Dissertation - Study of Child's behavior in a Pediatric Setting

THE EFFECT OF COLOUR AND ARTWORK IN A PEDIATRIC SETTING ON A CHILD’S BEHAVIOUR

Dissertation submitted by Dionne Sheena Pereira 113701112 B. Architecture VII Semester ‘B’

Faculty of Architecture Manipal University November 2014

Faculty of Architecture Manipal University

CERTIFICATE We certify that the Dissertation entitled “THE EFFECT OF COLOUR AND ARTWORK IN A PAEDIATRIC SETTING ON A CHILD’S BEHAVIOUR”, that is being submitted by Dionne Sheena Pereira 113701112, in the VII semester of B.Architecture undergraduate programme, Faculty of Architecture, Manipal University, Manipal is a record of bonafide work, to the best of our knowledge.

-----------------------------Faculty in charge

--------------------Director

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ACKNOWLEDGEMENT

First of all I would like to thank the God Almighty for his blessings. My warm thank to my dissertation guide Prof.Roshan Shetty for her inspiring support.

Her guidance has been of great value in this study. I’m honoured that Prof.Sangamitra Roy and Prof.Neelakshi Joshi reviewed my report and offered some very good ideas on how to go about my research. Special thanks to Dr. Sidney Pinto for taking time out of his busy schedule to help me contact paediatricians. I would like to also thank Mukesh who took me all around Goa and helped me find clinics and hospitals. This project would have been incomplete without the support and help of the, patients, parents and staff at KMC, the Oval park Medical centre and Criti-care hospital who took the time to share their stories with me. Their thoughts and ideas are the essence of this research.

This journey, far away from home, would not have been as memorable or interesting without the support and encouragement from my loyal friends and relatives who made me feel at home in Manipal and Goa. They helped me immensely by giving me encouragement and friendship.

I

gratefully

thank my

parents

for

their

unconditional

support

and

encouragement for as long as I can remember. Your love, devotion, and sincere interest are an inexhaustible source of inspiration for me. Thank you for always believing in me.

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ABSTRACT

Over the past few years the number of researches and publications related to how the built environment affects the patient’s well being in a healthcare setting has significantly increased. Professionals like Doctors, psychiatrists, architects, nurses, interior designers, sociologists, etc all believe that architecture has a significant role in the healing process in hospitals. The relationship between design and healing is very important as the elements of the built environment play a very important role in achieving a positive effect on the healing environment in a children’s hospital (Fiona de Vos, 2001). Children love colourful surroundings. But in a healing environment it is important to choose ones which can help to reduce a child’s psychological stress.

In the case of paediatric hospitals ‘art’ which is simply a graphic treatment applied to key surfaces throughout the hospital environment, is unlikely to function in the ways that children and young people have identified as being valuable in their experience of hospitalisation (Kate Bishop,2010). This research will investigate how colour and artwork in a paediatric setting affects a child’s behaviour. Interviews, observations and choice charts were used to access how patients and doctors felt about the colour and artwork in a hospital. The case studies were used to more richly conceptualize how colours and artwork help in creating a comfortable environment for children and in turn help to ease the examination process for doctors. The significance of this study is that by examining the role of colour and artwork in a children’s hospital and how it affects a child’s behaviour, designers now have a comprehensive behavioural base for choosing the type of artwork and the colour in a healthcare environments.

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Fig 1- Nationwide Children’s Hospital Lobby and Corridor Space (www.nationswidehospital.org)

“Colour and Artwork have the ability to transform the interiors of a space and are capable of creating dramatic effects on the minds of children.”

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TABLE OF CONTENTS PAGE NO.

CERTIFICATE……………………………………………………………………….II ACKNOWLEDGEMENT……………………………………………………………III ABSTRACT……………………….…………………………………………………IV LIST OF TABLES………………………………………………………………...VIII LIST OF FIGURES……………………………………………………………….VIII CHAPTER 1 –INTRODUCTION 1.1 Background study……………………………………………………………….1 1.2 Relevance of the study…………………………………………………………2 1.3 Aim………………………………………………………………………………..3 1.4 Research questions…………………………………………………………….3 1.5 Objectives………………………………………………………………………..3 1.6.1 Scope and Focus……………………………………………………………..4 1.6.2 Limitations……………………………………………………………………..4 1.7 Methodology……………………………………………………………………..4 1.8 outcome of the research………………………………………………………..5 CHAPTER 2 – LITERATURE REVIEW 2.1 Introduction………………………………………………………………………6 2.2.1 Children’s Behaviour………………………………………………………….6 2.2.2 Role of physical setting in a paediatric setting…………………………….7 2.2.3 Effect of colour on a child’s behaviour……………………………………...8 2.2.4 Colour preferences in a paediatric setting………………………………..13 2.2.5 Children’s Artwork preferences in a healthcare setting…………………15 2.2.6 Preference for natural elements…………………………………………...16 2.3 Conclusion……………………………………………………………………...18 CHAPTER 3 –CASE STUDIES 3.1 Introduction……………………………………………………………………..19 3.2 The case studies……………………………………………………………..19 3.3 The participants………………………………………………………………..20 3.4 Methods………………………………………………………………………...20 3.5 Data collection and analysis 3.5.1 Interviews………………………………………………………………..21 3.5.2 Observations…………………………………………………………….25 3.5.2.1 Case study 1-Kasturba Medical College…………………….25 3.5.2.2 Case study 2-Dr.Ramchandra Bhatt’s clinic………………...27 3.5.2.3 Case study 3-Oval Park Medical Centre…………………….27 3.5.2.4 Case study 4-Panjim clinic……………………………………28 3.5.2.5 Criti-care Hospital……………………………………………...29

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3.5.3 Choice Charts 3.5.3.1 Picture Choice Chart………………………………………...30 3.5.3.1.1 Corridors…………………………………………...30 3.5.3.1.2 Examination Rooms………………………………31 3.5.3.1.3 Waiting Area………………………………………31 3.5.3.1.4 General Wards……………………………………32 3.5.3.2 Colour Choice Chart…………………………………………33 3.5.3.2.1 Doctors…………………………………………….33 3.5.3.2.2 Patients…………………………………………….34

CHAPTER 4-FINDING AND ANALYSIS 4.1 From Observations and Interviews…………………………………………..34 4.2 From the Choice Charts………………………………………………………35 4.3 Individual Room Design………………………………………………………36 4.3.1 Reception and Waiting Area…………………………………………...36 4.3.2 Corridors…………………………………………………………………37 4.3.3 Examination Room/Doctor’s cabin……………………………………38 4.3.4 Play/Activity Areas………………………………………………………39 4.4 Findings…………………………………………………………………...…...41

CHAPTER 5- CONCLUSION…………………………………………………….43 REFERENCES …………………………………………………………………….44 APPENDIX 1- LITERATURE REVIEW TABLE ……………………………….45 APPENDIX 2- INTERVIEWS …………………………………………………….47 APPENDIX 3- COLOUR CHART ……………………………………………….48 APPENDIX 4- PICTURE CHOICE CHART …………………………………….49 APPENDIX 5- ROOM COLOUR CHOICE CHART …………………………...50

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LIST OF TABLES Table1: Effect of various colours on a child’s behaviour………………………13 Table 2: displays how many children and doctors chose each picture from the choice chart…………………………………………………………………………28 Table 3: shows the difference in colour preferences in a room of male and female patients…………………………………………………………………...29

LIST OF FIGURES Figure 1- Nationwide Children’s Hospital Lobby and Corridor Space……..…v Figure 2- Elements of Architecture……………………………………………….2 Figure 3- Methodology Overview…………..………………………………………5 Figure 4- Café space: Smilow Cancer Hospital at Yale New Haven….8 Figure 5- Waiting room at Eisenhower medical center……………………....10 Figure 6- waiting lobby at Randall Children’s Hospital…………………….…..11 Figure 7- Corridor at Scrips Children’s Centre………………………………….12 Figure 8 –Cafeteria at El Paso Children’s Hospital…………………………….15 Fig 9 (i)-Double height aquarium at Royal Children’s Hospital……………….16 Fig9 (ii)-Cylindrical aquarium at Nationwide Children’s Hospital…..…………16 Fig 11(i)-Art installation: tree with bird houses: Nationwide Children’s Hospital...........................................................................................................17 Fig 11(ii) –Art filled corridor at Randall children’s hospital…………………….17 Figure 12 – Reception at Dublin Methodist Hospital…………………………...37

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Figure 13 – Corridor at medical College of Georgia……………………………38 Figure 14- reception and waiting at Alta Bates Hospital……………………….39 Figure 15– Activity Space at The elementary Institute of Science …………..40

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1. INTRODUCTION 1.1 BACKGROUND STUDY When sickness strikes at a young age, one is unable to understand the changes and various treatments that need to be endured. This causes young children to be intimidated by the hospital environment in contrast to their comfortable environment at home. A good healing environment must focus on how better to support families during the transition in and out of the hospital and how better to support children and parents in maintaining a more normal life during their stay in the hospital.

Adolescents, however, have barely been consulted as consumers of health services ( Jedeloo, Staa, Latour, & Exel,2010). But the life expectancy of children with severe diseases has improved significantly, and the increase in the longevity of children with chronic diseases has led to an increase in the number of adolescents who suffer from such diseases and, consequently, an increase in the demand of hospital services for this sector of the population (Alderman, Rieder, & Cohen, 2003). Despite this, adolescents represent a very small proportion of the total number of hospitalized patients and they are underrepresented in the research on the quality of these services (Blumberg & Devlin, 2006; Jedeloo et al., 2010) The quality of healing greatly depends on how the hospital environment is able to reduce stress. Physiologically, stress causes changes in the body, such as, higher muscle tension, and high levels of circulating stress hormones.

Behavioural impacts of stress can include verbal outbursts, social withdrawal, passivity, and sleeplessness thus making stress a major obstacle to healing.

Hospitals today focus not only on the medical needs of patients but on their psychological and social needs as well. Professionals like Architects, interior designers, sociologists, psychiatrists, doctors and nurses have all agreed that architecture is a very essential component of the healing process. The relationship between design and healing is very important as the elements of the built environment play a very important role in achieving a positive effect on the healing environment in a children’s hospital (Fiona de Vos, 2001).

There is already consensus among researchers that the environmental aesthetics of healthcare environments are important to patients’ feeling of

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well-being (Caspari, Erikson & Naden, 2006; Olds, 1991; Ulrich, 1991, 1992, 2001). The central argument is that creating aesthetically pleasing environments will contribute to patients’ well-being by influencing their emotional response to the experience and environment (Caspari, Erikson & Naden, 2006).

Figure 2- Elements of Architecture (Modified Framework Based on OHE- Sita Ananth (2008))

The interior aspects (such as colour, ambience, artworks, ergonomics, lighting, etc.) greatly influence the mind of a child.

1.2 RELEVANCE OF THE STUDY Many colour guidelines have been proposed for healthcare settings, but these only offer hypotheses suggesting that certain colours may be associated with the well-being of the users of those spaces. Tofle, Schwarz, Yoon, and MaxRoyale (2004) conducted an extensive literature review and analysis of several colour guidelines and noted that there are considerable contradictions among guidelines and in the literature on colour. Colour has the power to transform a place- not just they way it looks but the way they feel and the way people live in them. It can stimulate or soothe, energise or pacify. Children love colourful surroundings. But in a healing environment it is important to choose ones which can help to reduce a child’s psychological stress.

In the case of paediatric hospitals ‘art’ which is simply a graphic treatment applied to key surfaces throughout the hospital environment, is unlikely to function in the ways that children and young people have identified as being valuable in their experience of hospitalisation (Kate Bishop,2010).

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The design of hospitals should consider the needs and preferences of the patients, but the preferences of adolescents have received little attention (Ullán, A. M., Belver, M. H., Fernández, E., Serrano, I., Delgado, J., & Herrero, C,2012). Some studies conclude that the first step to improve adolescents’ health-care experience is to ask them about their preferences (Britto et al., 2007).

What constitutes art has been the subject of debate for as long as art has existed and in modern hospitals it varies enormously from commissioned works by many individual artists to graphic treatments of key surfaces carried out by one artist and spanning the whole hospital. (Kate Bishop,2010). Since colour is an inseparable part of our lives, it is all the more puzzling to explain the lack of it in many of our new hospitals ( Sheila JBosch,2012) .

1.3 AIM Many elements of the built environment play a very important role in maximizing the quality of healing environment in a children’s hospital.

This research will investigate the colour and artwork preferences within a children’s hospital and how it affects their behaviour.

1.4 RESEARCH QUESTIONS:

Q. How colour and artwork affect a child’s behaviour in a healing environment? a. What colours do children prefer in different areas in a hospital? b. What type of artwork is preferred in different areas in a hospital? c. How colour and artwork can help create a positive effect on the children’s behaviour in a hospital environment?

1.5 OBJECTIVES: 

To study the behaviour of children in a hospital environment.



To observe how colour and artwork affect a child’s behaviour in a healthcare setting.



To examine the colour and artwork preferences of children in a hospital environment.

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1.6.1 SCOPE AND FOCUS: This research will focus on how different colours and artwork when used within a built environment (in a children’s hospital) affect a child’s behaviour.

This research will focus on the age group 5-12 years. This study will take into consideration the outpatient department in a hospital.

1.6.2 LIMITATIONS: While conducting the case studies, only 5 examples will be taken into consideration hence, the study area being narrow may not give an accurate idea about the effect and preferences of colour and artwork.

1.7 METHODOLOGY: 

Defining the research problem o Defining the research statement o Aims and objectives o Scope and focus



Literature Review

(Articles, previous research papers, books, etc.) 

Design Research a. Primary case studies: o Observations ( behaviour) o Survey: o Questionnaires ( for patients, relatives(of the patient), care-takers and staff)

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

Analysing the data collected o Comparing the literature and case studies and observing all the aspects of the built environment where colour affects child’s psychology.



Compiling and Concluding o

Acquiring all the necessary features of the built environment where colour can create a positive effect on the healing process in a children’s hospital by reducing stress.

Figure 3- Methodology Overview



1.8.OUTCOME OF STUDY

Children feel intimidated by doctors and hospitals as at a young age they get scared when they are examined with medical instruments. Children at a young age tend to be very restless especially in healthcare settings.

Adding distractions like colourful walls and artworks such as paintings, installations, ceiling features, etc are able to successfully distract the children for a considerable span of time. Doctor’s cabins and examination rooms should be more homely with lighter shades as they help create a calm atmosphere but play areas should be decorated with brighter shades.

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2. LITERATURE STUDY 2.1 INTRODUCTION To develop a better understanding of how colour and artwork play an important role in the healing environment in a children’s hospital, the literature reviewed identified various aspects of a healing environment which affect a child’s behaviour in a hospital. Most research across the various disciplines has assessed the quality of healing within the boundaries of the hospital itself showing how the hospital environment can be improved to reduce stress (Fiona de Vos, 2001). Striving to better understand the influence of colour on human behaviour, researchers looked at the physiological and psychological responses to colours. Building on these studies, various authors have claimed that specific colours have the capacity to arouse and excite people while other colours possess qualities that may calm or relax individuals (Kron,1983; Digerness, 1982; U.S. Navy, 1975; Birren,1950).The reference details are given in Appendix-1.

2.1.1 CHILDREN’S BEHAVIOUR British Columbia Day Care Action Coalition and the Early Childhood Educators of B.C offer good knowledge about children’s behaviour in their book ‘Guiding Children’s Behaviour’: Children’s behaviour is influenced by their overall development, their environment, and the adults who care for them. By nature, children differ in terms of their activity level, distractibility, and sensitivity.

THE ENVIRONMENT: The environment refers to all that surrounds a child. This includes both physical and social elements.

Things: When toys and materials are in good supply, familiar and developmentally appropriate, children are encouraged to focus and become involved in productive learning experiences. With groups of infants and toddlers, providing duplicates of toys is essential.

Space: The way in which space is used can either encourage or discourage desired behaviour. Where space is sufficient, children can play and work in a relaxed setting. It is important that sufficient space is available for the program

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of activities. Where areas are specifically designated for adults or children, and/or for individuals or groups, conflict is minimized. In short, space which is aesthetically pleasing, planned, and organized contributes to an environment which promotes good mental health and diminishes the potential for problems.

Redirection: This can be an effective strategy for all ages of children. With upset toddler’s , offering a substitute toy or engaging them in some other activity may quickly resolve problems or conflicts. As children mature, this strategy enables them to recognize their own emotions and behaviours and to redirect themselves away from an over stimulating situation, activity or location before inappropriate behaviours occur or escalate. When children are guided to develop impulse control and redirect themselves to an area that helps them to “feel better”; they are able to interact cooperatively again in shared settings. Self directed environments should be anywhere that a child can begin to “feel good” again.

2.1.2 ROLE OF PHYSICAL SETTING IN A PAEDIATRIC SETTING The role played by the physical setting in the healing process and more importantly for improving patient outcomes and the well-being of families and caregivers had been stressed by several authors such as Moore (2000), Ozcan (2004) and Visentin (2006). Joseph (2006) concurred about the influence of the physical environment on the healing process and elaborated further that the physical environment also contributed towards a better quality of life not only for the patients, carers and staffs but also the visitors (Mohamed Yusoff Abbas and Roslinda Ghazali, 2012). Recent studies have shown a link between a patient’s physical environment and an ability to manage pain and to heal. The need to mitigate stress is magnified when the patients are children. Helping them feel comfortable and to have a sense of control over their surroundings is a significant part of the healthcare design (Joan Saba, 2011). Design supports families, patients, and caregivers in the journey to wellness and gives them all a vital reminder that they are not too far from “home” (John Prangrazio, 2011).

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Figure 4- Café space: Smilow Cancer Hospital at Yale New Haven – One colourful addition is able to bring life to the neutral café.(The Application of colour in a healthcare setting-Sheila J Bosch,2012)

2.2.3 EFFECT OF COLOUR ON A CHILD’S BEHAVIOUR One aspect of colour is that it stimulates all our senses not just our eyes.

Certain shades have a therapeutic or relaxing effect. Orange is found to be a good anti-depressant while shades of blue and green are used extensively on walls and even floors for their healing and peace-bringing properties.

Dr.Kitty Lascurain examined how warm colours (red, pink, yellow, orange) and cool colours (blue, green) affect a child’s behaviour under normal circumstances: Warm Colours In general, warm colours elicit happiness and comfort, creating intimacy by making large, open spaces feel a little cosy. Bold shades of red, orange and

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yellow can stimulate the mind and have an energizing effect on the body beneficial for growth and development, but less than advantageous during the nightly bedtime showdown with your average, overly energetic toddler. Thus, warm colours are best used in moderation. Instead of painting an entire room A bold red or bright yellow, paint a single accent wall and tie in a few matching accessories.

Red Rich and highly emotive, red excites and energizes the body, increasing heart rate, blood pressure and respiration. Some studies suggest that the physical effects associated the colour red increases athletic ability. However, red is also associated with increased aggression, an inability to focus and even headaches. Some research suggests that exposure to the colour red may even hurt your child’s academic performance.

Pink Universally loved by little girls, pink evokes empathy and femininity and creates a calming atmosphere. However, despite an initial calming effect, pink can become irritating over time, leading to agitation and anxiety. While your princess may love this rosy hue now, be prepared for her to reject it in the future.

Yellow Bright and cheery, yellow is associated with happiness and motivation. Soft, subtle yellows promote concentration while brighter shades can stimulate the memory and increases metabolism. However, too much yellow can evoke feelings of anger and frustration resulting in fussy, over-stimulated babies.

Orange Friendly and welcoming, orange borrows many of its parent’s positive attributes. Orange has a distinctly social nature, inspiring interpersonal communication and putting people at ease. Like yellow, too much orange can be over-stimulating so use bold shades sparingly.

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Figure 5- waiting room at Eisenhower medical center: warm colours help alleviate anxiety.(The Application of colour in a healthcare setting-Sheila J Bosch,2012)

Cool Colours Cool colours have a calming effect on the body and can make your child’s room feel spacious and relaxing - Think open skies and rolling waves.

However, dark, cool colours can evoke all the doom and gloom of an impending storm and should be used in moderation. Despite their soothing nature, cool colours are not particularly inviting and can leave people feeling cold and reserved if the atmosphere is too stark.

Blue The exact opposite of red on the colour wheel, blue calms the mind and body, lowering blood pressure, heart rate and respiration and decreasing feelings of

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anxiety and aggression. Children who have trouble sleeping or are prone to tantrums and other behavioural problems may benefit from spending time in a blue environment.

Purple Associated with wisdom and spirituality, purple combines the stability of blue and the energy of red, taking on the characteristics of either, depending on the shade. Purple can also have a luxurious feel and is associated with wealth and royalty.

Green Green symbolizes nature and thus promotes a serene and calming environment. Associated with health, healing and wellbeing, green has a soothing effect on the body and mind, reducing anxiety and promoting concentration.

Figure 6- waiting lobby at Randall Children’s Hospital: Blue is a calming colour.(The Application of colour in a healthcare setting-Sheila J Bosch,2012)

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The colour composition should create a friendly, overall impression of warm tones. Strong nuances of colour may be employed as accents or within lounge areas. Aside from specifications pertaining to the building as a whole, colours should be used to distinguish between the various functional areas in order to achieve stimulating and invigorating colour dynamics, easy orientation, and diversity of architectural space ( Birkhäuser Verlag, 2007).

Figure 7- Corridor at Scrips Children’s Centre : reducing the institutional feeling.(The Application of colour in a healthcare setting-Sheila J Bosch,2012)

Empirical color research has shown that saturation and brightness have significant impact on users‘ emotional responses rather than hue itself (Augustine, 2009; Tofle, Shchwarz, Yoon, & Max-Rotale, 2003).

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\ Table1: Effect of various colours on a child’s behaviour (pictures of rooms source: SCRI report by Peter Barrett,Yufan Zhang-2009)

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2.2.4 CHILDREN’S COLOUR PREFERENCES IN A PAEDIATRIC SETTING At present, there is only a small amount of research done related to the effects of art and colour on patient experience and health outcomes. The evidence that exists supports the inclusion of art in healthcare environments because it assists in health promotion and patient well-being (Caspari, Erikson & Naden, 2006; Lawson & Phiri, 2000; Lawson, Phiri & Wells- Thorpe, 2003; Scher, 1996; Schweitzer, Gilpin & Frampton, 2004; Ulrich, 1991, 1992, 2001); it positively affects medical outcomes (Duncan, 2003; Staricoff & Loppert, 2003; Ulrich, Lunden & Eltinge, 1993) and it reduces the stress of patients and staff and increases the satisfaction of both with the hospital environment (Homicki & Joyce, 2004; Staricoff, Duncan, Wright, Loppert & Scott, 2001). In environments for adolescents, it has been found to be important that the artwork is age-appropriate and does not include blatant emblems of childhood such as cartoon characters, clowns, balloons and teddy bears (Blumberg & Devlin, 2006). References were taken from two similar significant researches done recently: 1. Blumberg and Devlin (2006) carried out a qualitative study to examine the preferences of 100 junior high school students ranging in age from 12 and 14 years with regard to the physical design of the hospital. The participants compared and appraised colour photos of hallways and lobbies for units with adult-oriented decoration versus child oriented decoration. Responses to the picture comparison task frequently mentioned colour and design, with 50% of respondents mentioning the colour palette in the adult-oriented hallway and 73% commenting about colours in the child-oriented hallway.

2. Park (2009) examined colour preferences among paediatric outpatients, paediatric inpatients, and healthy children (n = 153, aged 7-11) using the Munsell colour system for five hues—red (5R 7/8), yellow (5Y 9/8), green (5G 7/8), blue (5B 6/8), and purple (5P 7/8). These colours were 3. selected in their pilot study (n = 63) in which nine brightness/saturation combinations for each hue (45 in all) were tested to identify children’s most favourite and least favourite colours. There was no significant difference in colour preference among these groups of children, and,

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therefore, the study did not support the hypothesis that paediatric patients would have different colour preferences than healthy children 4. Research on children‘s and adolescents‘ preferences for hospital themes and colors identified that children may desire hospital environments that reflect their home environments and they need the ability to change the environment. Children and adolescents who participated in this research mostly preferred a single color scheme with mid-range blue and pastel green. Adolescents who aged 11 and above preferred more abstract design themes than younger children (Coad & Coad, 2008).

Figure 8

–Cafeteria at

El Paso Children’s Hospital :

Children’s Colour

Preferences.(The Application of colour in a healthcare setting-Sheila J Bosch,2012)

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2.2.5 CHILDREN’S ARTWORK PREFERENCES IN A HEALTHCARE SETTING

Artwork: Art should be age-appropriate and without the simplistic images associated with young children. It should include artwork completed by other children and adolescents, as this artwork in particular conveyed messages of support and welcome and the importance of children’s welfare to the organisation (Kate Bishop.2014).

Creating a healing garden or art program involves more than the addition of a rooftop terrace, a playground or colourful hallway murals.

Plantings, fountains, sculptures, paintings, and interactive exhibits are actually tools that not only lessen feelings of isolation, but also stimulate visual, auditory, tactile and olfactory senses. They should be safe, and invite moments of unchaperoned exploration and freedom (John Prangrazio, 2011).

Fig 9(i)-Double height aquarium at Royal Children’s Hospital (www.fpk.com)

Fig9(ii)-Cylindrical aquarium at Nationwide Children’s Hospital

Aquariums are highly recommended by doctors as very effective means of distraction for young children

2.2.6 PREFERENCE FOR NATURAL ELEMENTS Eisen (2006) investigated children‘s art preferences for those aged from 5 to 17 and found art images have potentially stress-reducing effects on children.

Natural art was the highest preferred art image for all ages studied. There was

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no difference in art preference between hospitalized and non-hospitalized participants. Further, there was no dramatic gender difference in art preferences (Blumberg & Devlin, 2006).

The idea that nature and art promote health and well being dates back hundreds of years. In the Middle Ages , hospitals within monasteries used gardens as places of healing (John Prangrazio, 2011). Now hospitals in modern settings incorporate art and natural elements for their promising impact on medical outcomes.

Fig 11(i)-Art installation: tree with bird houses :Nationwide Children’s

Fig 11(ii) –Art filled corridor at Randall children’s hospital

Hospital .(The Application of colour in a healthcare setting-Sheila J Bosch,2012)

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2.3 CONCLUSION At present, there is only a small body of research done with respect to the effects of art on patient experience and health outcomes. Most studies highlight the importance of the role of interior elements in a children’s hospital setting. Analysing the existing literature gives us an idea about the importance of the interior environment in a children’s hospital. The interiors especially colour and artwork act as stress-reducing elements for children which help in ensuring that children are comfortable in the hospital environment. Previous researchers have noted that natural artwork has tremendous stress reducing effects on children. Children love to see artwork done by someone their own age – this helps to create a sense of belonging and comfort.

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3. CASE STUDIES 3.1 INTRODUCTION In previous researches colour guidelines have been suggested for healthcare settings, but these only offer considerations that certain colours may be associated with the well-being of the users of those spaces.

Most of these researches focus on which colours are preferred in general by children in a healthcare setting but their colour and artwork preferences in specific areas of a hospital are rarely considered. For example a certain colour that is preferred in a waiting area may not be preferred in an examination room.

The observations focused on analysing how the interiors of a hospital help in acting as positive distractions for children in a healthcare setting. The interviews and questionnaires focused on examining children’s colour and artwork preferences in a paediatric setting.

3.2 THE CASE STUDIES A total of 5 different paediatric settings were taken into consideration.

One case study was conducted in the Women and Children’s block in KMC(Kasturba Medical College), Manipal. This single floor block was recently renovated and a new play area and wall art were the main additions. It consists of 5 examination rooms, 2 computer rooms and 2 doctor’s cabins.

Three clinics and 1 paediatric hospital were selected in Goa. Of the three clinics, two were located in Porvorim and one in Panaji: 1. Dr.Ramchandra Bhatt’s (paediatrician) clinic (renovated 7 years ago) caters to the local residents of the area consisting of a waiting room, consultation room and examination room all located on a single floor.

2. The Oval Park Medical Centre (constructed 5 years ago) caters to the surrounding areas as well. The children’s department (Dr.Dhanesh Volvoikar-Children and New-born Specialist) consists of a waiting area with a play space, two consultation cum examination rooms and one therapy room.

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3. Previously known as Panjim polyclinic-, it is now used as a paediatric clinic with a semi-open waiting area and a single consultation room both located on the first floor. Pediatrician: Dr.Lily 4. Criti-care Panjim specialises in new-born care and has an outpatient department-a fairly new hospital the interiors are plain white ceilings and walls with an aquarium being the only distraction. HOD: Dr. Veerendra Gaonkar.

3.3 THE PARTICIPANTS The participants involved in total from all the different locations were a small group of 50 patients (age ranging from 5 to 12) and 4 doctors.

First the doctor was interviewed and also asked which patients could be questioned. Getting the patients to respond was not an easy task because most of

the

children

were either too young or too

sick to

be

interviewed .Owing to the fact that the children were sick and some physically unstable and tired, the research was done with choice charts rather than asking them to draw or colour themselves. Most of the patient questionnaires were completed in the presence of their parents.

3.4 METHODS The methods used to conduct this research were: 

Observations: children’s behaviour in various areas within a healthcare setting.



A photographic choice chart-Patients and doctors



A colour selection survey – Doctors and patients



Interviews - Doctors

1. Observations included a description of the current interior space, the use of the space, an overview of the activities for children, and noting down how the children behaved in that space.

2. Owing to the fact that most of the children were sick or too young to write or fill out any questionnaire by themselves, three pictures of the

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same area (one with mild colours and no artwork, second with simple artwork and a combination of mild and bright colours, third with all the walls filled with bright colours and artistic projections ) were shown and they were asked to choose which one they would prefer. ) were shown and they were asked to choose which one they would prefer.

Similarly, the same pictures were shown to the doctors and asked to select which they thought would prove to act as a positive distraction to the patients.

3. Doctors were given a colour chart and asked to select which colours they would suggest are appropriate for various areas of the healthcare setting. The children were not given this colour chart as they would tend to choose colours they prefer in general. Instead they were given pictures of 8 empty rooms each with a different colour and the children were asked to choose any 3 they liked the most.

4. Interviews were conducted and doctors were asked questions related to colour and artwork in a paediatric setting.

3.5 DATA COLLECTION AND ANALYSIS The details of the interviews and choice charts can be found in Appendix-2, 3, 4 and 5

3.5.1 INTERVIEWS Interviews were conducted with four doctors. The interview details below provide an insight to how artwork and colour helps in distracting children and thus calming down their behaviour.

Q1. Do you think the interiors of a hospital can help in distracting children?

Dr.Ramchandra Bhatt: Yes, I personally do believe that the interiors play a very important role in distracting children especially in the consultation and examination rooms as here is where they are given vaccinations and examined. However the type of interior design preferences tend to vary from child to child Dr. Dhanush Volvoikar: Yes they definitely help in distracting them especially while giving vaccinations.

Interiors do prove beneficial in out-patient departments, children’s wards in

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hospitals and such situations where a child is more or less in a stable condition but a seriously sick child or even any older person may not be in a state of mind to even look at anything surrounding them let alone distract them.

Dr. Gitanjali: Yes form my personal experience I can tell u that interiors indeed help greatly in distracting children especially when they are being examined. They enjoy seeing different colours and paintings and it helps in calming them down.

Dr. Veerendra Gaonkar: Yes they definitely help in distracting them, especially when they are given vaccinations. In my current cabin I have plain while walls and I thought that I will add some colourful stickers and paintings as I have noticed how much they help in other hospitals.

Q2.Do you feel that the effect of colour varies with children’s’ personal choices? Or are their choices more or less similar?

Dr.Ramchandra Bhatt: When it comes to colour I would say yes it definitely does, I have noticed a significant difference especially between boys and girls. My cabin being painted a purple shade has helped in grabbing the attention of most of the girls but just a handful of boys.

Dr. Dhanush Volvoikar: My walls as you can see have been painted orange and off-white. I feel that any vibrant colours can help in distracting any child. Children usually like to be surrounded by bright colours in general and I don’t feel it is any different in a hospital/clinic. Also we don’t wear our coats often as children see them and tend to get scared and become less corporative.

Dr. Gitanjali: From my previous experiences I can say that in a clinic it is best to have pastel shades i.e. lighter shades of colours as i feel they help maintain a calm atmosphere for the patients, parents as well as the staff. Yes and obviously girls tend to be more attracted to colours like pink and purple whereas colours like green and blue tend to grab the attention of boys.

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Dr. Veerendra Gaonkar: I feel that any colours in their lighter shades help in distracting kids in a clinic.

It helps in calming them down. As I mentioned before since I have plain white walls, I feel children find it intimidating so in the new hospital we are building we have decided to put a lot of colours in the children’s department Q3.What types of distractions would you advice?

Dr. Ramchandra Bhatt: We previously had a play area in the waiting room, but we found that when many children are there, they tend to fight for the same toy or swing. When they are sick they become restless and mostly kids are unable to sit in one place. Most of the toys have been broken and regular banging of doors is heard. Hence I feel distractions which are fixed would be advisable. Children have a tendency to like nature as at a young age they prefer playing outdoors.

So nature related artwork and paintings would prove to be positive distractions Dr. Dhanush Volvoikar: I feel a play area helps in distracting the children in the waiting area. When it comes to the doctor’s cabin I feel things like television and sweets should be avoided as I feel such habits do not prove beneficial in the long run. Therefore I would advice bright colours, colourful paintings and wallpapers. I have found Aquariums to grab kids attention immediately which tends to last for a longer duration than any other distraction.

Dr. Gitanjali: In all the areas in a hospital I feel adding colour helps in diverting children’s attention form the fear they develop as soon as they realise they are in a hospital. In my new clinic I have designed a Winnie the pooh theme in the waiting area and a Mickey Donald theme in the doctor’s cabins. Cartoon wallpapers can be helpful in distracting children.

Dr. Veerendra Gaonkar: In a clinic it is very important to have a children friendly environment. I have found children to be attracted to the small aquarium we have installed outside in the waiting area. And any sort of large paintings or stickers on the wall are

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advisable since they help in diverting children’s attention for at least a short span Q4.Do you think having some feature on the ceiling or paintings on a wall helps?

Dr.Ramchandra Bhatt: Yes definitely it helps especially while examining or giving a vaccination maybe something like colourful paintings or pictures of cartoons. On the ceilings yes while lying down any ceiling feature helps in distracting the child during examination.

Dr. Dhanush Volvoikar: I feel ceiling features are more important than walls. as u can see above the bed I have installed some coloured panels with light behind them. I have observed that this feature is very helpful as when the patients lie down their mind gets distracted by the coloured glass panel.

Dr. Gitanjali: I would say filling the walls and ceilings with many pictures, paintings really helps in distracting the children. When they see a plain bland wall the stress they undergo tends to increase and they get scared. Pictures of cartoon, etc make them feel comfortable.

Dr. Veerendra Gaonkar: Yes, I feel adding some paintings and pictures and extending it to the ceiling helps a lot in distracting them and making them comfortable especially when examining or vaccinating.

Q5.In which areas of the hospital do you think it is most beneficial to have distractions (like artwork or colours)?

Dr.Ramchandra Bhatt: I think the in the waiting areas and examination rooms it is most essential to have such distractions. When the children enter the hospital they get scared as most of them do not like hospital environments, having some sort of distractions will help them calm down and make a more comfortable environment for them. In the examination rooms children being very restless in general need some sort of distraction so doctors can examine them freely.

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Dr. Dhanush Volvoikar: I feel artwork and colours are the best possible distractions that we can add especially in the doctor’s cabins/examination rooms because I feel giving sweets and addition of the television spoil the children.

Dr. Gitanjali: I would say in the waiting areas because if the wait is longer children tend to get cranky and restless so the addition of play areas and even artwork is a very good idea. Also in the doctor’s cabins where the children are examined – stickers on walls, colourful paintings can help distract the kids while the doctors examine them.

Dr. Veerendra Gaonkar: I would say most areas in the hospital require plenty of distractions as children do not like to visit doctors and hospitals. They feel scared and it is very important to make them comfortable in order for doctors to examine them easily without much hustle. In the doctors cabin for example I would say things on the ceiling like colourful panel and paintings are very helpful in distracting children while we examine them.

3.5.2 OBSERVATIONS In addition to the interviews and choice charts I also went round the paediatric floors and observed how children behave in a different areas of a paediatric setting.

3.5.2.1 Case study 1-Kasturba Medical College The wall art at the entrance foyer bought a smile to most of the children entering the department. However even though the play area was equipped with a slides and swings, most of the children being physically stressed due to sickness were unable to actually use this area and had no effect on their behaviour. In the waiting area they continued to cry and remained restless.

The cartoons shown on the television set helped distract only a handful of children mostly due to a lack of volume. The individual examination cabins are designed without any considerations for distractions. Children who were

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relatively less sick and physically stronger were seen running around the corridors. Here the only thing that was able to distract the children for sometime was the wall art with 3D projections and mirrors.

Artwork on the wall near the reception at KMC (Kasturba Medical College, Manipal)Effective in distracting children for a short duration

Corridors in KMC (Kasturba Medical College, Manipal ) – Bland colours create a sense of a hospital space thus making children restless.

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3.5.2.2 Case study 2-Dr.Ramchandra Bhatt’s clinic Porvorim, Goa The waiting area previously had a play area which was removed as the children used to break the toys. But now the children in the waiting room in search of something to play with end up banging the doors and pushing the chair around. In the doctor’s cabin the children are easily distracted by the long row of soft toys placed on a shelf above the examination bed. The entire examination room has been painted purple which tends to grab the attention of girls.

Purple interiors tend to grab the attention of girls more than boys-The row of soft toys opposite the examination bed helped to divert their attention while being examined.

3.5.2.3 Case study 3-Oval Park Medical Centre Porvorim, Goa The play area in the waiting area is able to attract the attention of only the relatively less sick children as the physically weaker children are unable to move their limbs around a lot. Upon entering the doctor’s cabin some children are happy to see the orange coloured walls but it does cause irritation to others. Dr.Dhanush Volvoikar has added a glass panel with light behind it on the ceiling which immediately grabs the attention of the children when they lie down on the examination bed.

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The orange coloured wall at the doctor’s cabin in the Oval Park Medical Centre tends to cause irritation to the patients when looked at for a longer duration 3.5.2.4 Case study 4-Panjim clinic The clinic is situated on the first floor of an Old Portuguese house. The waiting area situated in the veranda and is thus a semi-open area. Due to the lack of any fans/ air conditioners the heat tends to make the children restless but some were seen quietly observing the traffic and surrounding buildings.

However there are no distractions on the walls or around the waiting area so children were seen pushing the table in the corner and grabbing the pens and papers from the receptionist. In the examination room the small stickers helped to distract the children for a short duration of time but the dull walls and lack of natural lighting made the patients feel scared and made them uncooperative.

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The reception desk and waiting area is located outdoors in the verandaChildren tend to get restless mainly due to the heat

View from the waiting area is able to distract the children for only a short duration of time.

3.5.2.5 Criti-care Hospital, Panaji, Goa This hospital being well known is crowded with many patients. There are a few distracting elements like a small aquarium next to the reception and a painting of stars on the ceiling above the reception counter. However these elements are unable to distract the children mostly due to overcrowding. Most of the children were found to be restless and disturbed in the waiting room.

The doctor’s cabin is relatively brighter and this tends to create a positive energy in the room . However the bland walls tend to intimidate the children but the stickers of cartoons in the general ward help in distracting the children for a while.

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The interiors of the doctors cabin/examination room is completely white with no art or colour-children tend to get restless.

3.5.3 CHOICE CHARTS 3.5.3.1 PICTURE CHOICE CHART Three different pictures of various areas of a hospital were given to the patients and doctors to choose from and mention which feature of the picture appealed to them the most: 3.5.3.1.1 CORRIDORS

Figure 1(a): Lucile Packard Children’s hospital, Palo Alto CA

Figure 1(b): Children’s Health Center-St. Joseph’s hospital, Phoenix, AZ

Figure 1(c): Children’s Health Center-St. Joseph’s hospital, Phoenix, AZ

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Most of the children preferred figure 1(c). They found the grey spaceship against the blue background very interesting. Although there were a few who preferred 1(b) since they found the overall atmosphere to be soothing.

The doctor’s preferred 1(c) too as they said such colours and wall art helps in creating a more comfortable atmosphere for the children. They also mentioned that the blue and orange being bright can cause irritation but the contrasting white coloured floor helps dampen the glare of the colours.

3.5.3.1.2 EXAMINATION ROOMS:

Figure 2(a): Children’s Health Center-St. Joseph’s hospital, Phoenix, AZ

Figure 2(b): Huntsville Hospital for Women and Children, Huntsville, AL

Figure 2(c): Miller’s Children’s Hospital, Long beach , CA

Most of the male patients picked 2(a), which consisted of cool colours like blue and green, while most of the female patients preferred 2(c) wherein the interiors contained more of orange and pink.

Doctor’s preferred 2(a) as they felt cool colours prove to be more soothing than warm colours. They felt 2(c) had too many paintings on the walls 3.5.3.1.3 WAITING AREA:

Figure 3(a): Mattel Children’s Hospital at UCLA, Los Angeles, CA ,

Figure 3(b): Children’s Health Center-St. Joseph’s hospital, Phoenix, AZ

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Figure 2(c): Miller’s Children’s Hospital, Long beach , CA

Doctor’s suggested that 3(a) would be the best option for a waiting room interiors but contradictory to what they thought, most of the children preferred 3(b) as they liked the light blue colour of the room. The doctors felt that 3(a) would help in uplifting the mood of the children and the colourful paiting would be able to distract them for long waiting hours as it contained many interesting elements and is stretched over a large area of the wall. 2(c) was firmly disapproved by doctors as they felt the artwork done around the room was too intimidating.

3.5.3.1.4 GENERAL WARDS:

Figure 4(a): Sutter Children’s Hospital, Sacramento, CA ,

Figure 4(b): Mattel Children’s Hospital at UCLA, Los Angeles, CA ,

The doctors and most of the patients preferred 4(b). The children pointed to the artwork behind the bed and said that it looked colourful.

Further the doctors stated that the artwork being 3 dimensional was able to be viewed even by a child lying down on the bed and also easily accessible as kids love to move about and touch things thus addition of such elements eliminates the risk of them feeling restless when admitted

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overnight. They said that the 3 dimensional colourful projections are well contrasted by the plain purple walls adjacent to it.

table 2: displays how many children and doctors chose each picture from the choice chart.

3.5.3.2 COLOUR CHOICE CHARTS 3.5.3.2.1 DOCTORS The doctors were given a colour chart (APPENDIX-3).

Summary of colours chosen (colour codes) by doctors : Waiting Area: 1A, 2A, 3A, 3D, 4A, 4D 4I, 4J, 4K, 5A, 5E, 5B, 8A, 9M, 9O, 9K, 9A, 9J, 9K Doctor’s cabin: 1A, 2A, 3A, 3D, 4A, 4D 4I, 4J, 4K, 5A, 5E, 5B, 8A, 9M, 9O, 9K, 9A, 9J, 9K Examination Room: 1A, 1B, 1C, 1E, 3A, 3C, 3D, 4A, 4B, 4C, 4I, 4K, 4N, 5A, 5B, 5D, 5E, 7C, 8A, 8B, 9M, 9O,9K,10A Play areas: 1A, 1B, 1C,1E, 1F, 2A, 3A, 3D, 4A, 4B, 4D, 4O, 6A, 6B, 8I, 9E 1A,1B, 1C, 1E, 1H, 2A, 3A, 3D, 4A, 4D 4I, 4J, 4K, 5A, 5E, 5B, Corridors: 1A, 1B, 1C,1E, 2A, 3A, 3D, 4A, 4B, 4D, 4O, 5A, 5D, 5F,6A, 6B, 8I, 9E Reception and waiting areas: 1A,1B, 1C, 1E, 1H, 2A, 3A, 3D, 4A, 4D 4I, 4J, 4K,4O, 5A, 5E, 5B, 8A, 8E, 9M, 9O, 9K, 9A, 9E 9J, 9K, 9O

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3.5.3.2.2 PATIENTS Children were asked to choose room colours they prefer (APPENDIX-5)

table 3- shows the colour preferences in a room of male and female patients Girls have an inclination to colours like Purple, Pink, Yellow and even light blue whereas boys preferred colours like blue, green, yellow

4. FINDINGS AND ANALYSIS Pictures, for sick children, are an effective way used to describe their perceptions and observations about their problems, traumatic memories, and feelings and thoughts about environment and themselves (Malchiodi, 1998).

4.1 FROM OBSERVATIONS AND INTERVIEWS The wall art on the walls bought a smile to most of the children entering the department. However even though the play areas in the waiting rooms were equipped with a slides and swings, most of the children being physically stressed due to sickness were unable to actually use this area and had no effect on their behaviour. Those physically stronger were found fighting with each other as kids for the same toy or to play on the swings. In the waiting area they continued to cry and remained restless due to sickness. Children who were relatively less sick and physically stronger were seen running around the corridors.

Most of the doctors said that the interiors of the hospital do indeed play a very important role in distracting the children in the hospital environment. They are

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one of the most essential components to consider when creating a comfortable atmosphere for children. These distractions make examining and vaccinating children easier for the doctors. Ceiling features over hospital beds are preferred as they help in distracting children during examination. All the doctors interviewed suggested that aquariums easily grab the attention of children. Most doctors suggested the use of natural elements in paintings and artworks as children have a natural inclination to nature. Doctor’s suggested that artwork in the waiting areas and examination rooms are the most important as these are the places a child would be found in his extreme restlessness and positive distractions help in dampening such effects.

However doctors mentioned the fact that if the illness is too serious of an issue then even the most elaborate artwork or the best suited colours and interior designing will not be able to distract the patients for even a short span of time.

4.2 FROM THE CHOICE CHARTS When it comes to colour preference there were differences noted between girls and boys. Pink, Yellow, Purple and mostly warm colours were preferred by girls, while boys of the same age preferred cool colours especially blue and green. It was found that children preferred simply designed waiting areas with lighter shades and did not prefer bright colours with a lot of artwork. White was the least preferred colour by both doctors and children.

Doctors suggested lighter shades of colours in most of the areas of the hospital except for play areas in the waiting room where they suggested brighter colours.

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4.3 INDIVIDUAL ROOM DESIGN Different rooms in a paediatric setting have different design requirements based on their function. The intensity of artwork and the shades of colour vary extensively between different areas within a healthcare setting.

4.3.1 RECEPTION AND WAITING AREA It is one of the most crucial areas when it comes to interior design as the maximum time waiting will be spent here. Children at such a young age tend to be restless and can never sit idle in one place for a long time. Hence the waiting areas design should be able to distract kids for a longer duration of time and at the same time keep them calm and cool. Upon entering any clinic this is the first area that children see so it is very essential that this area creates a comfortable feeling. 

Artwork: Doctors suggested simple artwork like just a painting or an aquarium which prove to be positive distractions that help in calming down a child’s behaviour. The children too preferred a calmer atmosphere with simple artwork like just a painting or wallpaper. Too elaborate artwork can cause children to get more intimidated by the hospital environment.



Colour: Some doctors felt that brighter colours can uplift the children’s mood while the others said that brighter colours tend to get irritating to the eyes after a while and since the waiting area is a place where one may end up spending a lot of time soothing lighter shades of colours help in maintaining a calm and comfortable atmosphere throughout.

Most of the children too preferred lighter shades of colours in the waiting room.

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Figure 12 – Reception at Dublin Methodist Hospital: Art is used as a colour scheme component.(The Application of colour in a healthcare setting-Sheila J Bosch,2012)

4.3.2 CORRIDORS Corridors provide a linkage to different areas within a building. In a hospital if the interiors of the waiting area, play areas, examination rooms and wards are decorated with artwork and various colours on the walls, it is essential that corridors too have the same intensity of artwork and colour to ensure there is no break in the flow to ensure that when children are moving between areas they feel the same level of comfort and happiness they felt within those areas.

Artwork and colour can also be used as effective methods of way finding. 

Artwork: Doctors felt that there should be artwork like paintings, wall art and ceiling fixtures in corridors to ensure children feel comfortable even when commuting between spaces.



Colour: Both doctors and children preferred vibrant coloured walls with contrasting single coloured ceiling and flooring which helps dampen the glare of the colourful walls and artwork.

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Figure 13 – Corridor at medical College of Georgia: Colour and Wayfinding.(The Application of colour in a healthcare setting-Sheila J Bosch,2012)

4.3.3 EXAMINATION ROOM/DOCTOR’S CABINS Designing the examination room interiors is very important as this is the place where children tend to become restless and uncomfortable. Here it is essential to ensure that they are corporative with the doctor so that the doctor can examine them with much hustle. Offering sweets and toys does help but it is better if they are offered a distraction which doesn’t need to be held so that the doctor can examine the child without any obstruction. In such cases the interiors play a very important role in distracting the children.

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

Artwork: In the examination rooms artworks of a larger scale are preferable which should be easily viewable form the examination bed/chair. Ceiling features above the bed prove to be very successful in diverting a child’s attention. Special care should be taken to ensure that the interiors do not scare the children.



Colour: Lighter shades of colours are preferred by both doctors and patients as it helps in creating a calm atmosphere. However ways have to be found to ensure both genders are satisfied with the colour as warm colours like pink and orange tend to grab the attention of girls whereas cool colours like green and blue tend to grab the attention of boys.

Figure 14- reception and waiting at Alta Bates Hospital: Colour and lighting.(The Application of colour in a healthcare setting-Sheila J Bosch,2012)

4.3.4 PLAY/ACTIVITY AREAS When the wait is long a play area attached to the reception area serves as a very good means for children to kill their time thus preventing them from feeling restless and irritated. The design should be over a large area and able to immediately attract the attention of children 

Artwork: Plastic slides and swings can be added but sick children are mostly physically weak so they are unable to use such play items like

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slides, etc. More fixed interactive 3D projections are preferable like interactive touch screens. 

Colour: Brighter shades of red, blue, yellow encourage activity and interaction. These Brighter shades have a positive effect on the child’s behaviour and attracts them towards this area and uplifts the moods of the room/space.

Figure 15 – Activity Space at The elementary Institute of Science: Bright colours encourage activity .(The Application of colour in a healthcare setting-Sheila J Bosch,2012)

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4.4 FINDINGS

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5. CONCLUSION The use of colour has long been one of the most subjective aspects of interior design and especially so in healthcare settings. This may account for the fact that many of the newer hospitals are devoid of colour .This paper encourages a thorough understanding about where, when, and how colour can impact the healthcare experience. It presents the best summary to date of studies done on color and encourages further research Children feel intimidated by doctors and hospitals as at a young age they get scared when they are examined with medical instruments. Children at a young age tend to be very restless and especially in healthcare settings.

Adding distractions like colourful walls and artworks such as paintings, installations, ceiling features, etc are able to successfully distract the children for a considerable span of time. Doctor’s cabins and examination rooms should be more homely with lighter shades as they help create a calm atmosphere but play areas should be more on the brighter side. Fixed unbreakable artwork is preferred in most areas as children tend to pull and push anything they find. Doctor’s found ceiling features and aquariums as the most beneficial distractions. The regular inclusion of art and colour in a healthcare setting leads to a more child friendly environment which creates a more comfortable atmosphere for the children thus aiding the doctors in the during examination and consultation. This study reveals that it is possible for art and colour to play an important role in children’s experience in a healthcare setting by creating a positive impact on their behaviour and should be acknowledged by the creators of paediatric hospitals.

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REFERENCES Blumberg, R., & Devlin, A. S (2009). Design issues in hospitals: The adolescent client. Environment and Behavior, 38(3), 293-317.

Coad, J., & Coad, N. (2008). Children and young people's preference of thematic design and colour for their hospital environment. Journal of Child Health Care, 12(1), 33-48.

Designing the world’s best children’s hospitals-FACHA (2009) Muna Sulav Uttkan (2012) Cihldren Hospital Design in children picture : Procedia - Social & Behavioral Sciences 51(2012)110-114 Eun Young Kim(2011) Healing Healthcare design for adolescent patients: promoting holistic quality of life.

Fiona de Vos(2006)Building a model of holistic healing environment for a children's hospital : A dissertation submitted to the Graduate Faculty in Psychology in partial fulfillment of the requirements for the degree of Doctor of Philosophy,The City University of New York.

Kate Bishop (2012). The Role of art in a Pediatric healthcare environment from a children's perspective Procedia - Social & Behavioral Sciences 51(2012)110-114 Park, J. G. (2007). Environmental colour for pediatric patient room design Doctoral, Texas A&M University. (AAT 3296499) Peter Barrett, Yufan Zhang-SCRI research report 2-Optimal learning spaces(October 2009).

Ruth Brent Tofle, Benyamin Schwarz, So-Yeon Yoon, Andrea Max-Royale (2003) – Colour in Healthcare environment, Health environments research Sheila J. Bosch, Eve Edelstein, Jain Malkin (2012) The Application of Colour in Healthcare settings, The Center for Health Design Ulrich, R. S. (1991). Effects of interior design on wellness: Theory and recent scientific research. Journal of Healthcare InteriorDesign, 3, 97-109.

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APPENDIX-1

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APPENDIX-2: INTERVIEWS Name: Specialisation: No. of years in the medical field:

Q1. Do you think the interiors of a hospital can help in distracting children?

Q2.Do you feel that the effect of colour varies with children’s’ personal choices? Or are their choices more or less similar?

Q3.What types of distractions would you advice?

Q4.Do you think having some feature on the ceiling or paintings on a wall helps?

Colour Preference (wall) :

A1. Waiting area

A2. Doctor’s cabin

A3. Examination room

A4. Private rooms

A5. Play areas

A6. General wards

A7. Corridors

A8. Reception

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APPENDIX-3:Colour chart

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APPENDIX-4: PICTURE CHOICE CHART A.ABOUT ME (Please fill in) How old are you? ______ Are you a boy or girl? ___Boy ___Girl

B. Which one out of the three do you think is the best option for that particular area? What about the room do you find the most appealing?

1. Corridors

(a)

(b)

(c)

2. Examination room

(a)

(b)

(c)

(b)

(c)

3. Waiting area and play area

(a)

4. Wards

(a)

(b)

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APPENDIX-5: ROOM COLOUR CHOICE CHART Choose the room colour you like:

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