Razavi Journal of Medicine

Razavi Journal of Medicine

Toward Salutogenic Hospital Design for Health Promotion: A Mixed-Methods Study of Environmental Factors and Their Relationship with Patients’ Sense of Coherence

Articles in Press

Document Type : Original Article

Authors
Fatemeh Mehvar 1
Hamid Reza Azemati 1
Bahram Saleh Sedghpour 2
1 Faculty of Architecture and Urban Planning, Shahid Rajaee Teacher Training University, Tehran, Iran
2 Faculty of Humanities, Shahid Rajaee Teacher Training University, Tehran, Iran
10.30483/rjm.2026.254721.1485
Abstract
Background: Health promotion emphasizes reducing stress and strengthening individual coping mechanisms. Hospitals, as pivotal healthcare settings, can advance this objective through salutogenic design, which targets the enhancement of patients' Sense of Coherence (SOC)—comprising comprehensibility, manageability, and meaningfulness. However, empirical evidence linking architectural design to SOC remains limited.

Objectives: This study aimed to identify key architectural components supporting salutogenic hospital design and model their interrelationships with patients' SOC.

Methods: An exploratory mixed-methods design was utilized. A qualitative phase involving documentary analysis and a Delphi expert panel identified initial factors. Subsequently, a 45-item questionnaire was administered to 210 inpatients at Shahid Rajaei Heart Hospital (January–March 2024). Validity and reliability were confirmed via expert review, Cronbach's alpha, and exploratory factor analysis. Data were analyzed using SPSS-27 and structural equation modeling (SEM) in AMOS.

Results: Expert consensus refined seven initial factors into a six-factor user-validated model: legibility and functional performance, environmental comfort, naturalness, safety and hygiene, psycho-social comfort, and aesthetics. Reliability was acceptable (α = 0.726), and sampling adequacy was confirmed (KMO = 0.907). Correlation analysis revealed distinct associations: legibility correlated strongly with comprehensibility; environmental comfort and safety with manageability; and naturalness, aesthetics, and psycho-social comfort with meaningfulness. SEM confirmed significant interrelationships among all six factors with good model fit.

Conclusion: The findings indicate the complexity of patient safety challenges during the COVID-19 pandemic and the need for comprehensive approaches to improve safety conditions in healthcare systems.Specific environmental design factors significantly contribute to patients' perceptual and psychological well-being. The six-factor model validates a salutogenic design approach, demonstrating that environmental quality can enhance comprehensibility, manageability, and meaningfulness in healthcare contexts.
Keywords
Salutogenic design
Health promotion
Hospital architecture
Sense of coherence
Healing environment

Acknowledgements: The authors express sincere gratitude to all contributors to this research, with special appreciation to Dr. Hamid Noohi, Head of Shahid Rajaei Heart Hospital, for his valuable support and facilitation.

Availability of data and materials: All data generated or analysed during this study are included in this published article.

Conflicts of interests: The authors declare no conflict of interest.

Consent for publication: Not applicable.

Ethics approval and consent: All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable. Written Informed Consent was obtained from all subjects. This study is based on a research project approved by Research Ethics Committees of Shahid Rajaee Teacher Training University (Code: IR.SRU.REC.1404.011).

Financial disclosure: No financial support was received.

Author contributions: FM: Conceptualization, study design, data collection, data analysis, model development, drafting manuscript. HRA: Study design, scientific supervision, critical revision of manuscript, final approval. BSS: Methodological development, data interpretation, data analysis, model development. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work.

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

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Razavi Journal of Medicine

Articles in Press, Accepted Manuscript
Available Online from 23 April 2026