Urban Economics and Planning

Urban Economics and Planning

Investigating the Impact of Urban Environments around Rehabilitation Centers and Healing Components on the Quality of Life and Vitality of MS Patients

Document Type : Original Article

Authors
1 M.A. student, Department of Architecture, Saveh Branch, Islamic Azad University, Saveh, Iran
2 Assistant Professor, Department of Architecture, Garmsar Branch, Islamic Azad University, Garmsar, Iran
Abstract
Introduction 
Multiple Sclerosis (MS) is a multifaceted and complex disease with a wide range of symptoms that negatively impact patients’ ability to perform daily activities. MS is associated with psychological and physical conditions, with environmental factors playing a significant role in its development and prevention. Various elements contribute to the onset of this disease, including genetics, climate conditions, nutrition, and social circumstances (stress, life events, etc.). The complications arising from MS lead to physical and mobility issues, primarily observed among young adults aged 20 to 40. The challenges faced by MS patients encompass both physical and psychological aspects, potentially causing feelings of loss of control over their lives, which can result in depression, increased anxiety, and stress, ultimately diminishing the vitality of both patients and their surroundings. Given the rising number of MS patients and their specific needs on the one hand and the limited number of specialized rehabilitation centers aimed at creating a supportive environment for improving patients’ mental health on the other hand, it is evident that a shift in perspective regarding the design of treatment and rehabilitation centers is of great importance. This shift should allow for viewing a treatment center as a healing environment. Therefore, this research investigates the impact of urban environment design and the surrounding features of rehabilitation centers, seeking to answer whether the presence of green spaces and healing gardens can improve the psychological and physical conditions of MS patients and alleviate MS symptoms. It is also hypothesized that appropriate urban environment design and the existence of green spaces around treatment and rehabilitation centers will enhance patients’ quality of life by reducing stress and anxiety, thus improving their psychological status. The main objective of this study is to establish architectural principles and requirements aligned with factors affecting vitality (control over the environment) in healing environments as effective elements in enhancing the quality of life and increasing hope for MS patients and their families.
Materials and Methods
The research method is applied in nature, utilizing mixed research methods (combining quantitative and qualitative approaches based on primary data analysis and case studies). This study employs primary data and case studies conducted through survey-based descriptive-analytical methods. Initially, relevant literature was reviewed through library studies and online searches, followed by qualitative analysis using SWOT tables (strengths, weaknesses, opportunities, threats) for both domestic and international samples related to the topic. The results were extracted and incorporated into a questionnaire based on theoretical foundations, research objectives, and questionnaire formulation principles. Subsequently, the statistical population and sample were identified; data were summarised and categorized according to research goals before being analyzed using SPSS26 software. The statistical population for this research includes MS patients, their families, and healthcare providers in Tehran.
Findings
The findings revealed eight factors recognized as influential in the vitality of healing environments: expansive or enclosed views, accessibility, gardening activities, garden design, fixed or movable benches, choices for solitude or social interaction, and simplicity of the environment. The garden design emerged as the most significant factor identified. Correlation analysis results indicated that most independent variables positively correlate with the quality of life for MS patients while negatively impacting their psychological status. Specifically, variables such as “having expansive or enclosed views,” “accessibility,” “engaging in gardening activities,” and “garden design allowing individual choices” showed significant relationships with improved quality of life for patients while reducing anxiety, depression, and stress levels. ANOVA results further indicated that expansive or enclosed views, along with accessibility, had the most substantial impact on enhancing quality of life while decreasing anxiety, depression, and stress levels. Multiple regression analysis conducted to assess the direct impact of independent variables on MS patients’ quality of life confirmed that all independent variables (views, accessibility, garden design, etc.) significantly affect patients’ quality of life. Among these variables, having expansive views had the highest beta coefficient at 0.51, while sitting in sunlight or shade had the least impact on quality of life. Given that the average scores for most variables in this study were close to 3, it can be concluded that the design status of therapeutic environments around treatment centers is generally at an average level. This finding is particularly evident for factors like “expansive views” and “accessibility,” which received the highest scores. These components underscore the importance of suitable environmental design in enhancing MS patients’ quality of life.
Conclusion
The conceptual models’ content correlation with theoretical foundations focusing on environmental design’s impact on MS patients’ quality of life indicates that the conceptual model comprises two main categories of variables; each variable category relates to either physical or psychological conditions experienced by MS patients. On the one hand, independent variables pertain to environmental design characteristics that directly affect patient conditions; these include factors such as access to various spaces (sunny or shaded), suitable movement paths for individuals with mobility limitations, appropriate furniture, social activity spaces, and gardening areas. On the other hand, dependent variables reflect MS patients’ quality of life influenced by physical, psychological, social, and spiritual dimensions. Ultimately, research results suggest that appropriate physical space design within rehabilitation centers can aid in improving these patients’ quality of life while reducing issues such as anxiety, depression, and stress; additionally, enhancing vitality through increased control over their environment can expedite patient recovery.
Keywords

Subjects


Adibi Saadinejad, Fatemeh, and Azimi, Azadeh (2011). “Explaining security in the urban environment based on physical and design parameters (case of Babolsar city).” Environmental Research, 4(15), 81-105. SID. DOR:https://sid.ir/paper/130563/fa[In Persian]
Ahmet Tuğrul POLAT, Sertaç GÜNGÖR, Metin DEMIR. (2017).” The Design Principles of Therapeutic Gardens”, Internatıonal Journal of Landscape Architecture Research Uluslararası Peyzaj Mimarlığı Araştırmaları Dergisi E-ISSN. 2602-4322, 1 (2) 37-42. https://www.researchgate.net/publication/322520352_The_Design_Principles_of_Therapeutic_Gardens
Ananth, Sita. (2008). “The natural next step”. Explore: The Journal of Science and Healing, 4(4), 246-247. https://doi.org/10.1016/j.explore.2008.04.010
Aulia, D.N. (2016). “A Framework for Exploring Livable Community in Residential Environment. Case Study: Public Housing in Medan, Indonesia.” Social and Behavioral Sciences, 2(34), 336-343. https://doi.org/10.1016/j.sbspro.2016.10.250
Barger, B. Torquati, J. Larson, L. R. Bartz, J. M., Johnson-Gaither, C. Gardner, A. Moody, E., Rosenberg, S. Schutte, A. Murray, M. & Schram, B. M. (2021). Measuring green space effects on attention and stress in children and youth: A scoping review. Children, Youth and Environments, 31(1), 1–54. Retrieved http://www.jstor.org/action/showPublication?journalCode=chilyoutenvi
Berg, A.V.D. (2005). “Health Impacts of Healing Environments - A Review of Evidence for Benefits of Nature, Daylight, Fresh Air and Quiet in Healthcare Settings.” Groningen: University Hospital Groningen. http://www.agnesvandenberg.nl/healingenvironments.pdf
Boubekri, M. Cheung, I. N. Reid, K. J. Wang, C. H. & Zee, P. C. (2014). “Impact of windows and daylight exposure on overall health and sleep quality of office workers: A case-control pilot study. “Journal of Clinical Sleep Medicine, 10(6), 603–611. https://doi.org/10.5664/jcsm.3780
Callaghan, A. McCombe, G. Harrold, A. McMeel, C. Mills, G. Moore-Cherry, N. & Cullen, W. (2021). The impact of green spaces on mental health in urban settings: A scoping review. Journal of Mental Health, 30(2), 179-193.  https://doi.org/10.1080/09638237.2020.1755027
Engineer, A. Ida, A. & Sternberg, E. M. (2020). “Healing spaces: Designing physical environments to optimize health, wellbeing, and performance.” International Journal of Environmental Research and Public Health, 17(4), 1155.https://doi.org/10.3390/ijerph17041155
Ghaem, G (1991). “Research on urban planning and architecture for disabled persons in Iran - Establishing design criteria. Report of the CIB Expert Seminar on Building Non-Handicapping Environments,62(3), 13-26. URL:http://www.independentliving.org/cib/cibbudapest10.htm
Golkar, Kourosh (2018). Creating Sustainable Place: Reflections on Urban Design Theory. Tehran: Shahid Beheshti University. https://scholar.google.com/scholar?cluster=4974296230304736510&hl=en&oi=scholarr[In Persian]
Grahn, Petra., & Stigsdotter, U. K. (2022). “Landscape planning and stress: The role of environmental support for health and well-being.” Landscape and Urban Planning, 62(3), 13- http://dx.doi.org/10.1078/1618-8667-00019. http://iranms.org
Jalilisadrabad, S. Sattari, M. & Jalilisadrabad, S. (2024).” Urban furniture and its design considerations in urban spaces. “Urban Design Discourse, 5(4), 55–66 https://doi.org/10.48311/UDD.5.4.55_[In Persian]
Landani, M. and Rahimi, R. (2021). “Designing the area of the treatment center for bipolar patients with an emphasis on vitality.” Paper presented to the 4th International Conference and 5th National Conference on Civil Engineering, Architecture, Art and City Design. Tabriz, March 1400. P. 13. https://civilica.com/doc/1427820/_[In Persian]
Mardami, K. Bagheri, M. Hassanpourrahimabad, K. & Hashemnejad, H. (2013). Evidence-based design for health centers. Tehran: Asr Kankash. https://www.asrekankash.ir/product/69/ [In Persian]
Mehryar, Saeed (2015). “Studying the effect of natural environments on improving the mental health of patients.” Environmental Psychology Research, 6(3), 223-232. https://www.researchgate.net/publication/288156692[In Persian]
Moghadam, A. (2024). Urban diversity and spatial justice: A critical overview. In Migration and Cities,  61-79. DOI:10.1007/978-3-031-55680-7_4
Moghani Rahimi, Kh., Behzadfar, M., & Jalili Sadrabad, S. (2014). Urban planning as a stress reliever (Study case: District 8, District 1, Tehran Municipality). Journal of Urban Planning and Architecture, 27(3), 19-33.https://doi.org/10.22059/jfaup.2023.339729.672749[In Persian]
Mottalebi, Q. and Vojdanzadeh, L. (2015). “Knowing the effective factors in creating healing environments.” Safa magazine, Period 26, Number (72). Tehran, pp. 25-48. https://dor.isc.ac/dor/20.1001.1.1683870.1395.26.1.2.5[In Persian]
Nesarnobari, Mahsa & Oskuyi, Azita & Gharehbaglou, Minou (2015). “The Role of nature to provide healthy cities.” https://www.researchgate.net/publication/278203483_The_Role_of_nature_to_provide_healthy_cities
Oberlin, J. (2008). “Evidence that Pediatric Settings Can Heal.” Health Care Design, Available on: www.healthcaredesignmagazine.com, 2008. https://healthcaredesignmagazine.com/architecture/evidence-pediatric-settings-can-heal/
Polat, Ahmet Tuğrul, Güngör, Sertaç, & Demir, Metin (2019). “Principles of designing therapeutic gardens.” Journal of Therapeutic Architecture, 5(2), 35-42. https://ijlar.org/index.php/ijlar/article/view/131
Rashidi, Nadia, 2014, The role of environmental psychology in physical and mental health and individual performance, Second International Conference on Advanced Research in Civil Engineering, Architecture . https://civilica.com/doc/2121255 [In Persian]
Riahi Nejad, P., & Gil Amiroud, N. (2016). “Investigating the role of hospital interior design and the impact of its aesthetic and psychological factors on patients”. Proceedings of the National Conference on Contemporary Challenges in Architecture, Landscape and Urban Planning. https://civilica.com/doc/530362/[In Persian]
Rice, Gillian & Jenny Ingram & Jacques Mizan. (2008). “Enhancing a Primary Care Environment: a Case Study of Effects on Patients and Staff in a Single General Practice.” British Journal of General Practice, Vol. 58, No. 552 (July 2008), pp. e1-e8(1). https://doi.org/10.3399/bjgp08X319422
Sabouri Kenarsari, Milad and Delshad, Mahsa and Poursafar, Zahra (2017)” Studying the relationship between green space and reducing stress in people waiting in medical centers.” Fourth International Conference on Sustainable Architecture and Urbanism - Dubai and Masdar. https://civilica.com/doc/744437
Sakallaris, Bonnie & Macallister, Lorissa & Voss, Megan & Smith, Katherine & Jonas, Wayne. (2015). “Optimal Healing Environments.” Global Advances in Health and Medicine: Improving Healthcare Outcomes Worldwide, 4, 40-5. https://doi.org/10.7453/gahmj.2015.043
Siamian, F. Rostami, R. (2021). “Investigating the effect of hospital interior design on improving patients’ mental health”. Journal of Architectural and Building Engineering, 7(5), 003. https://civilica.com/doc/1487781/[In Persian]
Simonsen TPH, Brown SD, Reavey P. (2024). “Vitality and nature in psychiatric spaces: Challenges and prospects for ‘healing architecture’ in the design of inpatient mental health environments.” Health Place, 85, 103169. https://doi.org/10.1016/j.healthplace.2023.103169
Tanhai Ahri, Mahdia, and Ghomishi, Mohammad (2021). “Investigation and evaluation of architectural patterns in order to reduce the symptoms of multiple sclerosis (MS) patients.” Architecture and Urban Planning of Iran, 12(1), 221-236. SID. doi: 10.30475/isau.2021.158491.1148[In Persian]
Tsai, S. C, Wang, H, Lee, S. H, & Zou, Z. (2023). Cognition and interaction: From the perspective of daily therapeutic landscape of the coastal zone. Behavioral Sciences (Basel), 13(10), 794. https://doi.org/10.3390/bs13100794
Ulrich, Roger & Zimring, Craig (2021). “The Role of The Physical Environment In The Hospital of The 21st Century: A Once In A Lifetime Opportunity.” Report to the Center for Health Design for the Designing The 21st Century Hospital Project. https://www.researchgate.net/publication/260517435_The_role_of_the_physical_environment_in_the_hospital_of_the_21st_century
www.newwavearchitecture.com
www.smh.com.au
Young, R. C., Schulberg, H. C., Gildengers, A. G., Sajatovic, M., Mulsant, B. H., Gyulai, L., Beyer, J., Marangell, L., Kunik, M., Ten Have, T., Bruce, M. L., Gur, R., Marino, P., Evans, J. D., Reynolds, C. F. 3rd, & Alexopoulos, G. S. (2009). Conceptual and methodological issues in designing a randomized, controlled treatment trial for geriatric bipolar disorder: GERI-BD. Acta Psychiatrica Scandinavica, 120(1), 1-12. https://doi.org/10.1111/j.1399-5618.2009.00779.x
Yue, W., Chen, Y., Zhang, Q., & Liu, Y. (2019). “Spatial Explicit Assessment of Urban Vitality Using Multi-Source Data: A Case of Shanghai, China.” Sustainability, 11(638), 1-20. https://doi.org/10.3390/su11030638
Zeinali Azim, A., Faridi Thani, M., & Ebadpour, M. (2014). “Principles of designing healing gardens in hospitals to reduce stress and improve patients’ health.” Journal of Ethics and Urban Architecture, 2(1), 1-15. https//doi.org/10.22091/ethc.2024.11044.1031[In Persian]
Volume 5, Issue 4
Winter 2025
Pages 200-215

  • Receive Date 13 December 2024
  • Revise Date 13 February 2025
  • Accept Date 14 February 2025