Active Design Guidelines: Promoting Physical Activity and Health in Design

Keywords: physical activity; building design; environmental design; stair use; active living; built environment; workplace design; stair design; health; intervention strategies; active city; urban design; sustainable universal design
Methods: Literature Review, Research Synthesis, Evidence-Based Analysis
 

The Active Design Guidelines address those responsible for the planning and construction of buildings, streets, and neighborhoods. The publication seeks to educate designers about opportunities to increase daily physical activity, including measures such as making stairs more visible and providing inviting streetscapes for pedestrians and bicyclists. Several of these strategies are common sense; many are supported by academic research translated into practical recommendations. No single strategy alone will solve the obesity crisis. Implemented over a broad range of urban and architectural projects, however, these measures can contribute significantly toward bringing about healthier lifestyles in our communities. A number of the strategies in these guidelines can also reduce energy use in buildings, thereby benefiting the environment.

A Regional Survey on Residents' Preferences on Patient-Centered Medical Home Design in Rural Areas

Keywords: patient experience; patient-centered medical home (PCMH); physical environment; rural health
Methods: Exploratory Survey
 

This study aims to explore the rural residents’ preferences on various aspects of the patient-centered medical home (PCMH) model and the associated physical environment features. Using a convenience sample, an exploratory survey was completed by 362 rural residents in the Midwestern region. Survey items were designed to gather information on both rural residents’ preferences for five key PCMH attributes (comprehensive, patient-centered, coordinated, accessible, and quality) and of the physical environment that supports these attributes. Analyses were arranged along these key attributes. 

Results indicated that residents’ demographics affect their preferences for spatial features for PCMH. The three most important environmental factors for PCMH for the rural residents are privacy, extra chairs in the exam room for family, and space that supports information sharing and communication among patient, family, and healthcare staff. Through structural equation modeling analysis, residents’ preferences on comprehensive care, patient-centered care, coordinated care, quality, and safety have been shown to affect their preference for the space features. The open-ended survey shows that rural residents are mostly satisfied with their current healthcare environment in terms of supporting patient-centered care, while other aspects still have room for future improvement.

In Evidence-Based Design for Healthcare Improvement: Using the Built Environment as a Tool, Chapter 4.2, pp. 203–221.
Authors: Hui Cai, Kent Spreckelmeyer, Brock Slabach, and Mark Burnett

Keywords: rural healthcare; critical access hospital (CAH); post-occupancy evaluation; innovative design; best practice; evidence-based design
Methods: Expert Interview, Post-Occupancy Evaluations, Case Studies
 

Rural hospitals face mounting challenges due to economic disparities, workforce shortages, and outdated infrastructure, which hinder their ability to deliver high-quality care. This book chapter examines the evolving landscape of rural healthcare, focusing on Critical Access Hospitals (CAHs) and the role of evidence-based design in addressing systemic issues in rural hospitals. Drawing on expert insights, post-occupancy evaluations, and case studies, the chapter explores how innovative facility design can enhance patient outcomes, staff efficiency, and financial sustainability. A comparative study of two rural hospitals in Kansas highlights the impact of design on operational performance and community engagement. 

The chapter also presents a prototype for a community-integrated rural hospital that revitalizes Main Street and fosters synergies with local institutions. Key strategies include flexible care spaces, shared work areas to allow cross-staffing, telemedicine integration, and community-based health initiatives. The findings underscore the importance of tailoring healthcare environments to the unique needs of rural populations and call for collaborative efforts among designers, researchers, and policymakers. Future trends emphasize outpatient care, digital infrastructure, and holistic approaches to community wellness. The chapter advocates for a paradigm shift in rural healthcare design—one that positions hospitals as central to the social, economic, and environmental health of their communities.