Analogously to the medical placebo effect, people seem to anticipate the quality of treatments based on external stimuli. In order to gain insights on the effect the built environment can have on a person’s judgments and behavior with a particular focus on health related issues, a quantitative survey (N = 851) with four groups before and after the renovation of a rehabilitation clinic has been conducted. In line with an overall modernization of the clinic, the entrance, the lobby, and some patient rooms have been changed. In the lobby, a service counter and coffee bar have been added as well as light colors and new flooring material to achieve a more modern and clean atmosphere in the sense of aesthetical appearance of the space. The outcome revealed that patients rate the intention to change their health behavior as well as the quality of food or significantly higher in a modernized clinic. These differences cannot be directly attributed solely to the changes in the building. Analogously to the medical placebo, an effect referred to as design placebo effect is, therefore, proposed to explain improved ratings of aspects that have not directly been changed due to the intervention. Other significant effects are attributable to winter and summer climate. During summer time, ratings for waiting area, atmosphere, patient rooms, as well as for staff were significantly higher. It is, therefore, assumed that aesthetic attributes, such as architectural design, or friendliness of the weather, exert their effects as perceptual placebos that directly influence judgment outcomes and behavioral intentions. Further research is needed to match certain design and general environmental features to their effects on patients and investigate their effect strength.
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Health behaviour is a crucial aspect regarding overall health and well-being. However, the role of aesthetics and the built environment in relation to this is often neglected. Disciplines such as consumer psychology use aesthetic features of objects and environments such as colour, lighting and haptic structures to increase sales, customer loyalty and brand awareness in various contexts. In many cases these designs prime a certain mental concept to influence subsequent thoughts, feelings and behaviours. While there is a growing body of literature regarding the profound effect these design decisions can have from a consumer perspective, this knowledge is hardly used in the context of health promotion. In contrary, in settings such as schools, universities and hospitals, the built environment does prime specific mental concepts however often randomly and without designers being aware of it. In a series of experiments in (a) a university (n = 83) and (b) a clinical context (n = 36), participants were confronted with primes (positive vs. negative) in the shape of lecterns that were supposed to prime health related mental concepts such as sense of control and health-related behaviour. In the clinical context participants confronted with positive primes mentioned significantly more sport-related words in an association task. Furthermore, the primes seem to influence whether participants choose healthy vs. unhealthy rewards after the task. In the university setting, for some resiliency related items (e.g. motivation regarding planned behaviour) students answered significantly more positively standing at the lectern resembling the positive prime. Although, only mild effects could be found, these results indicate that objects and interiors might influence health behaviour by priming certain mental concepts. More research is needed especially on the role of duration, intensity and extent of the design intervention for using objects to prime health behaviour change. Key messages The design of the built environment can be seen as a prime that might influence health behaviour change. In the context of public health, evidence-based and research driven design can be an effective tool for health behaviour interventions.
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