A summary of Color in Healthcare Environments: A Critical Review of the Research Literature
As a San Diego-based professional interior designer for the past 30-plus years, I understand only too well that color is a fundamental element of the design environment. We have created millions of square feet of healthcare environments for our acute-care and senior-living clients all over the United States and overseas. Our clients have asked us, too many times to count, what would be the appropriate color scheme for their projects. What would make their patients and staff feel better and work better?
According to Color in Healthcare Environments: A Critical Review of the Research Literature, color choice “is linked to psychological, visual, aesthetic, and technical aspects of human-made environments.” Therefore, we tend to choose colors based on geography, culture, and user characteristics. Similarly, the lighting, size, and shape of the space will also affect the color palette we choose. This color study was funded by the Coalition for Health Environments Research (CHER, now known as The Center for Health Design [CHD] CHER) in 2002-2003, and written by Ruth Brent Tofle, PhD; Benyamin Schwarz, PhD; So-Yeon Yoon, MA; and Andrea Max-Royale, MEDes.
The necessity for a color study of this nature became clear to CHER committee members after much discussion about the possible links between color and patient health. It was decided that a research study would help determine if in fact there was evidence to prove that various colors do make a difference in patient health, staff effectiveness, and healthcare facility efficiency. We felt that this topic affected everyone and would have a broad range of influence for the entire healthcare field—designers, planners, and end users alike.
The authors' goal was not only to provide a literature review on color in healthcare, but also “to separate among common myths and realities in the research and application of color in healthcare design.” It is important for us as design professionals to realize the relevance of the evidence that is presented in this study. It is clear that color use is not based on empirical data, but rather on “pseudo-scientific assertions.” As a result, many trends in color choices are based on inappropriate information.
After reviewing all available research on the topic, the following conclusions were reached:
There are no direct linkages between particular colors and health outcomes. There was not enough evidence to promote a causal relationship between environments painted in particular colors and patients' healthcare outcomes.
Specifying particular colors for healthcare environments to influence emotional states or mental and behavioral activities is simply unsubstantiated. While studies have shown that color-mood association exists, there is no evidence to suggest a one-to-one relationship between a given color and a given emotion. In spite of contradictory evidence, most people continue to associate red tones, for example, with stimulating activities and blue tones with passivity and tranquility. Clearly, colors do not contain inherent emotional triggers. Emotional responses to colors are caused by culturally learned associations and by a person's physiological and psychological makeup.
There are demonstrable perceptual impressions of color applications that can affect people's experience and performance. For example, there are indications in the research literature that certain colors may evoke a sense of spaciousness or confinement. However, the perception of spaciousness is attributed to the brightness or darkness of color and is highly influenced by contrast effects, particularly brightness distinctions between objects and their background.
The popular press and the design community have promoted the oversimplification of the psychological responses to color. Many authors of guidelines tend to make sweeping statements that support myths or personal beliefs. Likewise, most color guidelines for healthcare design are nothing more than affective value judgments whose direct applicability to the Architecture and interior design of healthcare settings seems oddly inconclusive and nonspecific. The authors of the color study would advise against the creation of universal guidelines for appropriated colors in healthcare settings. The complexity of user groups and the multiple uses of the environment make efforts to prescribe universal guidelines a waste of energy.
The study of color in healthcare settings is challenging because it occurs in the context of meaningful settings and situations. Our judgement of a color in certain settings is a result of multiple layers of experience. Consequently, we should be cognizant of these layers when selecting a color palette. Our reaction to color will be based on perception, cognition, and physiology. Analysis of color in any environment means respecting other kinds of processing forces such as culture, time, and location.
The literature review outlined by this study shows us common mistakes to avoid when we are selecting colors for healthcare environments. The authors insist that “while users of healthcare settings should be allowed to contribute to the color selection whenever possible, the process should not be focused solely on satisfying people's preferences.” Instead, it is suggested that the primary consideration in color selection be on the purpose and intended use of color within the space. It is from this point that designers will be able to “create color combinations for the sake of the users that draw both on art as well as science.”
I had the opportunity to share the study with one of our clients, San Diego State University, when it was building its new Student Medical Center in San Diego. The physicians wanted to know what color selections to make for their new medical center. I was able to show them what the evidence did and did not prove about “healing colors.” This helped establish creditability with the client. I see it as our role as design professionals to constantly educate our clients and expose them to all evidence that helps to add credence to our solutions. The study is an invaluable tool for this.
In conclusion, the color study answers two basic questions about color. The first is, “What is empirically known about human response to color and how, if at all, color influences human perception or behavior in a specific setting?” The simple answer is, very little.
Secondly, “Which color-design guidelines for healthcare environments, if any, have been supported by scientific research findings?” It is clear that universal color-design guidelines are not supported by any strong evidence.
These are not the answers we wanted to hear. We all would like very much to have a guideline for this aspect of the design world. As in other fields, explanatory theories may help to predict outcomes of environmental interventions. Therefore, it is possible that we will someday be able to predict influences of color on people based on theory.
The color study states that “clearly, the research of color in healthcare environments is an important endeavor. Yet, the subject matter is complex and multifaceted. Furthermore, mastering this knowledge for the application of research findings in healthcare settings requires caution and sensitive creativity is paramount.” The obvious implication, therefore, is that careful consideration of culture, geography, use of space, etc., is essential to the color choices we provide our healthcare clients. As designers, we should not base our color selections on market trends or personal beliefs.
The color study is an excellent, practical body of information and useful in your understanding of evidence-based information about color. This is only a cursory overview of some salient points presented in the color study; therefore, we at The Center for Health Design (CHD) CHER encourage all in the healthcare design field to peruse the complete document for additional insights. This study is available through The Center for Health Design's Web site (http://www.healthdesign.org). HD