children. It is necessary to delve into children’s needs before designing interior architectural facilities. Distractions from audiovisual elements are the primary preference because this stimulation is multisensory, and the presence of audio and visual elements can stimulate optimally. In a future study, audiovisual factors can be separated from visual factors. When planning interior architectural facilities for children, audiovisual factors need to be prioritized as they serve as positive distractions, specifically for child cancer patients during chemotherapy.